Around Dodge City and in the territory on West, there's just one way to handle the killers of the spoilers, and that's with the U.S. Marshal and the smell of guns smoke. Starring William Conrad, the story of the violence that moved West, and the story of a man who moved West. The first man they look for, and the last they want to meet. It's a chance they job, and it makes a man watchful. Breakfast yet? I'm waiting for Chester to get back from the depot. Somebody told him there was a telegram down there for me. There's a telegram here. Uh-oh. You should have left it there, Matt. No. Telegram usually means somebody's coming to Dodge, looking for you, or that you've got to go somewhere and look for them. Either way, it spells trouble. If it wasn't for trouble, Doc, I wouldn't have a job. Well, then you are the quit. It's a poor thing when a man has to make a living off other people's troubles. Uh-huh. Tell me something, Doc.  They know I haven't talked about that. I guess we are pretty much alike after all, man. Uh-oh. Well, good to ask you, Chester. Well, I got it, Mr. Bond. Are you looking so glum about, Chester? What does it say? You better read it yourself. Kind of private life. Uh-huh. U.S. Marshall Dodge City, Kansas. Coming to get married. Noon train. Saturday. Meet me. I'm Mavis McCloud. Oh. Mavis McCloud? That's a right-pity name, Matt. She pretty too. It's done. We're really going to get married. Oh, you're pretty foxy, Matt, keeping us quiet. Now, wait a minute, you two. If you're all through talking, I'll tell you something. Oh, we don't quite. Matt, you don't seem to be... Listen, I'm... I'm with men. All right. Now, uh, this may be kind of a shock to you, but... Other than my two closest friends, I wanted you to be the first to know. Yeah, don't, yeah. Doc. Yeah. Chester, I'm not about to get married. And once more, I never heard of any Mavis McCloud. She still might be... I don't care if she looks like Lily Langtree. But Mr. Dillon ain't even going to meet him. Yeah, I'm going to be there, but right now, let's go get some breakfast and talk about something else. There, Mr. Dillon. Straight up, and there comes old Frank, you know, right on time. Yeah?  Oh, no, Chester. I think Frank should run on time. Actually, that's what I mean. Hey, look, looky there. Just get it going into people there, see? Chester. Mr. Dillon, I swear I never thought I'd word to her about this. He's probably expecting some mail or packages or something. Anyway, he's never seen me. Hey, how are we going to tell Meg with McCloud when we're alone? I don't know. Whoa, whoa, whoa, whoa! There you go. Would that be her? Do you think would that be her? Chester, I told you I never even heard of her. How would I know what she looks like? You're right, pretty, Mr. Dillon. She's the only female lady there. Okay, let's go after that. I'd get her. I'd get her to be about 15, wouldn't you? Yeah, about that. I'd get her to be about 15, wouldn't you? Yeah, about that. I'd get her to be about 15, wouldn't you? Excuse me, miss. Yes? I'm Matt Dillon. Oh, maybe you can help me. Oh, maybe. I'm looking for the U.S. Marshall hit, you know what? Well, I'm the Marshall, man.  Then you got my telegram. I did. Well, that's right. You didn't have my name on it, did you? Of course not. How would I know your name? Oh. Oh, my goodness.  Wow. Oh, how awful. I mean, how awful for you. Well, I'm still a little confused. Oh, this is Chester Prott. Oh, how do you do, Chester? Well, I'm proud to know you, man. Yeah. Oh, I'm so sorry, Marshall. Dillon, I guess I could have explained more in the telegram. Oh, that's all right. Who did you come here to marry? Well, I don't know. You don't know? Not yet. I just got here. You were the only man I've met. Uh, Chester. Yes, sir? Don't run the depot there and see if you can find Kitty, will you? Yes, sir. I sure will. Uh, hey, there's... I'll be 19 in December. No? Oh, where are you from? I went to. Well, why not? Because I didn't know what for a gentleman to ask a lady so many personal questions. All right. Well, why did you send me that telegram? Because I thought I could stay through the Marshall help. Well, helping you do what? Get married. Oh, don't you look like that. I'm not crazy. See, women out here, don't they? Well, don't they? Yeah, they need them. And I'll make a good wife to you. But, of course, it'll have to be the right man, Marshall. I won't marry just anybody, you know. And you can stop shaking your head now. Dillon, I found her. Hello, Matt. Kitty. This is Mavis McLeod. Hello, Mavis. Welcome to God. Oh, thank you, Kitty. Kitty. I know Matt. That's what you told me all about her. You don't mind the Marshall, Mavis.  You know, certainly he is. He's been looking at me as though I were a bug of some kind. Kitty, you take care of her, will you? I'll go and try to figure something out. She'll be okay. And Kitty, don't... Don't worry. I won't take it as long, Ben. Okay. You let me know if you need anything, Mavis. Besides the husband I need. I was wasting my time. She met a young fella called Barney Wales. And three days later they got married. Kitty called it love at first sight. But anyway, I knew Barney. And he was a sober, hard-working cowboy who started a little spread of his own not far from Dodge. It was a good match. It looked like they were going to make out fine. At least I thought so. Until one day when I was sitting in my office trying to keep cool. I'm looking for Marshall Bill. At the end of that night there. Come on in, mister. My name's Louis Staley, Marshall. What can I do for you, Mr. Staley? I've come a long way. Huh? All the way from St. Louis. I'm looking for Mavis McCloud. That's my business. Oh, that may be. What makes you think I'd know? He sent you a telegram from St. Louis. I knew she was headed out here somewhere, so I checked. Mavis doesn't kind of arrive in a place unknown. I see. Then tell me where she is. Not that I know why you want to see her. And I'll find her myself. She's around here somewhere. She's married, Staley. What? She's married.  Who'd you marry? What difference does it make?  We'll see about that. In the meantime, I'll hold you responsible. Okay, so you'll hold me responsible. Why don't we settle that right now? I'll find her first, Marshall. And after I've killed her husband, I'll come looking for you. Well, now there's about the bloodthirstest man I ever did see.  He might try it, Chuck. I think I'd better write up and talk to Barney Wales. I'm sure not today, you ain't. What? Well, Barney and Mavis is in town today. I've seen them over at the Dodge House this morning. They're staying tonight there. I'll go find them there before Louis Staley does. Hey, Mavis! Hey, it's the Marshall. Hello, Marshall. How are you, Mavis? Oh, I'm fine. I mean, we're fine. Aren't we Barney? Well, sure are. You gotta write out and have dinner with us some Sunday, Marshall. Mavis, here's the best dog John cooked to you ever saw. Gotta be strange if a girl from St. Louis couldn't cook. Why'd you say that, Marshall? Mavis ain't from St. Louis. At least why she never told me she was. It doesn't matter where I'm from, does it, Barney? Of course not. But how'd the Marshall know? There's only one way. Lou told him. Lou? Yes, Louis Staley. Well, who's he, Marshall?  What? For marrying Mavis. I see. He loves you too, is that it? No, no, not exactly. Well, what then? I made up for them, Cloud Barney. My real name's Staley. There's only one thing I want to know, Mavis. Yeah? You love him? I hate him. Okay, let him come, Marshall. I'll fight him.  I'll take care of Staley. I never run from a fight in my life, and I don't aim to start now. Oh, please, Barney. No use arguing. If this Staley's looking for me, he can find me. I'll go about my business like always, but I'll sure keep one eye open. Take a walk after justice. Anything to get out of this saloon for a while. What did you want me to do? Get in. That's man over there at the bar. There's a tall dude looking fella. Who is he? His name's Lou Staley. You ever heard of him? No. I thought maybe Mavis McLeod might have said something about him. He's never mentioned him, but I've hardly seen him since he got married. What's it about? Well, Staley's kind of disappointed over Mavis getting married. Said he's gonna kill Barney, and then me, and I don't know who will. Oh, for heaven's sake. He followed her out here from St. Louis. Well, that's it.  No. Mavis' real name is Staley. What? Yeah. Well, I guess Mavis kind of fooled all of us. I can understand Staley wanting to kill Barney. Yeah, that's not my business how Mavis messes up her life or anybody else's, but murder's wrong, no matter what the cause is wrong. Look here. He's seen us, too. Hello, Marshal. Kitty? You couldn't be in here, Mavis. I know Kitty, but I had to come. Where's Barney? He's talking business with some paddle buyers over to that guy. He doesn't know I'm here. This is no place for you, you know. It's good enough for Kitty. He's missed my own place. I explained all that for you. Well, I didn't come here for fun. I ran into Chester out in the plaza, and he told me I'd find Ruth Staley here. I've got to talk to him. It probably won't do any good, but I've got to try. Well, he's over there at the bar. I know, I saw him. But I didn't dare walk up to the bar, and I don't know who the mom was. Okay, Mavis, I'll get him. You know, I guess I won't have to. I knew I'd find you sooner or later, Mavis. I want to talk to you. It's too late for talk. I told you what I'd do, and I'm gonna do it. No, I want to talk to you alone. You can go out back, Mavis. The door's right over there. Nobody will bother you outside. Come on. I'm doing it good, Mavis. You know it, Paul. I don't like his kitty. Why not? Talking's better than fighting, isn't it? Talking isn't gonna stop him. There's nothing wrong about him. Sort of like he sees anything but himself. Like he's all alone in the world. Well, any man in love acts like Captain America. Yeah, maybe, but that doesn't make you just keep coming back at time up and throwing him on the train for back east. Well, I wish you'd do something. Mavis. Mavis, look at Mavis. For the killer? Well, you go after the savior, Mavis. I'll take care of her. I'll get the savior. And I'm gonna carry Mavis over to Doc's first. And you better come along. My dear family, do you know when it's the worst thing I ever heard? Are you shooting a lady? Doc says she's got a fair chance, just to...  I'm gonna do more than that. Yar, what? You'll please. Well, Bonnie's still here. It's about to happen. Yeah, I hope so. I'll be with that 10th stand over there. I know that one killer. I'll just have a buyer. Oh, that's Bonnie with his back doors there. Any sphere that walks up here from Texas is tougher than a mirror, and you know it, have you? I got better beats than that, but you're gonna have to pay for it. No, Bonnie... Hello, gentlemen. What are you doing here, Marshall? Something wrong? Well, what is it? Tell me. Where's Mavis? Now, wait a minute, Bonnie. Look, do you trust me? Well, sure, do, Marshall. Of course, why shouldn't I? Well, there's no reason, but I...  Don't let a parent something you don't know anything about. Chester. Yes, sir?  I'll fix this so he can walk when he comes to take him to jail. Well, I don't know what to do with him. Okay, sir. I tried every saloon and gambling house in Dodge. I got Chester. It was past midnight when we entered the Dodge House once more. Had a talk with a clerk, then went up to Barney and Mavis' room. You reckon period is running off, Mr. Jones? No, he won't run until he does what he came here to do. Are you sure he won't be surprised if you don't come here any more? Unless that clerk downstairs bungles it. Well, I don't know. All he's got to do is say, Barney, come, you know, a while ago and went upstairs. Now, that sounds easy, Chester, but he might get scared. Is there anything? Well, but maybe he's scared of a man who goes around shooting women. The clerk doesn't know about that, Chester. Besides, Staley may be crazy, but he's armed and he's dangerous. I guess you're right. Hey, Barney got real wild when he come to him. He found himself all tied up. I had a terrible time with him. Why, Chester? He says Mavis' is going to be okay, huh? He's doing fine. Wait a minute, Marshall. About last night, I'd have found Lou Staley somehow, and I killed him any way I could, Marshall. It might have been murder, Barney. Yeah. I guess this is the first time I ever thanked a man for knocking me out. What's going in now? What's up, Matt? Barney? Where's Mavis, Doc? Well, she's in the back room. Except for a little fever. She's coming along fine, Barney, just fine. Of course, you have to stay quiet for a few days if you can't be moving around. Can I see her now, Doc?  Mavis told me about the shooting. You know what happened? What, Doc? She tried to take Staley's gun away from him. That's why they were fighting over it, and it went off. He didn't try to kill her at all. You know, it's funny about Staley. What?  A wife? Yeah. Is that so? Oh, you're doing me. And Mavis seems like such a nice girl. Well, you never know, Doc. What's she doing? Yeah. Mavis is about to see. Okay. Hello, Marshall. Mavis. There's something I want to tell you, Marshall. Okay. Barney already knows. I told him yesterday after you left. It's about Lou. I know what you think. But I've known him all my life, Marshall. And Lou was crazy to do something wrong with him. I guess I was ashamed of him. I've told everybody sooner. Especially Barney. You're not responsible for his being crazy. No, no, wait. Lou always says he'd kill anyone I married. That's why I ran away. Mavis, you were asking him off a lot of a husband crazy and not. Marshall, Lou Staley wasn't my husband. He was my brother.  And I don't ever want to see you again. Bless us across your dining room table from Sunday. This is George Walsh inviting you to join us again next week when CBS Radio presents another story on gun smoke.


Hello students! In this video, we're going to be talking about narrowing topics and analysing problems. Okay, so remember, in Assessment 1 and Assessment 2, in this subject, you need to write a problem-solution essay. Assessment 1 is the first draft of this essay, and Assessment 2 is the final draft of this essay. You are given the broad topic area. It might be something like food safety or scams. You need to narrow this topic down into a problem-solution essay question. Okay, here's an example. So, the broad topic area is healthy eating. And, after thinking about it for a minute, you decide your question is discuss healthy eating. Okay, the good part of the question you have a function word, discuss, but other than that, there's no narrowing. You cannot just have an essay question such as discuss healthy eating. You need to narrow the question down much more. We recommend that you talk about the problem in the question. So, for example, you could have unhealthy food is a serious issue, discuss the causes and effects of obesity and present some solutions. Okay, this is better than the first question, but it could still be further narrowed. Unhealthy food by itself is a very big issue with many causes and many effects. So, we could think about what type of unhealthy food will be discussed, for example, fast food, soft drinks and so on. So, for example, you could have discussed the problems caused by eating chocolate and present some solutions to solve these problems. This is fine, much better. The question is appropriately narrowed. Okay, so we have the narrowed essay topic. We have identified the problem. Now, we need to analyze the problem. To analyze, you need to break down the problem into research style questions and then find information. Breaking down a problem is important because it helps us to avoid jumping too quickly to solutions that might only address the impacts and not the causes. So, you need to start thinking about the root causes of the problem. Taking the essay question on chocolate as an example, you need to ask questions such as Why do people eat chocolate? Is chocolate by itself unhealthy? What ingredients in chocolate cause problems? What are the health effects of eating chocolate and so on? This is how you've analyzed a problem. Okay, that's it from me. Here are some further resources and a video to help you in writing an essay question. All the best and remember, enjoy your time at university.


I'm gonna be making my girlfriend literal edibles. Oh, is it good? Oh my god, that's amazing. Well, I have something to tell you. I put something in it. I put it in it. That was actually an edible. You ate two and a half. Big slices. You're literally toast right now. I don't even think it's hit you fully yet. Do you? Bruh. Babe. What was the question? Like, I'm floating. Like, I was literally like, what the f**k is going on? All right guys, so as you can see by the title today, I'm gonna be making my girlfriend literal edibles. And I am at the store right now, trying to pick out a brownie mix because I'm gonna make edible brownies. And there's so many different flavors, but I think I'm gonna have to go with the basic fudge brownie because look at how good this looks. Oh my gosh. She's not gonna be able to resist this. She might eat too many of these. Like, I might wanna try one actually. But this is gonna be the perfect recipe for what I got cooking up. See what I did there?  Okay, you know what I mean. All right, what is good mom squad? And welcome back to our channel. As you can see, I just picked out the edibles that I'm gonna make. I'm gonna be making fudge brownies. So they're gonna be amazing. A little twist to this video. The edibles are actually not gonna be edibles. They're gonna be fake. So I am not doing anything when it comes to cooking drugs or giving my girlfriend any of that stuff. I would never do that to anyone. I would never secretly bake something and then give it to someone without them knowing because first of all, you don't know how they're gonna react to it. So you might be thinking, wait, how is Mariah going to get all loopy and high if she doesn't eat an actual edible? Well, there's a twist to that. That is called the placebo effect. Have you ever taken something and automatically it makes you like feel better or like, you know, parents, when you're younger, they give you like a tic-tac and they say that it's like medicine that makes you feel better. And it makes you feel better.   And this is gonna be so funny because Mariah is going to, I feel like, act high. We're just gonna see how she reacts. She's gonna be freaking out. By doing this, I've actually seen people think that they're high or think that they're drunk when only they were drinking water or just eating something that didn't have weed in it. So this is gonna be a super funny video. It's all gonna be for jokes. Mariah's not gonna have any idea that these are just regular brownies. So she's literally gonna be thinking that she's high. I just, I wanna see what she does. Like I've seen so many people do this same video on YouTube and the person literally legit acts high. Like acts like they're on some drugs or whatever they're gonna do. So this is gonna be a super funny video for you guys. Make sure to stay tuned. I'm gonna cook these up right now.  Like just, I'm gonna get her to try as much as I can.  I just ate five weed brownies. I am about to be out of my mind. But guys, make sure to give this video a thumbs up. Hashtag team built in the comments. This is gonna be so funny. I am so glad that I found this video before Mariah even came across it because if she tried this on me, I would probably make myself feel high.  I don't know if she's gonna be pissed at the same time but either way, I feel like Mariah's gonna be like, just loopy or whatever she's gonna do. And one more thing before I end this intro, don't do drugs kids, drugs is bad for you. Stay out of trouble and stay tuned because we're gonna see a funny reaction from Mariah right now. I love you guys and let's get back to the house and bake these up. All right, so I hear Mariah in the other room. I'm gonna start baking this right now because it's gonna take 50 to 52 minutes to make because I'm making it in this pan and the smaller the pan, the longer it takes to make, I guess. But I'm gonna go see what Mariah is doing because I hear her in our other room. We're gonna get this going. Let's go. Holy, wait, babe, did you clean the house? I came over to film you but you cleaned the house when I was gone? Yeah, I cleaned the room.  You couldn't help me out. You told me to go shopping. I think, you know what? I have been doing a lot of work and I wanted to come in here and lay down for a second because I'm sweating. So I asked this girl if she wants to go shop with me, right? And she's like, well, I have to unpack. I'm like, why are you unpacking? We're going on another trip in three days. I know, but I have to unpack what I... You have to unpack and repack? Because it's got dirty clothes in there. Yeah, I gotta repack and put new clothes in there. Okay. I'm gonna wear the same clothes that I wore to Chicago. Well, I'm just glad that she cleaned the house because I was actually kind of annoyed that she didn't come shopping with me because I love when she comes shopping with me. And especially when there's girls hitting on me like they did today at the grocery store. We're leaving hating on you. Hating on you. There's these girls in the, like, everywhere. There's probably like 10 or 20 of them hitting on me. Okay. When you say it like that, are you going shopping? You won't know because you did not go shopping. If you went shopping with me, you wouldn't know. But anyways. I cleaned the house. It's either I came with you shopping. The house would have still been dirty. Or, you know, we could have been multitasking.  That's what we did. Okay, okay, whatever. It all works out. It's a team effort. Yeah, exactly. What happens when you live together? So, I got something also. Besides the normal dinners that I've picked up, I got something a little extra that I'm baking for you, actually. So, it's gonna be an insane, well, I would like for you to not see it. So, as long as you don't go in the kitchen and play with it, but I am baking you something. Is it like crazy good? Yeah, you're gonna get like some bake. Does it involve ice cream? Anything with ice cream? Does it involve ice cream? No, it's just baking, you know. You ever baked? Yeah, I baked. You have been baked? I've been like baked? Yeah, I've baked before. You've been baked in the kitchen. Why, what? Yes, I've baked in the kitchen before. Hey, well, no matter what, it's gonna be awesome. You're gonna love it and it's gonna be delicious. A little treat for us in our stressful weekend that we had traveling to Chicago, going to Six Flags, pumpkin patches, getting rained out from Six Flags. Now, we're off to go to North Carolina to see Bill's sister and we're bringing Snap. Yes. And then a couple days later, stay tuned, we might be getting a new intro done. We honestly should vlog for our vlog channel, Snap, like on the plane and like the whole like kind of trip. Yeah, we should. Comment down below if you want us to do that for our next vlog channel video, but. What I'm saying is, we might be coming out with a new intro, might be flying someone out to film us an intro. So stay tuned. And then, sorry, one more thing, a week later, we're seeing a YouTube couple. We're seeing a YouTube couple that y'all love, her best friend, or one of her best friends. So you guys can guess, comment down below who you think we're- There's a lot of stuff going on, so stay tuned. Make sure to subscribe to our channel so you do not miss any of it.  You get dessert before dinner today. I actually just had ramen, so it's actually perfect because I can just eat that. You didn't make me a ramen? All right, we're gonna talk about this off camera. I'll see you in 50 minutes. All right, Marvel Squad, that is done. It's been a total of 55 minutes. It is done. Me and Mariah have actually been watching the new show on Netflix. Hey, whoa, whoa, whoa, chill. The new show on Netflix, Squid Game, we just started it. No, don't spoil it for us, please. Do not spoil it for us, but we are eight minutes into the first episode, but are you ready to see your surprise? I can see it in that bowl right there. Oh, don't look, Mariah. She literally hasn't came over here the whole time. Do you know what it is? Maybe? Oh, okay. Yeah, I did. Homemade brownies, guys. No, there's the fudge brownies. Did you get ice cream in the tube? We have ice cream. Yeah, we do have ice cream. But yes, they're fudge brownies and they smell amazing. Literally, like, look at that. They're literally so soft. Right now's the perfect time to eat it. Right now? Yeah, I'm gonna cut it up and we're gonna eat it right now. I hope you eat a lot because I want you to enjoy this. I really don't think. Okay, maybe not, don't do that, but. Why? Because there's a lot of calories. There's a lot of calories in it. Just eat, okay, just go off, bro. You as much as you want. Why? I'm gonna cut this up. Woo, it looks so good. All right, this is a good treat while we're watching our Netflix show. Oh, I ate a lot. You said you wanted a lot. Babe, you said you wanted a lot. I don't know if I'm gonna be able to eat all of that. Well, here, here's your fork. Go into town. I ate a little bit over there when I was cooking it up. But it's actually really good. It might be a little hot, so make sure to be careful. But eat up, girl. Eat as much as you want. Is it good? Yeah? Woo, it's a success, guys. I knew she would love it. What's this accruing for? Just, we've been traveling so much, you know. We've been doing, there's been so many things on our, we literally have three trips this month. We're flying down someone this month and there's so much going on that I just thought I'd make you a little treat and just kind of clear your mind a little bit. Cause this is gonna clear your mind a lot. A lot? Yeah, a lot. Do you feel, feel anything? It's really good. Oh, is it good? Oh my God, it's amazing. Do you feel anything? It's right in my mouth. It's moving. Huh? Nothing, I was just asking. I was just wondering how do you feel? I'm fine. Feel good? Nice.  It's like, you feel fine? Like. Yeah, I feel great. Good. All right guys, so we kept watching our episode. Mariah, obviously loved.  You don't feel any different? No, why? Why do you think I've been filming this?  So do you realize how much brownie that you just ate? Yeah. Well, I have something to tell you. I put something in it. What did you put in it? Did you put laxatives in it? Laxatives? No. No, not laxatives. What? I added a little bit of some stuff in it. What did you add? Babe, what did you add? Seriously, tell me. It's an. The seeds.  Babe, are you serious? Babe, there's weed in there. Look at how much she ate guys. Babe, I ate probably more than my body can consume. How much did you put in there? Do you feel any different? Babe, do you realize how much you just gave me? Why didn't you just give me a little- Dude, my cheeks hurt. I'm laughing so hard. You ate the whole piece. Do you feel weird? Babe, you know I don't like animals. Why would you give that to me? You know I don't like that stuff. I know, but do you feel weird? It's a prank. That's not a prank. That's like scary. I don't like animals. I don't like the way that makes me feel. Do you feel weird? I need to escape me a few things. Do you feel weird? I don't think so, yeah. I don't know if it hasn't hit me yet. Babe, seriously, why would you- I'm sorry.  That's not funny. Right, you ate a lot of it so stay tuned because you are gonna be feeling loopy. No wonder why I'm forgetting what I was saying earlier. Wait, what do you mean forgetting? I was forgetting what I was talking about. Because you're high, right? Babe, I don't like it. Hey, I'm gonna start filming in a couple minutes because this- My body's touching up. Is it actually? Babe, I don't like it. I don't like the way that I'm feeling. I already told you. I don't like the way that edibles make me feel. They hit me weird. And on my head's getting tight. I feel like I can't move. Wait, your head's actually getting tight? I feel like my head's like- Babe, you ate a lot. So you're probably gonna get stoned.  This girl's gonna look at you. She's laughing already. You feel giggly? Look at her. She's already getting stoned.  Why would you do that? I'm a little girl. Hey, good luck. Only five, two. Good luck, I know.  Woo! Brian, what are you doing? She's been pacing around the past 30 seconds. If I sit down, it'll jump. Wait, you're- It feels like- You're lying. Like I'm falling into the couch like- And it doesn't help that my legs are sore from the gym. I feel like I can't even feel like- What are you doing? You can't feel your legs? Well, I actually can't feel my legs, babe. You're lying. I can't feel my legs. Babe, you're stoned. You're stoned. Stop!  You're stoned. Guys. It's funny. It is funny. No, because I feel like I'm gonna throw up.  I can't sit down because I feel like I'm falling into the couch. I feel like I go- Brian's in the couch. Watch. I feel like I might sit. I feel like I- I like I can't- I feel like I'm sinking. Like I'm sinking. Mariah, you're literally toast right now. I don't even think it's hit you fully yet. Do you- Brian. Babe! Don't go to sleep! Are you actually serious right now? How do you feel?  Babe, that was like- Are they? Yeah, you're high. You're so gone right now. Babe, why would you give me that? Look at how chill she is. Mariah's got Mariah's toast. Look at her on the couch. It really feels like I got in a cloud right now. You're in a cloud. I didn't even feel you touch my face when you did that. I can't even feel that. Oh my gosh. Why would you give me that much? Because it's funny. You're high. You're stone now. It's so hard. I feel like I'm not seeing straight. Like I feel like looking outside, it looks like just like nothing. It looks like nothing outside? Yeah. Why would you- Why are you acting like this? Why are you acting like this? You got the munchies? You're lying. Babe, do you realize you are just like floating and eating toasty of those chips without any sauce? Oh my gosh. Why did you take so much? What was the question? Nevermind. Nevermind, you're good. Hey, pay attention. Babe, you gave me too much. I can't think. Why are you guys giving me all these questions? Hey, do you want to go swimming? Do you want to go swimming? No. Do you want to go swimming? I'm trying to drown so I can't feel myself. I'm just like standing. I'm like, dude, babe, this is why I don't like- Edible makes me feel goofy. Like I feel like I'm not even- Like I'm like floating. Like I'm floating. Like I was literally like, what the f**k is going on? I like to get even like, I don't feel anything. Babe, who are you calling? Don't call anyone when you're high. Why? I want to tell her that I'm stoned. She's my best friend.  Hi. They'll give me an Edible. I don't know what I'm even saying right now. Like I can't feel myself and it's freaking me out. Wait, what do you mean he gave you an Edible? I don't know, he knows I don't like that stuff.  I need to end this. My face is over there. Babe, can you please hang up? Why are you hanging up? Come here, just hang up. No, I don't feel good. I feel like I'm going to blow up. It's gonna be okay. Drink some water and lay down. Babe, hang up. Why? You can call her back when you're not high. No, I don't feel good. I ate too much of it. Why would you do that to me? I'm trying, I'm trying. Dude, I can't sit up. Babe, I need to tell you something. Just hang up the phone and I need to tell you something. I'll call you back. Okay, get some water. All right, all right. Bye. I can't believe you called Julia. You're stoned. I have something to tell you though. What?  What? Mariah, I would never give you an Edible. Tell me one out of 10, how high are you? Dude, I'm feeling really high.  Yeah. How was that possible when I didn't even put anything in the brownies?  Why do I feel like, why do I feel like? How was that physically possible? But why do I feel like I'm legit high? Unless the brownie mix from the grocery store feels like it looks like guys are not even tripping. Like, I feel like... Oh no, you are tripping. I feel like I'm high. Babe, you're not high. I was just, I was honestly just joking. They were regular brownies. I just wanted to see how you react if I told you that they were Edibles. Wait, wait, wait, no, no, I'm not. You were not, Mariah, there was no marijuana in there at all. There was no drug. Why did I get the munchies at? Because it's all in your frickin' head. I see people do this on YouTube and I cannot believe it actually worked. Bro, now I feel like I'm still high, like I'm still feeling like that. You actually just gave me... Babe, I was dead when you were calling Julie. I was like, wait, should I edit before or after? I had a frickin' call her back. She's probably still in the baby. Julia probably thought that I was like, why would Bill do that? I'm surprised she didn't say that on camera. But guys, I literally put nothing in the brownies. Bro. That is not funny. Are you, do you feel good now? I gotta kinda recoup because I still feel high. I seen this video on YouTube before and it's a placebo. Like, you know how parents used to give their kids tic-tacs and say that it's medicine and it would work? Well, people were giving their husband's wife, whoever, food and telling them that it was an animal. That's so embarrassing. Mariah? Focus on YouTube. Mariah?   Bill, that's not funny. So embarrassing. Guys, I did not like this video off. I just made a vlog in front of my best friend. This was the best reaction.  This was the best reaction on YouTube. That's not funny. It was hilarious. And I cannot wait to watch this again. I'm so sorry, guys. Hashtag team, Bill. I actually thought I was high. I know. Do you still feel high? You're so fake. Honestly, low-key. Low-key? I kinda do. I do, and I'm tripping out harder because I'm not high. I know I'm not high. I feel like I'm high. Guys, I'm so mad because we got a new robot vacuum and I wanted to have it go around the house. So Mariah would act funny or follow it or something and act all high. But I do wanna show you our new robot vacuum. You guys have heard that we did a robot vacuum giveaway from Dream Tech from our other vacuums. Well, we have a better, better, way better vacuum that unloads its own garbage.  Show up. This is the Dream Tech Z10 Pro robot vacuum with the automated dirt disposal. And not only that, it empties itself for 65 days. So that vacuum lasts 65 days. That's two months. That's literally two months. No, we're not having to change it. Do not have to empty out our vacuum. That vacuum sounds for us because once again, it is a robotic vacuum for over 60 days. Look at this thing. And the lines from today. Oh, yeah. The lines are amazing. Look at this. You cannot get any straighter lines, guys. The link is in our description. It empties all the dirt into this bag. And this bag's full right now. I haven't emptied it since we got it. I need to, yeah. This is my favorite vacuum ever, guys. And Dream Tech is such a reputable company because we also own three others. Or maybe even four. Oh my gosh. Stay tuned for the next. Other vacuums. Yeah, we have another vacuum. We wanna show you guys. It's so cool. The link is in our description, guys. Make sure to go grab one of these vacuums because literally it'll change your life.  This is such a good gift to get your mother or someone that just moved out of the house. Or someone that just doesn't have a robot vacuum because these change your life. I got one from my mom, a Dream Tech also. And it literally changed her life. She has a cat. It picks up stuff that you would not even expect. Every single time it goes, it's full. Before we leave, we do have to do our daily notification shout out. And this shout out goes to lovely Lena. Shout out to you. Thank you so much for being a part of our channel. We love you.  Make sure to be subscribed to our channel and comment down below.  I'm gonna try to get you up as well. How can you do better than that? You literally acted high. You are so gullible. This is the most gullible girl you've ever seen. That was the best reaction on YouTube. Find me a better reaction. You literally could not. You're acting so silly.  Hey, it's okay. It's okay. Everyone has a low point in their life, babe. And today was just a low point for you and your team, Mariah. Guys, thank you so much for watching this video. And we will see you in the next video. But until then, peace. Love you guys.


I am so ready to get spooked, I've even brought a spare pair of niggas. I just want to know, do you scare me or not? Ah! Oh, my God! Is that what a haul of tonight's gonna be like? Yeah. Sorry. I'd see you then. Bloody hell, that was scurry. I've never shot myself in an interview before. Thinking? Yeah. I'm not drunk yet. There are loads of people I know here tonight. Sophie and Nathan from Jolly Shore and my best friend and business partner, Adam. What do you want to drink? Get me and Adam some zombies. Last time I saw Charlotte was at our engagement party when she threw up all over herself. Trust Charlotte's still the limelight. The press has been going crazy about it. How's things been since the engagement party? Just the noises how the press put a big spin on it. I know, yeah.  I've never tried to be anyone else but myself. It don't really bother you, does it? Like, it's not like you're from a bar. I never had that. I'll do it again next weekend. Everyone relates to it, do you know what I mean? I am never going to change who I am despite what the press says about us.  Maybe tonight? No, not tonight. Never guess what we're doing next weekend. What? Josh's mum and dad are coming to mine for the weekend to meet my mum and dad. Has Latisha and Gary met Josh's mum and dad? No, this is the first time. Oh my God. I'm excited for Charlotte about the parents' meeting and she's been looking for more commitment from Josh and this is a big deal for them. Shall we just have a drink? Come on, let's go. Like, come on, we're going to go. To be out with Josh having fun. I know we've had a bit of a rough patch lately but right now we're getting on so well. I'm happy that we're back normal, you know? It's a... What do you mean? It's gotten going with Josh. Like, even at the time, we were arguing a lot. I would have hoped that you didn't ever want to quit the relationship. It's a lot of good job. Business was just going bad that month. This is back on track this month. I do feel like we've turned a corner. All it took was a little bit of communication to get our schedules aligned and now things are better than ever. Love you. Cheers. To trust and love. To trust and love and a new beginning. Hi, I'm Charlotte Crosby. Don't forget to hit the subscribe button here for even more amazing MTV videos.


It was fascinating actually. You know, he came to me from from left the field. I had a casting director who, you know, made me look outside the regular reservoir of actors and said, what about Troy? And I was like, wow, another, another Australian. He did an audition. He was such an angel.  He was so magnetic and mysterious. It just his presence that I knew he could carry the screen without very many words. Troy is such a contradiction. He's such a world figure now. He's such a identifiable hero to so many people. And yet he's supremely, some would say, you know, awkward. And what I loved is that as an actor, he really kind of, it was like a black belt. If he was a black belt in music, he was like he'd arrived on the movie set and put his white belt on. And he just sat there and he observed. And he was a sponge. And he was very quiet. He was very curious. And he was very collaborative. And he asked me a lot of questions, but he just felt like he was part of the process. But he also was quietly observing. And when I said to him at the end, is he going to do some acting again? He said, oh, wait and see if I'm any good in the movie. And then I'll decide. I was like, I think you're all right. I wasn't going to put any modern music in the film. You know, one of the rules of love and action was no secular music or no, no, no modern music. And I thought I'll stick to that as a sort of a modus operandi for how I would choose music and just have score. And then I used one of Troy's songs later when I when I chosen you beginning to the film, which was childhood footage of Lucas, but it was a previous song of Troy's that he'd already released called The Good Side. But that meant that I'd opened up the door to modern music. And then there was a song I wanted to play on a record in the most tender scene in the movie. And I thought, well, maybe we could compose something new and pretend it's an old song. And I got Jonesy from Sega Rostov to write some chords on a piano. And he said, I love Troy Savant. Would he write the lyrics to it? And Troy literally wrote the lyrics in a few hours. And it's it's truly just such a divine song. Well, one of the first things we did actually was, you know, first of all, whenever I wrote a significant draft to the script, the first draft, and then when I did a significant, you know, restructure a pass on it, I would always send it to Garrett. He was my main partner, you know, the author of the memoir. But we sent the those drafts also to GLAAD. You know, GLAAD are just such a great watchdog of representation of LGBTQ individuals in TV and cinema. And we wanted to make sure for our own sake, now, like promoting the movie that we had the support of GLAAD. We had the Trevor Project. We invited many LGBTQ kind of advocates and bloggers to the set. It was very important that, you know, especially as as a straight cis man making a movie about something that at first I didn't feel I was qualified to make, I felt like I needed support. I needed my own education of sorts. I needed as much representation in front of and behind the camera so that as a team, we are moving forward, feeling like we're doing the right thing. So yeah, it was very important.


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Let's do a quick one. We'll do the usual body chaos stuff. Egypt music here. We have the app overview, right? So we have this three, yeah, it's that quickly in your chat. So also be kind of tutorial on how to do this. We have the index HTML main JavaScript and app. Byton's script. This is a flask application meant to be shared with you when we are done or have something useful. Fetching EEG data, the fetching data function retrieves EEG data from a specified URL using query parameters for start, count, and channel. It handles responses and errors from the network request, updating data and visualization. The update data function reads values from a user interface such as the data slider, channel selector, and window size, fetches the corresponding EEG data and then plots this data using the plot EEG data function. It also calls the convert EEG to music function to initiate the music generation process. Plotting EEG data, the plot EEG data function creates or updates a line chart using chart. JS to visualize EEG data, converting EEG data to music. The convert EEG to music function fetches the URL to initiate the conversion of EEG data to music notes. The play sequence function then plays these notes. MIDI and soundfront integration, the script integrates with WebMIDI. JS for handling MIDI devices and soundfront player for playing music sequences. Eventlessness and initialization, the script uses DOM content loaded to ensure the DOM is fully loaded before executing. It sets up eventlessness for UI elements like the data slider and the play button. It also initializes the soundfront instrument, a piano in this case, and configures interaction with MIDI devices. We haven't shared the Python script yet, but the problem with it is that when you run it, it says a conversion is successful, but this bit should have generated the notes, which it does not. So we have to fix that. So the music player is working, I don't know if you can hear it. You probably can. Testing one of the notes and then the idea is that when you slide through the EEG, more notes are being generated. So it's breaking the EEG down and converting different frequency components into musical notes and we're using a grand piano. We haven't started prompting it yet. This is just loading the code. So the three files, we have the index HTML, we already loaded. Main JavaScript code and the Flask application itself. So we have these routes. The plain one is calling index HTML, get the EEG data using the load data function and convert EEG using load data and then converting to EEG. Yeah, the convert EEG to music scales the EEG frequencies and maps them into musical notes. We have some scaling in there as well. And the linear, we're using linear interpolation at this stage. Just something simple for mapping. Yeah, we're still in debug mode because the mode doesn't work right now. The problem, I'm getting to the nitty gritty of it. And yes, we'll be having this errors, main js line 90. Yeah, we're not getting the notes. So we need to fix this troubleshoot properly. Expected data is not being received. Yeah, we're not receiving notes back in the issue. Might not be sending the expected data format. There might be an issue with how the data is being fetched. Okay, so we don't have any errors in the terminal. Yeah, the network traffic is okay. We have a sound font now. That's the bit that we were struggling with last time. So we have this grand piano loaded. It's working okay from there. When you move the position within the EEG file, yeah, we should have been getting data. Convert music returns to hundreds. So it's working okay. Spectre network traffic, the digit music. Correctly handling the response. Yeah, there might be a problem with that last bit. But first of all, this bit is not returning the notes. Yeah, we'll keep troubleshooting. So the backend sending. Right, so we had that test that we were doing just sending, just sending this notes. It's in different format. Okay, so that's not happening. Yeah, let's try a single note. Say C4. Yeah, this one should be returning the note. Doesn't give any errors. Yeah, what are we doing wrong? Something in the JavaScript. Yeah, we get a 200 response. That's fine. Problem is that the app, the EEG, it's the one using the function. Yeah, we have that already. Can print the notes. But then you can understand what the return statement. Yeah, I'm pretty sure we don't have any cause issues. Right, sending notes. Printed, okay. We've started putting in endpoints being hit. This is expected. Shows that the router is seeing correct parameters. Sending notes. Okay, we must be having issues with the front end. So the backend is working correctly. I'm just scripting sure that the JavaScript function is sending the server response correctly. Should be expecting a JSON object with the keys, message and notes. So that doesn't happen. You're getting a 200 for the response. Asynchronous, this might be the problem there. So first of all, we're getting a 200 for that response, for the get request. Yeah, the content, content message only has, it should have the notes in the JavaScript part. Hcon, the Egypt music. Yeah, data and data notes. Yes, I'm getting no data received. No notes data received. Okay, when the data console log here. And what's all that? It's something to do parsing that JSON response. And as to this, we should print the notes above in the terminal. Okay, does it though? Okay, we change this print test to 65. So this one again, because I'm not convinced I'm actually getting there. No, it is. No idea what the problem is. Right, that's actually has the response data. A get Egypt data, contrashift C. No, that's, yep, that's getting the data into the convert to music, which says conversion successful. Doesn't have the notes. Okay, doesn't have a fetch. So it has this function. It's the structure. So we have, yeah, we have a fetch URL there. Data, data notes. Okay, might finish it next time. See you later. Bye.


The Savannah effect. Why do we love water greenery and open spaces? Do you know why? I mean That's one reason She loves the ocean, but the Savannah effect is the effect where human beings love to see open space greenery Water trees flowers Why do we do that what's going on in our Stone Age brain? It's not just because it looks pretty and because the ocean is calming It's the real question is why is it coming? Well, it turns out that when we were cavemen in our Stone Age times an Open space meant that tribes could see opposing tribes coming over the hill So there was plenty of time for them to see an opposing tribe that might come and kill and rape and pillage If there was greenery and shrubs and Plants then it signified being able to eat food Signified a place where they could grow food It's signified fertile ground and if there was water well same thing it meant that it'd be able to drink water It it meant life Why do portraits in Art galleries why are they so popular why do humans love to just look at portraits of landscapes? Why do people love to look at landscapes? Because it appeals to our Stone Age brain. It appeals to our cavemen brain of Oh, we can see the opposing tribes and all there's likely to be able though There's likely to be food and water there think about it when why Central Park in New York City so popular because It's in the middle of the sprawling metropolis metropolis people like to go there and they see water they see lakes They see trees they see greenery It's like oh Oh, it's wonderful. They see open spaces It's not just because oh We like the color green or we like the sound of water It's because it's appealing to our reptilian brain our Stone Age brain for survival There's a book called riveted by Jim Davies It's a wonderful book. It's got an orange cover on it. He goes into more details as to why we like landscapes And talks a little bit more about the savannah effect So if you want to read more about this definitely check out that book But as I'm standing here at Laguna Beach, California Looking at water or be it not drinking water and open space and I can see people Heading me I can still see people behind me This is appealing to my Stone Age brain making me feel safe making me feel happy So whenever you're thinking about living somewhere If you want to increase your levels of happiness try to make sure That you see open space Water and greenery Studies have shown that your happiness levels increased because of it Go ahead and leave a comment down below right now. Tell me what you think about this Make sure you follow me on snapchat for more behind the scenes of my daily life and uh, if you want to get my uh secret formula For a beating procrastination. Just go to jameswanick.com and I'll send you My free book on how to beat procrastination All right, so from Laguna Beach, California I'll catch you on the next one


Welcome everyone to our first virtual grand rounds. We are honored to have a guest speaker for our visiting professor rounds. And Dr. Kathleen DeGree will be introducing her in just a few moments. You can all see in our in the chat below that Megan Johnson has posted the CME phone number and the CME code for anyone that would like CME for this program. Please also post any questions throughout this quick hitting talk. I'll be monitoring the chat for any questions and time permitting at the end I will pose any questions that Dr. Newman at the end. If you do particularly want a question answered if multiple individuals do pose the same question or just say they want to that question asked I'll make sure that those rise to the top and are asked. Again, welcome everyone who were joining us and I'll turn the time over to Kathleen DeGree to introduce our speaker. Yes, I welcome to the neuro ophthalmology grand rounds and we're just unbelievably thrilled to have Dr. Nancy Newman with us today. I've known Nancy for several years. She's a true giant in her field. She's not a physical giant but she is a giant in neuro ophthalmology for sure. She holds the Leo Dell Jolly Professor of Ophthalmology and she's a professor of neurology and neurosurgery as well at Emory University. She directs the neuro ophthalmology unit. Her background is she went to Princeton University. She also studied at the University of London on a Marshall Scholarship then she was at Harvard University. She trained in internal medicine and neurology at Mass General Hospital, and she was a chief resident in neurology and then did her neuro ophthalmology fellowship with Simmons LaCelle at Mass Eye and Ear. And she's a fellow of the Academy of Neurology, the American Neurology Association and of course of NANOS. She's the past president of the North American Neuro Ophthalmology Society. She was chair of the board of directors and now she is the senior vice president for education at NANOS. And Nancy has many, many claims to fame. She's written over 500 papers. She's written several books. I'll tell you that the sixth edition of Walsh and White, the big three volume tome was edited by Nancy Valerie and of course, Neil Miller. And then she and Valerie wrote a wonderful book that I have in my office and you can borrow it. And it's also in our library, the Bloomberg Library called neuro ophthalmology illustrated where she really goes through all of neuro ophthalmology and has illustrated several of these. She's an outstanding lecturer. She really is somebody that we've tried to get to come here and she gets to be the first virtual professor here at the University of Utah at the Moran Eye Center. And Nancy, thank you so much for coming to us virtually today. Thank you so much. My pleasure. So sorry I couldn't be there. I was really looking forward to it in my, my, there are these reminders that come up on your email and my flight from Salt Lake is due to depart to come back to Atlanta and a couple hours just wanted you to know I just got that email. My disclosures on the bottom. Not many of them are relevant to this so I am I am really delighted to be here and I'm delighted to be here for, for multiple reasons, even though I'm not here. And one of them is that Kathleen degree is is my hero and everybody's hero. And I would do anything that she asked me to do. Judith Warner is kind of like my baby sister since we both trained with the same wonderful person similes cell. And so I had was looking forward to this I'm enjoying it but it would been a lot better to be there. Anyway, I thought that I would choose this particular topic to talk on because it's just a multitude of topics and I've got lots of people out there I assume. People have different interests and to talk for an hour is a long time and so the way I get around it is I'm going to do basically all of neuro ophthalmology in about 50 minutes. And it's an update but I'll slip a little bread and butter in there along the way.  I always ask the question where first right first where then you get your what's and then you get your now what.  Do topics with updates starting at the eyeball going through the optic nerves segueing into the brain the visual pathways back through the pupils and then the ocular motility and then we'll be done so fast in your seat belts it's a very fast paced lecture if you don't like or not interested in what you're hearing about just wait 30 seconds you'll hear something else. And we'll go from there. So, starting with the retina. And the retinas relates to neuro ophthalmology. What's what's new in that regard so the first thing is within the subject matter of acute retinal ischemia whether it be an ophthalmic artery occlusion central retinal or inclusion, or even transient monocular vision loss of retinal vascular origin. Although these entities all have different visual outcomes, they have the same systemic implications. And the reason is because they are all the result of a vascular problem with the anterior circulation to the brain or the, which is the carotid circulation. And so it has the same mechanisms and causes as cerebral ischemia, and there are now 12 articles in the past eight years, which you cannot miss and they all say pretty much the same thing. They basically say that if you take anybody with retinal ischemia whether it be permanent, like a CRO or transient like transient monocular vision loss from retinal origin, and you do an MRI on these patients looking for silent DWI positive acute areas of cerebral ischemia. You will see that in up to 53% of CRO patients 31% of BRO patients and 18% of transient monocular vision loss patients will have these silent DWI MRI findings, which are little strokes in the brain. And it identifies a subgroup of patients at an extremely high risk of major stroke, especially within the next week and within the next month. And so DWI MRI has been concluded to be needed to be performed within 24 to 48 hours of visual loss to allow for effective prevention of recurrent stroke. So what does that mean? That means that the people on the front line for these vision loss problems, which are the optometrists and the ophthalmologist need to follow guidelines from the American Heart Association, the American Stroke Association, and now the AAO, that these patients equal a stroke. Now it's not so hard for ophthalmologists to equate a CRO or a BRO with a stroke. It's a little harder for them to take so-called amaurosis fugax and know that there is a almost one-fifth chance that there's going to be this silent little cerebral ischemia, and there's no way to know who those patients are, right? And so we have to make sure that they have any neurologic complaints and equate that with a stroke. So we have been trying to get the word out. We're doing it through the American Academy of Ophthalmology publications. We have had it in the practice parameters. And I can't. Okay. I am now muted again. Am I unmuted? Someone is background noise. I'm going to briefly mute everyone. Okay, Nancy, you should be good to resume. Thank you so much. You're welcome. So we're getting out the word that any patient with an acute retinal ischemia should have an immediate referral to the nearest stroke center. So what do you do? Well, educate yourself and help your colleagues. Establish a network with the closest stroke center. You're lucky. You're in Salt Lake. I'm sure there are many of them. And find your favorite local stroke neurologist with whom you will work out that network. And here's the simple message. All you have to do is make the correct diagnosis and send the patient to a stroke center. Boom. Now, I often get the question, well, what if it's two weeks out instead of one week? Certainly within one week, they should go to an ED or a stroke center or whatever network you and your stroke neurologist have worked out. If it's not acute, make sure you cover yourself and cover that patient by talking to the stroke neurologist and they usually will get the patient into their clinic as an outpatient within the week. Are there any other retina things that are of interest to neuro ophthalmology? Well, it for decades, longitudinal population based studies such as the Blue Mountain study, the Eric study have actually included retinal photographs as part of their longitudinal analysis. And what they're looking for are not C.R.A.Os and B.R.A.Os. They're looking for retinal vascular changes as indicated here, subtle things. And then they read those and it turns out that these findings have predictive value for association for stroke, recurrent stroke, cognitive impairment, cardiovascular disease and peripheral vascular disease. Now that's on a population basis. Is there any way that we can translate that information into a single patient predictive value? And the answer is going to be in deep learning. Because if you can have somebody retinal image scanned and this added into the score for their predictive risk for vascular disease, it will be truly amazing and only something like deep learning is going to be able to do that. What about on the individual basis? How can we use retinal photography for that? Well, our group has piloted the use of non-migreatic fundus cameras in emergency rooms and in neurologic clinics and in pediatric clinics. And we showed as early as in 2011 in our New England Journal article that non-migreatic fundus cameras are easy for non-aphthalmic trained individuals to use. Take only about 10 minutes to train and then less than three minutes to take good quality photos. You don't have to dilate the pupils and the pictures as you see on the right are really beautiful. And it has shown that, not surprisingly, that things are being missed in the emergency room. We showed that it's feasible. We showed that it's feasible in children as young as age two. And we've shown that it's easily transferable with good quality images to smartphones, even old smartphones. In a lecture I gave at the American Academy of Neurology in 2017, it was like the Emperor's New Clothes where all the neurologists were elbowing each other and saying, you don't really use that aphthalmoscope, do you? Or do you ever see anything when you do? And the reality is these pictures are magnificent and certainly are a lot better than emergency room providers and neurologists. And it's not like you're doing it for nothing. In the ED studies that we did, 12% of patients who had these photographs had relevant findings on the photographs as diagnosed within 24 hours by neuro-ophthalmologists reviewing the photographs that would have changed the patient's management in the emergency room, such as bilateral disk edema like you see here. So there's an issue, though. We did these photographs. The second phase, we gave the ED providers the photographs. They did better at finding the abnormalities. They were up to 40% instead of zero. But they still were missing a lot of things. So they weren't interpreting the photographs as well as you would hope. So what's missing is that little piece like in the EKG machine, or not only do you get the EKG, but you get the automatic interpretation of the EKG. And it'd be wonderful to have that automatic interpretation. Now, tele-automology is doing that to some extent, but you still need an ophthalmologist at the end of the phone, and you need to transmit the images. But deep learning, artificial intelligence will likely allow, like an EKG machine, an immediate interpretation of these photographs in the ED, in neurology clinics, in other types of clinics. If you think that this is a complete Star Wars type idea, it's happening right now.  And although I'm embargoed in one week, this will be published in a very major, very major journal. And so I think this is going to completely revolutionize what it means to re-put examination of the ocular fundus, which has been so enforced and pushed by Kathleen DeGree and others that it's important and has to be done. It's going to reintegrate the importance of that into clinical examination. So it begs the question, should we stop teaching ophthalmoscopy to our students and Kathleen, I think we're going to go through a few years where there's going to be a transition, but I honestly think the answer is going to be yes. Now let's move on to the optic nerve. And you know, you have an optic neuropathy for sure. If you have to get decreased vision and abnormal visual field, a relative affron pupillary defect, nothing in the media, a normal retina, ruling out retinal detachment and either a swollen or pale or normal optic nerve, if it's acute. And so there are all these categories of optic neuropathy that one needs to consider, just like any piece of tissue, but there's something specific about the optic nerve that allows you to think of two special categories, and that is an optic neuropathy due to elevated cellular pressure, which is glaucoma because the nerve inserts in the eyeball. And optic neuropathy due to the fact that the optic nerve is not really a nerve, it's a white matter tract of the central nervous system, as my mentor would say, it's a card carrying member of the central nervous system, and therefore it is covered by the same fluid and coverings as the rest of the brain, and therefore it is subject to the pressures in the brain, and therefore you can have an optic neuropathy from elevated intracranial pressure, if it is transmitted along the nerve to cause swelling of the optic nerves bilaterally, and that of course is called papillodema discadema due to raised intracranial pressure. And of course, it can happen for any reason that causes raised intracranial pressure. Unlike most other optic neuropathies which tend to have central defects and spare the periphery, papillodema like the other mechanical optic neuropathy glaucoma tends to spare central visual acuity until very late in the disease, but involves severe peripheral visual field constriction. And the causes can be anything that causes raised intracranial pressure from a mass lesion to hydrocephalus to a meningeal process which does not allow the fluid to passively resorb into the venous sinuses until the fluid builds up in the CSF compartment pressure or venous sinus thrombosis or anything else that would cause raised venous pressure which similarly would make the CSF pressure have to build up in order to passively resorb into the veins. And finally, if you rule all those things out, you have idiopathic intracranial hypertension and the mechanism for doing that, as you see here, everybody deserves good imaging, preferably MRI and MRV. And if it's normal, a lumbar puncture, and if the lumbar puncture shows normal CSF contents and the pressure is elevated to end up with IIH, of course, always reconsider cerebral venous sinus thrombosis and make sure you have adequate use of the venous sinuses. And the IIH diagnosis in 2020 is, of course, very infused by the important article written in 2003 by 2013 by Kathleen and colleagues, which gives new criteria for the diagnosis of IIH, making it not just a diagnosis of exclusion, but also including radiographic findings of elevated intracranial pressure, as you see here. Now, IIH is everywhere there are obese people, and I can tell you, shelter in place is not helping this. I personally have gained three pounds so far, and very concerned about this. The United States of America tops our most obese countries, and it is still growing, and we know that the incidence of IIH is growing almost completely in concert with the increase incidence of obesity. This was a very scary article written in the New England Journal of Medicine recently, which projected that in just 2030, the United States will have a 50% prevalence of obesity. It's really frightening. So, how do we manage these patients? The first thing is, we have recognized over the past couple of decades that there are certain characteristics of a patient and of a patient's presentation, which make them at particular risk for vision loss, and therefore, even though most IIH patients do okay, and you have time to manage them correctly, there are certain red flags that should make you be more attentive to certain people when you make that diagnosis of IIH. And those red flags are in the United States African American race, and this is beyond issues of access to care or socioeconomic things, and it's very interesting. Black race is also associated with a higher risk for glaucoma, not doing as well, another optic nerve disease. Male gender, we know that males get this disease much less often, only in 10% of cases. However, when they do get it, they tend to have worse visual function. Severe obesity, so morbid obesity over a BMI of 40 has worse visual function. Certain other characteristics like anemia, sleep apnea, and hypertension do not bode well for these patients. A rapid vision loss at presentation. So first of all, severe vision loss at presentation. The horse is probably out of the barn by then. These people have to be watched because they don't have much left to lose. And a rapid onset so-called fulminant IIH, where within two to three weeks they go from no symptoms to horrific symptoms, and these people usually end up needing surgical intervention. One quick word on headaches. It's like bringing coals to Newcastle with Kathleen there, but remember headaches are very common in the general population. They're very common in the IIH population. They're often severe and disabling, but there's no correlation with the level of the CSF opening pressure. And even when you get rid of the papillodema, you improve their vision and you have documented that you have lowered the CSF pressure in many of these patients, the headaches persist. And so you really have to get these patients to a neurologist to help their headaches and the help is not necessarily in further lowering their intracranial pressure. The treatment after the diagnostic lumbar puncture is in general acetylzolamide. You need to get them to lose weight. I often tell them that only not even 10% of their body weight is all they need to reverse the disease. This makes it a more tangible possible thing for them to do. Someone's 300 pounds, you're telling them they don't even have to lose as much as 30 pounds, and that helps them in this process. And you predict the prognosis with visual fields. And ultimately, if you end up having to intervene, most of the surgical therapies have about the same outcome, so you get what you can get. We tend to use the CSF diversion procedures and those who have more headache, we tend to use optic nursing fenestration, only in those patients who really, how are their vision is threatened. The new kid on the block is venous stenting. We don't have a lot of data on this yet. It appears to be effective, but we don't know what it means to have a stent in your veins for 40 years or more. And so it does work. It basically, whether it's the chicken or the egg, it opens the stenosis and that allows for the pressure to go down. I will say that these patients, nearly 100% of them, depending on how you measure it, will have transversinous stenoses just as a result of their race intracranial pressure. And so just because they have stenoses doesn't mean you should stent them. Don't treat the MRI. There is no correlation with the degree or presence of these stenoses and the ultimate visual outcome in these patients. Again, don't treat the MRI. Moving to inflammatory causes of optic neuropathy, we know typical optic neuritis, which can be retrovulbar or in one third of cases anterior. The optic neuritis treatment trial, my goodness, 1992. That's a really long time ago. That's when Clinton first got elected president. Look at that. That's a long time ago. Anyway, it showed us there was no difference in visual acuity between steroid and placebo groups at six months. And although the intravenous steroids might accelerate recovery, it was only for up to about two to three weeks and then everybody caught up. What it did show us is that oral steroids, at least at the dose of one milligram per kilogram is a bozo no-no, not only didn't help but it doubled the risk of recurrence in either eye. I think the most important part now about the optic neuritis treatment trial was the longitudinal portion of it that kept on going. What it showed, and it was the first really to do that, was it showed that, well, after a brain article by Reorden set up, teed up the idea is that even having one typical periventricular MS-like lesion on the baseline brain MRI when you show up with an optic neuritis puts you at high risk for the subsequent development of multiple sclerosis, approximately 75% at 15 years. Risk, whereas you have a normal brain MRI, you have about a 23% risk of clinically definite MS at 15 years. The other thing that the ONTT showed us, which brings the ophthalmologist back into the picture in a big way, as a gatekeeper, is that if you have even a typical isolated optic neuritis and you have a normal brain MRI at baseline and any one of the following five factors, you never get MS. And those factors are no pain, no light perception vision, which anybody can figure out, but for you, severe discodema, hemorrhagic discodema, and retinal exudates. And so if you have any of those things, this is a different disease. This is not the optic neuritis associated with multiple sclerosis, making again the fundus examination and the ophthalmologist input very important in this disease. I will mention the 2017 McDonald criteria, because I think it's important that you know two aspects of this. Remember, the McDonald criteria, it still is you have to have dissemination in space and dissemination in time to make the diagnosis of multiple sclerosis. And what the 2017 criteria did is it relaxed the criteria so that you could actually use the symptomatic lesion that they present with in order to get dissemination in space. And you could use the symptomatic lesion to get dissemination in time. In other words, if one was enhancing and the other lesion was not enhancing. And so you would say, wow, okay, here's my patient here. Does she have MS?  And the answer for everyone clinically out there, I hope, is of course she has MS. But according to even the new McDonald criteria from 2017, the symptomatic lesion cannot be the optic nerve. And so by those criteria, she does not have MS. And why? Why when we see people like Steve Galletta on here, why did that happen? And the answer is because people don't make the diagnosis of optic neuritis very well. And why don't they do that? They don't do that because there are other causes of inflammatory optic neuritis that are not related to multiple sclerosis. One is neuromyelitis optica, right? And it usually causes a bilateral severe, no recovery or recurrent optic neuritis. But now that we have a marker for it with the antibodies, we're seeing that sometimes the optic neuritis can be unilateral and it may not be that severe. We always check for it. The new kid on the block for optic neuritis is a new therapy that's been approved by the FDA. It's a lot more expensive than rotuximab, but it's very, very effective. It's now not the only new kid on the block and these other therapies are coming out as well. Maybe that'll drive down the price. The newest kid on the block is the MAG antibodies. Again, more likely than typical plain vanilla optic neuritis associated with MS to have a bilateral recurrent. There's more often discodema, usually mild, with these folds around the optic nerve head. There are more often cells in the CSF and you should think about MAG antibodies because it will change your management. You don't treat these patients with conventional MS drugs. And the take home message, I think for everybody and nearly every up neuro-neuro ophthalmologist that I know is doing this. And by the way, this tram track look on the MRI, classic perineuritis involvement, perineural involvement, classic sheath enhancement for MAG. So the take home message is obtain aquaporin-4 and MAG antibodies in all patients with optic neuritis. Let's move to just a brief note on OCT that again calls to Newcastle to an ophthalmology group. I don't need to tell you that neuro ophthalmologists like to look at the RNFL, but we've been really taken lately with looking at the ganglion cell layer complex in our patients. And these measurements, especially RNFL, have actually been used as endpoints in multiple sclerosis trials, treatment trials, because they correlate not only with axonal loss and visual dysfunction, but they correlate with brain atrophy and MS, disability and quality of life. I think it's in the compressive and infiltrative category, however, where our use of the GCC has become extremely important and helpful for our neurosurgical patients. Here is a patient with compression of the chiasm and the left optic nerve and you see the mass here, you see the visual fields here. Here is the GCC. If you flip it upside down and backwards, it's truly amazing because you basically see the visual field imprinted on the macula. Look at that. It's truly amazing. So it's very sensitive and very corroborative of the findings on visual field. Now, sometimes you don't see any abnormalities on the visual field. The MRI shows it compressing the chiasm and the patient may have asthma or be a little risky for surgery and the neurosurgeon says, is this tumor causing any problem? And so you get the visual field. It's normal. You get the RNFL. It's normal. Look at the GCC by nasal visual loss showing early chiasm compression. This patient got operated on. So the GCC is more sensitive and will show things earlier than the RNFL and even visual field testing. But however, we still need visual field testing. Look at this by temporal hemianopia, normal RNFL, normal GCC. What caused that? Well, likely pituitary apoplexy, something recent. Because remember, even the GCC takes a few weeks to become abnormal and will be normal in acute optic neuropathies and the RNFL will take usually six weeks or more to become abnormal. Looking at vascular causes of optic neuropathies, the main one being enteroschemic optic neuropathy, in which obviously you have swelling of the optic nerve head, presumed due to ischemia, usually in older patients. The substrate for this to happen is the disc at risk, the so-called crowded optic nerve with no cup. And as I mentioned in our earlier lecture today, yes, this is a tertiary care center where we did this study and it's going to be biased toward very atypical forms of naion or optic neuritis. This we're going to see strange cases, but nearly a quarter of our naion patients were less than 50 years old. So the age at onset doesn't necessarily rule out naion. And I showed this table where, yes, it's important to consider age, but if there isn't pain, there's dyscadema and things don't get better. And especially if on a good quality MRI of the orbits with gadolinium and fat suppression, the nerve appears normal. You need to think about naion in your differential diagnosis. And this is particularly important as you see in this study. Again, a tertiary care center where 122 patients were referred with optic neuritis turns out that only 40% of them ended up actually having optic neuritis. And amongst the misdiagnoses, non-arturidic enteroschemic optic neuropathy was very high up. And this is important because if you get an MRI and a patient referred to you as a neurologist as having optic neuritis and you see a Ditzel, you may be inclined to commit these patients to long therapy with immunosuppressive drugs when what they really had was an Naion. And this new Naion, I wish I could tell you a bunch. We do now feel very comfortable that obstructive sleep apnea is a risk factor for Naion. We don't know if treating it necessarily helps, but it is a risk factor. And we do know that there is indeed a higher rate of Naion in patients who have recently used the performance enhancing drugs, the results of this buried in this journal that everybody gets daily, I'm sure the Journal of Sexual Medicine, but there's about a three times increased risk of Naion. On the treatment side, unfortunately the quark study was halted. There is still ongoing the Regenera study which looks at patients with chronic optic atrophy having had Naion a year before and sees if this is helpful in any way for recovery. Just a note about giant cell arthritis obviously need to think about it in any patient over the age of 50 and be careful systemic symptoms of headache, jaw claudication are absent in about 25% of cases. The new thing for GCA is Tosalizumab as again New England Journal article which showed that it is quite effective in steroid sparing, steroid sparing. It allows you to get these patients off steroids faster. It's this population it was tested on was not necessarily the same population we see with vision loss and the recommendations worldwide still are not necessarily to use Tosalizumab acutely, but rather to use it as a steroid sparing agent in the more chronic phase of treatment of GCA. I promised a little note on toxic nutritional optic neuropathies and the note is simply this, think about them in any bilateral optic neuropathy. And the agents you should think about top of the list or a thambutol check the med list, linozolide which is an antibiotic often used in cystic fibrosis patients, amiodarone it looks a little like Naion it may actually be Naion that gets triggered by amiodarone involvement of the small vessels we don't know. But make sure you at least look at the med list, and if it's happened in one eye, speak to the cardiologist about is it safe to discontinue the amiodarone. The PDE five inhibitors as we spoke about methanol and ethylene glycol toluene or glue sniffing and then find out if they had a hip replacement in the early 2000s, a number of these patients their hip hardware disintegrates and they get cobalt toxicity cobalt chromium metallosis with bilateral optic neuropathies and peripheral neuropathies. A couple of notes on what's new in hereditary optic neuropathies. Most of the hereditary optic neuropathies are indeed due to mitochondrial dysfunction. That's why they're called optic mitochondria apathies. The two big ones are labor serratory optic neuropathy which is due specifically to point mutations in mitochondrial DNA, but autosomal dominant or CARES disease dominant optic atrophy is also a mitochondrial disease because it's involving a gene that is on a nuclear chromosome is abnormal and it makes an abnormal protein, which is usually usually transported into the mitochondria. To help with mitochondrial function. Um, just a note on labors. This is a bilateral sequential optic neuropathy occurs simultaneously and about 50%. It's more male than female. Um, and it is a devastating disease, usually legally blind. It is associated in 90% of cases with three primary point mutations in mitochondrial DNA and since they mitochondrial DNA disease, it is inherited maternally because all the babies mitochondria comes along with their cytoplasm from mom's egg. Um, what's new in treatment besides your usual genetic counseling symptomatic low vision health and the answer to things I debonone and gene therapy. I debonone is not FDA approved for the treatment of anything in the United States. It is approved in Europe for labors. The dose is 300 milligrams three times a day. Your patients will get it off the internet. So you need to know about it. It is not the penicillin of labor, serenity, optic neuropathy, but it does appear to help some, especially if given in the first year of onset of symptoms. What about gene therapy I wish I could tell you we have a slam dunk here we do not, but we may at some point so it's important just to know a few things. First of all, we're very good at getting DNA into a nucleus of a cell. We don't do not yet know how effectively to get DNA directly into mitochondria to complement mitochondrial DNA. So we have two techniques for gene therapy for mitochondrial DNA disorders. The first is nuclear transfer techniques. This is pretty extraordinary work. It's done already in England. Basically, you take mom's egg, which has mutant mitochondrial DNA.  You've cured it in the germline. It will never happen again, never be at risk. And if you think that this is, you know, futuristic mojo, there's a three year old boy who is the product of a US doctor going to Mexico to help a Jordanian couple conceive a baby with three genetic parents. And he's doing great. He had the NARP mutation, not labors, but this is being offered in the UK, but I think it will be a long time before our government would ever allow genetic engineering like this to cure labors. So what do we have instead? All the studies to date have used something called allotopic rescue. Allotopic rescue takes advantage of the fact that most of the proteins necessary for mitochondrial function are actually coded for on nuclear DNA made in the cytoplasm and transported into the mitochondria. So what we do is we inject a AV vector, we get the good gene that's abnormal in the mitochondrial DNA into the nuclear DNA, the normal protein is made here, and we get it into the cytoplasm. And we have two finished studies that looked at this one looking at labors onset less than six months, one looking at labors onset of vision loss six to 12 months. And like I say, it's not slam dunk. However, there is an improvement after injection of the gene therapy in one eye, in both eyes showed improvement over what would be considered the natural history. This is the early patients, they're injected, they still worsen, but at some point less than a year, they start to improve. Is this just that we don't understand the natural history here the two studies put overlapping each other, or is there really a bilateral improvement that is beyond natural history which has always been felt to be poor for this disease. And most of us really were worried that we were just missing the natural history until we ended up doing a non human primate study in which we injected the gene therapy in one eye and then three months later sacrifice the animals and looked at all the places. You see there with yellow stars and found the DNA had migrated along the visual pathways and so perhaps that's the answer this is very early we really do not know. So leaving this topic I just want to say for any of you who are involved in rare diseases. If you think about a study I did in labors back in the early 2000s, it took eight sites to recruit nine patients and it took us two years. These studies we've done, we have over 180 patients recruited, and the Chinese have nearly 200 patients recruited of labors patients, and we did it within a year and a half. And the answer is because we have enlisted lay organizations who do not have HIPAA rules and they can keep registries and as soon as we have a trial. They click a button and not only do they educate and counsel and have support groups with these these platforms, but they are so helpful for clinical trials so so go go and collaborate with your patients. Getting back into the brain. Let's talk a little bit about homonymous hemiopias usually due to strokes. The natural history of these disorders is that if they're going to get better, the hemiopia usually does so is in the first few weeks, and will certainly have done so by three months. And so that's always good not only for prognostic value but good to know when you're trying to decide whether a therapy is helpful such as vision restoration therapy retraining, which I am definitely not going to get into today. But what I will get into today is a really cool couple of articles that just came out in the American Journal of ophthalmology, in which a computer takes a picture of the actual visual field maps the patients visual field defect and then squashes the entire picture into the residual visual field of the patient. Is that really incredible or what so we're very excited about this obviously the technology is going to have to get better and lighter. It's a little heavy and cumbersome, but I think this is really exciting for patients with visual field defects including homonymous hemiopias there's an altitude note here. Pupils. It's not new to remind you about aproclonidine as the way to diagnose a Horner syndrome, your neurology colleagues probably still think that you need to use cocaine. You don't aproclonidine working on the basis of super sensitivity of a denervated Horner lid and Pupil will reverse the anisocorrhea make the Horner people bigger and reverse the ptosis regarding ocular motility. I'm sorry for those residents who heard this already I think the most important thing to talk about here is the fact that non invasive vascular imaging whether it's MRA or CTA is basically 100% sensitive to picking up aneurysms big enough to cause third nerve palsies. And so don't be too complacent, however, because these aneurysms are still being missed. And the reason they are being missed is because either the radiologist is not told the right thing to look for, or the radiologist did not have training in neuro radiology or vascular diseases so please know your radiologist talk to them and get get somebody to look at your scans who knows what they're looking at. Quick note on the degenerative diseases so now I'm segueing back into the cortex and other areas of the brain. There's a lot of bruja out there a lot of interest in using OCT measures of RNFL and GCC to predict diagnosis to predict clinical course of patients with Parkinson's disease Alzheimer's disease. Here's this article that just came out in neurology and clinical practice that the eyes have it and you can you can predict dementia risk in Parkinson's disease. I would caution people to jump on this bandwagon too soon for the individual patient this may turn out to be markers that may be helpful in clinical trials etc. But where the ophthalmologist really can help people with Parkinson's disease PSP other disorders in which the patient has has facial freezing and has difficulty with cognition is ophthalmic stuff, specifically Parkinson's disease. It's not getting them more dopamine that's going to help their visual complaints their visual complaints are more ophthalmic than anything. So they have convergence insufficiency they have difficulty getting their eyes into the reading ad of their spectacles. They have dry eye they don't blink they have blepharitis at a higher rate. So what can you do get them the low vision get them single vision glasses for distance single vision glasses for for reading.  This is not a new article but I always end with it because it's my absolute favorite. I don't think we can get away with doing this study now without getting consent which would give it away but basically we. I had noticed that for a lot of my malingering patients that they came into my exam room which of course is not sunlit and has no windows, wearing sunglasses.  All neurologists know this by the way, I didn't. The teddy bear sign is when you have people come in for overnight EEG monitoring for seizures for possible seizures. There is a high correlation, especially in adolescents and adults that if they arrive for their testing carrying a stuffed animal that there will be a correlation with non organic non epileptic seizure disorder. So we did the study and sure enough, wearing sunglasses when you haven't just had cataract surgery or you don't have UVitis is very predictive of non organic vision loss. Well, I thank you. I did end with about seven minutes for questions. If you're not totally stunned. Just to give you a highlight of what I think will be emphasized next year when I do this talk somewhere. I think artificial intelligence with deep learning systems is going to revolutionize ophthalmology in so many ways from the neuro ophthalmic point of view. I think the the areas where it will have the most effect is with ocular fundus photography, as well as OCT imaging of degenerative diseases. For clinical trials. IH there is a clinical trial going on right now for stenting. Mog, anti ischemic optic neuropathy I hope and labor's hereditary optic neuropathy for sure. So at this point, I will excuse you all. It's been very hard for me to do this. I'm I usually feed off my audience find the person who's starting to fall asleep and really look at them. Get some laughs back from people. So I apologize if if I was off a little I don't know. But I really appreciate the chance to be here. And thank you very much. Nancy this was extraordinary thank you so much for doing this I can tell you, no one fell asleep. I've been watching all the videos at least so we do have a few questions if it's okay and then at the very end I'll just turn it back over to Kathleen degree just to say a couple of final parting words so first question came from Judith Horner the beginning, probably asking for my behalf and other others in the room. What parameters do you use to distinguish transient vision loss due to ischemia versus transient vision loss due to other factors. Well, see, this is where I think the ophthalmologist are the gatekeepers. And there is a list longer than the tallest person I know is arm, regarding all the ocular things that can give transient monocular vision loss. And since your word is going to be taken in the ED, you are the one who's going to have to figure this out. In general, transient monocular vision loss due to retinal ischemia. Will not be painful. It will be fairly sudden in onset, it can take whatever pattern it wants, it can be colored or non colored, it can be black, it can be gray, it can be altitudinal it can be constrictive. It rarely would be anything less than a minute. It rarely would be anything more than 10 minutes. But the main thing is doing a excellent eyeball exam to make sure you're not missing one of the things pigmentary dispersion glaucoma angle closure glaucoma. And the AI, all the many things that can cause ocular reasons for transient monocular vision loss. Our next question is how do you go about encouraging the emergency room to purchase a non midger attic fundus camera. The hardest thing is to change behavior and the hardest among physicians and the hardest thing is to change behavior. If it wasn't something you learned in your residency. So the younger folks in the emergency department at Emory have uniformly been begging, begging for a camera in the ED because we have to take it out when the study was done. And I'm embarrassed to say we still don't officially have one there, although because the higher ups have not put it in the budget. And when you look at how much is budgeted when you build an ED, they all have that of thalmoscope and otoscope hanging on the wall. One camera would do it for a busy ED. And it's cost less probably than a couple of EKG machine so you really have to work within your system. I'll tell you what happens in Australia, where there is more of a uniform health system so people making decisions can make it for everybody. They had a horrific lawsuit regarding missed papal edema in a full minute IIH who went blind who had gone to emergency rooms like five or six times and didn't have their fundus looked at. And if you think you're, it doesn't happen here. I personally must be involved in at least 10 individual lawsuits like that. If you think that one of them would pay for probably every camera needed, given the amount of money that a lawsuit costs. So in Australia that happened now every hospital in Sydney has a camera. That that that makes sense. Hopefully we're going to take. So is it going to take a bad event to make it happen in in your setting I don't know. I hope not. I think what's really going to change things is this article about to come out in this major journal next week. Because once we test that with non medriatic photos and once we test it in EDs and neurology clinics, etc. You're not only going to obviate the need for tele ophthalmology. You're going to have immediate interpretation of a fundus disc appearance. It's not going to keep you from consulting ophthalmologists when you need to consult them. But it's going to make you feel a whole lot better that somebody is normal when they're normal, and a whole lot more concerned if something's abnormal, so that you'll get a console. We have one last question from Brad cats go ahead Brad. So I actually had just two questions. One quick one is your, are you using high dose oral steroids at Emory. Yes, our neuro immunologists will offer patients very, very, very high dose, like having to swallow hundreds of pills a day. In order to do the bio equivalent of IV salumetrol. They were doing that when patients really did not want the bother of IV steroids because in many cases they still would have had to come into the hospital, although there are at home arrangements. With the COVID, they do exclusively that. That unless they're worried that someone is aquaporin four or Mog and therefore needs not only IV steroids but possibly plex. They're trying to keep them out of the hospital. So they're doing it uniformly with very, very high dose oral. Yeah, and just for the benefit of the audience. Dan plague our excellent Moran ice center pharmacist is keeping 50 milligram prednisone pills in stocks so that if you do have a patient that needs high dose oral steroids for optic neuritis. You know we have it on hand whereas like otherwise you'd have to go to like three pharmacies to get enough pills like Nancy says hundreds of pills to treat somebody for three days. I would point out though I mean this, there are very few studies they basically show it may not be harmful. They don't necessarily show that there's any more efficacy than frankly what we know with IV steroids which is that the outcome probably still is the same it may affect the MRI slightly but it's it's not. You don't have to treat people with high dose steroids period if they have a run of the mill optic neuritis and they don't want to be treated. Sure. Yeah, no I usually give the patient the choice I tell them what the, what the outcomes are going to be and let them pick. The final thing I wanted to say is that you know Salt Lake City is the capital for photophobia. And so I just wanted to make a point out about the sunglasses sign is that sometimes that can be a sign of somebody that has severe problems with photophobia for reasons that haven't been treated and sometimes those patients will have functional vision loss and but oftentimes if you treat the photophobia sometimes the vision loss gets better or if you treat the underlying cause of the photophobia. So I wouldn't. Yeah, I would just be careful about patients with sunglasses sign doesn't mean they don't have something wrong with them, but it can mean they can have functional vision loss. Fair point. Thanks Nancy. I just want to say this was a tour de force through neuro ophthalmology. We're so grateful that you were our first virtual E ran round speaker. You did an outstanding job and just wonderful from retina all the way to the brain. Thank you so much for just an outstanding. Thank you so much for coming. Thank you. Stay well everybody. Yeah.