Hi, I'm George Eunice. I do not wear stockings. I don't know if that makes me less cool than the last two people I'm in charge of the STEMI and PCI programs here And I'm going to talk a little about ACS and acute MI syndromes particularly in women and how that differs from the presentations we normally Think about in men and some statistics and data in that regard In a case presentation too, so ACS affects 390,000 women a year Worldwide outcomes in women are worse than they are in men the mechanisms behind this disparity are kind of unclear But it's been shown time and time again Women are underrepresented in clinical trials, and I'll get to that a little bit later And I want to start off with a case This is you know when I started making this presentation a couple weeks ago I was trying to think of a case that I would present and then this woman just showed up that day and She just sent me one-year-old African-American woman who I've known for many years who has who's on dialysis And she has hypertension hyperlipidemia Diabetes hypothyroidism and a recent UTI as well as a history of prior bypass and a PCI With a Stengen-Olimax LED at the anastomosis, which was done at bentob two years ago She presented to the ER with nausea and vomiting all night long abdominal pain and her adjuvant was painful and tender depalpation During dialysis the day before she had a little chest pain her blood pressure Blood pressure was up in the 210s over 90s at that time She had recently been evaluated in this hospital for atypical chest pain just in February and had a normal stress test and normal Like many of you may I get texts with consults. This is the actual consult that I received called it into your office ESRDCED chest pain and chronically elevated troponin. So I was okay. Well, I told my fellow to go check it out Let me know what's going on So here's her labs These are old from July and this is when she came in here's your chronically elevated troponin And it's a little higher But you know a dialysis patient is hard to interpret what to make of that the CK is a little higher But it's not dramatic either the MB is a little higher, but it's not dramatic And she's denying any chest pain saying she just has abdominal pain Here's her EKG from August that was in our system really not much to speak of there and Here's the EKG at 2 a.m. When she hit the ER. She started to develop T wave inversions as you can see Kind of diffusely This is a 653 in the morning. She's developing more pronounced T wave inversions as well as ST changes But she feels fine. You saw her enzymes. She just has abdominal tenderness no chest pain I mean reproducible you touch your abdomen it hurts So the broad differential diagnosis here includes ACS Mulligan hypertension elevated troponin from that or chronically elevated troponin from vomiting Abdominal pain and and the dialysis patient who knows So what we do next to calf echo just kind of watch her Psycholar enzymes Just treat the abdominal pain and see what happens I'll get back to her and tell you what happened. So different types of ACS We're going to go through an ACS. What does that exactly mean? It's any spectrum of pathological events that leads to ischemia or myocardial injury So that of course includes STEMI meaning complete thrombosis, which leads to myocardial necrosis non-STEMI where there's partial thrombosis with myocardial necrosis and unstable angina where there's a partially included vessel, but there's not Objective necrosis yet and then some overlaps and germs in between The presentation of coronary disease in women as you well know is often different than it is in men and the media is aware of this and has been trying to promote awareness of this issue and You know when you look at the medical facts women are more likely to have unstable angina than they are STEMI in Gusto to be STEMIs were shown in 37% of the men only 27% of the women and this was confirmed in the gap with the guidelines coronary registry Baseline risk factors in women women are generally older and sicker when they present with ACS Compil compared with their male counterparts Again in the same guest of TV trial they had more diabetes more hypertension more CHF and this has been confirmed in multiple studies and registries worldwide Sicker the definition of sicker here kind of varies by age Younger women are more likely to have diabetes and CHF and stroke But as women as the eight patients age women over 70 the differences are less pronounced than they are in younger women Diabetes however appears to impact women more than than in men in one study the inner heart study looking at 27,000 patients Diabetic women were 4.3 times more likely to have an LI than women who do not have diabetes Whereas the risk is 2.7 and men There is elevated risk of coronary disease and female diabetics in multiples trials and the reason for the discrepancy here is really unclear Lifestyle factors play a role for everybody But obesity seems to play a more common a more pronounced role in women under 55 who present with acute coronary syndromes, but not so much in older women Smoking as well a stronger risk factor for MI in women than in men and Particularly in younger women with a relative risk of 7.1 versus 2.3 in men Smoking is thought to be the biggest risk factor for coronary plaque erosion Which is a common mechanism of ACS that we'll get into which is different than plaque rupture, which is what we typically think of In addition, there are psychosocial factors to be aware of depression among patients with MI Depression is more common in women than in men and this is particularly more pronounced again in younger women under 55 Who are twice as likely to have depression compared with younger men Other comorbidities including chronic kidney disease are two times more frequent in women who present with STEMI And that's associated with worse outcomes Menopause is an important risk factor with menopause. You have the loss of circulating endogenous estrogen Which is thought to have a protective mechanism and the incidence of acute MI sharply rises in women after menopause However exogenous estrogen replacement therapy as we know precipitates acute events Oral contraceptives have long been associated with the risk of venous thromboembolic events Looking at whether that influences ACS there's a 15-year Danish cohort showed that the absolute risk of MI in women on OCPs was rather low But the relative risk increased with larger doses of estrogen while it was unaffected by progestin This slide sort of summarizes a lot of the things that we've talked about includes it in terms of Issues specific to women in ACS Age depression hypertension smoking diabetes obesity chronic kidney disease all these are more common in women And then there's other specific factors pregnancy which you've heard about today And I'll talk about a little bit as a risk factor for MI particularly with spontaneous coronary dissection menopause and oral contraceptive therapy So symptoms that women present with Often a little different than with men or a view of nine studies showed that the absence of any chest pain was more common with women than in men And men are sorry women are more likely to have upper back pain neck pain arm jaw dyspnea weakness and sense of dread And again, this is you know been made it into the media and particularly online Women's health.gov has a campaign to educate women on you know Don't miss your heart attack and be aware of the symptoms that that may happen And you know facts that just women often seek long you know way longer before seeking care in heart attack situations than men do This is from CMS really which is a campaign showing a lot of different ads Really or just just pictorials on what it heart attack feels like to a woman. This one is chest pain lightheadedness or sudden dizziness Swordness of breath. I like her facial expression on this one Breaking the ad into a cold sweat nausea Left upper upper body pain Discomfort in one or both arms back shoulder neck jaw and upper part of the stomach Unusual fatigue pathophysiology As I mentioned before plaque erosion is sometimes is Seeing more often in women than it is in men as opposed to plaque rupture that we normally think around think about On ibis plaque rupture may be observed and up to a third of women who have ACS and have no angiographic stenosis at heart angiography This is a result thought to be a result of endothelial dysfunction as well as leukocyte activation and inflammation But the details of why this happens particularly why more often women is not really clear And there's been some postulation of being related to coronary spasm, which we do know is more frequent in women This is a little pictorial that just shows the same sort of principles, you know plaque rupture There's a big lipid laden core which then has a lot of inflammatory cells and there's rupture in a thrombus forms that includes the whole Lumen, there is no such lipid laden core in this plaque here where plaque erosion has occurred in a thrombus has formed That's at least partially including the lumen You heard a little bit today about Prtomatinia's coronary dissection, so I won't belabor this but it Deserves a mention in this kind of a talk where the layers of the coronary or the coronary's spontaneously separate and intramural hematoma forms and compresses the true lumen and impairs intergrade flow 70% of reported cases of SCAD as they call it are in women This is what it looks like on angiography. This is what it looks like on OCT And is often associated with other diseases that affect arterial beds such as fibromuscular dysplasia lupus Connective tissue disorders, and of course is very strongly associated with pregnancy SCAD accounts for 11% of STEMIs in women and 9% of all ACS in females under age 50 So definitely to think about in young women with ACS There's no randomized data on how to best manage these patients, stents, medical therapy, bypass, everything's been done Mortality is 1 to 5% with postpartum women or sorry peripartum women having the worst prognosis These are OCT images of the pathophysiologies. I just mentioned the plaque rupture plaque erosion and SCAD over here Takasubu, I know Dr. Costello had talked about earlier today stress related cardiomyopathy are also known as apical ballooning syndrome which is often triggered by an acute emotional stress and They a pronounced LV dysfunction, which is reversible and that accounts for up to 3% of all ACS cases And it's also more common in women And up to 6% of all ACS in postmenopausal women and may take weeks to resolve or sometimes days So evaluation and management of women pretending with acute coronary syndromes If we look at the guidelines, it all it says is it's pretty much the same as for men They should be managed with the same pharmacology as men and attention to weight or renal based doses I mean, it's all the same stuff women with high risk features should have an early invasive strategy Pregnant women it's reasonable to pursue revascularization if an ischemia guided strategy is ineffective for managing life-threatening complications in a pregnant woman So no real difference in terms of the guidelines Diagnosis troponin levels ACS and women on average tend to be lower than they are in men and Probably partially from that for that reason the ACS diagnosis is missed more often in women than it is in men Women under 60 with ACS are given an admission diagnosis other than ACS more frequently than men So it's totally missed when they come in frequently There's these new higher sensitivity troponin assays that are coming out Which may allow us to detect MI much earlier than waiting four to six hours with our current troponin assays And they may have gender cut-offs, which may help improve detection of MI and women particularly in the early hours As I mentioned earlier the women have a delay to present in presentation for ACS compared with men In the Cadillac trial there was a 2.6 hour delay to presentation for men versus three hours for women since the onset of symptoms I saw one study from Hong Kong where it was pretty marked with 53 hour delay for women compared to 15 hours for men It seems like everybody was delayed in that trial This delay of course may contribute to poor outcomes that are seen in women And you know there's many factors that may play a role here including awareness misinterpretation of symptoms which may be atypical Barriers to accessing care fear of what may happen if they do go to the doctor or go seek care and embarrassment for what they may be feeling The medications in terms of treatment now and procedures that are used are similarly effective in men as there are in women There's no sex-based differences that have really been detected all in terms of effectiveness But despite this women tend to receive fewer evidence-based medications and be less likely to have invasive interventions than men are Women are less likely to have PCI and heart cath at all in STEMI patients fear women receive reperfusion with primary PCI or Litics compared with men and this persisted after adjusting for other clinical factors Adortable needle time less than 30 minutes was only achieved in 28 percent of women Whereas 35 percent of men and door to balloon less than 90 minutes and only 39 percent of women versus about 45 percent of men Women also receive less aggressive medical therapies studies have shown there's less use of aspirin 2v3a Thenopyridines heparin beta blockers and even statins the absolute differences are frequently small, but the trend is consistently seen The benefit as I mentioned for all these therapies the oral therapies is all the same as it is in men Women do have a higher bleeding risk than men with ACS and this may be from differences in body surface area and drug Metabolism form of co-kinetics, but there's no difference in efficacy What about outcomes? Women have increased bleeding and vascular access complications compared with men Particularly younger women have a much higher risk of vascular access complications compared to men as well as higher in hospital Mortality post PCI young women have twice a two-fold greater risk of early death after MI A higher risk of 30-day readmission a higher two-year mortality Women over 70 however have improved survival and lower mortality than men do Access like complications. This is a meta analysis of a lot of trials Which all show the same thing which is that women have higher access like complications and men do Where the highest risk patients are the elderly those with low BMI chronic kidney disease and congestive heart failure An analysis of some big bleeding trials replaced to acuity and horizons Nearly 14,000 women showed major bleeding at 7.6 percent of women versus 3.8 percent of men So just being a woman increased your risk of bleeding by 80 percent and women had a higher one-year mortality 3.7 versus 2.7 percent the use of bivalorudin rather than heparin Reduce bleeding as well as mortality in the in the women who were studying these trials No talk by me would be in be complete without a radial approach plug because this is something near and dear to my heart The radial approach may decrease bleeding risk in women the safe PCI trial compared access sites in women only and It was in elective patients as well as STEMI and non STEMI patients Now in the study as a whole they terminated earlier because the overall risk of bleeding was rather small in all of the patients And there was no difference in PCI access site complication rates radial versus femoral But there was a significant decrease in bleeding or vascular complications among all cats that were done in the radial or femoral approach In the rival trial women were twice as likely to cross over to femoral meaning they couldn't complete the case Radially and had to switch the growing approach. There was a higher incidence of encountering radial spasm The rate of PCI was equally successful Major vascular complications in general was higher in women, but was reduced in the radial approach Where the number needed number of radials needed to treat a complication in women was 33 versus 49 in men If you look at data from the large national database the ncdr The same trends are seen women are twice as Risk twice as much risk of having a vascular complications with a diagnostic or a PCI Vascular complications are a strong predictor of mace including a 75% higher risk of death and am I in a stroke and By the same, you know as I said before women were less likely to undergo radial procedures compared to men Smaller arteries smaller body size increased tortuosity. Those may all be factors Bleeding post PCI was higher in women than men using bleeding avoidance strategies did reduce the absolute risk of bleeding and With the highest risk being in using radial and bivalor and and that produced the greatest production and bleeding risk in women. I Worryed about women in clinical trials The FDA has Been aware that the women are underrepresented in trials and have a campaign also which you can find online Trying to recruit women to participate in clinical trials Early major trials didn't really include many women at all and they were need not even any subgroup analysis by sex So in the early 90s the NIH and FDA had a mandate to include women in more trials So if you try to look at how that works in the years before that from 1966 to 1990 Women were 20% of ACS trials whereas after that 1991 to 2000 it was 25% So I guess that's better But it's not exactly representative because over that time period women accounted for 43% of ACS patients Who presented so you know despite these efforts women are still underrepresented and it's not really clear why? In all of these mixed-sex trials particularly with ACS You know maybe there's been postulation about concerns of safety for women of child brain potential who are pregnant etc But that doesn't really explain the absence of older women in the trials People have pointed to general unwillingness of women to volunteer or higher tendency to withdraw But that hasn't been seen in hypertension trials or in single-sex trials So it's not really clear what are the barriers to enrollment of women in these situations So in summary women and men present with similar symptoms in many cases though at different rates and Women often have alternative mechanisms such as SCAD, vasospasm, plaque erosion in addition to plaque rupture that is usually seen in men Women tend to receive less aggressive invasive and pharmacologic care than men despite similar efficacy Sex-related outcomes vary by age and young women have a worse short and long-term outcomes in young men But older women have similar outcomes to older men and Representation of women in clinical trials needs the increase in order to understand these sex-related differences And so I think that the take-home is we have to have kind of a heightened suspicion for ACS when women come in with atypical chest pain Then we do in men because a lot of these patients are being missed So getting back to the initial patient that I had shown you here's her next proponent It's actually coming down from 1.66 to 1.24 her CKs are not that exciting and her MBs a little higher But again, nothing nothing that dramatic It's four o'clock now and here's her EKG at this point. Remember, you know started out looking Similar to this but but not quite as dramatically. So so again, what do we do a cart calf echo just kind of watch her what I did is I ordered an echo and you can see here that there is a I don't know if it projects well up there as it does on my screen But you know the whole answer wall on apex do not appear to be moving too well The base is kind of hyper kinetic similar to on the two-chamber view see similar findings So this is another Takasubo case which had a lot of confounders But she's a coronary patient with prior bypass and stenting and she's elderly on dialysis and wasn't a typical patient you might think of for Takasubo and Here's the UKG the next morning her EKGs are just amazing I Felt like I needed to catheter anyway, even though I was pretty certain of the diagnosis because she does have a Lima with a stent in it and you know this, you know, I thought it was probably the right thing to do You know, I thought it was probably the right thing to do So the first thing I did was an LV angiogram and this is 48 hours after presentation and she's already better So the whole apical Stunning that was present 48 hours ago has already resolved And her coronaries were fine This over here is the Lima with the stent in it the right coronary and here you can see the sirk circulation Her coronaries were fine. So just sort of highlighting some of the issues we talked about. Thank you


All right. Hi everyone. I actually just renamed it Interactivity. I like the Interactivity also but it depends on the context. Who are you talking to? And today I'm going to talk a bit more about the hardware side of my interaction with artists. I'm not an artist myself but I like playing with them and helping them if I can. The way I'm going to talk about it is kind of geographic as I was saying. I grew up in France, traveled a little bit in different parts of the world. So quickly I go through Europe, South America, the US, and Asia. Normally I would give a quick background about myself but basically I've been playing with music for a while. I gave up school for that. Then I went back and I kind of learned a lot of cool things to do with sound and technology. And obviously there's a lot of equivalence in other media like videos. So I start with Europe. My final degree was a remotely controlled segue. So it's not very artistic if you think about it but it gives a point of view of how technical I was trying to get at the time. Kind of taking another path maybe now. So just to show you because it's funny. Very quickly. I'm sorry. So you can remotely control the thing and just enjoy it. So you can see she's not very confident. It's the first time she's taking it and it kind of works. Well I just keep quickly. Well that's a remote. Whatever. Just to show a little bit of some of the tech. Then in my same degree I was also honoured to make a little scholar project that was in partnership with the museum. There's this artist who makes this real-size rhinoceros. The idea was to give some interactivity for the visitor in the museum because this rhinoceros can actually open its furniture. It has a table and everything you could store things. And basically in the museum you could not really feel how powerful how all the cool things you could do with it. So I offered that project and it was accepted. The technique is using a kinect. You can see up there. And when you get in the middle it shows you different points of view. When you get in the side it shows you other points of view. And finally on the right side also. And if you try to touch it then that's actually the sound of a rhinoceros. When they are attacking another one they do this word sound. The idea was that at this era of digital everything when you want to touch things we have other ways of helping people in their curiosity. And I thought that would be a cool way of playing with kinect. That was a few years ago. So in general this talk is about showing what I did and if any of you is interested in doing something similar or using some of this I'll have everything on github. I'm happy to share. I'm happy to explain it. Another project I did after I graduated was a musical controller. So you carry this thing very beautiful on your body and it's actually four pads. So you can see this is one and so on. And you can hit them.  There's like the kind of Arduino called TINSI, a wireless module and that's the receiver. We're here. And it behaves as a midi instrument. That's amazingly simple to use. If ever one of you wants to play with music that's pretty cool. So little demo. So that was just showing one pad. So he's kind of bit boxing but with his body. So body boxing or bit body, I don't know how you call it. We called it body ar drum but the sound, the acronym was bad. So we called it tap me. It's bad. Another project using the energy of the visitor or the user. This one is a cycle kind of augmented reality bicycle on which you pedal and generate energy to video project whatever you want. And so we use a motor from a washing machine and basically the energy that you generate is enough to power a video projector computer for variable speed video. And that's a very simple first test also. So the video projector is inside of a track. The thing was totally mobile and autonomous electrically. So we video project by the background and on the side you have people bicycling and it shows them another point of view of where you could be and the faster you go the faster the video goes. So you feel like you are actually traveling in that. As you can see an amazing videographer. So then I went to Columbia. Got to work with interesting artist. She's a photographer and she weaves pictures. So it's not that obvious but if you take twice the same picture and you cut it vertically for one and cut it horizontally for the other then you weave them. You get this interesting shape that I was frustrated because I didn't really understand it. So I suggested to make it physical like mobile and I found that this analogy of the hologram was interesting. So basically if you if you move with there's a sensor that detects your position and if you get closer you have a bit like in this old school hologram. The points of view or the piece of art itself changes a bit like if you were a VIP visiting the artist while he's doing it. So this is the the actual picture moving physically. It's not a photoshop thing or video and so you can see the vertical stripes are moving vertically. So this is a sonar sensor, an Arduino and a simple motor with a servo. Then I got to play with a group friends called Systema Solar. They do a lot of amazing shows in Colombia and they travel a little bit and there was this kind of frustration on the DJ. To me there was not enough visualization of what he was doing. You hear it, it's amazing but you don't really understand what he's doing. So I played with a vinyl kind of virtual scratch system it's called Serato. The vinyl has a timecode. You can listen to it with an Arduino and analyze the signal.  So you can see the this thing is just eight LEDs that are rotating at the speed of the vinyl. So just a proof of concept once again. If the vinyl goes backward you can see it on the on the LED and if it goes slowly you can also see. Just a way of visualizing things. Then I went to San Francisco, worked for this company called SIFTO. They make these touch screen based cubes that can detect each other and they also have an accelerometer. With my musical background I had this first idea of controlling music with it. Sadly I lost the video I have it there in San Francisco but not here. But basically each of the cube can for example control a track. It can control an effect, it can control the volume and it can also enable for example the recording mode depending on what software you play with. I got to play with another kind of interactive system. These cubes they can emit sound. They talk to a bass that has a speaker and there was this frustration again that you cannot communicate with the phone. So I worked with this application that can detect DTMF. It's the old school tonal system that you would have when you call someone like this. And you're going to hear it. So you see I had ABC in the cubes and here you can see ABC was transmitted just by the sound. So very simple proof of concept again. And if you have CAB, it just does CAB.  Then I worked with guys I made in the hacker space called Noisebridge in San Francisco on this project called Pulse of the City. This artist there was frustrated again. Everything is about frustration and how to solve that. She was frustrated by these coin machines on which you pay. It's the park meter. You put coins and you can pay for your car and it's kind of ugly and it's everywhere. He wanted to give it some love on some more aesthetical part and bring some smile. So we put a Raspberry Pi, an Arduino, the usual suspect, battery, 3G module, USB or whatever. And the idea was to allow people who walk by, just to pass by, hold the handles and make music at the speed of their heartbeat. So the video is actually not really obvious. So that was in Boston, but there was also one in San Francisco. That's the mayor, as you can see. Very serious. And the artist. Once again, if you want to play with variable speed, sound or music or video or whatever, this is pretty simple. I have that on GitHub. I can show you. Then I went to this festival called Burning Man with the Noisebridge gang. There's a lot of amazing art installations. It's the biggest art gallery in the world. It's uncurrated. You can go put your thing. Everyone sees it. There's like 68,000 in the last time when I went. I think it's even bigger every year. So this was a set of installations, a couple of mushrooms that throw flames to that are interacting with lights. So that's probably the most impressive. But basically the one I was working on was this mushroom that makes sounds. When you get closer, it's breathing with a kind of stressful way. The closer you get, the faster it's breathing. And if you want to calm in down, you just hug it. There's a little pressure sensor that I made with a fabric that has carbon inside. And if you put that in sandwich with conductive fabric, you can measure the pressure. So infrared sensors to measure the distance of people around and pressure sensors that were made with fabric. You could buy something already made, but it would not be big enough. So we made our own. Pretty simple. Then I came to this hacker trip to China with this guy called Mitch Altman. If you know him, you can recognize the haircut. We got to visit a few interesting places. There's this Tsinghua University that was organizing a visit from different hackers from all over the world. If you're interested, they are actually organizing the next occurrence for October. It's open. Anyone can go.  I'll give you the link if you're interested.  And that's like a two week period in Tsinghua, Beijing, and two week in Tsinghua, Shenzhen. That's how we were invited. And then they show us around factories and we get to see all the tricks that they have and get to present our projects. You can recognize the hat. But yeah, I'll talk about hardware a little more in depth if you're interested afterwards. But yeah, that's a really interesting thing to get to. Not only see how factories are, but a lot of really cool hackers facing in China and how people see that over there. It's quite different. Then I lost something here that was written grow well. So I arrived in Singapore and I got to spend some time in this place called grow well. That actually just shut down. Maybe not shut down, but ends the pop-up last Saturday. But they play with growing things and go to experiment like some of these sensors to see how you could have an automatic watering system or how you could monitor mice to try to understand how they behave in face of your traps that usually don't work. If you're interested by that, it's really a not project how to catch mice. Then I got to meet Jacqueline at the end and George actually met him in Hong Kong and then he came here and understood that this place is actually where it's happening. So we will see how this collaboration go, but maybe we'll get to do an interesting project that involves fire and dancing. She might be the dancer, we'll see. And now I'm working on this wireless motion sensor that I call TWIS for tangible wireless IMUs. IMU meaning inertial measurement unit. The idea is to measure either object motion or your own motion or your cat or your mice motion. But it's the sensor itself that is moving to measure its own motion. I feel like there's something interesting if you want to play with motion of things. But to explain how we came up to this idea that I'm going to show a little afterward, this is basically what my startup in France does. We make these big multi-touch screens that also can be used to control music, but not only. In this case we have objects that are recognized by the table and they have all a unique identifier and they all can control a different filter, effect, volume or just on-off for a track by rotating them because we also measure the orientation of it. So you might be familiar with the reactable. This is an open source equivalent. So that's my lab in Paris. This guy is the guy who invented that open source. He developed that open source version and we just kidnapped him to have that thing with us. So we have that in Python now, but it's originally in C sharp I think. So we've got this frustration of the two-dimensional aspect of the table. You cannot interact when you take the object outside. So we thought let's just play with the common thing that you would use like an Arduino motion sensor and a wireless module. The problem is that the antenna is not really happy with metal in front of it. The magnetic sensor doesn't like metal also. So we had these interferences problem and it was too big and we made a smaller one. So I actually have it in my pocket if you want to maybe pass it. So I can do a quick demo with my phone and show you in video also. I have a problem with the Bluetooth in my computer right now, but I have a Python app that does the same in the computer normally, but it actually crashes in my computer right now. This is still a prototype. All of it is open source, the hardware, the firmware and the software. So if you are interested in measuring the orientation of things or how it's moving, it's actually sending the accelerometer data for the three-dimension of it and the orientation of the object itself. So you have the north and south but you can also rotate and the idea is to forward it using the protocol called OSC. So you can control visualization, motors, sound, flames. That's what I want to do, my little fantasy and maybe parent something. So that's a little demo we did with one of our big tables. So it's just controlling a 3D model of a clock, of a watch. So just the rotation, how you tilt it. And I went to this hackathon in San Francisco with friends from CIFTO. We did a little musical controller just as a proof of concept in 24 hours. The idea is that there's this analogy between sound and color, hot sound, hot color that can be used to maybe teach kids the simplest way of understanding music. So we have this kind of musical writing system. So each color is virtually a sound and you have a feedback on the object itself. So inside of the object, you have inside of the egg, you have this sensor that I was showing you and that's what happens.  So we won the hackathon and we'll see what's the next step. So thank you for listening. If you're interested in any of the project I made and want to play with it, you go on my www.honet.eu, my website. The slides are here. It's good. We can put it online. Let's do it.


What ever happened to you? You get to be the teacher You're not the man the paper for Leave me and give me


Welcome to Access to Trader, the number one community for those who are committed to taking control of their trading in order to achieve success, profitability, and longevity. Thank you for joining us. Here's Dan Shapiro to help you find your edge, master your process, and own your future. Hey guys, good evening everybody. Welcome to another edition of theAxisToTrader.com nightly wrap up show. I hope everybody is doing well. So let's talk about the numbers towards the end of the day. Nothing earth shattering one way or another. You have pretty flat day across the board. All the indexes taking very, very modest losses on the day. Again, you can't even say the word modest without even chuckling. The market's been on an absolute terror, especially the Qs. Ever since they reclaimed the 50 day moving average, the morning was very, very aggressive. We'll get to the individual pivots in a second, but this is good. This is exactly what you want.  Because what's going to wind up happening, all those people are talking about the market's overbought, the market's overbought. Eventually we'll get overbought and you don't want that. You want the slow, lethargic build. You have three days of upside, one day down, one day sideways, rinse, repeat, rinse, repeat. Because that's the slow grind. That's exactly what you need. If you get one of those situations, then the NASA goes up 100 points every day, every day, every day.  I'm good. I'm good. And if people who are not participating on the long side say they're good, the biggest permable bulls in the world turn around and go, this is too far, too fast, then you're going to have an aggressive back this. We don't want that. We want that organic resday. That's the most aggressive bulls statement you could possibly have. Again, last week, the two biggest ones were Microsoft, right? Microsoft guided pretty much crappy numbers. Miss the top, miss the bottom line, big rally. Google did exactly the same thing. Not as big as rally as Microsoft, but still you can see a lot of bulls in the world. You can see a lot of bulls in the world. You can see a lot of bulls in the world. Big rally. Google did exactly the same thing. Not as big as rally as Microsoft, but still you can see a move from Google from 104 all the way up to nearly 116. And today it was no different. You had Pinterest, right? You had Pinterest come out. My wife loves Pinterest. If you guys don't know, Pinterest is like one of these sites. It's great for like decorators and stuff like that to get ideas for your house and stuff. So my wife is constantly on that site. Really, really cool site. Again, I don't know anything about the business model, but the point is, you know, they didn't exactly paint a rosy guidance rosy. Well, not guidance, but a rosy financial outlook and the stock is up 20% after the close. And that's again, that is the most important part is when you're talking about bull market, bull market and getting clues of what a bull market looks like. This is it, right? This is absolutely it right here. This is Microsoft. This is Google. This is Pinterest. Even, you know, even the DREC, right? The DREC of the world, Roku, right? Roku, you know, Roku had a big snapback day today. Granted, it was down 25% on Friday. But the point is that they're taking back even the garbage names. Even Metta was up, you know, a latte at a certain point before he gave up. So yeah, we're getting really, really good bull market action. You know, is this getting a little bit, a little bit tiring? Okay, you can make that case, right? A little bit tight, but again, it doesn't mean the market is a short. It means that, hey, don't get long at the top of the range. Or if you are trading stocks that look very, very good, watch for the option flow. Like again, we talked about in the video over the weekend update, right? You know, you look for stocks that are coming deep, deep tight into the range, right? In the video, we talked about over the weekend square, right? We talked about square over the weekend. We talked about, what was it? What was the other one? Airbnb, right? We talked about Airbnb. Look for charts like this, you know, super duper tight charts in case they do fail, right?  But again, if you look at some of the names, you know, getting a little tired. Again, I personally think it would be a lot healthier if we can rest the next two days on the indexes. Again, if you look at the queues, you know, you can see here, you know, big, big run, especially from the lows from four days ago. You had to run literally from 293 all the way to 319. That's a big, big run. I think it needs a couple of days just to rest. Will it? God knows. Who knows? But I think it needs it. Even a name like Amazon, even a name like Amazon had a really strong quarter, had a big, big run, right? Really, really big run. And you know, kind of just faded, it kind of faded off the top of the supply here that it hit back to back days. Even Tesla, what are you going to say, right? What possible are you going to turn around and say, oh man, Tesla, Tesla, bearish? It just needs a couple of days worth of rest. You can see here today, it kind of, the last time, and again, this is where we talk about repetition, right? The last time Tesla put in an inverted hammer, right? You see the same thing, right? Inverted hammer here, inverted hammer today, right? The last time Tesla put in an inverted hammer and had a couple of days of back-testing obviously exploded. Well, we had an inverted hammer today as well. Again, does that mean this is the top for Tesla? And we're talking about Tesla's going to the 500 tomorrow? No, it's just, again, it needs a rest. The stock just in the last four days, right? The last four days has gone from 776 to 935. It just needs a rest. Ideally, and again, I'm going to watch this thing for the next couple of days for a possible back-side move just to get some flow, right? Just to get a little bit of flow to the downside. But ultimately what we want to see for the next couple of days, you know, is kind of drift a little bit lower. And you see this rising five-day, right? This is kind of where we want to get long the next time around. Again, anybody who's buying it up here, man, what are you doing? The stock has gone up 150 points in the last four days. Like why do you need to be long today, right? You had your opportunities here and here and the earnings high and the earnings high continuation. What are you doing up here, right? It's going to thousands. It's not going to thousands tomorrow. So, yeah, I think that's basically what it is. I think a lot of stocks do look tired. Even the names, you know, even the names that had really good earnings like Etsy, it hasn't even put in its second run yet, right? And that's the whole point. You know, a lot of these names are just kind of taking their time. And that's good. The longer they continue to build, especially the indexes above the 50-day moving average, of course you're going to be bi-biased. But certain days you're going to turn around and be like, I don't know how good the aggression is going to be. Again, maybe we get surprised tomorrow, right? Maybe something that we sent an alert for three weeks from, you know, three weeks ago kind of wakes up. But I wouldn't be surprised, okay? If we had kind of a lethargic day tomorrow, you know, I think there's some pretty decent value out there, especially, again, like if Tesla starts kind of a back test, obviously there's a lot of room to the downside. Again, no harm, no alarm.  But there are some names if you look for tomorrow's session, you know, there's some value, right? Like, look at a name like Workday. A lot of people are not going to really pay attention to a Workday. But again, look how tight this ranges, right? All it's doing is getting rejected off the supply. If Workday could just get above the supply, who knows? Maybe this thing could wake up. Square that broke out today, right? First close above the supply. Maybe it has a follow-through day. So again, that's kind of the charts that I'm watching for tomorrow. Let me give you guys a couple more. Let me give you guys a couple more on the long side to look interesting. Shopify had a whole bunch of $40 calls coming in for today. I still think it might be a day or two away. But just in case, again, same similarities, right? If you see last time the stock traded right into this daily supply, right? The next day confirmed, you know, had a $4, $5 run. Well, you know, I'm kind of watching the same channel here. Maybe Shopify wakes up tomorrow and puts in a repeat performance. I don't know. Again, I don't have a lot of enthusiasm tomorrow either way. The only one I'm looking for a back test tomorrow is Tesla. Maybe tomorrow, maybe the next day. But again, Tesla needs to breathe. I think we're all in agreement for Tesla to run to 1,000, to 1,100, to 15,000, whatever the hell, or the moon, right, whatever comes first. It needs a little bit of a back test first. Again, kind of case in point. Last time Tesla rested, right, was rested for three days, reclaimed the five-day moving average and went. Here's the inverted hammer. Here's the inverted hammer. So do we get a second performance of that inverted hammer like we saw the first time? Right, we'll see. Right, we'll see. But we're obviously prepared on both sides. So let's talk about the pivots today. Very aggressive early day. Again, NVIDIA was definitely our focal point. They were coming for really aggressive calls today. They were coming for the 85 weeklies, the 87 and a half weeklies, the 190 weeklies. Again, here's the move. Beautiful move right to 89. 82 and a half, 183 needs a new base for continuation from Friday's break. Here was NVIDIA. This was the only one that you really, really needed today. Really nice move today. Perfect move, right? So here's the 82, 82 and a half, 183 traded right to supply just a little bit shy of 189. Just a phenomenal move, really, really good move, especially it was very aggressive. Google were waiting for that 1675 new base to confirm. Google traded up to 1672 today, so still watching that. I was watching Meta to the downside. Obviously they never got there. It exploded back up. Airbnb, nice move today. 111.16 needs a new base for continuation from Friday's break. We're getting reports tomorrow. Not only does Airbnb report tomorrow. You got some big ones on tap, right? You got tomorrow. Let's see here. You got tomorrow. Today is not really a lot. Pinterest, you got ATVI. Tomorrow, you got AMD. You got PayPal. You got Starbucks, Uber, Gilead, Airbnb, Caterpillar, Occidental Petroleum, Sirepta. So you got some pretty decent names for tomorrow's session. But Airbnb, nice move here. 111.16 needs to build. I thought it could get to 1350. It got to 14. Nice move there. Amazon and Apple, we talked about this on the weekend update. Again, red to green moves on both of them were pretty strong. Amazon ran up about $2. And again, it doesn't sound like a lot, but keep this in mind. It's post splits. It's $2. It's like the equivalent of 40. So again, it's so liquid right now. You can take some pretty good liquidity on there as well. Apple did the same thing, both to the upside. Square, 76.44 needs to build. Again, we covered that on the weekend video, I believe. If not, I apologize. But anyway, here's a 76.44 traded all the way up to 79. Listen, this thing gets above 79 and starts building. I think it has more upside. Snow, again, another one. 150 needs to build on snow. Here was snow. Again, you had a lot of really strong movers in the morning. Here's the 150. Went to almost 154. I got to check what earnings are. Again, take on the way up. On Amazon, take on the way up. 137.40 is supply traded to like 38.39. Square, 78.30 supply. Went to 79. Snow, 152 on deck. Went almost 154. And that's about it. So that's it. That's it. Listen, not every single day you need this massive, massive game plan. Sometimes you need, it's like a bottle of wine. You ever hear that expression? You kind of need to have the wine breathe. You need the market to breathe a little bit. Listen, is it possible we continue this move to the outside? Yeah, of course it's possible. Again, the longer we stay above the 50-day moving average, the higher probability every single day we'll go higher. And the probability of more shorts will get trapped into weakness. But again, at the same time, I'm not naive. I understand that number one, gravity is real. And the last thing you want to do is keep on pushing and pushing and pushing.  So that's it. That's kind of the game plan going into tomorrow. We're watching Tesla. There's two sides that I'm watching. But I want to see if it could kind of gas out tomorrow and put in a lower high. Just again, just for a trade to the downside. Again, it doesn't necessarily even have to be for tomorrow. But again, at some point, gravity does kick in and a backside move does come. We'll see if we could pay attention to it and see if we could identify a channel back to the downside. So that's it, guys. Have a great, great, great evening tomorrow, guys. Have a great trading session tomorrow. I'll see you in tomorrow's video. And with God's help, we'll all be there together. Take care, guys. Have a great, great night.


During the years 1971 through 1991, the Mine Safety and Health Administration, MSHA, has documented 277 lives saved by the use of canopies of mining equipment and underground coal mines. MSHA believes that there have been additional saves but not documented. MSHA made an effort to document saves before the 1988 Roof and Rib Regulations were promulgated. Ronnie was operating a scoop, cleaning debris in a return air course which required timbers to be removed. When he dislodged some of the timbers, the mine roof dropped to a four-feet thick, fell and trapped him for approximately 20 minutes. We've asked Ronnie to tell us his story. Well, I was operating a scoop. Larry Lindsey and John Hoblin was operating a pinner. And I would scoop on one side and clean up a few feet and then I would go around and they would come in where I was at and I'd go on the other side and start cleaning back towards them. And my scoop got low and I told them that pull up and stop them, talking to them, told them that I was going to go put my scoop on charge. And we sat there and talked for about three to five minutes about the rough conditions and asked them how it was drilling and everything. And I started to scoop up and got me another load of gobb to take with me on the way down. When I put it in reverse and turned the back light on and started backing up and when I turned around it just failed. I was listening for Larry and John to holler because I know they would be hollering and I was wanting to get make sure that that they was all right. I mean to where they seen me or the rock get and get them. I didn't know whether the rock had fell on them or not or nothing. And they was hollering from where they was at and I couldn't hear them. So they had to run around about 11 breaks to get to where I was at because we had other rock falls that was working around. And when Larry got to the corner he hollered and asked, was it all right? And I said yes, I answered him. And then I knew that they was all right. Ronnie, what was some of your first thoughts right after the roof failed? Well, my main concern was the canopy going to hold it up because we had talked about it several times, different ones of his head on how stout they really was. And I seen real quick that it was plenty stout. What did you all have any communications? Yeah, he hollered and asked if I was all right and I told him yes, I was fine. And he hollered back at John, told him to go get some call for some help. And John ran to the phone and called and Larry started removing some of the rocks so I could get out. Did he was kind of happy to see you? Yeah, we were both pretty happy to see each other. Did he make any comments?  And I told him, I'd almost let you. So what started out to be a bad day turned out to be a good one, didn't it? Actors all over and done. What kind of advice would you have to fellow coal miners out in the coalfield who some of them still prefer to run equipment without canopies? Would you have any advice to them? Yes, sir. If they was knocking any timbers or anything supporting the roof, I would advise them to have a canopy.  I have four children, wife and four children. I got a daughter, it's 23, I got a son that's 20, got two twin daughters, it's 11. I guess it all happens so you get home safely, wasn't it? Yeah. Ronnie, I noticed you got a beautiful farm and you're building a new home. Do you think all this would be possible without that canopy? No. If it hadn't been for the canopy, I don't think I'd have been here today. I know I wouldn't have been here today.