A very good evening aspirants, welcome to the Hindu newspaper analysis brought to you by Shankarae's Academy. Today's date is 30th of August 2022. So before getting into the list of articles, I have an announcement for you. See the pre-storming test series batch one is going to start in Ananahar. Starts on 12th of September 2022 and the first test will be on 19th of September 2022. The series will be covering 66 tests which also includes general studies, CSAT and three mock tests. All the tests will be conducted in offline mode on the scheduled dates from 2 p.m. to 4 p.m. followed by live discussion from 4 30 p.m. to 7 30 p.m. The students who missed the offline test can take the test after two days in online and they will be provided with recorded discussions. The availability of online mode test is until our mock test before Praline's 2023 examination. The explanation key will also be provided to the students. So with this announcement displayed here or the list of news articles that we are going to discuss today, let's get into the first news article discussion. Now let us take up this open article for our news article discussion. See in this article the author has discussed about how the state's finances have a greater impact on centers budget. Through this, the author explores the recent issues in the fiscal federalism. Here, author's opinions are important because he is advisor to the Prime Minister's Economic Advisory Council. So in this news article discussion, we'll see what is fiscal federalism, the issues in it, as cited by the author and what needs to be done to resolve the issues. Now let us first look at the term fiscal federalism. What does the term mean? See in the context of India, it refers to financial relation between the union and the state governments. See it generally deals with how the revenues and expenditures are shared by the two governments. Now regarding the fiscal relation between the center and the state, the author has pointed out three recent issues that needed immediate attention. So let us briefly see what these issues are and the suggestions of the author to address them. Firstly, the issue of goods and services tax that is GST is taken up. See the concern in GST includes mainly the rate structure. Here, rate structure means the different slabs of GST. See as you all know, in India GST rate for various goods and services is divided into four slabs. They are 5%, 12%, 18%, and 28%. You should note that there has been growing calls from the states to simplify GST into three slabs for promoting ease of doing business. Many proposals were made in this regard, but currently GST council is considering a three-tier GST structure of 8%, 18% and 28%. From this, you can understand that they are aiming to increase the lowest tax slab from 5% to 8%. Other than this, the inclusion and exclusion of commodities is also an issue of friction between the center and the states. That is inclusion and exclusion of commodities from one GST tax bracket to another is a problem here. See, recently you would have heard about the inclusion of essential commodities under the GST regime. It was done to increase the revenue collection. For example, take rice, it is an essential commodity. Before July 2022 only branded rice attracted GST tax rate of 5%. But from July 2022 onwards, even the unbranded rice will attract a 5% GST when they are pre-packed and labeled for selling. The same change is done for unbranded pulses, wheat and flour as well. This change has caused issue between the center and states because the change has increased the price of these essential commodities. Additionally, when we talk about GST, the major problem between the center and the state is the GST compensation. See, as you know, GST compensation concluded on June 30, 2022, but states like Tamil Nadu are asking for an extension of compensation. So this also triggers the center. So overall, the issue in GST among center and status tax rate, inclusion or exclusion of commodities and finally the compensation issue. Now regarding this, author has pointed out the importance of GST council in resolving that issue. See, since a proper institutional mechanism is already in place in the name of GST council, according to the author, problems relating to GST mechanism can be addressed effectively only through GST council. Now let us come to the second problem. It is regarding the state level expenditure patterns, especially relating to the welfare schemes. This is much relevant in light of the recent freebies issue. The argument is the states are excessively spending for the welfare schemes.  See, schemes need money. So the states have to spend. Sometimes they borrow and spend for welfare schemes. This increases the depth to GSTP ratio of states. Such high depth to GSTP ratio lowers the fiscal position of the states. Now again, you may ask why this worries the center. It is because this has impact on the depth to GDP ratio of the country as a whole, which in turn affects India's credit rating. So this was the second issue. Now coming to the third one, it is the issues in implementation of centrally sponsored scheme by the states. See, in India, certain centrally sponsored schemes fiscal burdens are shared by the states too. So it leads to fiscal strains in states budget. Now from issue two and three, we can understand the emphasis is on states expenditure mainly regarding the expenditure for welfare schemes. Author suggests to divide the expenditure of the states into two categories and prioritize spending accordingly. In the first category mandatory spending is listed, which includes expenditure on education, health, etc. See, these are essential. So needs to be prioritized and spending cannot be reduced in these part. But in the second category, discretionary expenditure is included. The expenditure is called discretionary when it is governed by annual or other periodic appropriations. See, the aim of discretionary public expenditure is to stimulate the economy during period of excess slack. So authors suggest to reduce this expenditure and only take it up for short period of time during the time of need. Now the second suggestion is to go for subnational fiscal correction. Here the subnational fiscal correction refers to the fiscal consolidation of states finances. Fiscal consolidation is nothing but the ways and means of narrowing the fiscal deficit. Other than this, the following measures can also be done like expenditure prioritization need to be done diligently by both levels of the government. Also institutional mechanisms for solving these fiscal problems between the center and the state need to be revitalized. For example, the Interstate Council constituted under article 263 of the constitution needs to be rejuvenated where it could act as a medium for solving the fiscal issues between center and the states. So these are also some of the important points that you have to make note of from this news article discussion. So in this news article discussion, we saw in detail about what is fiscal federalism and we saw the three recent issues which needs immediate attention. Apart from discussing the issues, we also saw some of the suggestions given by the author. So these learnt points. Now let us move on to the next news article discussion. Now take a look at this news article. See, according to this news article, the Metra's High Court has directed the Tamil Nadu government to geo-reference all the wetlands in the state. After geo-referencing, the court has asked to superimpose the geo-reference on satellite imagery of the 24,684 wetlands mapped in the state under the National Wetland Inventory and Assessment that is NWIA Initiative. Okay? The government has asked the Tamil Nadu government to do this exercise so that the exact location of the wetlands could be identified and their present status could be determined. Only after finding their exact location and present status, they can be notified under the Wetlands Conservation and Management Rules 2017. So this is about the news article given here. In this context, let us know about water wetlands, what is geo-reference and a few facts about National Wetland Inventory and Assessment that is NWIA. First, let us begin with water wetlands. See, wetlands or areas where water is the primary factor that controls the environment and the associated plants and animal species. Okay? According to Ramser Convention, wetlands include area of marsh, fin, peatland, natural or artificial water bodies, temporary or permanent water bodies, lakes, rivers, brackish water and finally marine water and the depth of the marine water at low tide does not exceed 6 meters. So wetlands includes all type of water bodies but the only condition here is water is the primary controlling factor that controls the environment and the associated plants and animal species. Okay? Now having seen the basics about wetlands, now let us see about what is geo-referencing. See geo-referencing is the process of assigning locations to geographical objects within a geographic frame of reference. To put it in simple words, geo-referencing involves assigning exact geographical coordinates to an object in a map or a digital image. So the process of geo-referencing involves taking a digital image. It could be an air photo, a scanned geologic map or a place of a topographic map and adding geographic information to the image. Now look at this image. This is a geo-referenced scanned map of South India. Here real world coordinates that is the geographical coordinates or assigned to each pixel of the scanned map. The geographical coordinates can be found at the bottom here. See the news article said the Madras High Court has directed the Tamil Nadu government to geo-reference all the wetlands in the state, right? Why is the court asking the Tamil Nadu to do that? This is because if the wetlands in the state of Tamil Nadu are properly geo-referenced, a digital database can be created. This database can be used to prevent encroachment of wetlands. So that's all about geo-referencing. Now finally let's see a few facts about national wetland inventory and assessment. See NWIA is a national level wetland inventory created by the Space Application Center Ahmadabad. Here SAC or the Space Application Center comes under ISRO. CSAAC is involved in using the resources of ISRO for national and social benefits. Likewise using data from the remote sensing satellites of ISRO, the SAC created a wetland inventory for India. As a part of this exercise SAC in 2010 released the national wetland atlas. Look at this image. This is the wetland atlas of District of Tiruvallur in Tamil Nadu. The issue with the national wetland atlas is the scale. See the Tiruvallur map is drawn at the scale of 1 is to 10. That is 1 centimeter on map is 10 kilometer on ground. So this is not very accurate. When this map is properly geo-referenced as instructed by the Madras High Court the accuracy can be increased vastly. So that's all about NWAI. So in this news article discussion we saw about what are all the wetlands. Then we saw about geo-reference how geo-reference actually works and then we saw about national wetland inventory and assessment initiative. So with these learnt points now let us move on to the next news article discussion. Have a look at this news article. This news article talks about the scheme for economic empowerment of denotified nomadic semi-nomadic tribes. In short the scheme is called as SEED. See for the implementation of this scheme the union social justice ministry has been allocated 200 crore rupees. Now the problem is none of the applications received so far under SEED's online portal has been approved yet. The reason that the official site for this delay is the delay in categorization of all 1400 communities under the scheduled caste, scheduled tribe and other backward classes into these groups. See the categorization of DNT's NTS and SNT's is essential for the implementation of SEED because there is no separate schedule in the constitution provided for their reservation right. So the state governments were asked to uniformly categorize these communities under scheduled cast, scheduled tribes or other backward caste lists and then provide a sub-categorization in their certificates declaring them as either DNT, NT or SNT. Okay so this is the crux of the news article given here. In this context let us see who are denotified tribes or DNT's. We'll see about their culture and tradition, livelihood, their status in India and then we'll discuss how SEED will empower them. Okay before that the syllabus relevant to this news article is highlighted here for a reference just go through it. First let us start with who are denotified tribes or DNT's. See denotified tribes or DNT's or communities that were notified as being born criminal during the British regime under a series of laws starting with the Criminal Tribes Act of 1871. So through a series of laws starting with the Criminal Tribes Act of 1871 a number of acts were enforced by the British Raj between 1871 and 1947. All these acts notified certain communities as criminals by birth. Later these acts were repealed by the independent Indian government in the year 1952 and these communities were formally denotified. Okay now what you have to note here is a few of these communities which were listed as denotified were also nomadic. I hope you know the meaning of nomadic. Here nomadic and semi-nomadic communities are defined as those who move from one place to another rather than living at one place all the time. Here the distinction between nomads and semi-nomads just lies in the degree of mobility practiced by them. For example the duration distance and frequency of movement is short for semi-nomads when compared to nomads. Okay so now coming to the culture and tradition of denotified nomadic and semi-nomadic tribes. See they have diverse ideological patterns, culture, political and social lifestyles. Most importantly they have a very traditional customs and their practices have an ancient heritage. Then they have their own gods and goddesses. Likewise their own festivals and celebrations are also diversified. See the social and cultural characteristics of nomadic communities are closely related with their economic activities. For example most of the families move in groups of five to twenty with a senior member who is responsible for settling disputes and he or she leads the group. And in some communities there is a system of meeting on annual customary camping where reunions, marriages and even cattle trading takes place. And remember in the case of India large majority of denotified and nomadic communities are primarily patriarchal. Okay then when we talk about their livelihoods they are nomadic which means they move from place to place for making tools and utensils supplying basic goods like salt, wool, providing medicines and herbs and even for entertaining people. So with their skills and ability to travel for long distances with their kin they provide essential goods and services to sedentary agrarian communities. And historically nomadic tribes and denotified tribes never had access to private land or home ownership. These tribes used forest and grazing lands for their livelihood and residential use. Because of this these communities had strong ecological connections and the current changes in ecology and environment seriously affect their livelihood options. Okay now coming to their status in India see it has been estimated that South Asia has the world's largest nomadic population. In India roughly 10% of the population is denotified and nomadic. While the denotified tribes have almost settled in various states of the country the nomadic communities they still continue to be largely nomadic in pursuit of their traditional professions. Okay so the government in the year 2014 had constituted national commission for denotified nomadic and semi-nomadic tribes which is in short called as NCDNT. They worked for a period of three years and they worked to prepare a statewide list of cast belonging to denotified and nomadic tribes. Also the commission worked to suggest appropriate measures in respect of denotified and nomadic tribes that may be undertaken by the central government or the state government. Okay earlier in the year 2008 also there was this Renke commission to identify and list the D&D communities. And then in the year 2019 a development and welfare board for denotified nomadic and semi-nomadic communities has been constituted. This is for development and welfare of denotified nomadic and semi-nomadic communities. Okay lastly let us see how this seed scheme will empower them. See firstly know that this scheme is for the empowerment of denotified nomadic and semi-nomadic tribes. This scheme is formulated for families having income from all sources of Rs. 250,000 or less per annum and they should not avail any benefits from similar schemes of central government or the state government. Okay this scheme is for a period of five years starting from the financial year 2021 to 2022 to 2025 to 2026. Okay and it has four components. First is to provide coaching of good quality for D&D, NT or S&T candidates. This is to enable them to appear in competitive examinations. Secondly is to provide health insurance to D&T, NT and S&T communities. Third is to facilitate livelihood initiative at community level. This component is to build and strengthen small clusters of D&T, NT and S&T communities institutions. And the last component is to provide financial assistance for construction of houses to the members of the D&T, NT or S&T communities. Okay so remember the scheme will be implemented through a portal developed by the Department of Social Justice and Empowerment and this scheme comes under the Ministry of Social Justice and Empowerment. As I already said for the implementation of this scheme, Rs. 200 crore were allocated and it is expected that the SEED scheme will empower the denotified tribes. But the news article reports that there is delay in categorization and because of that applications received on the SEEDs online portal has not been approved yet. So government has to keep a check on this and make sure the funds allocated is wisely used for the needy. So in this news article discussion we saw in brief about denotified tribes or D&Ts and we saw in detail about SEED initiative. So with these learnt the points now let us move on to the next news article discussion. Now take a look at this news article. See the news article says the IAF is set to receive its first unit of indigenous light combat helicopters that is LCH in Jaipur in the first week of October. See while the Indian Army plans to acquire 95 LCH the IAF is still working out the total number of LCH to be acquired. So this is about the news article given here. In this context let us see some of the important points about LCH in preliminary perspective. First let us see when the need for LCH was realized by India. See during the Kargil conflict of 1999 the absence of an attack helicopter which could operate in ultra high altitude areas was felt acutely by the Indian Army and the Indian Air Force. At that time India operated Russia made MI-17 helicopters and the MI-17 helicopters were not designed to operate at greater heights. Due to this itself the Pakistani army intruded into our side of the LOC. So after the war the government started taking measures to develop indigenous LCH. In 2006 the Hindustan Aeronautics Limited that is HAL announced its intention to develop a LCH which could operate in the harsh desert conditions as well as the high altitude areas of Ladakh including the CH in Malaysia. So with this basic information now let us see some of the features of LCH. See the LCH is designed and developed by Hindustan Aeronautics Limited that is HAL which we saw earlier. It is an indigenous helicopter containing 45 percentage of indigenous content by value. The LCH is powered by two Shakti engines. It has a maximum takeoff weight of 5800 kilogram. The LCH has a maximum speed of 268 kilometer per hour and it has a range of 550 kilometer. It has an operation ceiling of 6.5 kilometers that is the LCH can operate up to the height of 6.5 kilometers. The LCH has several stealth features armor protection and night attack capabilities and it is equipped with air to air and air to ground missiles and it also has a 20 mm gun and 70 mm rockets. These are some of the features of the LCH. Finally let us see the role that the LCH will play once it is deployed. See as the LCH can operate in high altitude conditions the army is planning to deploy the LCH for combat roles in the mountains. It will be mainly deployed in the eastern command along the LAC. Secondly due to the LCH ability to fly at low height at a very greater speed it can be used in the anti-tank operations by the army. Thirdly due to its stealth capability it can also be used to scout enemy presence and relay useful information to the army. Fourthly the LCH is also suitable for air defense roles and destruction of enemy air defense assets like the surface to air missiles. And finally the LCH can also be used in urban warfare missions and combat search and rescue operations. So these are some of the important points about light combat helicopters very important topic make note of it. In this news article discussion we saw about some of the important features of LCH and we also saw about the role that the LCH will play once it is deployed. So with these learned points we came to the end of the news article discussion now let us move on to the next part of the news article discussion which is the preliminary practice questions. See today we have two preliminary practice questions and there is no quiz question for you today. Now look at this first question let me read out the question which one of the following is an artificial lake. Option A Kodaikanal, Option B Kulleru, Option C Nainital and Option D Renuka. See the correct answer for the question is option A Kodaikanal. See Kodaikanal is a man-made lake located in the Kodaikanal city in the Nikal district in Tamil Nadu. Kulleru lake is present in Andhra Pradesh and it is the largest freshwater lake of India between the deltas of Krishna and Godavari river. Nainital, it is located in Uttarakhand it is situated in the foothills of the Himalayas. Then coming to Renuka, see this lake is located in Himajal Pradesh. So the correct answer for the question is option A Kodaikanal. Now moving on with reference to India's defense consider the following helicopters. First one is Cheetah, second one is Cheetak, third one is Rudra which of the above has Torrent gun, rocket system and air to air missile. See the correct answer for the question is option D 3 only. See Rudra is the weaponized version of the advanced light helicopter named Dhruv. It was designed and developed by Hindustan Aeronautics Ltd that is HAL and it was developed to meet the requirements of Indian Army and Air Force. This multi-role helicopter of 5.8 ton class is powered by two Shakti engines and it has 20 mm torrent gun. Apart from this it also has 70 mm rocket system along with air to air missile. So the correct answer for the question is option D 3 only. Now moving on the questions displayed here or the main question for you today just go through the questions write an answer and post the answer in the comment section. So with this we came to the end of the news article discussion. If you like the video hit like, do comment and don't forget to subscribe to Shankar Reyes Academy YouTube channel. Thank you.


Thank you for this introduction. My name is Vaughn Rickrazier. I'm an interventional cardiologist at Texas Heart Institute and CHI Health, Baylor St. Luke's Medical Center. I'm also program director of peripheral vascular introspection at Texas Heart Institute and Baylor College of Medicine in Houston, Texas. The title of my presentation is TAVR versus surgical aortic valve replacement and and the survival, hemodynamics, bioproesthetic valve deterioration and long-term outcomes and the need for re-intervention. As far as my disclosures are concerned, I'm on the Speaker's Bureau for Metronic. So what is the currently available percutaneous valve that are available, so-called TAVR? When Metronic Evolute Pro is self-expanding valve that we can see on the left-hand side and Edward Sapien, the 3-valve is a balloon-expanding valve and more recently there was a device that was approved, Abitovascular Portico device that's also self-expanding valve. Now when we look through the history of different clinical trials, we can see as far as the core valve is concerned, there was extreme risk study and as far as all-cause mortality is concerned, we can see it from 2011. Then the next generation was Evolute R-valve that in comparison with the surgical outcomes in high-risk patients, we can see that in yellow line the surgical mortality was higher than with the percutaneous Evolute R-valve. Followed that, a new valve was introduced to Evolute Pro and that was studied in intermediate-risk patients in comparison with surgical approach and we can see the results are very similar at two years follow-up. Finally, the more recent so-called low-risk trial with Evolute Pro plus a valve, comparing the surgery to TAVR and we can see that surgery had slightly higher mortality and slightly similar stroke rate at 20 for a month of follow-up. Now, limited data exists on the incidents and factors that are associated with structural valve deterioration after TAVR and also after surgery from a large-scale multi-center and randomized clinical trials. However, previous work demonstrated that early generation intravalvella or balloon expandable bioprostesis have significantly higher five-year rates of a structural valve deterioration in comparison to surgery, whereas newer-generational annular valves have similar structural valve deterioration rates, as we can see here in this particular diagram at five years of follow-up, where the sapon XT was the early generation balloon expandable valve with a 9.5% mortality of five years and a newer generation sapon III had significantly lower mortality of 3.9 and surgery is mortality at five years with 3.5%. Now, prior analysis have shown that the TAVR with supranular self-expanding bioprostesis such as Evolute R and Evolute Pro had significantly lower hemodynamic valve deterioration or re-interaction due to stenosis than surgical valve repair. And this has been shown in a notion eight-year follow-up study. Core valve versus SAVR as far as bioprostatic valve failure is concerned where at eight years of follow-up SAVR's biologic valve failure was occurring in 10.6% of patients versus only in 7.3% of patients that had a core valve procedure. As far as hemodynamics are concerned, when we look at the late mean gradients after core valve versus surgery and five-year follow-up in cardiovascular high-risk patients, we can see that the effective orifice area for core valve is shown in blue, was larger than with surgery. And as far as mean gradient was concerned, again on the right side, we can see that it was also larger with core valve than with surgery. Meaning that core valve performs well and better as far as effective orifice area is concerned and also as well as mean gradient is concerned at five years of follow-up. Now, that is also available for balloon expandable valve from the choice trial that was carried on in Europe, in Germany, and we can look at the late mean gradients comparing core valve versus sapient valve. And we can see that the gradients at five-year follow-up shown for core valve in blue are significantly lower or almost half of what they were with a sapient XT valve. That was a previous generation sapient valve. The comparison of sapient self balloon expandable valve versus evolut self-expanding valve are shown in this particular study that was published by Ring in American Journal of Cardiology in 2020. We can see as far as echo measurements are concerned at one one follow-up, the gradient was significantly lower for evolut valve than for sapient. And when we look at mean gradient higher of 20 millimeters of mercury, which is significant, again was significantly lower for evolut than for sapient. And when we look at one-year follow-up, again similar findings were observed for better outcomes with evolut than with sapient. On the right-hand side, we can see again, as far as mean gradients are concerned, they were significantly lower in comparison with sapient valve as we can see here as well. In this particular study from Australia, as far as one-year mortality is concerned, we can see that impaired valve hemodynamics at one-year follow-up showed definite effect as far as the risk and mortality is concerned and there was a significantly higher mortality in patients with severe impaired valve hemodynamics than in patients with normal or mildly impaired valve hemodynamics at one-year follow-up. Now as far as additional data related to structural valve deterioration in patients that undergo TAVR versus SAVR merits further evaluation. And recent analysis that was presented at ACC meeting in March of 2022 looked at this particular aspect and the study objective included a core valve evolut pooled data analysis to evaluate five-year incidents outcomes and predictors of hemodynamic structural valve deterioration in patients undergoing supranular self-expanding TAVR and surgery from the core valve U.S. Pivotal and Sir TAVR trials. And what we can see here at five-year follow-up in patients that had a larger than larger than 23 millimeter annulus again significantly higher structural valve deterioration with surgery than with TAVR. And this was particularly true for patients that had smaller orifices such as patients that had a very small annulus of less than 23 millimeters but it was also important for patients that had larger annular. Now, when we look at core valve pooled data analysis as far as predictors concern for both surgery and also TAVR we can see that in pooled randomized trial for TAVR the all cause mortality was higher when structural valve deterioration occurred also cardiovascular mortality was higher need for hospitalization for aortic valve related conditions was higher and the composite assessment was higher. This was also true for surgical valves as well as we can see further down and it was true for all TAVR valves for all variables included. Now additionally the univariate and multivariate predictors were analyzed and all the patients fared better as far as structural valve deterioration is concerned rather than younger patients and male patients fared better than female patients and this obviously had to do something with the annular size. The body surface area was a negative predictor. It means causing more structural valve deterioration. The larger the body surface area the highest of structural valve deterioration is concerned. Patients that had a prior coronary intervention and also patients that had a prior atrial fibrillational flutter had lower structural valve deterioration. A potential explanation for those two findings are that patients that are treated for coronary heart disease and prior intervention and patients that are treated for atrial fibrillation and flutter require more aggressive antiplatelet and anti-correlation therapy than are normally given to patients after TAVR. Now one of the great concerns after TAVR procedure is the incidence of and significance of patient prosthesis mismatch. It means that the prosthesis that is used is either too small or too large or it's under expanded or it's overexpanded. And this was particularly true in the so-called WIN TAVI trial which is women's international registry and we can see as far as predictors of patient prosthesis mismatch is concerned in this particular study it occurred roughly in 36 percent of patients which is quite concerning. This was more common for smaller valves less than 23 millimeters that occurred roughly in 50 percent of patients and particularly true for balloon expandable valves which again occurred in 43.5 percent of patients. However patients with self-expanding valve had significantly lower incidence of prosthesis patient mismatch as is shown in a blue graph. Now as far as subclinical leaflet thrombosis and reduced leaflet motion or so-called halt or thrombosis of the valve is concerned obviously this finding carries quite concerning and in certain instances quite concerning consequences. In surgical literature the incidence of halt or silent leaflet thrombosis in surgical bioprostesis occurs is somewhere between 0.8 to 4 percent of patients. However post-tabber halt ranges significantly between 4.5 to 40 percent depending on the publication. Now more recently FDI has expressed concerns and have called for prompt attention to this clinical problem. The images on the CT on the left-hand side and also on the right-hand side in diastole and systole are shown with patients that have limited valve leaflet motion or thrombosis. Now in this particular study that was published American Journal of Cardiology in 2020 as far as halt is concerned comparing a tabber versus a surgery at 30 days and also at one year we can see that at 30 days the incidence was similar for both for surgery and percutaneous valve deployment somewhere in the range between 60 to 70 percent of patients. Most of those were so-called mild halt or a certain degree of moderate halt and at one year of follow-up the numbers were higher. There was statistically no significant difference between saber and tabber and as we can see most of the tabber patients had a relatively mild degree of halt and significantly lower degree of halt than with surgery. Now more recently Dr. Popma presented at the ACC meeting in 2020 results with evolut data as far as a more than 50 percent halt which is quite concerning halt and we can see at 30 days it was a little bit higher with the saber than tabber. However at one year follow-up it was higher in saber patients than in tabber patients. Now as far as partner three and sapien data data is concerned saber versus a tabber is concerned in subclinical leaflet thrombosis we can see that with sapien three at 30 days the occurrence was roughly occurring in 13 percent of patients and in surgery significantly lower in 5 percent of patients. At one year of follow-up the incidence of halt was similar in both sapien and surgical group occurring between 20 to 28 percent of patients. One of the concerns as far as tabber is concerned treatment of patients with bicuspid aortic valve with a tabber. Here we can see various degree of complications as far as bicuspid aortic valve is concerned. It can be present with no raffae present with non-calcified raffae or patients that have fused raffae and severe calcifications. The new classification that's shown on the right-hand side we can see from no calcification to a severe calcification of infusion of raffae. We can see that patients with more advanced disease and severe fusion and calcification have dramatically higher mortality at two or three years of follow-up. One of the main detriment as far as tabber is concerned with self-expanding and also with balloon expanding valves are concerned calcification in the left ventricular outflow as well as calcification of the annulus and the valve leaflets and less than optimal outcomes related to aortic regurgitation as is shown here. There are numerous studies that have been published related to bicuspid aortic valve related to tabber procedure with both balloon expandable and self-expandable valve as we can see here in the study by forest and all that look at the evoluted self-expanding valve. There was evidence of more need for re-intervention in balloon expandable valve. There was no difference in mortality's concern or stroke or coronary obstruction or patient prosthesis mismatch or any changes in hemodynamics is our concern. Now in a MacArthur study that studied the sapien 3 balloon expandable valve stroke was somewhat higher at 30 days and also at one years with balloon expandable valve but no difference in mortality or gradients or perivalvular leak. And we can see in another study in that was published in the journal of cardiovascular imaging in relatively small number of patients that at 30 days there was no difference in mortality or stroke or patient or pacemaker or gradients needed. In the study comparing sapien 3 and evolut are concerned we can see in the last study shown here on the bottom with a follow-up at 30 days and one year that bicasperiortic valve had higher risk of conversion to surgery need for second valve implant high incidence of perivalvular leak and need for re-intervention for device failure. There was no difference in mortality or stroke or perivalvular leak between balloon expandable versus self-expandable valve. Balloon expandable valves had lower rate of second valve and a need for a permanent pacemaker but had higher rate of annular rupture. So in conclusion, the supra annular family of TAVR devices provides better acute valve performance and larger effective orifice areas than surgical bioprostesis. Acute valve performance such as gradient effective orifice area or patient prosthesis mismatch was statistically better with supra annular TAVR than surgery up to eight years of follow-up than after aortic valve replacement. The supra annular valve has less hemodynamic valve deterioration than SAVR at five years after aortic valve replacement and intra annular balloon expandable TAVR has similar or higher rates of structural valve deterioration and bioprostatic valve failure compared to SAVR. However, additional longer-term studies are needed to compare intra annular TAVR to supra annular TAVR for long-term outcomes. There are ongoing studies in patients with TAVR after SAVR for smaller annular such as aortic area of 43 millimeters square annular and also in women that have a smaller annular to determine the implications of acute hemodynamic performance and long-term outcomes. Thank you very much for your attention.


The title of our sermon this morning is God's Unfailing Comfort. God's Unfailing Comfort, and we are in 2 Corinthians chapter 1 verses 3 through 7. In 2 Corinthians chapter 1 verses 3 through 7, we are, we're introduced to one of the primary themes that runs throughout this letter of Paul to the Corinthian church. The theme is this, Union with the Lord Jesus Christ through repentant faith means fellowship with Christ in his suffering. Union with the Lord Jesus Christ through repentant faith means fellowship with Christ in his suffering. Paul would say that he suffered the loss of all things. He counted them all as rubbish, that he might know Christ, that he might know the power of his resurrection and the fellowship of his sufferings. The suffering is not described in the Bible as a mere possibility in the life of a Christian. Suffering is expected. Suffering you might say is guaranteed. Peter tells the persecuted and dispersed church across the Aegean from Corinth, and he tells us today, he says, beloved, don't think it's strange concerning the fiery trial, which is to try you, as though some strange thing happened to you. Rejoice to the extent that you partake of Christ's sufferings. Peter himself had learned what it meant to suffer for Christ, and he understood God's purpose in his suffering. Turn with me to Acts chapter four, Acts chapter four. Peter learned this experience, learned this lesson, and he learned it the hard way. He learned it through experience. We see this beginning with Peter in Acts chapter four in verse one, Acts chapter four verse one. After Pentecost, Peter and John go up to the temple in the afternoon about the ninth hour, and Peter is preaching boldly on Solomon's porch, calling the people to repentance for crucifying their Messiah. And Peter proclaims, beginning in verse one, as they spoke to the people, the priests, the captain of the temple, and the Sadducees came upon them. They were greatly disturbed, verse two, that they taught the people and preached in Jesus the resurrection from the dead. And they laid hands on them and put them in custody until the next day, for it was already evening. So here at the beginning of the early church and the early days of the early church, Peter and John spend the first of what would be many nights in jail for the cause of Christ. But what Peter would learn, what Paul would learn, and what you and I must learn is that Christian suffering goes hand in hand with preaching the gospel. And furthermore, suffering, the suffering of God's people, suffering for Christ doesn't choke the spread of the gospel. Christian courage in the face of Christian suffering advances the spread of the gospel. Look at verse four. However, many of those who heard the word believed and the number of the men came to be about 5,000. In other words, the church was growing like wildfire. Suffering for the gospel, as we see here in Acts chapter four with Peter, suffering for the cause of Christ is commonplace in the New Testament. It's normal. Again, it's expected. That suffering goes hand in hand with the spread of the gospel. That suffering goes hand in hand with ministry in the Lord's church. That suffering goes hand in hand with a conversion of the lost and the growth of the early church. I want to establish at the outset that this is the kind of suffering that Paul is concerned with in 2 Corinthians chapter one, verses three through seven. He refers to it in verse five as the sufferings of Christ. And he'll refer to it repeatedly as we work through the letter. Look at verse eight. Verse eight. Paul writes, for we do not want you to be ignorant, brethren, of our trouble, which came to us in Asia. And for what reason did the trouble come to him? It's for the preaching of the gospel, right? That we were burdened beyond measure, above strength, so that we despair even of life. Yes, verse nine. We have the sentence of death in ourselves, so that we should not trust in ourselves, but in God who raises the dead. Flip the page and look at 2 Corinthians chapter four. In chapter four, look with me beginning at verse seven. In verse seven, Paul writes, but we have this treasure. What's the treasure that Paul's referring to? It's the gospel. If you go back up to verse four, Paul's speaking here of the gospel. We have this treasure, the gospel, in earthen vessels, in weak, breakable, frail, valueless, you might say, earthen vessels. So that, he says in verse seven, the excellence of the power may be of God and not of us. We are hard pressed on every side, yet not crushed. We are perplexed, but not in despair. We're persecuted, but not forsaken. We're struck down, but not destroyed. Always caring about in the body the dying of the Lord Jesus, that the life of Jesus also may be manifested in our body. Flip the page and look at 2 Corinthians chapter six and look there beginning at verse three. Verse three, Paul says, we give no offense in anything that our ministry may not be blamed, but in all things we commend ourselves as ministers of God. And in what way here does he commend himself? In much patience, in tribulations, in needs, in distresses, in stripes, in imprisonments, in tummels, in labors, in sleeplessness, in fastings. Suffering goes hand in hand with preaching the gospel. Suffering goes hand in hand with ministry in the Lord's church. Flip over to 2 Corinthians chapter 11. 2 Corinthians chapter 11. This theme runs throughout the letter and this is the suffering that Paul is concerned with in 2 Corinthians. He's concerned with Christian suffering, the sufferings of Christ, Christians who suffer because of the cause of Christ preaching the gospel of Christ. In chapter 11, look at verse 22. In verse 22, he distinguishes himself from false apostles and the way that he does this here is by pointing to his suffering. Now consider this for a moment. Paul is going to distinguish himself from false apostles by pointing to his suffering for the sake of the gospel, for the sake of Christ. Look at verse 22. Speaking of the false apostles, are they Hebrews? So am I, Paul says. Are they Israelites? So am I. Are they the seat of Abraham? So am I. Are they ministers of Christ?  I am more in labors, more abundant, in stripes above measure, in prisons more frequently, in deaths often. From the Jews, five times I received 40 stripes minus one. Three times I was beaten with rods. Once I was stoned, three times I was shipwrecked. A night and a day I've been in the deep, in journeys often, in perils of waters, in perils of robbers, in perils of my own countrymen, in perils of the Gentiles, in perils in the cities, in perils in the wilderness, in perils in the sea, in perils among false brethren, in weariness and toil, in sleeplessness often, in hunger and thirst, in fastings often, in cold and nakedness. And besides the other things, what comes upon me daily, the suffering isn't just physical, right? The suffering is mental, the suffering is emotional. What comes upon me daily, Paul says in verse 28, my deep concern for all the churches. So we walk through the letter, we look at these texts. Is Paul wallowing in the misery of his affliction? Is Paul complaining, griping here? Is he grumbling to God? No, no. Paul understands Christian suffering in the same way that Peter does. Look at Philippians chapter one, Philippians chapter one. He's come to learn a hard lesson of Christian suffering. He's learned through his experience. He understands Christian suffering in the same way that Peter does. Philippians chapter one, and look there at verse 12. Paul says in verse 12, I want you to know, brethren, that these things which happen to me have actually turned out for the furtherance of the gospel, so that it has become evident to the whole palace guard and to all the rest that my chains are in Christ. And most of the brethren in the Lord, having become confident by my chains, are much more bold to speak the word without fear. We want to grasp a sense of that in our text this morning, right? This is the suffering that Paul is referring to. This is the suffering that Christians enter into when they preach Christ. When they go out in the power of the Spirit to preach the gospel, Christians are going to suffer. Christians are going to suffer. It's not an unusual thing. It's not a strange thing. It's a normal thing. It's an expected thing. And Christians taking Paul's example lean into that suffering. They understand the purpose of that suffering. They understand the context of that suffering. They understand what God's doing through it. And that's what we need to understand this morning from our text. The specific concern of Paul in 2 Corinthians chapter one, back there, verses three through seven, is the suffering of Christians for the cause of Christ. Jesus had told his disciples, right? He tells you and I, a servant is not greater than his master. If they persecuted me, they will also persecute you. That's the story of the Lord's church for 2,000 years. That's the history of the church. The seed of the church is the blood of the martyrs. Christians have suffered in the cause of Christ for 2,000 years and the torch has been passed to us. The sufferings of Christ in verse five, or Christian suffering, is that suffering experienced by Christians because of their association or because of their identification with him. You can suffer because you eat a bad plate of shellfish, right? Or you might suffer a little bit when your mother-in-law comes to town. I don't because I've got the best mother-in-law, right? You might suffer a little if your mother-in-law comes to town. You go over to somebody's house, they own a cat, you might suffer a little. That's not what Paul's referring to here, right?  Their sufferings are like signposts that point them to ultimate suffering, ultimate judgment. All along the way, their suffering is to point them toward the wrath of God. That's not what Paul's referring to here. Paul is talking about suffering of Christians for the cause of Christ, sufferings of Christ. So what are the sufferings of Christ? What are the sufferings that you and I will experience in our association with or in our identification with Christ, among many things, right?  When you're married to a godless man that mocks your faith and you patiently endure in loving him for the sake of your witness for Christ and for the sake of his soul, that's suffering for Christ's sake. When you esteem the reproach of Christ far greater riches than the approval of so-called friends or the approval of so-called family, that's the sufferings of Christ. Most often, most often, the Christian suffering that Paul is referring to is that suffering that you experience when you refuse to fear men, when you refuse to be ashamed of the gospel, and you open your mouth to preach Christ and him crucified. Most often, the suffering comes from that. No matter how many laws are passed, no matter what quote-unquote liberties we may enjoy, no matter how many courthouses hang the Ten Commandments, no matter how many schools allow prayer, in God we trust can be all over our money.  Even in this country, in this day and age with the quote-unquote liberties that we enjoy, if you take a stand for Christ, if you preach the gospel, then you will face persecution. We hear often in the church today, right now in this country, we don't face persecution as Christians did in other countries at other times. But if you are taking a stand, if you are taking a stand, if you are preaching the gospel, then you will know what Christian suffering feels like to a degree. If you're taking a stand for righteousness, if you're preaching the gospel, then you will share in the sufferings of Christ.  And you'll do that in fellowship with the Lord Jesus Christ himself. Don't think it's strange, brother, right? Christian suffering is expected. What would have been strange to Peter? What would have been out of the ordinary to Paul? Paul would have been the absence of persecution or the absence of suffering. For a quote-unquote professing Christian to say, I'm never persecuted. Paul told Timothy, all who desire to live godly in Christ Jesus will suffer persecution. It's pretty clear, right? Think about that statement. Paul told Timothy, all who desire to live godly in Christ Jesus will suffer persecution. If you don't regularly face some kind of scorn, some kind of derision, reproach or reprisal, then seriously, right now as you're sitting here, seriously this morning, ask yourself the question, why not? If you're unfamiliar with what I'm talking about, unfamiliar with the testimony of Scripture on this point, you've got to ask yourself, why not? When was the last time that you were persecuted? When was the last time that you faced scorn, derision, reproach for the sake of Christ? Woven into the fabric of this text. This is a glorious and encouraging text. A woven into the fabric of this text written in the white spaces between the lines, so to speak, is the call to all genuine disciples of the Lord Jesus Christ to go forth to him outside the camp and bear his reproach. It's a motivation. The text compels us to go out to Christ. Listen, we have no continuing city here. We look for the one that is to come. We are pilgrims. We are sojourners. Therefore preach the kingdom and his coming. Preach Christ and his coming. Preach him and him crucified. Take a stand for him. Go outside the camp, bearing his reproach. Endure the suffering. Listen, don't just endure the suffering. Embrace the suffering. Those are the sufferings of Christ persevere in the faith. Far from being an indication of failure, suffering for Christ is a mark of those who are his. Far from being an indication that Christ has forsaken you. Suffering is one of the means by which you enjoy fellowship with him, the fellowship of his sufferings. God, God isn't distant. God is not far off. God's not aloof, right? God's not remote.  So when you see in his word the call to preach Christ, you can go out in your faith knowing that God is a God of unfailing comfort. You can go outside the camp, bear his reproach knowing that God is a God of unfailing comfort. You can pour contempt on your pride.  And Paul wants this to be our perspective in 2nd Corinthians chapter 1. Paul is facing persecution, suffering for the cause of Christ and his suffering is great. We see it written on the pages of this letter, but the Corinthian church is suffering for the cause of Christ. Sufferings within, sufferings from without, and there's suffering as well. And Paul wants to put that suffering in perspective for the church at Corinth and for the church at Chiliota. And he begins, he begins in verse 3 with a proclamation of praise. Putting this suffering in perspective, he begins with a proclamation of praise in verse 3. Look at verse 3 with me. Blessed, Paul says, blessed be the God and Father of our Lord Jesus Christ, the Father of mercies and the God of all comfort, who comforts us in all our tribulation that we may be able to comfort those who are in any trouble with the comfort with which we ourselves are comforted by God. For as the sufferings of Christ abound in us, so our consolation also abounds through Christ. Point one on your notes this morning, praise God for his unfailing comfort. Praise God for his unfailing comfort. In verse 3, as Paul writes, Paul's heart and mind is filled. He's not, his heart and mind aren't filled with the details of his own suffering, or he's not preoccupied with his own suffering. He's filled with praise for God.  We see that in the Old Testament. Paul in verse 3 puts a distinctively Christian twist on that statement by saying this, blessed be the God and Father of our Lord Jesus Christ, the Father of all mercies and the God of all comfort. For Jewish Christians, if you can imagine their context, even with this carefully worded opening statement, Paul is drawing connections between the God of the Old Testament and Jesus Christ, the promised Messiah of the Old Testament. The same God who in the Old Testament was the God of our fathers, the God of Abraham, the God of Isaac, and the God of Jacob, that same God, the God of the Old Testament, is the God and Father of our Lord Jesus Christ, the Messiah, the promised Deliverer, the Savior of sinners. Paul continues with the Old Testament connections here by referring to God in characteristically Old Testament terms. He refers to God as the Father of all mercies and the God of all comfort. Right? First, the Father of mercies. God's mercy, God's mercy is a truth. It's a reality that can only be described in terms of our wickedness. You have terms like grace, terms like mercy. Those terms are meaningless. They're empty apart from an understanding of our own hopeless condition.  Turn with me to Psalm 103 and let's look at the picture of this. Psalm 103, God is the Father of mercies, the God of all comfort. Why is this important to the Corinthians? Why is it important to us? Because as we enter in to suffering, as we go forth to him outside the camp, bearing his reproach, we want to know that the God who is God overall is the God who is a God of mercy and a God of comfort. We need mercy, amen. We need comfort. Psalm 103, look at verse one. This is the Psalm of praise for the Lord's mercy. And David here, it's interesting, begins the Psalm with the same expression of worship that Paul used in 2 Corinthians, chapter one, verse three. Look at verse one with me. David begins, bless the Lord, oh my soul, and all that is within me, bless his holy name.  It's interesting in the Old Testament that often his mercies are described as tender. They're tender mercies, right? His love for us, his care, his compassion toward us. The fact that he doesn't hold sin charged against us is a tender mercy to God's people.  The Lord executes righteousness and justice for all who are oppressed. He made known his ways to Moses, his acts to the children of Israel. The Lord is merciful and gracious. He is slow to anger and abounding in mercy. He will not always strive with us, normally keep his anger forever. Look at verse 10. He has not dealt with us according to our sins, nor punished us according to our iniquities. Now that's the definition of mercy, right? Mercy is when God refrains from giving us what we deserve. Now again, let that sink in for a moment. Mercy is when God refrains from giving us what we deserve. We deserve to be punished according to our iniquities. We deserve to be dealt with according to our sins, right? And the wages of sin is death. Every person here deserves death.  Mercy is seen in God's sovereign decision in Christ to withhold his wrath from those who repent and believe the gospel. It doesn't mean that he disregards our sin. It doesn't mean that he doesn't uphold his justice. No, he lays the guilt. He lays the charge at the feet of another who bears the wrath that we deserve. That's Jesus Christ the righteous. In that atoning sacrifice, in that atoning sacrifice, he gives us what we don't deserve, which is grace, right? Grace, salvation, forgiveness of sins. In this, God is merciful and gracious, slow to anger, abounding in mercy. Look down at verse 11. For as the heavens are high above the earth, so great is his mercy toward those who fear him. That's not an exaggeration. That's not hyperbole. I think we know a little more today, considering our understanding, our scientific discovery, how high the heavens are above the earth, the extent of our universe. Our minds can't comprehend how massive our universe is, and David says, for as high as the heavens are high above the earth, so great is his mercy toward those who fear him. His mercy is great. David knows something here of the greatness of the Lord's mercy. If you think about David, right, in his context, David knows something of the greatness of the Lord's mercy because David knows something of the heinousness of his own sin. We understand more the greatness of God's mercy when we understand more his holiness. We understand more the greatness of his mercy when we understand more his hatred for sin, his abhorrence of sin, his despising of sin. The more that you see God as holy, the more that you will praise him for his mercy. The more that you will say with Paul, blessed be God, the father of all mercy. Look at verse 12. This is the mercy of God. For as far as the east is from the west, so far as he removed our transgressions from us. As the father pities his children, so the Lord pities those who fear him. For he knows our frame. He remembers that we are dust. He is the father of all mercies. He's characterized by mercy. His nature is to be merciful. Secondly, he's the God of all comfort. Look at back at 2 Corinthians chapter 1. He's the God of all comfort. He's the father of mercies and the God of all comfort. The God who has mercy is the God who gives comfort to his people. We don't deserve it, but he gives it. Right? And Paul praises God as blessed because of the comfort that he has experienced in the midst of his own suffering. Paul has suffered and Paul has experienced the reality of God's comfort in his suffering and he praises and worships God as a result. Here's where we get to the main point of this paragraph, right? In 2 Corinthians chapter 1. As many of us might be, Paul isn't preoccupied here with the extent of his suffering. Paul is preoccupied with the gracious comfort of God. We have a tendency, don't we, to put our eyes in our circumstances, to focus our mind, focus our attention on our circumstances. What Paul is exhorting us to do here in 2 Corinthians chapter 1 is to get our eyes out of our circumstances, right? To lift our gaze and put it on God, the God who is the God of all comfort. Ten times in this short paragraph, Paul uses the root word for what our English translations render as comfort. The New King James on occasion says consolation. It's the same root word. Ten times in this one paragraph, right? Paul is now preoccupied with the comfort of God. So when Paul might be tempted to complain about his circumstances, when he might be tempted to grumble or to gripe or heaven forbid blame God for his circumstances, what is Paul doing here? Paul is worshiping the Lord. He's expressing gratefulness to God. He praises God for his unfailing comfort. And that should be the Christian's response, right? That's a Christian's response to your circumstances. When you're in the midst of your circumstances, difficult circumstances, trial, adversity, hardship, distress, those circumstances should provoke in you, should cultivate, should compel in you, worship to God.  God is the God of all comfort. I want you to see three points here from these opening verses beginning in verse three. First point I want you to see is God's provision of comfort. And we'll look at God's purpose for comfort and God's promise of comfort. First, God's provision of comfort beginning in verse three. Paul writes in verse three, blessed be the God and Father of our Lord Jesus Christ, the Father of mercies and God of all comfort. Here it is in verse four, who comforts us in all our tribulation. God is the God of all comfort, who comforts us in all our tribulation. In other words, there is no tribulation, there's no trouble, there's no adversity, there's no distress, no suffering for which God is unable to provide a sufficient and particular and gracious comfort. No situation in which God will fail or can fail to meet your specific need in Christian suffering. Again, Paul has in mind here, Christian suffering, suffering experienced in union with Christ, or in identification with Christ. But now the comfort of God doesn't it also extend to all our suffering? You experience the comfort of God in all our suffering. If you're sick, certainly the comfort of God can help you in your sickness. If you are facing adversity in your family, certainly the comfort of God applies in your circumstances. God is the God of all comfort. He is the one who comforts us in all our tribulation. Certainly the comfort of God extends to all our suffering, a loss of a loved one, the loss of a child, the pain of a rebellious child, sickness, financial concerns, loss of a job. God's comfort in these circumstances, and we're talking specifically here of Christian suffering, the sufferings of Christ. God's provision of comfort in these circumstances isn't a mere feeling. It's not just a feeling of security or a feeling of contentment. The word here for comfort carries the sense of encouragement. I want to put that together for you. It carries the sense of help, the sense of exhortation. It's a derivative of paricaleo, someone coming alongside and encouraging you in the right direction. God's comfort is that comfort which strengthens hands that hang down. God's comfort strengthens feeble knees. God's comfort motivates and compels us to press on in perseverance. It's not just a feeling. It's not just warm fuzzies. It encourages us, motivates us to press on in faithfulness. One commentator said that God's comfort is not a tranquilizing dose of grace that only dulls the pain, but it is a stiffening agent that fortifies one in heart, mind, and soul. That's God's comfort in time of need. God's comfort in suffering. Through faith, God's comfort strengthens our resolve. It undergirds our will. It produces faithfulness in the trial, faithfulness through suffering. It's not just a feeling here, not just an emotion. Let me give you some examples. You can jot these down. I think they'll be helpful to you. First, God's comfort brings humility and dependence upon him. God's comfort brings forth humility and dependence upon him. Deuteronomy chapter 8, verse 15, among many, among many, right? Deuteronomy chapter 8 verse 15, the Lord your God led you through that great and terrible wilderness in which were fiery serpents and scorpions in a thirsty land where there was no water, who brought water for you out of the flinty rock, who fed you in the wilderness with manna, which your fathers did not know in order that he might humble you and in order that he might test you to do you good in the end. That's the comfort of God in the midst of trial, that he would humble you, that he might test you to do you good in the end. God's comfort teaches us to wait on him. God's comfort teaches us to trust in him. Psalm 27, verse 13, David says, I would have lost heart unless I had believed that I would see the goodness of the Lord in the land of the living. He exhorts in verse 14, wait on the Lord, be of good courage, and he shall strengthen your heart. Wait, I say, on the Lord. Get a sense of the exhortation, right? The encouragement. We're not talking about emotion here. We're just a feeling of contentment, a feeling of security. We're exhorted to wait on the Lord. We're exhorted to be courageous. God's comfort bolsters our faith in him. God's comfort bolsters our faith in him. Romans chapter eight, in verse 38, Paul says, for I am convinced that neither death nor life nor angels nor principalities nor powers nor things present nor things to come nor height nor depth nor any other created thing shall be able to separate us from the love of God, which is in Christ Jesus, our Lord. Now Paul experienced that, right? Now Paul understood that on a theological level, the promises of God out of the word of God. And Paul believed God. Paul also experienced the truth of that statement. Paul through experience became convinced that neither death nor life, angels nor principalities, powers nor things present nor things to come, nothing would separate him from the love of God, which is in Christ Jesus, our Lord. God's comfort bolsters our faith in him. Through God's comfort, we know that we're preserved by him. We're under his sovereign care. We're in his caring hands, so to speak. Listen to this from Isaiah 43 verse one, Isaiah 43 one. But now thus says the Lord, who created you, O Jacob, and he who formed you, O Israel, fear not, God said, can you see the exhortation, right? Don't fear. Fear not, God says, for I have redeemed you. I have called you by your name and you are mine, God says. When you pass through the waters, I will be with you. And through the rivers, they shall not overflow you. When you walk through the fire, you shall not be burned, nor shall the flames scorch you. For I am the Lord your God, the Holy One of Israel, your Savior. Through God's comfort, we know we are preserved by him. God's comfort comes with strength that results in joy. Flip over to 2 Corinthians, 2 Corinthians chapter 12. A few pages to the right. 2 Corinthians chapter 12. Look there at verse seven. And again, Paul referring to his own suffering here. And consider from this text how God comforts Paul. Verse seven, lest I should be exalted above measure, lest I should become prideful, Paul says, by the abundance of the revelations that he had received, a thorn in the flesh was given to me, a messenger of Satan to buffet me, lest I be exalted above measure. For the sake of humbling Paul, this messenger of Satan was given. Verse eight, concerning this thing, I pleaded with the Lord three times that it might depart from me. And he said to me, my grace is sufficient for you. My strength is made perfect in weakness. God's comfort comes with God's strength, God's power, God's might to meet your circumstances. Therefore, Paul says his strength, God's strength made perfect in Paul's weakness. Therefore, verse nine, most gladly Paul says, I will rather boast in my infirmities. I'm going to boast in my own weakness so that the power of Christ may rest upon me. Therefore, I take pleasure in infirmities, in reproaches, in needs, in persecutions, in distresses, in sufferings, Paul says, I take pleasure for Christ's sake, for when I am weak, then I am strong. God's comfort comes with strength. God's comfort comes with joy in him, our provider, him, our strength, right? God's comfort is found in his word, it's found in his word, Psalm 119, verse 49, Psalm 119, verse 49, where the psalmist says, remember the word to your servant upon which you have caused me to hope. This is my comfort in my affliction for your word has given me life. Paul said in Romans 15, verse four, for whatever things were written before were written for our learning that we, through the patience and comfort of the scriptures, might have hope. God's comfort is found in his word. God's comfort is the assurance of fruit from trial, the assurance of fruit from suffering. Hebrews chapter 12, verse 11, no chastening seems to be joyful for the present, but painful. Nevertheless, afterward, it yields the peaceable fruit of righteousness to those who have been trained by it. God's comfort comes through an increased strength to persevere, to persevere through the suffering. God's comfort brings perseverance. James said, count all joy when you fall in the various trials, brothers, knowing that the testing of your faith produces patience. God's comfort encourages us with the hope of heaven. When you're in the midst of your suffering, when you're in the midst of difficulty, you can remind yourself from the word of God that this life is not forever. This is not your best life now, if you're in Christ. That's coming. Romans chapter eight, verse 18, the Spirit himself bears witness with our spirit that we are children of God. And if children, then heirs, heirs of God and joint heirs with Christ, if indeed we suffer with him. Notice the conditional clause there, right? We are heirs of God and we are joint heirs with Christ, if indeed we suffer with him so that we may also be glorified together. Paul says in verse 18, for I consider that the sufferings of this present time are not worthy to be compared with the glory which shall be revealed in us. And you notice Paul's mindset there in Romans eight, right? I'm willing to endure suffering on this side of heaven knowing that the sufferings here don't compare an iota to the glory that's going to be revealed on that side of eternity, right? I remember an experiment a while back where they took children, put them around a table and they gave them a marshmallow and then said, if you can sit there with that marshmallow and not eat it for the next 15 minutes, I'll give you another marshmallow. And virtually all the kids just ate the marshmallow, right? They didn't want to wait 15 minutes to get another one.  You get two at the end of 15 minutes if you'll just wait. We in our flesh can't wait. We have a glory that will be revealed on that side of eternity. If you'll suffer with him, if you'll wait with him. This is not worldly wisdom, right? This is wisdom from God's word. This is not pop psychology. It's not a pep talk. This is God's words of comfort to Christians in their Christian suffering. God's comfort, God's comfort comes from the knowledge that you share in Christ's suffering, right? It's a comfort to God's people to know that they share in Christ's suffering, which is precious on the side of God. Listen to Peter in 1 Peter chapter two, verse 19, Peter says, for this is commendable. If because of conscience toward God, one endures grief, suffering wrongly. It's commendable. For what credit is it if when you are beaten for your faults, you take it patiently? But when you do good and suffer, if you take it patiently, this is commendable before God. For to this you were called because Christ also suffered for us, leaving us as an example that you should follow his steps. Who committed no sin, nor was deceit found in his mouth. Who when he was reviled did not revile in return. When he suffered, he did not threaten, but he committed himself to him who judges righteously. Who himself bore our sins in his own body on the tree. That we having died to sins might live for righteousness by whose stripes you were healed. For you were like sheep going astray, but have now returned to the shepherd in oversee of your souls. On the testimony of God's word, we know that every single trial, every difficulty, every last moment of hardship, every ounce of Christian suffering is a gracious providence of God. It's a smiling providence of God determined by him in love to do you good, to do you good. All this comes through God's comfort in times of suffering. Back in second Corinthians chapter one, the comfort that God provides through suffering isn't theoretical. That comfort's not elusive. Again, this is not pop psychology. This is not a pep talk. It wasn't mere theory on the part of Paul. This comfort, this understanding was grounded in Paul's experience. Paul learned the value of God's comfort in the agony of his suffering, in the crucible of suffering. He learned the joy of God's provision in the helplessness of his suffering. We often learn this. We learn these lessons when we realize we can't do anything. In our circumstances, when we come to the end of ourselves, we learn these lessons. The only place to learn these lessons, the only place to know the comfort of God is in the crucible of affliction. You have God's provision of comfort. Secondly, you have God's purpose for comfort. God's purpose for comfort. Look at verse four. God in verse four, he comforts us in all our tribulation so that we may be able to comfort those who are in any trouble with the comfort with which we ourselves are comforted by God. That's a mouthful. Follow me along. Paul begins in verse four with what one Greek scholar called the timeless present tense, the timeless present tense. You could literally read it as this, the father of mercies and the god of all comfort, who is comforting us in all our tribulation comforts us so that we can comfort others. We have ongoing comfort. We have ongoing encouragement. It gives you the sense, doesn't it, of God standing beside us, parakalo, God standing beside us in all that we face and all that we suffer. And he does that for you as a provision for others so that we may be able to comfort those who are in any trouble. So now having been the beneficiary of divine comfort in trials, you're then equipped to draw from that experience, right, to draw on those resources and to encourage and comfort others. Now notice with me in verse four, I want you to see three components necessary to fulfilling this purpose. Three components. First, you identify with those who are suffering. You identify with those who are suffering. Doesn't mean you go through exactly the same thing, right? You're going to face trials, situations that are completely different. It's the experience of God's comfort in suffering that is the necessary prerequisite, right, that helps you to identify. And Christ is our supreme example of this, right? He identified with us in our suffering. Hebrews chapter two, verse 17, the author says that therefore in all things Christ had to be made like his brethren that he might be a merciful and faithful high priest in things pertaining to God to make propitiation for the sins of his people. For in that he himself has suffered being tempted, he is able to aid those who are tempted, right? Hebrews chapter four, verse 15, we do not have a high priest who cannot sympathize with our weaknesses or sympathize in our suffering, but he was in all points tempted as we are yet without sin. First, you identify with those who are suffering. Secondly, you take the opportunity to offer comfort and encouragement to those in verse four, those who are in any trouble. You take the opportunity to comfort the gifts of God. If you think about this, the consolation of the spirit of God, that gift that God has given you in your trial and your suffering, you're not to hoard to yourself, right? Christians aren't to live for themselves or to live for others. You're to serve and edify the body.  Third, you do that, verse four, with the comfort or by means of that same comfort that you were comforted with. One, you identify with those who are suffering. Two, you take the opportunity to minister to them. And three, verse four, you do that with the comfort or by the means of that same comfort with which you were comforted, the same exhortations, right? The same encouragement, the same word of God, same passages of scripture, the same promises, the same hope, the same focus, the same faith, same correction if necessary, the same love, the same exhortation, the same patience. And notice in verse four that this is the comfort, the comfort with which we ourselves are comforted comes, it says there by God, from God. God is the ultimate source of all that encouragement. You are to be a faithful means. God is the one who comforts, right? You are the means through which God will comfort his people. You're to take responsibility for that and to comfort your brothers and sisters. God's provision of comfort, God's purpose of comfort. And three, God's promise of comfort, God's promise of comfort. Look at verse five, for as the sufferings of Christ abound in us, so our consolation, our comfort, same word there, so our consolation also abounds through Christ. Work for abound there literally means overflowing, overflowing. When we go forth to him outside the camp, when we go forth to bear his reproach and as we suffer in association with him, even though that suffering may overflow toward us, you know what I mean, right? There are times at which you may think that it's more than you can bear, that it's just like a Mack truck coming down the road, right? The light at the end of the tunnel is not a light, it's a train. And it is overbearing towards you. Even though that suffering may seem to overflow toward us, even though it may seem too great to bear, too difficult to endure, God's provision of comfort and encouragement and strength and perseverance and hope, God's comfort overflows toward us. He lavishes it upon us to meet every need. As the suffering rises, as the circumstance rise, God's comfort rises to match. God's consolation abounds through Christ. And God can infinitely multiply our comfort, according to the measure of our need, right? And God will never, God will never come up short. David says in Psalm 94, verse 19, David says, When the cares of my heart are many, your consolations cheer my soul. As the cares of David's heart increase, so do the consolations of Christ. God provides an unfailing comfort in all our sufferings for Christ. This demands a response. Paul gives the text, Paul gives the explanation, praises God for an unfailing comfort, and that comfort bears responsibility on the church at Corinth. It presupposes our responsibility to that. It demands a response. If you're here today and you're lost, if you've never turned from your sin, if you've never turned from your sin to put your faith and trust in Christ, if you're not following hard after him in the fellowship of his sufferings, then you are headed for ultimate suffering. The sufferings that you experience in this life are signposts. They should point you away from ultimate suffering and point you to Christ. Turn from the path that you are on.  Go to him outside the camp, bear his reproach. One of the difficulties, we'll talk about this more next week, one of the difficulties of the state in which we live, state of our country is that we suffer under the desires of the flesh, the lusts of the flesh, the pride of life. We desire comfort, but not God's comfort. We desire leisure. We're prone to wander, prone to laziness, prone to call ourselves Christians and yet not witness for Christ. And what this promise of comfort in 2nd Corinthians, chapter one, verses three through seven, what this promise of comfort provides for us is the compelling motivation to go to him outside the camp and bear his reproach, to go to him in the fellowship of his sufferings and proclaim Christ to a lost world, to enter into that same suffering that our brothers and sisters since the time of Christ have faced for the cause of Christ. The torch has been passed to us. What are you going to do with it? Right? Let's go forth to him outside the camp and bear his reproach. Let's pray. Let's take a few moments, pray silently. Ask the Lord to convict you where you fall short of the experience or the demands of this text and pray for grace and comfort as you battle to be faithful to him. And let's pray for the furtherance of the gospel for his sake. Let's pray.


Dreamscape presents The Unlikely Lawman, a Huey Calloway adventure by Steve Kelton and Elma Kelton. Narrated by me, George Goodell. CHAPTER ONE Huey Calloway was in his element. It was spring, and West Texas had on her Sunday best. The morning sun was warm, the effects of earlier rains beginning to show. Green shoots had appeared in the few clumps where grass grew, and much of the rest of the ground boasted tallow weed and other plants Huey knew but couldn't name. Most of the cows he saw had babies by their sides, full udders, and a thin layer of fat beginning to show in their ribs and over their hip bones.  Huey was on horseback, taking it all in with the pride of ownership, but without the headaches or expectation of reward. These were two seas cattle and belonged not to Huey, but to ranchman C. C. Tarpley, who had just fired Huey at the chuck wagon that morning. It wasn't the first time Tarpley had fired Huey, and it probably wouldn't be the last. Huey had even quit once or twice himself, but the two always came to an accommodation eventually. Huey was a good cowboy and C. C. valued that, even if he didn't value it enough to pay well. Parsimony was a common condition among the ranch owners Huey had known, though C. C. Tarpley displayed a more severe case than most. Huey had a month's worth of C. C. Stingy pay in his pocket, a round horse that would watch a cow, and he was gloriously unemployed. So close to his 40th birthday that he could hear it taunting him in quiet moments, Huey was the older of two sons. The widowed father had a restless streak that he stamped indelibly on his firstborn. The three colloies, Pa, Huey, and Brother Walter had drifted constantly within the East Texas region of Blackland Farms, picking up what work was available to them. As a boy, Huey drug a cotton sack for miles before he was big enough to put behind a mule and a pair of plow handles. They were an ill fit for his hands from the beginning, and Huey chafed to be somewhere else, doing something else. Brother Walter, a year younger, took to farm work like he was born for it. It was only at Huey's insistence after Pa died that the two brothers went west looking for cowboy jobs that were said to be plentiful in the Pecos River country, and the brothers found the job situation to be as advertised. A decade and a half later in 1904, Huey had earned a reputation in West Texas and Eastern New Mexico as a top hand, and Walter was back behind a plow, but this time it was his own, and he was turning back native sod on his own land. Walter was the only one of the colloway clan, what little Huey knew of it, to own land. Back in East Texas, where it rained, Walter's homestead... Sample complete. Ready to continue?


What's up internet? We've talked about fitness trackers in the past and one of the more popular lines is Fitbit's Charge Line and the latest in that series is the Charge 6. But you might be wondering what's the difference between the 6, the 5 and the 4. Wonder no more because that's what we're going to talk about this video. I've tried all of them. I've used all of those for several months each. So you might be able to save a few bucks if you go for an older generation which has the features you need or to splurge it a bit more on maybe the newer models which you don't really need. But what you probably need is a Windows activation code which you can get for cheap from our sponsor. Piliin ang preferred Paypen logo. Wala pang 5 minutes nagsiziki ka na para sa Windows mo. Maraming na kaming na tulungan. Dati, sadong depressed ako. But now, I've found a love of my life. Dati, ing-resin walang purpose ang life ko. But now, I'm a world-class Zumba instructor. So, web developer ako content creator for a YouTube channel and ngayon, ganun pa rin ako pero activated na yung Windows ko. Kaya ako nag-ahanap ka ng legit, mura at original software. Check out cdkoffer.com. Check out cdkoffer.com. Check out cdkoffer.com. Alright, so the charge is the most well-known line from Fitbit and we'll start with the oldest first, the charge 4. Right off the bat, GPS on this one is not that great. I had multiple times throughout my usual jog where the Fitbit would tell me and it would drop later on on the maps that it just lost connection to GPS and my location on the map would be like I'm teleporting through walls because suddenly I'm jumping from one location to another. This was consistent failure on the charge 4. So if you want accuracy and you're in an urban environment, the charge 4 might not be a good fit. Its screen is also not colored compared to the charge 5 and charge 6. Its charger is a different design. It's this claw-like thing which you have to really wrestle on to the charge 4 before it charges properly. It doesn't have the ESD sensor or the thing that you pinch on the charge 5 and charge 6 to register how stressed you are. So there is a clear divide between charge 4 and the 5 and the 6. What it does have going for it is that it's cheap now. You can probably find a good one still running that's second hand. Plus it does the basic tracking functions well. Sleep, steps, heart rate, all of those things seem to register accurately enough while I was using the charge 4. Now I was using a second hand charge 4 but to be fair, its battery life was still decent. Plus I'm not even a fan of the new sensors. Like that stress sensor thing. I barely use it on the 5 and the 6. So actually I was pretty happy with the 4. Plus it has the niftiest animations. You know the kind of notifications you get when you've hit 10,000 steps or some other kind of milestone during the day. The charge 4 had the nicest animations between all three of the models that I tried. And I happily used the charge 4 for more than a year actually. I didn't feel the need to upgrade. So if you're just looking for the basics and I know GPS should be part of the basics but for me it's more about tracking heart rate and steps rather than an accurate representation of where I went for my jog or my run. You can probably find a charge 4 that's still ticking and save yourself a few bucks since it is an older model. Now I'm not very careful with my fitness tracker so my charge 4 did get beat up a lot. Not a problem. It's sturdy enough to withstand most drops and accidental hits on the wall and things like that. No problem. Onto the charge 5 which I initially got first. My first Fitbit ever was a charge 5 and it does have a color screen. It does have that stress detector. It does have a similar charger to the charge 6. So there's a clean division between the 4 and the 5. A lot of new things got introduced into the 5 which aren't present in the 4 but which were carried on onto the 6. But the 5 was the one that I had for the shortest amount of time less than 6 months because it's battery died on me. So I don't know if that's a failure of that particular product line or I just got a lemon. But in less than a year my charge 5 died on me and that's when I decided to go with a second hand charge 4. But while I had the charge 5 I used it every day. Used it to track my sleep, my heart rate and my daily exercise. Everything was top notch. So the analytics I was getting seemed accurate enough. I did not have a problem with the GPS which I experienced later on with the charge 4. It was nice to have a colored screen but if that's what you're looking for wait until I talk about the charge 6. So as the charge 5 was my first wearable it was a good introduction to this kind of space. It was easy to set up and install easy to link to my phone easy to link to the Fitbit software. The software itself has evolved over time so I won't really talk about it. The UI has gotten a little better in the latest incarnation but it does take a little bit of getting used to. And for some reason Fitbit doesn't allow you to have multiple trackers. So let's say if you have a smartwatch which you want to wear to the office so you look a bit more dressed up compared to a casual tracker you have to manually add that smartwatch and remove the current fitness tracker that you're using. Even if they all connect to the Fitbit software.  As mentioned the 5 does introduce the new stress sense where you pinch the wearable and you have to keep it like that for 3 minutes and it tells you how stressed you are. On paper it sounds interesting in practice I rarely use it. So on paper the 5 sounds like a big jump from the 4 addition of a new sensor and better GPS color screen. But and moving now to the Charge 6 the Charge 6 has all of that but basically better. So I'm currently using now a Charge 6 the screen is better it seems a little bigger it seems a little brighter plus for sure the animations are more fluid. This is the easiest Fitbit among the 3 that I've tried to read while you're running. The font seems a bit bigger the animations as I mentioned the Charge 4 has the best animations the Charge 6 animations are you know kind of like blah but at the same time they look the best on the screen. So far it's also the best want to understand when you flip it and it actually shows the screen like flip to look at compared to the Charge 4 and the Charge 5 it has a stress sensor that we saw in the Charge 5 and its GPS is good. Again, no problems unlike with the Charge 4. But if you're choosing between the Charge 4 and the Charge 5 actually I would recommend the Charge 4 just because you can save a bit of money I don't really care about the color screen I don't really care about the stress sensor but if you already have a Charge 4 and are thinking of upgrading then I don't see any reason why you would want to go with the 5 skip to the 6 it has a better screen better animation on the screen and it's a lot easier to interact with the device when interacting with it is so fluid the responses to the Charge 6 I'm not sure if they slapped in a better processor again, I don't like to look at specs I go more on the actual user experience my actual user experience with the Charge 6 is that it's very smooth with the 4 and the 5 sometimes there's a little bit of a delay sometimes you would toggle the exercise on to walk or to run it would take just a little bit of time to get there nothing like that with the Charge 6 plus the Charge 6 has the best battery life I've experienced with any of the 3 models like I can go several days and again I'm a religious user so it's basically on me all the time and I do have a daily exercise which I try to do in spite of all of those things I can go several days without charging the Charge 6 from a value standpoint again, there are some things about the Charge 6 I don't really use like the stress sensor but the little things about it I do like like the slightly bigger screen seems like a slightly bigger screen it's snappiness in response time all of those I think are worth a bit more so if you're looking for a basic fitness tracker to track sleep to track heart rate to track steps the Fitbit charge line is sort of go to I mean it's sort of top of mind to recommend I would recommend the Charge 6 or the 4 the 5 was a transition device a lot of new things added which really got refined in the Charge 6 not a lot of new things in the Charge 6 but since it's already there you might as well get it to avail of all of those nice little add-ons that they were able to incorporate to streamline from the 5 which really added a lot of new things if you just want to go super basic and you want to save a bit of money then the Charge 4 to keep testing accurate I did the same route for months on end with all of these fitness trackers I wore them every day for sleep walking around the house walking around the mall and things like that so I got a really good sense of all of them for their strengths and weaknesses the most annoying really was the Charge 5 I mean it was nice to have at the time but it just died on me for no particular reason that I could tell the battery just got wonkier and wonkier until finally it wouldn't turn on and yes I tried to restart it believe me I tried it just wouldn't work so far though I've had this for about a month the Charge 6 is going pretty strong and it is quite strong I'm using the Charge 6 with a third party strap the kind of metal strap with a magnet clasp to it and the problem with this third party strap is that it would just detach itself by itself so I would be sort of unslinging my backpack and whenever I would flip my wrist it would detach by itself and the Charge 6 the actual unit would fall to the ground and there are no this happened multiple times and yet this thing is still ticking along just fine with no scratches so if it's a direct drop like flat face palm onto a hard surface no problem I've done it multiple times with this thing and so far so good now it could have been user error because when I flipped the strap around like I attached it to different ends it suddenly didn't have that unclasping by itself problem anymore but the problem is it's very awkward now to take off it's like the magnetic clasp is in the wrong place all of that is as na side though it's a third party strap not from Fitbit so I'm not sort of including it in the how I felt about the Charge 4 Charge 5 or Charge 6 I would recommend though if you are going to use a fitness tracker I do prefer these kind of metal straps over the rubber things that usually come with a fitness tracker I think they just look a bit more subdued so they blend in more to your outfit if you're going to be using it every day plus the feel on my skin I don't know rubber just feels icky over time the metal feels natural it doesn't feel too cloying or damp the Philippines tropical climate things get damp quite quickly the metal seems to allow my skin to breathe more so whatever your fitness tracker if you're going to be wearing it for extended periods I do kind of recommend this metal strap mesh thing as frequent viewers of the channel know airflow is king that allows you to do that over the default rubber straps that come with a lot of the fitness trackers but that's it between the four the five and the six I would recommend the four or the six so if you're one of the normal PC guys who watches the channel please do try to get out more alaga natin yung health natin I know several our gaming sessions really feel good but keeping yourself healthy so that we can play more games is important also thanks for watching nagbabenta rin kami ng fully assembled rigs we clean computers kasama na rin yung excellent cable management namin and CPU cooler repasting sa cleaning we also clean and repaste GPUs na sa makati yung physical store namin and you can also buy from our site www.hwsugar.ph na 100% palaging up to date yung inventory dun kung instock yung item sa amin available yung sa site thanks for watching and maybe one of these days maghita tayo sa shop