Good morning, we are going to continue our discussion on various spray nozzle designs. Towards the end of the class, we had looked at two sort of designs of spray nozzles. One that is just a through hole through which you squirt liquid that is pressurized, a design that is commonly used in diesel injectors and another which is more widely used design called the simplex swirl atomizer. The simplex swirl atomizer is fairly simple in its construction, essentially a set of tangential passages bring the fluid into a chamber called the swirl chamber and that swirl chamber has another has a converging passage in which the swirl action is accelerated, so the swirl velocity is accelerated and that acceleration causes the liquid to exit the spray nozzle by just forming into a thin film that is sticking to the walls of the orifice and the big advantage of this design as we discussed in that class is that the size of the film that is formed is what is going to determine the drop size later on not the size of the orifice. So, I have now sort of decoupled machining practices from fluid mechanic performance of the spray nozzle which is always a good thing. What we are going to do just briefly is to look at one of these spray nozzles in action. We are going to look at a video of a fairly common simplex swirl nozzle from a water spray container we will see in just a moment the let me start to play the video this was captured at 10000 frames a second and is being played back at 30 frames a second let me pause the video here. Now what you see over here is the tip of the spray container what you see coming out is a conical sheet of water and the conical sheet of water when I play this you will see is not just a steady cone it is sort of flapping it is got a temporal oscillation to it it is flapping and is undergoing let me pause the video so is undergoing a certain kind of break up process so this flapping liquid sheet exiting the swirl spray nozzle is what is responsible for its break up and as you can see the sheet is breaking up right around the region where my mouse is pointing and further downstream you essentially have drops that are that are moving downstream so this is another this is an instance where you know the sheet thickness is not very obvious in this film but the sheet thickness is much smaller than the orifice through which the sheet is exiting and that sheet because of its unsteadiness is responsible for the sheet itself breaking up into what looks like rings you can see the oscillatory motion of the sheet now I want you to I want you to now go we will go back and make some observations now if you look at this there is a the sheet the conical sheet exiting the nozzle is not steady and is flapping and this flapping motion is due to the a the swirl action which is causing the liquid sheet to expand outwards and the very fact that fluid mechanically this kind of a velocity profile is unstable we will look at that as we go along as well now this flapping liquid sheet causes the liquid sheet in this particular instance you can see evidence that it is sort of breaking up into rings and the rings themselves are further breaking up into drops further downstream so if you will imagine for a moment a sheet like this breaking up into rings the ring diameter or if you will it is like a toroidal ring the the torus diameter is now going to be determined by the film thickness it is going to be on the order of the film thickness and that film thickness being small by accelerated swirl is naturally going to be responsible for smaller drops downstream ok. So, that is the mechanism by which drop size is controlled in a design like this ok now another feature to observe here is that well again it is not very obvious here but the fact that I have spread the liquid out into a swirling liquid sheet is going to naturally cause all the drops to be concentrated in a doughnut of sort of sort with a hole in the middle where there is no concentration of fluid now there may be applications where that is good where I want all of the drops to be only on the periphery I do not want anything in the middle. But in instances where I want a uniform distribution of drops for example a paint spray when I paint a wall I want to have a relatively uniform coating all over I do not want a thick edge on top and bottom of the spray and a sort of a less dense coating in the middle I do not want that. So, I would rather prefer a full sort of a more uniform coating of the spray paint and for that there are designs that have evolved which are sort of evolutions from the simplex nozzle the simplex atomizer is like I said it is one of the most widely used and many of the other designs you will see today are all based on the basic simplex concept. So, one variant of the simplex concept is what I what we are seeing here in this schematic the liquid comes through the through this sort of an annular passage and because of these veins these veins cause the liquid to be introduced into this region through with a certain kind of a swirl action. So, you create a natural swirl inside this chamber that is going to be oriented in that direction except you are also introducing some liquid directly through the middle through a center or a face of kind. So, not only is this going to create a swirl action, but it is also going to create some liquid coming straight through this way. So, the resulting spray is going to be a combination of a pressure swirl and a pressure jet atomizer and the. So, therefore, this is essentially to control the spray pattern coming out of the nozzle pattern is an indication of whether the drops in the spray are distributed in a hollow cone or in a solid in a solid disc like distribution. So, in this particular design it is more likely that you are going to have drops in the middle. Now, because of the way the simplex part of this nozzle works in relation to the pressure jet part of the nozzle. So, this is more like a pressure jet spray and this part is more like a simplex spray. Because of a combination of these two the drop sizes coming out of the pressure jet are going to be generally larger than the drop sizes in the simplex spray. So, while I have ensured that there is sort of a more uniform volume drop volume distribution that drop volume in the middle of the spray near the center line of the spray is going to be distributed into larger drops in comparison with the drops on the periphery of the spray. So, this is sort of a by result of this kind of a design there is really no way around it as far as this design is concerned. But we have at least overcome the problem of having nothing in the middle no fuel or no liquid in the middle. The next kind of design is again an offshoot of the simplex nozzle and this particular design is it simplifies a few different aspects of the simplex nozzle in by making the passages fairly large. This is again a schematic where the liquid is injected through the middle through this what we are seeing here is sort of a cut section of the nozzle itself. And there is an insert this is typically called a swirl insert that is responsible it is sort of like two fans two veins in the that are oriented as an x. So, the liquid that comes up the first vein is going to come is going to cause a swirling action in this direction the liquid that comes up this vein is going to cause a swirling action this way. And by engineering a small passage here we can cause some fluid to come directly down the middle as well that column of fluid that comes down the middle is also going to be is going to be in the vicinity of this swirl vortex that is formed inside the inside the simplex nozzle as a result it is also going to be a swirling column of liquid that is going to come out in the form of a spray. Again your this is a solid cone design, but I can by taking this y. So, I am going to try and draw a schematic of this the fluid that comes up this way is going to cause it to swirl this way the fluid that comes up the other way is going to cause it to swirl this way and that causes a swirling action in the swirl chamber. So, the drop size in this case is again determined by the angle of these of this swirl insert in some sense that angle is going to determine the magnitude of the swirl velocity in relation to the axial velocity. And that essentially determines like the swirl momentum flux that swirl momentum flux is what is responsible for the degree to which the film is sticking to the wall. One of the features of all of these nozzles is that I have one fluid inlet that brings fluid into the nozzle and all the fluid that enters the nozzle is sprayed. Now, as I increase the supply pressure. So, in if you go back to the simplex design for a moment as we increase the supply pressure at this point which is the same at all the four inlets as we increase that supply pressure. You are likely to see that the flow rate through this nozzle goes up because the geometry of the passages remains the same as the pressure goes up the flow rate through the nozzle goes up. As the flow rate goes up because of the nature of the geometry the swirl velocity also goes up. So, there is a range of operation where increasing the pressure increases the flow rate without adversely affecting the drop size in the spray that is usually the range where simplex nozzles are employed. But because of the nature of these features. So, essentially if you will imagine these are like restrictions they are like fluid mechanic restrictions. People have found over many many kinds of designs that in a typical simplex spray q goes as the square root of delta p. I use the symbol delta p for supply pressure it is essentially the difference in the pressure between the actual absolute pressure at which the liquid is supplied and the pressure into which the spray enters. It is known for a moment that the spray enters pure ambient conditions. So, delta p is the same as the gauge pressure that at the entry to the nozzle. And this relation that the flow rate goes as square root of delta p is sort of empirically observed in many many different kinds of nozzles. Actual data shows that this is the exponent is not exactly 0.5, but close to 0.45. So, q goes as delta p raise to the power 0.45 that is again over a wide class of simplex nozzles. There is a problem with this square root kind of dependence that I if I increase the supply pressure by a factor of 4 I only get a factor of 2 change in the flow rate. So, if I want to double the flow rate conversely I have to increase the supply pressure 4 times which is usually quite difficult to do just to again get some order of magnitude estimates. Most simplex spray nozzles operated pressures between about 2 bar to about 7 bar. So, like for example, your spray water can that we saw just a moment ago is probably the nozzle part itself is operating at a pressure right about 2 to 3 bar to go up from about 2 bar. If I have to double the flow rate coming out I have to go up to 8 bar which is prohibitive in many applications. So, but on the other hand I want to be able to modulate the fuel output coming out in the form of a spray. I want to be able to control what comes out the mass flow rate of the let us just say fuel that comes out of this spray nozzle. Because for a one simple example is let us take a process furnace. So, I have a boiler in which there is an oil fired burner. So, we are spraying some kind of a petroleum based oil into a combustion chamber to create heat for use in a process heating application. Now, when I start up this process cold on a Monday morning I require a high throughput of this of heat and consequently a high oil flow rate. But after I have heated up the contents of this let us just say boiler or the process heater up to a certain temperature I only want to maintain it at that temperature. I do not I only want to add as much heat as required to overcome losses around the losses to the ambient environment. So, the start up requires a very high flow rate the maintenance of that temperature only requires what is often called trickle heating. So, how do I what sort of a spray nozzle can I use that will give me a certain flow rate for start up conditions and something like a tenth of the flow rate during normal operating conditions. This kind of a problem is also encountered in an aircraft where you the at the take off point the pilot is running the aircraft full thrust which is when all the atomizers are firing at their highest flow rate. But when the pilot is only cruising at some high altitude you do not require full thrust and so the spray nozzles have to now scale back and operate at a much lower flow rate condition. But at the same time produce a good spray quality spray quality in terms of drop size. So, here is a design that does that this is called a spill return atomizer if you will consider this essentially there is an inlet. So, the inlet is at some pressure at some supply pressure typically let us say 7 bar 7 bar is about 100 psi 10 bar is about 150 pounds per square inch. So, these are all units that are used commonly in the spray industry. So, let us just say the supply is at 7 bar and this is supply going into a conventional simplex nozzle. So, this part here is a regular simplex atomizer it would be it would exactly be a simplex atomizer. But for this one hole that brings the fuel back out of this swirl chamber called the spill return. Now, let us see what this does let us say I will take a situation where I have a valve on this line if that valve is completely closed then whatever supply goes into the swirl chamber has to come out in the form of a spray. If I partially crack the valve open then a part of the flow rate is now allowed to come back to a supply tank of sorts. And by controlling the opening on this valve I can control the actual flow rate of the spray coming out of this of the nozzle the flow rate of the spray coming out in the form of drops. Now, typically again from observations what we find is that between the two extreme cases where the valve is completely closed and completely open the actual flow rate of the fuel going into the swirl chamber does change. When the valve is completely open there is actually more fuel going in. So, even though you have less spray coming out in the situation where the valve is completely open there is more fuel going in through the inlet line. But most of it is returning back to the through the spill line into the tank. So, by opening the valve completely we increase the flow rate coming into the nozzle, but decrease the flow rate coming out in the form of a spray. It is a little counter intuitive, but it is a very elegant design to get ratio of highest to lowest flow rates by almost a factor of 10. A factor of 10 is not too difficult to achieve in a design like this. So, if I take the situation where the valve is completely closed it is just a regular simple spray nozzle. When the valve is completely open you have a high flow rate coming into the swirl chamber because of that you have a high inertia associated with the swirl. So, actually as the valve is opened the flow rate coming out of the swirl nozzle goes down, but since the angular momentum flux in the flow rate is higher than when the valve is completely closed the drop size is lower. So, we will just write this down. So, if I take a reference situation where the valves position is completely closed inlet flow is let us say q the spray flow is also equal to q. When the valve is partially open the inlet flow rate is greater than q and the spray flow rate is less than q and if d is the drop size this is less than d. So, as you open the valve the spray flow rate decreases and because you are putting in a higher angular momentum through the higher flow rate because the inlet flow rate is greater than q and all of this inlet flow rate is coming in through tangential passages, but the flow going out is not taking back any of that angular momentum it is only taking out linear momentum. So, you introduce the flow with some angular momentum, but the what is coming out through the spill line is only in some sense linear momentum flux. So, all of the angular momentum flux that came in with the higher flow rate is now entirely with the spray alone that causes a lower film thickness and smaller drops. So, very nice design to actually get many different design objectives achieved. Now, like I said a factor of 10 ratio between the highest and the lowest flow rate is quite possible not difficult at all. Now, what is I mean nothing in life comes for free there is an overhead in that let us say if q is my completely closed condition flow rate and if I take the fully open condition let us just say I have the inlet flow rate is some now greater than q and the spray flow rate is a tenth of q. So, this is assuming a turn down ratio on the order of 10 turn down ratio is defined as the highest flow rate possible in that nozzle divided by divide by the lowest flow rate. So, when I have a factor of 10 lower flow rate coming through there this inlet flow rate is let us say is typically about 3 times is a factor of 3 higher. So, I am putting in 3 times the flow rate to get a tenth of the flow rate as opposed to this if I had a simplex nozzle that was designed to spray q by 10 at a with a supply pressure of 7 bar that would use much lower energy. So, essentially the amount of energy that I am inputting now at this fully open condition is 3 q flow rate at a supply pressure of 7 bar that energy is clearly greater than putting in q by 10 flow rate at a supply pressure of 7 bar. So, it is like the pumping power required is much higher in this case, but then in return for that you gain the flexibility of being able to control what the spray flow rate is on the fly without needing to do anything to the pump and the pumping system by opening and closing a valve we can control the throughput coming out. Again just to sort of complete this discussion since the angular momentum flux is higher in the fully open condition the cone angle is now bigger because you have a higher swirl velocity per unit flow rate the cone that is that comes out of the liquid spray nozzle is now going to be of a wider angle. So, typically the spray angle increases as you go through this process of opening the control valve. So, these are all designs where our intention is to create as you see axis symmetric sprays all of these designs thus far are only intended to create sprays which have a general axis about which you expect the spray to be symmetric. Now, there may be many applications where I do not want a symmetric spray I want something that is more like a flat spray. So, typically if I am in the business of washing the sides of a building let us say I do not want an axis symmetric spray as much as I would like a fan spray. So, what I want is a flat spray that I can use to just clean dirt on the side of a wall this is one such design. Now, the simplest way to imagine this is that again you have liquid coming in on one side the liquid goes through comes out in the form of a jet here and this is basically a profile to spread this jet coming out on this side into a film.  So, as this liquid jet falls on the spoon you can easily see how it spreads out into a fan and the fan breaks up just like the conical the you essentially create a high speed fluttering fan of liquid sheet it is essentially a liquid sheet that is fluttering and this fluttering liquid sheet is going to break up further into drops that is the design for of this flat spray. So, called flood nozzle it is called a flood nozzle because it is one of the nozzles that gives you a very high flow rate with reasonably good drop size reasonably good is a few hundred microns is very achievable in a design like this and the basic principle is exactly the same as water falling on top of a kitchen on top of a spoon in a kitchen faucet and what you create is a spray that is sort of like a fan. The next design is also intended to create a flat spray except it is slightly different than the flood nozzle design the outside looks something like this I am going to try and see if I can draw a cut section through here when I take a cut section through this section here this is what it looks like what you essentially have happening here is that the liquid goes through the central part and the outside is made to converge at this at this section somewhere on the inside over here. So, if you will imagine the liquid sort of converging from two sides and on top here if you look at this view from top that is essentially like an eye of a cat. So, this view is going to create an orifice that looks sort of like the eye of a cat it is oriented in and out of this of the plane of this board. So, these two liquid jets if you will converging on to come near the cat's eye orifice essentially causes this liquid to be spread into a thin film and that thin film is now going to break up and create a fan spray in this direction. So, in the other plane if this is my cat's eye I end up creating a fan spray most pressure washers that you see you know that are used to use that use high pressure water for cleaning use a design like this. So, anywhere that you require a flat fan like spray with a reasonable reasonably low drop size. So, you do not want something that is completely atomized because the intention of these application is to actually have drops impacting the substrate and cleaning dirt or cleaning grime I do not want to create a mist that just diffuses into the air. So, I in fact in a in an application like this I do not want very good atomization I just want drops to be distributed into a fan where the drops themselves are large enough to ballistically carry their momentum all the way to the substrate. So, some of these designs are intended to show you that good spray quality does not always mean extremely fine atomized spray. A classic example is a firefighter when a firefighter uses a fire hose nozzle and shoots a cylindrical jet of liquid let us say towards the second floor of a building you do not want any you do not in fact want any atomization for all practical purposes it is a pressure jet. But I want the liquid to remain intact and be carried all the way to the target which could be on a second floor. Now, this requires a certain kind of nozzle design that keeps it from getting atomized. So, typically you will see fire hose nozzles are extremely streamlined to prevent the introduction of any kind of disturbances to the cylindrical liquid jet and you create even at a relatively high Reynolds number a fairly laminar looking jet. So, the surface is devoid of many perturbations and that is the starting point for this jet to remain intact all the way to the sub all the way to your target. In the process if this jet were to break down and give you atomized quality jet. So, if you create drops you are more likely to not reach the target substrate because these drops the same volume of liquid distributed into a collection of drops is going to have a higher drag force on it which is going to prevent it from reaching the target. So, these next few examples are intended to show you that there are many in some instances competing design interests that are achieved through these designs. So, this is again another instance of a non axisymmetric geometry where you want some atomization because you want the liquid to be distributed, but you do not want extremely fine spray you do not want an extremely fine spray. Let us come to this in a little bit I want to first talk about typical air mixing atomizers up until now the source of energy remember we said there are two things that the spray nozzle does. One it brings the liquid in contact with the with a source of energy that is essentially the objective of a spray nozzle. The source of energy in all of the previous designs was the liquid inertia itself. So, the liquid moving fast in a stagnant environment of air was the source of energy the we are now going to look at some designs where air in some compressed form is used as the source of energy. So, we will start to look at this first design where if you will imagine liquid entering through these annular gaps and coming out. So, this part here is a non axisymmetric so these are tangential injectors injection slots. So, this part here is just like a simplex nozzle. So, I have liquid being injected through a pair or some number of tangential slots and these tangential slots cause a little swirling action in this region I have some sort of a spill over of this liquid sheet. On the outside we have air coming in again remember this is sort of a an axisymmetric design. So, this air is also being fed in through here and this indicates a swirler typically a swirler is used to decrease axial momentum flux and you I mean you do not want to dissipate momentum you do not want to. So, essentially it is there to decrease the axial momentum flux and increase the swirl momentum flux. So, this air swirler causes the air coming out of these passages to take on a swirling velocity field and is now allowed to come directly impact this spilling film. So, if you will this is a liquid film this spilling this liquid film that is spilling over from this point here is impacted by this high speed air this impacting by high speed air is primarily responsible for atomization. So, it is typically a design like this will operate at the liquid supply pressures on the order of less than 50 one tenth of a bar. So, it is very low liquid supply pressures the liquid supply pressure is only intended to sort of push the liquid through it is not a source of energy for the atomization itself. The atomization is entirely being controlled by the air stream and. So, this is the region where the air coming out of this swirler the swirling air and the liquid film that is spilling over from the tip come in contact and. So, this is where you start to form a spray here this is one design of what is called an external mix air assist atomizer. The second is where is sort of similar except the air pass air is now more directly injected directly on to the liquid film itself. So, if this is the liquid film that is going to be spilling over the air coming out is more directly impacting the liquid sheet that gives you different kind of a spray. Now, as you can probably imagine this is going to give you a much more narrow spray than in the previous instance where I had swirling air that is coming in at some angle like that. The third design is where the air and the liquid film. So, this is the air part and this is the liquid film that is now spilling over the relationship between the air and the liquid film is much more congenial the co exist for a little while and it is only by the shearing action that the atomization takes place. So, the objective of a design like this is also. So, the air here is serving two purposes unlike the previous two instances it is serving for it is serving the purpose of atomization, but it is also shaping the spray. We will see what this means in just a moment because you have this the air outside by controlling this angle I can control the spray angle itself the angle over which all the drops are going to be distributed. So, this gives me an independent control parameter in this in these two designs it is hard to do that in the first in the first second in the first and the second design it is hard to control the spray angle using the air usually there is another source of air that may be required. So, these are all configurations called air assist atomizers and specifically they are called external mixing air assist atomizer because you have a simplex nozzle and outside the simplex nozzle you have created an air passage that would cause further atomization. And you are now using the simplex nozzle only to introduce fluid into a certain geographical region into a certain spatial region. So, in all these in the in these designs that use air like we said air is the source of the atomization energy and more specifically we will see later on that it is the relative velocity between the air and the liquid that controls the atomization quality. So, I would rather not have a high speed liquid flow I want to slow it down as much as possible, but increase the air velocity to where I am able to achieve the required atomization quality. Only problem with making the liquid flow rate the liquid flow rate is also independently controlled by the liquid velocity. So, I cannot independently vary the liquid velocity without changing the liquid flow rate in a in this kind of a design. So, for a given flow rate I can choose an air velocity and therefore, an air flow rate that is sufficient to achieve a certain level of atomization. So, I first fix the liquid flow rate and based on that we choose the air flow rate that is required to completely atomize this fluid. Now, in all the three previous designs that we saw where you look at a typical simplex nozzle or even a flood flood fan spray flood nozzle you are injecting into stationary air and the spray angle as well as the drop size are fluid mechanically controlled by the inertia in the liquid itself. So, the level the number of design parameters that you need to control these two qualities are provided by the tangential offset. So, this the you know how far away from the center line is the tangential orifice that is going to in some sense control the swirl momentum and the second is the size and number of those holes those are usually the two parameters that you can control to affect the flow rate and the spray quality independently. Now, as far as the spray angle is concerned there is some interesting ways of being able to control the spray angle one of the simplest ways is where let us say I take a swirl nozzle that is got a set of tangential holes just like that I show this hole to show that it is a tangential hole. So, that creates a certain swirl action inside the spray nozzle and by shaping this exit passage appropriately I can control the angle over which the liquid film will depart. So, this versus if the spray was if the passage was only sort of like that then I would get a spray that is slightly narrower in the spray angle. So, by shaping the exit geometry of the simplex spray nozzle one can control the actual spray angle. So, quickly just to recap the different designs that we looked at today we looked at the swirl atomizer in some more detail and looked at a couple of different flat spray nozzle designs in terms of the flood nozzle and the fan spray nozzle. We also looked at spill return and then finally we started to look at air assist atomization. We will continue this discussion in the next class.


Good evening, everyone. Today I will be discussing my paper on MRI features of COVID-associated rhino-orbito-cerebral mucormycosis. It is a case study of 20 patients and I am junior resident in Department of Fatal Diagnosis and Imaging, MSBHU Varanasi. So as we all know that India is currently seeing a massive rise in cases of COVID-associated mucormycosis, Hino nasal disease being the most common. Mucor is an opportunistic fungal infection that causes acute fungal disease that warrants early diagnosis and treatment and MRI plays an important role in mapping the disease extent. There are only some case reports and only few case series in the literature that explain the MRI features of ROCM. So the objective of our disease was to describe the spectrum of MRI features in 20 patients with post-COVID ROCM. What were the materials and methods? So this study was concluded in SSL Hospital, IMSBHU from May 2021 to June 2021 in Department of Radio Diagnosis and Imaging. It was a cross-sectional observational study and a total of 20 patients were enrolled in the study and their MRIs were evaluated. Inclusion criteria for our study was all the post-COVID patients who had Sino nasal disease and which were microbiologically proven to be the cases of rhinoorbital cerebral mucormycosis. Exclusion criteria were all the patient who had symptoms but microbiologically they were negative who had undergone intervention for the disease and contraindications to MRI like claustrophobia and metallic implants. Imaging protocol MRI was performed on a 1.5 Tesla scanner. Agile scans were obtained from T2 vertex whereas coronal scans from tip of nose to the cerebellum and the sequences that we took were T1 weighted, T2 weighted, axial flare, coronal stir, DWI, ADC, SWI and post-contrast even weighted images. Now for the scan evaluation which was a very important part of our study we followed a compartmental approach. We evaluated Sino nasal, extra sinus, orbital intracineal disease separately. For the Sino nasal disease we mainly looked for the mucosal thickening, T2 hypo intense content within the sinuses, what was the pattern of sinus mucosal enhancement and whether there was any bractaminate sign present or not. For extra sinus we looked for disease extension into the premaxillary facial tissues, whether there was any retroental fat stranding, hyperintensity in the premaxillary tissue, whether there was replacement of fat in the pterigopalata in FOSA by any soft tissue and altered signal intensity was looked for in the intratemporal FOSA muscles. For orbit preceptile extraconal intraconal compartments were evaluated separately we looked for fat stranding on T1 weighted and T2 weighted imagings and hyperintensity on axial flare images and coronal stir images. For extracular muscles we looked whether the muscles were bulky, had any altered signal intensity and fuzzy margins.  Soft tissue at the orbital apex was looked for in patients to confirm any presence of orbital apex syndrome and in patient with soft tissue we looked for whether there was any dilatation and non enhancement of SOV which can lead to the extension of disease into the cavernous sinus and finally we looked for globed deformity which is indicative of extensive retroorbital disease. Now intracranial extension of the disease was looked for in the form of meninger enhancement and thickening involvement of cavernous sinus. I see a direct spread along the nerves and a direct panel canal infiltration in the form of abscesses or cerebritis. Now a few images the first three images show the pattern of sinus mucosa involvement. In the first image we can see in the first image we can see that there is nodular mucosal thickening on the right side whereas on the left side we can see T2 internal T2 hypo intense content which can be due to the presence of paramagnetic substances which are prescenium fungal hyphae. On second is the T1 weighted post contrast image in this we can see that there is a thin peripheral rim of mucosal enhancement with a central non enhancement and on the left side we can see that there is mucosal enhancement on the periphery of the mucosa whereas it has central non enhancing hypo intense content which also is indicative of fungal disease and on the last image we can see a classic black turbinate sign with non enhancement of premaxillary facial tissue, a non enhancement of turbinates and the muscles in the intratemporal fossa with this all is indicative of necrotic tissue which warrants extensive debridement. Now for orbital involvement there is a preseptile hyper intensity on the right side on coronal stir images in the middle image we can see that there is non enhancing soft tissue adjacent to the orbital floor which has caused the displacement of orbital muscles inferior rectus as well as the medial rectus. In under third image we can see flare hyper intensity in the extracunnel as well as in the intracunnel compartment which is indicative of extensive retro orbital disease associated with deformity in the globe this is called as posterior tenting of the globe which is the classical guitar pick sign. Now for optic nerve involvement on the left side we can see that there is restriction in the optic nerve which is indicative of optic neuritis similarly in the same patient we can see that there is extensive retro orbital disease compared the fat with the right side with the guitar pick sign and on the last image we can see on the right side that the optic nerve is bulky with fuzzy margins negative of direct infiltration of the nerve. Now for brain involvement on the right side we can see there is non enhancement non enhancement of the maxillary artery compared it with the normal left side as well as the internal as well as the extracunnel part of the internal carotid artery in the middle image we can see the left cavernous anus thrombosis there is non enhancement of left cavernous anus thrombosis with adjacent abscess in the left inferior temporal loam and this was the NCA territory in fact in in a patient with ROCM. Now this is first image is in with an ADC image which shows the extension of disease along the trigeminal nerve up to its exit point in the pond so we can see that left trigeminal nerve is thickened compared with the normal right side this is the second image shows cavernous anus thrombosis with non enhancement of the cavernous anus left cavernous anus and its convex margins and the third image shows the cerebellar abscess. Now what were the results discussing the results 65% were male and the average duration of disease onset post COVID was 20 days diabetes and steroid were the most important risk factor and among all the diabetics 95% were 95% were diabetic with 57% of them having uncontrolled diabetes mellitus we can see that diabetes and steroid were most important risk factors MRI features 20 patient all the 20 patient has Sano nasal disease that is the stage 1 and stage 2 disease 14% patients had stage 3 disease that is Sano nasal orbital disease and 8 patients have Sano orbital cerebral that is the stage 4 disease and among the sinus maxillis anus was most commonly involved with frontal sinus being the least common sinus involvement 55% patient had heterogeneous sinus mucosine involvement whereas 40% patient had black turbinate sign in the orbit involvement extraconal compartment was most commonly involved and the globe deformity was seen in least number of patients most common extra sinus site involved was premaxillary facial tissue which was seen in 60% of the patient and pterigopilatine fossa involvement was seen in 30% assessing the pterigopilatine fossa involvement is very important because it can serve as crossroads for the disease extension bilateral Sano nasal disease was noted in 85% of the patient whereas bilateral orbital disease was seen only in 35% of the patient and equal to 8 that is 40% of patient had intracranial extension with meningel enhancement followed by cavernous anus involvement being the second most common so meningel enhancement was seen in most common form of intracranial extension followed by cavernous sinus and then followed by the intracranial abscesses so moving on to the discussion we all know that India has witnessed a huge surge in COVID-19 associated ROCM cases in epidemic proportions we have described the MR MR findings through our study the observed imaging findings in our study indicate the aggressiveness and infiltrative nature of the disease with the involvement of paranasal sinus orbital soft tissue and spread along the vascular and neural structure while mucosal enhancement is a non-specific finding more than half of the study patient had black turbinate sign which indicate necrotic tissue necessitating debridement involvement of pterigopilatine foci should be diligently looked for because it can act as a cross-road for disease spread into the infrared temporal foci as well as intracranially and finally the role of radiologist in cases of ROCM should be focused more towards mapping of the disease rather than diagnosing an early identification of extension beyond their beyond the anatomic boundaries as helping the clinician in deciding the treatment protocol thank you


Hello, my name is Akriti and this is my one month over to baby Ivan It's I believe a month back when we were all Devastated and roaming around all the hospitals of Delhi There were few hospitals where we went and they couldn't even understand what he's going through He was having high fever 102 from last three days, and he was just getting grossing drops then we came to Manipal and We met Dr. Vinay Kumar Roy and then he was diagnosed the same day the very same day He admitted him and he was diagnosed from meningitis and sepsis which is which was a very high-grade infection and I was not in a good state also to talk to anybody But now he is good. He's fine and Dr. Vinay Kumar Roy came as a blessing to this child and to me and my husband The entire facility hospital staff everybody was so caring towards him that Hospitals are generally not home but he felt it was home for him and So thanks a lot to entire Manipal facility staff and everybody and His father lives in the US because his work nature is at such but Dr. Vinay Kumar Roy He calm this down. He's so supportive in nature that his father with a very relaxed mind He went abroad. So thank you so much


Hello and thanks for reading my article in Envision Magazine this month. I wanted to dive a little deeper into the success that we're finding when it comes to equipping our team with the right things to say. We run into patients all the time who will say things like, well, I thought my insurance covered a full pair and I didn't have to pay anything. Or why are you so expensive here? Or can I just get my prescription? I'm gonna go online. We hear these things all the time, right? Well, our response is typically some version of sure or a defeated agreement of sorts that we're just like, oh, okay, yeah, I guess you can have your prescription. And honestly, in its worst form, we'll start to cause doubt in ourselves, right? We'll start to think, well, are we priced too high? How am I supposed to compete with those prices? I don't want to lose patience. We get sort of this doomsday effect going. Well, if we really hone in on what our patients are actually saying and equip ourselves with some comebacks or queued up really great responses to keep the conversation going, not only will you be able to keep the patient from shutting everything down, but you can capitalize on the conversation enough to keep the patient interested and ultimately have the opportunity to sell them on a pair of glasses later. Now, here is where most of our offices really are missing the boat with these two things. Number one, we often avoid taking a hard look at things that suck to see how we can even improve them. No, thanks. No one likes hearing that a patient is taking their business elsewhere or that they're complaining about our pricing. It makes us feel like failures and the easy trap to fall into is blaming the patient. That would look something like this. Well, you pay for what you get or hope they'll be back or they'll regret it, right? The alternative is to point the finger at ourselves and ask, what can I do to change how the situation ended up? It's easy to come up with an excuse of, oh, well, they said they can't afford it. Is that really what they said or did they say that you were expensive so they don't really see the value? This is hard for many of us as humans, right? Those that reflect on these moments to learn and try to become better are those types of people that can adapt to situations and take the role of, you know what? I'm here to learn. I'm always learning. And that's so much of what the success is in this field, yet some of us really get stuck in a rut when we stop learning. When you're able to reflect on these things and you create solutions, it will take time to become really great at it, right?  You'll stumble over your words that you're using because they're new words and new ways of talking. But this is how you make it perfect. The best way to implement these new skills is with the team, which brings me to my second part of what we're missing the boat on, empowering the whole team to know what to say to these patients. When you do that, you can all practice it together. You can hold each other accountable, right? And you won't run into the issue of Sally at the front desk messing it up for all of us because she wasn't taught the best way to keep the patient engaged. Is it really their fault? Not really. We have to teach everyone. And when they say they are just here for an exam or I just want what my insurance covers, Sally will have a response. Having an entire team that's equipped to address your patient's objections and answer the really hard questions is transforming our member opticals.  However, if you're looking to save a little time, you can access the amplified optical course that I've been referring to through this whole thing. And you can do it right now. Why? Because it's included in your office's Spexy Plus membership. And if your office does not yet have a membership, check it out. It's only $34 a month for the entire office and we never have contracts. You just stay as long as you love us. So thank you for joining me today. Reach out with any questions that you have. We love being able to help. I'll see you next time.


Hey everybody see McParty here in Mountain View Dodge. What do I have here and beautiful 2019 sport? This one here is about the sport hood. It's got the 22 inch wheel It's got power side steps. Look at that. That's awesome. Leather seats, heated seats, cool seats, only 48,000 kilometers on this thing Beautiful truck. Got the 12 inch screen. Got the panoramic sunroof. Lots of room back here for storage and everything Spray liner already. You got the rails in the back, back up cameras, back up sensors, trailer tow, you're ready to go. So, who are you gonna call? Stephen Ferdin. Where? Mountain View Dodge. Have a great day.


Mae'r bwysig yna i chi'n ddweud o'l panel, oherwydd mae'n gweithio'n ddweud o'r panel yn ymlaen yw mewn. Oherwydd mae'n ddweud fe gyddion gwybod yma o'r panel, oherwydd Arman yn ei ddod ymlaen i Michelle Van Herp. Susan Eldon, dyfedd, rydyn ni'n rhaid i'r Jay Socomosis y Llywodraeth, rydyn ni'n rhaid i'n gweithio'r ysgrifennu. Rydyn ni'n gweithio'r ysgrifennu i'r Brithys. First of all, I just have to congratulate MSF, as I'm here at MSF event, on the fantastic work in this area. So I work, as John said, in the product development team, I focus on vaccine development at WHO, and I'd just like to highlight just a couple of points that WHO, with the international community, are working on in vaccine development. So firstly, this is a sideline in the context of the current Ebola outbreak but it could be really very important for this question preparing for the future and that's the vaccine development. Mae'n cychwyni wneud o wahanol gyda'r swyddfa yn O'r Lystiwn, O'r cychwyni ymlaen ffordd yma i gwybod y c tasion, a'r swyddfa y maen nhw ar y cywethaf, y bydd y cyflwydd o'r lle ddioleth yma i gêmwys ar y cyflwydd. Mae'n cyflwydd sydd yn fawr, ond mae'n cyflwydd yma, mae'n cyflwydd i'r lle ddi soldiers yn y lle ddioleth yma i gêmwys i gêmwys i gêmwys i gêmwys i gêmwys of clinical trials that went from the idea to initiation completion of enrollment and many of those have reported many of those have already been published in the 20 years that I've been working in this is far far in excess of anything that's ever been done in vaccine development for for any disease so let's just acknowledge this is clearly too late for this outbreak but for the question is preparing for the next outbreak there is going to be an I fath yw'r pwyllt yn naddwyd i wneud hynny o'r gweithio'r hebizedd o gweithio a gwneud ffeithio'r leidi psychiatrach. Mynd Gaergymeth trafodon ar gyfer debyg mewn gweith яw ffordd presidu cyflonau a gyweithio, mae'n ei gallu effectiliaild gan gyfan Gweithregen i'w'r leidio cerdyn ffawr a gweithio'r leidio yw'r leidio, dyl yn gweithio'u gweithio ac yn cyhoeddech am ffarnwseng yn gweithi'r leidio. A oedd yn y pryd yn y pethau gweithio, dyma y maen nhw, gyda'r cynyddoedd sy'n cyfnod ar gyfer. Rydyn ni'n mynd i chi, rydyn ni'n mynd i gyd y bydd.  Yr unrhyw ddechreuwyd yn dweud. Yr gweithio'r cynghwyl o'r prif, a'r hoffa gael weithio'r cyfriddau sy'n gwael amser yma. Mae gennym ar y mynd yn y Llanfaidd Cynlluniau Cynlluniau, sy'n rhywbeth gweithio ymrhywbl yn cydweithio. Mae'r newid yma am y cynl Ethiopia, mae dyma o'r cymdeithiau sy'n gyfrwyng fuddaw. notation. maen nhw'n diawn mult o Gymryd Filia, Mae'r whole unrhyw, ddifodl, yn 10 dweud, ysgol y ddau a'r rhesaith hwn yn y context ar y mynd i'w diwylliant, a cyhoi bod yna'n hynny'n dwylo. Mae'n ddylch chi'n ddull, mae'n ddull iawn i ddweudio'r ddweudio'r ddweudio'r ddweudio, mae'n ddweudio ar WHO ac yn ddweudio'r ddweudio, wrth gwrs, y targed profiwyl yn gweithio'r 我 filtering forward looking guidance to put all these measures in place before the next outbreak. Not only about the Ebola, but other public health emergencies. Thank you. Finally, I have a laundry list of things I could talk about, but in two minutes I'm going to have to put them aside. We could talk about how to engage the populations, but Ombarto has touched on that. I think we can say that he's going to do better. He's done better with that than I will quickly. We should talk about how to deal with mobile populations that move around faster than we can keep up with them. We could talk about how to improve our delivery of care. And we could talk about how to capitalize on what we've learned and how to be ready for next time. But I'd like to address something that I do advisedly in this room. We need to solve the problem of doctors and epidemiologists. We have yet again been in the field, gone through a number of coordination meetings where the well-intentioned person at the head of the table wearing the official hat engages us in a discussion of what has happened to the three motorcycles that were ordered last week and where they are. And then we move on to the discussion of the per diem, which has not yet been authorized and might get paid next week. We need to learn how to coordinate a diverse range of partners with variable amounts of experience and Ebola outbreak activities. The people who are in charge of supervising these activities need to know how to set good objectives for what they need to be done, mobilize the appropriate resources to do that and monitor the way of progressing and achieving those objectives. And I know that when I was in medical school, this sort of thing was not taught. Nor when I did my public health training or my epidemiology fellowship was any of this stuff taught. We have a naive assumption that the people who should be running public health interventions are always doctors or epidemiologists or nurses. But management and coordination is a skill set. These things are learned. Some people are better at these than other. And the system that we have in place does not, it's not a meritocracy. We do not pick the most appropriate person to be sitting at the front of the table. And as I'm sitting next to somebody from WHO, I will say that this is not our problem alone. And if we cannot learn how to manage an outbreak of this scale and this complexity effectively, I think we risk repeating a number of the problems that we ran into. So I'd be happy to talk at length about any of the other things that we could have talked about, but I thought I'd get that one out there because it's not something that we bring up often enough, perhaps. And I have plenty of anecdotes of people who want to cringe. Okay, thank you very much. So that's the opening gambit. And now it's over to you. So who would like to ask a question? Yeah, my name's Rob. I'm one of the public health trainee. I guess from a public health perspective, wouldn't the best simplest and also most difficult way of preventing another outbreak be to improve the capacity of the health protection systems in the countries where the outbreaks might occur so that actually cases are identified early and then actions are taken to prevent spread? So a little while back when we were talking about how we were going to prepare for the next outbreak, I mentioned to somebody, the issue of better surveillance will be brought up yet again. We say this after every outbreak. We came late. If we detected it earlier, we would have been able to respond earlier. And I'm not against surveillance. But if we had detected this outbreak a month or two earlier, we could have arrived in Gekidu and failed to control the outbreak that much sooner. The problem was not that we were necessarily late, is that when we got there, we were ineffective. We did not engage the community as a partner in outbreak control. We went on with the same messages we'd used before. Unfortunately, we failed to employ lessons that we'd learned in the past. And I don't know that we've ever figured out the best way to engage communities, although we're getting better at it, but we certainly did not get them on board. Cases hid, contacts were very difficult to follow, and we didn't go in with enough people to get things under control. And surveillance would not have improved that. I still think, yes, we should detect these things sooner, but the problem is what do you do after you've detected the outbreak? How do you get in there and get it under control quickly? A gentleman down here first, and then up there. Bertie Squire from School of Tropical Medicine, Liverpool. One of the things that struck me a lot all through today is the issue of the need for person time. I've tweeted about this, but actually none of you have mentioned this. The human resource that is going to be required to respond isn't sitting ready. It has to come from somewhere else. So there's something that we need to discuss, which is about how we get sufficient human resource across all of the disciplines, all of the skill sets that you've mentioned. Management Administration Coordination is clearly one of them, but the whole business of interacting with patients, interacting with communities, needs numbers of people who are able to do this and mobilise this. And it's not just a question of the international community, it's also about local communities. I think that hasn't had enough attention. I don't know what the panel thinks. Mitenin, would you like to tell them? And probably you are right. I think that in our case, we managed to engage... I mean, we have plenty of national staff working with us, and we had a fantastic response from all the international staff that we had, but it's true. I mean, the workforce was the one... The workforce was the one limitation that we had whenever we were asking for hands-on activities. So it's something that for sure needs to be well prepared in advance. I think that we engaged quite a lot in training that it's something that MSF was not used to. So we were aware of that need, and we were aware that to have someone ready, hands-on to be able to treat patients was going to take us quite a long time. So we decided to invest in treatment, and I think that that had a good result probably late, but it had a good result. And I think that is something that we should take as an example for the next one. Susan, do you want to start? Maybe just a couple of practical examples that I can give from that. On the first question about surveillance, one of the things we found really effective was community-based surveillance. So people from those local communities that actually knew where things were happening, and that is an area where you can really mobilize local resources, and that was seen to be very effective. The other thing is, I think, is to recognize the downside. None of the teachers were working at the time, and so they were massively employed, and all the TBAs, the traditional birthday. So they were all brought out in mass to work in the Ebola response, and there was a massive backlash at that time about what happens about all of those other services. So it wasn't simply straightforward to just bring in massive amounts of local people into Ebola, and so there's something about... I think that's my point, is that you're stealing from somewhere else where there's a hold. Yeah. There's a whole dynamic that has to be addressed at that. Okay, the gentleman at the back with a... Bruce Reeder, MSF Swiss in Canada. Two questions if I could, both in a sociological anthropological dimension. What should be the future in terms of changing traditional practices, for example, around bushmeat exposure, traditional burials? What is the role of the local community and the international community and such potential social change? And based on what Amberto had mentioned, to what degree can we incorporate anthropologists, sociologists in the early response team? And are they quick in response or does it take weeks to do such assessments to help field teams? You want to say that? That's a very good point. We learned the lesson about the need for anthropologists a long time ago and anthropologists have been part of our outbreak response for at least 10 years now. Yeah, at least 10 years now. There are a couple of tricks there, though. One is finding the right anthropologists and finding a way to make use of what they say. Sometimes we get very great ethnographic analyses that explain the root causes of the problem and it goes back hundreds of years and you can blame colonialism and the problems between the capitalism. But then you say, well, yes, but what do I do all of that operationally? How do I change my actions or engage in some activity that makes use of what you've done? And that's a little bit trickier and we've had a bit less luck with that. I don't know that we often try to change what they do as accommodate some of the things that can't be changed and leave it to them to change the things that they can change.  They understand what's going on after you give them some time and you engage in a dialogue with them. And often they will, if you explain the risks in terms that work, often they can propose ways that will be the least burdensome change to what they do that is acceptable within their community. And we often find compromises where we get the opportunity and time to engage in that dialogue with them. So we have had some successes there. Unfortunately, we're often overmatched in these outbreaks and we focus on the things that we do well. We build fortress management center and take care of the patients and have a very patient-centered approach and we figure we'll get to that anthropologic stuff when we have the time because we're short on staff and what have you. So I think we need to push that as a priority earlier and figure out how to engage with the anthropologists in a way that is operationalizable if that's a verb that I just made up. Most sure it is, but I'm going to drift. I've got a question, I think, for John and probably for Susan as well. So we heard from our keynote speaker about the importance of an early response and he also showed the picture of the academic timeline for getting proposals out there and maybe funding of project proposals. Just from the two of you, maybe, how can we overcome some of those barriers for next time? Okay, I think that's a tricky one. I mean, at the moment, of course, so you get a real epidemic that goes up and comes down and then you get a research epidemic that goes up and comes down and they're offset by some considerable period of time. So at the moment we're in this rather unseemly scramble for the last few cases and it's really, you know, and quite political. And so we have to move that. So I think it's up to me, I think it's up to a number of other things. The funders who need to be much quicker off the mark, there are certain things you can do up front so you can plan certain trials. For instance, there should be, or plan certain studies, but you only really get to that stage having properly analysed the data that's come out of, say, this epidemic. And I don't think, I can see that happening now that the data that's available will fizzle away and we'll lose that opportunity to analyse it properly. And then line up the potential things that should be done rapidly in the event of another outbreak. Ezra was talking about different anti-malarial treatments, you know, there's an obvious clinical trial that could be done there if, you know, and why not plan that right now? You know, do the analysis of the observational data we have and then plan that right now. You know, there's no reason not to. Well, John mentioned that the funding needs to be there so that's where I come in. So we were the, you know, one of the key donors at that time and what we can't do is address the sort of stuff and the staff and a lot of those things. But on the funding side, I think one of the most important lessons was having flexible funding early on. So trying to have a small pool of resources that we could then mobilise for people who could say, actually I'm trialling this with a community or actually I've set up a little bit of an isolation facility. I can do a borehole here, I can do this and that. So can we make that funding flexible and fast to those people already on the ground doing that? And I think our ability to mobilise that quicker and to seed out that innovation was probably key. The frustration came with not being able to do that fast enough and at scale because it did take us longer than we wanted to. The other frustration was not being able to get the actual massive logistics of the stuff, sheer amount of stuff and staff that need to come in. Okay, quick couple of last questions. So I'm Vicky from MSF UK and I think the question is to the non-MSF people on the panel, including you, John, because it's a follow-up on what you just said. So there is a very large number of samples, Ebola samples that are spread around the world, held in a significant number of hands. So does that represent an opportunity for us to continue with research and development in order to prepare for the next time? And if so, what is the best way to manage that multiplicity, if you like, of opportunity? I'm going to hand that to Vazig himself. I think that's a potential role for WHO there. Well, as it happens, I know a meeting is never a solution to anything. But what we need are ways forward with sample sharing. And this is a really critical question. That, as it happens, there is a major consultation on this on Wednesday, next week, in Geneva. We have a couple of days before that. We have a big group of leaders globally who are coming to begin, move forward with the whole, laying out the blueprint for all of these kinds of activities. So this is one of those. There are many others. How do we better share the epidemiological data? How do we, next time this happens, how do we better get all of the information out there about the natural history of disease when a new pathogen is emerging? The case reports, the clinical trials of preventive therapies, diagnostics and sample sharing. But all of these are really big, very important to actually strategic issues. And we're taking this on. I mean, from our side, what we can do is come together and develop norms and standards for expedited working in these areas. I mean, it's not okay, in my view, for people to be holding on to things, information, information or samples, ultimately against the public health needs. So we need to find a way, incentives and safeguards to enable people to do that. And one of the other issues that I think goes across all of this is how do we get information out there? So we, I don't know if anybody saw it, but WHO launched our public position on aggregate results sharing. This is not in emergencies, but this is the general position on public disclosure of results from all interventional clinical trials. This came out in Plos Medicine just a few weeks ago. And essentially this is in line with the timelines, timeframes for results reporting that are emerging in the EU and the US FDA and just highlighting there's a big problem in general with publication bias and dissemination bias, which is not new, but just this is something that we can actually fix. Funders can ensure that if they fund a clinical trial that the results become available at some point. There's a lot of discussions about participant level data sharing. There's actually a step before that, just ensuring that all studies which occur are reported at some point. And if anybody is interested in, I could send you the list of all of the citations that confirm that this itself is a big problem outside of emergencies. There was a publication in the New England Journal of Medicine recently that showed that even those trials that illegally required to be reported in the USA, only a very small fraction of those that illegally reported comply with a timeframe. So even legislation is not enough if it's not enforced. I think funders could have a big role here. But those timeframes outside of emergencies are way too long, even if you met those. And we're talking about 12 months from the primary completion date. And in my experience working in this emergency, that there are examples of good practice with people sharing information. Obviously, you have to have the information because the outcome of that can be actionable for responses for public health programmes, et cetera. So I think that is a big ticket item that we need to improve expedited sharing. And it's on. I mean, one of the things is, is WHO strong enough to ensure that this happens? And is WHO going to be at the end of this outbreak stronger or weaker than it was before? Well, I mean, that's a big question. I mean, essentially, as you know, we're not a police force. We are the UN Public Health Agency. So this depends on the community coming together and coming to agreement on that. And we are catalyzing that. In some areas, people come together and take really effective action. And you can go to the extreme, like the framework conventions in tobacco control, where all of the countries decide they want to sign up to legal measures. That's where people want to go at the end of what you can do before that. If we will come together and come to agreement on how we can take this forward, then yes, I think we can make major progress in the next few months. Michela, quickly. And then final question from the lady in the back. Coming back to the original question of day, I think that, yes, we can shorten a little bit the research time or the time that we spend in research. And there are two main aspects. I think that preclinical data, we had a pipeline for Ebola and there was no preclinical data. So that could be advanced. We had vaccines. There was no phase one. So we cannot, in the middle of the outbreak, decide to do a phase one. We should have done that before. So I think there are two aspects that we can do for the next hour of breaks to be sure that whenever the outbreak comes, we are at the right time for the right trial. Yeah, very good point. Last question. Now with the decrease in the media attention or in the attention overall to Ebola in a few of the past meetings, there's kind of a trend where history is starting to be rewritten and in quite a dangerous way. So I'm asking, I know MSF is, I know we're doing evaluations and different evaluations of what the response was to Ebola, what the history actually was, what we could have done better, what we need to do for next time. I'm just wondering if the other agencies are doing the same thing, if they're planning to do the same thing and to do a critical analysis of the response so that next time, the response can actually be a better one. I think that's an easy answer. Yes, there's an epidemic of that going on now. So I think with that, I think we're going to have to finish there, unfortunately, it's been a fascinating discussion. I thank the panellists for participating and not all of the questions were terribly easy to answer, but thanks again.


If you watch Common Ground online, consider becoming a member or making a donation at lptv.org. Lakeland Public Television presents Common Ground made possible by the Minnesota Arts and Cultural Heritage Fund and the citizens of Minnesota. Production funding of Common Ground is made possible in part by First National Bank Bemidji, continuing their second century of service to the community, a partnership for generations. Member, FDIC. Welcome to Common Ground, I'm your host, Scott Knudson. In this two segment music episode, meet the band Crimson Winter as they perform at Nevis' music destination, Terrapin Station. Then jazz guitarist and guitar teacher, Louis Sampson of Bemidji performs at the Lucky Moose in Walker, Minnesota. Playing live, it's fun to provide the entertainment, so to speak. It's a surreal experience having people there just to watch and listen to what you came up with. It's really a cool feeling. We're Crimson Winter and I'm John Murphy and I play the bass and I also take care of vocal duties. My name is Nathan Kelly, I'm the drummer for the band. And my name's Sebastian, I play guitar and sing vocals as well. Collectively as individuals, we've played together for about two years, but Crimson Winter has been together for about nine months or so. It's a good question to ask like what our sound is because I think that's a question we don't even fully understand ourselves. Well, it's been described as like 70s, like kind of on the progressive rock scene and infused with a bit of metal. We also kind of have some a little bit of punk elements with how Nathan drums and how he incorporates his own style in there. It's interesting just how everything comes together as far as the writing style comes. We have multiple elements in it, all the way leading from your prog rock and your hard rock towards your metal and everything. And when everything comes together, it seems to work out nice. We're able to get everything to flow the way we want to and we're very happy with our sound. Writing music for us, the way we approach it, there's a couple different ways. Sometimes Sebastian comes in with a quarter of a song written, or like most of a song written, or sometimes all of a song written and he'll be like guys what do you think about this? I threw this together and we're like yeah, that's awesome. And we'll write different parts for an arrangement like he'll throw in a drum track or two. And sometimes we'll get together and we'll be jamming. We'll be doing just random stuff and we'll stop and say hey, what was that? You're just playing right now and they'll come up, well I don't know. It's like okay, well that was really cool. I like that, what you're doing. And then we just kind of take that and we roll with it and see what happens. I'd say in general as far as like melody or lyrics, it's typically more of like the backing music behind it all will come up with, like the riffs and the drum parts. And then once that's kind of solid and we're getting a feel to that, typically me or John will start like coming up with some melodies and then we'll all like throw in some lyrics to it. That's kind of true of my own writing as well. I'm Barry Riff's first melody later. And I wouldn't say it's anything like in disregard to the melody, it's just that's kind of what presents itself last to us at least. I think it's a lot more like focused on the motif until the melody eventually reveals itself because I think it's a lot of what I like thinking about when writing a song is serving the song and putting into the song what it deserves. You need a good pancake batter for the pancake. The overall feeling of the Terrapin station show. I mean I was really excited but there was a little part of me that was a bit nervous because this was a bit of our pioneering show for the community where we practice and write our music. So this wasn't just Minneapolis where people were like, okay sure it's another band you know this is like our home turf and there was a little bit riding on you in that way but I think overall it became a really fun experience for me and it was something I was able to walk away from and be like yeah that was a really good show. Going into it yeah I'll admit I'm sure they could admit too that yeah we were nervous if we weren't then we would have had the passion behind it. Definitely for the first two songs like I was a bit nervous but kind of once we got playing and more in the rhythm of things the groove it kind of died down got more comfortable with it but I mean it's really crazy just like being the focal point of 50 plus people. I'm Kiki Carter Webb and our band is called Dancing Light. This is my husband Greg Webb. The Terrapin station performance really came about because we had a bunch of family coming to visit for Greg's mother's 90th birthday and so they all wanted to hear us play they wanted to hear Sebastian and his band play so we called Brian at Terrapin and said hey how about a show over at Terrapin while the family's here. He thought it was a great idea and we put that together. It was so much fun. We love Terrapin station. Playing at Terrapin station has always been a real treat for us from the very first time we performed there and we performed there several times over the years. I love any environment that you know that I guess comparable to that that's really designed for listening to music and there isn't really no other focus going on there. Very different than playing in a bar where there's some other activity that sometimes is more important to the people in the room when you're just there and everybody's just there for the music it's so beautiful it allows you to really go deep into the playing into the performance and into the interaction with the audience. The idea of bringing Crimson Winter in there to perform I just knew that they would love it. I just knew that you know that it would give them an opportunity that they hadn't really had yet. The night at Terrapin station was just a wild night. We had family there, we had friends there, we had the public there it was open to the public as well and there was just such an energy of anticipation both in performing for family that lives far away and our grandchildren being there and then having Crimson Winter play a real concert for the first time and it was just so much fun to watch those boys come alive on stage. Having our son get into music is sort of a dream come true. We have other children who connect with music but he is the first one who sort of we feel the camaraderie of being deeply into music and passionately loving to play and to write and to perform. We've sort of been mentoring Crimson Winter just in the sense of offering them our experience as musicians and doing a concert together just seemed like a really good idea and I think they had some question about well how is that going to work because of the difference in our musical styles. We all had that question. I think we did. When I was approaching people to even to tell them about the concert there was at first a little bit of wondering well now is this person going to like both of these musical genres together or is this person going to prefer one over the other and there was an inspiration behind the whole idea of doing a show together and I started to just allow that to be what it was and to trust that I didn't really have to decide for the people coming to see us what they were going to like or not like and I could just say well come out and experience it. It was amazing to be playing songs that we've done for years like yes it does with Crimson Winter because they were just had all this youthful energy so powerful and there too are the grandchildren coming up on stage the energy was just electric for me personally. I had such a good time playing music with Crimson Winter we had some beautiful rehearsals here days than the weeks before we did the Terrapin show and to do that with them on stage it's kind of amazing really in so many ways because of course we've known Sebastian all his life and he's known John Murphy since he was probably in third grade and there was a long time there were most of what they would do together is play video games and it was never really I never imagined that there'd be a day not only that they would both be so focused on music but that we would get to play with them on stage and be a part of a concert together and having the grandchildren come up on stage and play percussion it was a lot of fun and I know for them it was huge they were just beaming afterwards like that they had been a part of the band. They were rock stars. I think the general feeling you get from playing with Sebastian's parents I think practicing up to it it's kind of a cool feeling because you get to play out of your style and you get to play with something a little bit softer and yada yada and you kind of get a different sonic experience a musical experience and in a way it's a nice sort of break for you as a musician. Playing with my parents and we all had family in the audience even if we totally botched the show they hate our songs whatever they're still going to love us and care for us.  True and another aspect of that is that it's also your family so it's like wow I don't know what these guys think of it but here's the first time it's like hey mom, hey dad, check out this rip-roaring heavy riff. I do. This is what I do. Hello, my name is Lou Samsa and I'm playing guitar at the Lucky Moose in Walker. When I do perform these songs as far as my thinking goes I just I want to play these songs with lots of emotion with feeling. When you know a song well you can play with much more feeling. If you don't know it as well as you should then you're worried about what the next phrase might be or exactly that next chord and then that takes away from the feeling of music. To me I can't explain the feeling I get from out of music when I play it's wonderful. Sometimes I literally almost fall out of my chair I'm so excited about it. So I know I'm very sensitive if I go see a movie sometimes I'm crying like a baby and I think that shows in my playing I think we all have this potential to feel this but I that's one thing I never I never did figure out for sure do we all have the capacity to feel music emotionally because sometimes you see people play they might play one note and it might be like this just one note they're feeling that note and then you get another guy that's just sitting there kind of stone faced so I don't know what he's feeling and that's the saying that you hear many times you can always tell a player just he might only play one note but it reflects that emotion is there I've been teaching guitar for about 50 years I actually started playing guitar when I was 11 years old I'm 65 now so I've been doing this since the dawn of man but I got introduced to music and guitar probably when I was a little kid went out like about fifth sixth grade I used to listen to Elvis Presley and the Beatles and that really got me motivated and I remember learning songs and singing along with them and I remember getting myself worked up into tears there was something about music especially these particular songs by Elvis and the Beatles and Ricky Nelson for that matter but initially there was something very moving about music I knew there was something there even though I didn't take it seriously I loved it but I had other interests that I followed you know whether it was sports or what have you in fact when I decided to go to college I didn't think I was going to be a guitar major or going to music at all I actually wanted to become an elementary teacher and so here I am at college at the Magistrate University I'm actually from the Iron Range from a town called Chisholm but I came here to college majoring in elementary education and after two years I decided to quit college and move back home and start a band with one of my friends and I moved back to Chisholm and I started a band there and we were together for about two years and we were playing in some of the bars around I was making some money but the guys in my band weren't quite as serious about it as I was so I decided to go back to college and you know finish my degree but meanwhile when I was in college I met another guitar player actually he was a bass guitar player and so we started another band and so here I am in Bemidji going to school but also playing this band on the side you know and at that time we were again playing on the weekends but meanwhile I met a guitar player that moved into town here in Bemidji actually his name was Kevin Daly and I took lessons with him for a good year and he basically changed my life after I was with him for that year I realized that I wanted more of this guitar business so I still finished my elementary degree and then I took up music now at the time they didn't have a guitar major here so I had no choice but to do voice because you have to pick an instrument so I chose voice so I ended up getting a degree in vocal and elementary not to mention I was qualified to teach driver education and I even have a degree in piano technology after I finished my degree in music and elementary education I was substitute teaching around town for a while and I actually was tuning pianos in town but there was something about that guitar that was always beckoning me it was always after me so before you know it I started other bands and I was always playing in bands I got to the point where I actually quit tuning pianos which monetarily was probably not the wisest decision because it was a very good income doing that but my guitar was always calling me so I ended up actually teaching guitar here in Bemidji Kevin Daly, my guitar teacher that got me into all this he was teaching guitar at a little music store here in Bemidji called the Melody Shop now Kevin actually moved back to Minneapolis and when he left he got me the teaching job at the Melody Shop so I actually started teaching guitar at the Melody Shop where I was at for 18 years actually so I was always able to make a living teaching guitar lessons which I love by the way one-on-one and also playing in bands so that's how I was able to make my living just teaching guitar and playing in bands and I've been doing that for a long long time it's been about 36 years because after the Melody Shop closed here I went right to Over Beaks so I was at the Melody Shop for 18 years and then at Over Beaks now for about 18 years so just this passion I have but the interesting thing is I was always kind of thinking I was good but then with the computer I did get on the computer and actually scope out some guitar players that actually taught guitar online great jazz guitar players and they actually brought the world to me I realized that was way behind way behind so right now I actually practice about 2-3 hours every day and I've been doing this now for about maybe 3 years now so my playing is getting better I feel a joy I love it I just wish I had the passion to do 10 hours a day which great players do it's a lifelong commitment it's hours and hours and my hat goes off to the people that can do that but what can I say it is beautiful even if you do a little bit about a year ago I played at the Lucky Moose Bar and Grill in Walker Minnesota which I actually do now as a musician I play at restaurants and I play at weddings at the Forest Edge Winery and Rutgers, different places like that I do a solo performance and I play a variety of music in fact I like to refer to myself as eclectic electric I play a little bit of country a little jazz, some blues a little rock a little bit of classical just a little variety of music which I love because it brings out different emotions in me before I did this solo stuff I play here straight basically pretty much every weekend but it wasn't until I was about maybe 55 years old where I started doing solo solo work which I really love probably because it's enough to just take care of myself let alone worrying about three or four other bandmates I've got plenty to worry about with just me but I will say that being a solo guitarist you really have to know your songs well because when you play in the public you never know who's there there might be some music professors there there might be people with cameras there and I've learned in the past that I didn't know my songs as good as I should have because there's more pressure that's involved and it's easy to to mess up but I know this about myself that if I really dig in and practice like you should you get to the point where you know that song so well that even if you get distracted the song can still flow because this muscle memory and it's so locked in your head that even though you get distracted a little bit you don't fall apart you can just keep it going so for myself I'm sure everybody's different for myself if I know the song real well that gives me the confidence and when I have the confidence I have no problem now some of the venues I perform at the people are just eating talking so their undivided attention isn't really on me so it's more laid back of an atmosphere which relieves a little pressure but you got to remember that while people are eating they still look over and they listen and I guess my goal is if it feels good to me I'm assuming it feels good to the audience I think we're all human beings and I think they can tell if you love something and it feels really good for you I think they can pick up on that so right now I still teach private guitar lessons still at Overbeaks and also at Bemidji State University where I'm an adjunct instructor and I still do my solo guitar work and so this is what I do for a living and it's wonderful I've always loved sharing what I know and I still love doing it to this very day I love teaching guitar when I give lessons I'm hoping that the person would like to make guitar their career this is the way I teach I don't fool around I'm not demanding I don't get upset if they don't practice all I can do is try to inspire them get them excited about guitar because you can actually make a living whether you play in the military or if you're a studio guitarist or if you play in a band or if you teach private guitar there are a lot of venues options to make a living playing guitar so as an instructor I enjoy watching my students grow actually they pass me up and I remember one of my earlier students from years ago who practiced 10 hours a day he passed me up in 3 years and I remember that was kind of hurtful for me to pass me up and I had played for 25 years and he passes me up in 3 years and he went on to move to New York a great guitar player actually his name is John C from Bemidji here so as time went on I had others that basically did the same thing so now it's enjoyable to watch my students pass me up and I can only wish them the best for high levels of success I would like to encourage everyone to at least study some instrument I am a believer that if you study an instrument I think that carries over into all areas of your life I think that will just make you a better person I think you will be able to achieve higher levels in any other field just by studying music because it's so completely involved with your whole body, your mind the physicality, the emotional I highly recommend everybody to study music as far as unlocking some potential in my students as far as their guitar playing goes it's wonderful to see the light bulbs go off in their eyes when they can start creating music I love when I see a student grow but I have to say we don't all grow at the same levels and I think the accomplishments and feeling of certain people are just going to be higher that's life sometimes you're actually married to your instrument and some people make I've had students that were on their way and they actually decided to fall in love with somebody which is great but I will say their guitar playing went bye bye and I'm married, I've got three kids it's been awesome, I was able to manage everything so I've been blessed to have a wonderful family and my wonderful guitar and you know if that works for you great but some people can't have both I mean if they really want to get to that high level, if they just want to play a few chords and have fun for the rest of their life that's fine but as far as that commitment to get to those higher levels sometimes we might have to make that very difficult decision whether you want to play guitar or do you want to get married or not because some people will tell you that instrument is you're married to it what can I say if you're interested in learning how to play your guitar at a higher level or if you're interested in hiring me to play at a special function you'll find me in the Bemidji phone book Lewis Samsa I think the audience actually appreciates seeing somebody live working at their craft it would be like myself when a plumber comes over to my house and I'm watching him I admire that or a mechanic or a carpenter I think it's wonderful to watch somebody who knows what they're doing I admire, I respect it and I think that the audience for musicians is the same I guess what I would say in a nutshell is that you can find art in everything and in every one and in every occupation period 333-3014 To watch Common Ground online visit lptv.org and click local shows for episodes or segments of Common Ground call<PHONE_NUMBER> Production funding of Common Ground was made possible in part by First National Bank Bemidji continuing their second century of service to the community a partnership for generations with DIC Common Ground is brought to you by the Minnesota Arts and Cultural Heritage Fund with money by the vote of the people November 4th, 2008 If you watch Common Ground online consider becoming a member or making a donation at lptv.org