There we go. So welcome to our first speaker of the 9th Virtual International Day of the Midwife. Our keynote speaker this morning is Mary Renfrew. Mary is the Professor of Mothers and Infant Health at the University of Dundee. She has been a health researcher and midwife for over 30 years after qualifying from Edinburgh University. Currently, Mary is a member of two WHO advisory boards, a board member of UNICEF UK, and is leading the work to review the midwifery standards for nursing and midwifery council. In 2014, Mary was elected as a Fellows of the Royal Society of Edinburgh. Welcome Mary. Thank you Sarah and hello everyone. Good morning, good afternoon, good evening and good night. Wherever you are in the world, we I think are all around the 24 hour clock. So it's brilliant to have you here listening and participating. It's a real honor to be talking to this conference. It's fantastic. It's the International Day of the Midwife 2017. Happy IDM 17 and thank you very much for the invitation to talk to you. We're going to be talking about a really important topic today, rebalancing care and transforming lives and that is what midwives do every day of the year around the world in every country. Before I start talking, I'll just draw your attention to the Twitter names down at the bottom of my slide there. If you do want to tweet, that's great. That's my own Twitter at Mary Renfrew, but you'll also find I'm good to talk about the Lancet Midwifery series and that Twitter is at Midwifery Action and the hashtag is Lancet Midwifery and I think if I'm right, Sarah, the hashtag for the whole conference is hashtag VIBM 17 if you want to tweet. So this slide here shows you the summary, if you like, of the Lancet series on Midwifery which was published in 2014 and it says Midwifery is a vital solution to the challenges of providing high quality maternal and newborn care for all women and all infants in all countries and that proudly went on the cover of the Lancet which is the highest profile medical and health journal in the world with their full support and it has had such an impact across the world and I'm going to be talking a bit about that tonight but I think we should all feel proud on this international day of the midwife that we can say with evidence and with total confidence that Midwifery is a vital solution for all women and infants in all countries. I'm going to talk, set the scene a little bit, look at national and global challenges and talk about how Midwifery is I think a bit of the crossroads right now and I'll explain that. Then I'm going to talk about the Lancet series on Midwifery and some of the key messages and then talk a little bit about Midwifery and how it rebalances care and transforms lives. My session tonight fits right in with the key theme of the international day of the midwife this year which is partnership. It's midwives, mothers and families, partners for life and partnership is such a huge part of what we all do whether that's partnering with women themselves, partnering with other midwives with other professionals or with organizations in all sorts of ways. So let's start by looking at the global challenges. Many of you work in many, many different countries and you work in very different settings from each other but actually across the world we're still seeing over 300,000 women dying as a result of pregnancy and childbirth across the world. That's more than 800 women every single day. It's unacceptably high and still a major challenge for all of us. As well as that, about 2.6 million women will encounter stillbirths. There'll be 2.9 million neonatal deaths and of course many, many more women with serious morbidity and ongoing harm after that. And the sustainable development goals, particularly sustainable development goal 3 is really challenging us to tackle that and midwives really are at the front line of bringing in several of the sustainable development goals and particularly the one on happy and healthy lives. But those are not the only global challenges. It's not just about lives that need to be saved. It's also, as you know, about lives that need to be lived. About 138 million women and 136 million babies survive birth every year. It's not just about survival and death. It's about what happens after those babies are born. And what we find looking at the evidence, looking at the literature, looking at what people write about organizing maternal and newborn care is that often those longer term and psychosocial outcomes are overlooked, the attachment, the formation of families, how you become a mother. There's also unsustainably high rates of unnecessary interventions, caesarean sections of physiotomies and so on, inductions that are unnecessary. They're life-saving interventions when they're needed, but very, very high levels in many, many countries of interventions that are not needed. We see growing inequalities in outcomes and care more affluent women often get better care paradoxically than women living in more deprived circumstances. And care and compassion are often seen as less important and yet they're integral to system failures when things go wrong. It's often the failure of care and compassion either for women themselves or often between staff. And it's breakdown of communication and compassion between staff that actually cause problems. We also see sadly high levels of disrespect and abuse of women and children in the health system and there are now many, many accounts of that as we become more and more aware of that across the world. And often we have a disconnect between the evidence that's telling us what to do and the policy and the practice that actually makes that happen. Midwifery itself, it's essential, we know it's absolutely fundamentally important for women and children, but it's often contested and I'm going to talk about that a little bit later. What do I mean by midwifery at the crossroads? Here we are in 2017 and there's a whole lot of different trends and developments across the world, whether that's in world politics or whether that's in economics and particularly in the world of maternal and newborn health where both economics and politics has a huge effect. There are some really important things happening and I've put some of them on this slide. You may know about the global strategy for women's, children's and adolescents' health and I'm coming back to it towards the end of the talk and its strap line is survive, thrive and transform. It's a real challenge to the world to tackle the big problems for women and children but not just see them as problems, see them as opportunities for transforming society. There's a strategy for every newborn to end newborn deaths. The strategy is towards ending preventable maternal mortality that are global and involve all sorts of different organizations working together and we know a lot more about midwifery now than we used to. The 2014 report on the state of the world's midwifery for example gives lots of details about midwifery across the world and that graph in the middle is part of our opportunity, our risk and our choice. That is the trends in Caesarean section rates just in developed countries, the high income countries across the world back over the last 25 years and what you see there is a steady, steady growth, a relentless growth in Caesarean sections. Some of those will be life-saving, many of those will be unnecessary and we're actually seeing that trend in middle and low income countries as well in some parts of the world as systems develop. So we have lots of challenges, we also have lots of opportunities and it's those opportunities that I really want to talk about tonight. But also one of the things that happens when people start to talk about quality of care and I'm sure this will have happened to you in your own countries. Once you start talking about the quality of care that women and children need sometimes people just disagree. Some people stress how we have to save lives whereas others talk about health and well-being. Some people are focused on women's health whereas others are focused on children. Some people talk about the need for essential interventions and others are talking about a discourse of normality and care. Some people think that it's all about the birth and they focus on the birth, others look more at the continuum and then we've got the language of high risk versus low risk, safety versus choice. There's all sorts of decisions and choices and different ways of looking at high quality maternal and newborn care. In the middle of all of this, there's midwifery, midwifery which cares both for women and children, midwifery that cares both for women who are having very straightforward pregnancies and births and also those who are having lots of complications. Right in the middle of the page, it's essential but actually it's contested and sometimes it's even rendered invisible. When we read some of the evidence and the research around midwifery and its impact, we find it's not even mentioned and we found indeed in one of the previous Lancet series on maternal health that midwifery was called obstetrics and was rendered therefore completely invisible. It's also often contentious and contested. This recent report from the World Health Organization surveyed midwife's own stories, their own voices, their own realities of the lives they lived at the moment and they found high levels of problems, harassment at work, not being treated with respect, not having the financial support they need to exist and many, many of them being exhausted and these were midwives across the world living in different circumstances. Now this report is a very important one and it's called to people's attention what's going on for midwives worldwide and there is a film that's been done by Fran McConville, the lead midwife at the World Health Organization that will be on the Facebook page for this conference and is currently on the WHO website and it talks a bit more about this report as well as talking about this event and the International Day of the Midwife itself. Right at the heart of these problems for midwives this survey found were issues of gender inequality and disempowerment and it's not just the women that midwives care for who tackle those who have to live with those problems, it's midwives themselves as well. So what can we do to help decision makers? What can we do to change this situation? And what light can we bring in using evidence around what should happen around the world? Back a few years ago a number of organizations got together, the World Health Organization, UNFPA, the Gates Foundation, the International Confederation of Midwives and the Lancet and they decided to inform international decision making by having a Lancet series on midwifery. It was truly, truly exciting and exciting development. And as that group talked and talked with some of us about doing this, we became really clear that the most important way to look at the evidence and to look for the evidence was to start by putting women and children right in the middle of the page. And I'm coming back to that because it's a really key issue all the way through the rest of my talk. So what is the Lancet series on midwifery? Many of you will have seen it. For those of you who haven't, it's a series of five papers, four of them published in 2014, that looked at quality care in various different ways. I'm going to talk a lot tonight about paper one around midwifery and quality care where we define midwifery and looked at the impact that midwifery could have, a huge impact. The second paper looked at the scale of that impact on survival and mortality, particularly in low income countries. The third paper looked at different countries' experiences of strengthening midwifery and tackling mortality. The fourth paper looked at how we actually improve, what can we do to change health systems to bring in midwifery to increase the numbers of midwives and the quality of care provided. And the fifth paper just published a few months ago is a research agenda that is really, really important for funders to look at about how we ask different questions to improve our evidence. And thanks, Sarah. She's just put up the link to the whole series. You can read the papers, they're completely free. You have to register on the site, but reading the papers can be downloaded free. The series was put together by all of these authors. I'm not going to stop very long on this slide, but just to say these fantastic authors, about 50 of them from five continents, midwives, researchers, obstetricians, pediatricians, economists, epidemiologists, all got together and shared views, shared experiences and shared talents to really do this job. Very multidisciplinary, lots of partnership. The biggest question we had to start with, surprisingly, was what is midwifery? And the reason we had to do this was we found that different people from different settings, from different backgrounds, all had different views on what midwifery was, what midwives do. From country to country, midwives actually are allowed to do different things. In some countries, their scope of practice is very limited. In others, there actually are no midwives. And in countries where there are midwives and those midwives are strong and able to do their work, even there, their practice can vary. So it was quite important when we were looking at the evidence to work out what we meant by midwifery, just look at the work of midwives, because the scope of practice was so varied. So we set out to do that and we agreed, first of all, we had to start with women and babies when we were thinking about what they needed, what did they need from midwifery? Then we thought, so what we have to do is we have to build around them a health service that really works for them. And then we thought, so inside this health service, we put lots of different things because women and babies need all of these different things sometimes. They may not need very many of them. They may have lots of complications and need lots of those. Then we looked again at that diagram and we thought, you know, that's not right. There's something about midwifery that's different. And we moved midwifery there, wrapped around every woman and every baby and that felt a lot better because actually all women and all babies need midwifery and some of them need those other things as well. But if they have that midwifery wrapped right around them, then they can access those other services as and when they need and they'll have someone to help them do that. And we thought, so that looks a bit lonely now. And actually that is midwifery. That's a visual image of the words that we then put on the page. And these are the words that we put on the page about midwifery. Skilled, knowledgeable and compassionate care for childbearing women, newborn infants and families across the continuum from pre-pregnancy, pregnancy, birth, postpartum and the early weeks of life. Core characteristics of midwifery include optimizing normal, biological, psychological, social and cultural processes of reproduction and early life, timely prevention and management of complications, consultation with and referral to other services, respecting women's individual circumstances and views and working in partnership with women to strengthen women's own capabilities to care for themselves and their families. We've had really positive feedback about this definition, but of course I'm really keen always to know what people think. And if this reflects the work that you do, so please, comments in the chat box would be really, really welcome. What we then had to do was basing ourselves on this work. We then had to go and examine all the evidence, which we did. And we built out of that evidence a framework for the quality care that women and babies in every country need. And what we realized was that all women and all infants kind of need the same thing. They may be living in different settings. They may be living somewhere in real poverty or they may be living somewhere really affluent. They may have had other babies before it, maybe their first baby, they may be having twins, they may be having one baby. Actually, they still all need high quality care and they need this. We need this that we then summarized from all the evidence from this framework. And I'm going to talk you through it quite quickly tonight because we don't have a whole lot of time, but you can go back and read it and take your own time to think about it. This framework has now been used by people to plan education curricula, to plan services, to think about monitoring services and planning their own work. So let's have a look at it in more detail. The first component is that we're thinking about all childbearing women and infants and care that needs to be given to everybody. We then think about extra add-on care for childbearing women and infants with complications. So we haven't divided this into high risk and low risk. Sometimes if somebody becomes labeled as high risk, they actually stop getting the normal care that other women get sometimes. So in the care for all childbearing women and infants, they need education, information, health promotion, assessment screening and care planning, promotion of normal processes and prevention of complications. And then for the women and infants with complications, they also need some of them for slime management of complications. And then the special medical obstetric and neonatal services. You'll notice those boxes get smaller as you go along and that's because fewer women need that. If women get those good preventive and supportive care, then they need less. They'll get less complications and they'll need less specialist care there. Now moving on down the framework, having those practices is not enough. People need care organized in the right way. They need it available, accessible, acceptable and good quality. They need adequate resources and a competent workforce. Really importantly, they need continuity and those services integrated across community and facilities. But that's not enough either. They need it provided with respect, good communication, community knowledge and understanding and care that's tailored to women's circumstances and needs. But that's not enough either. They need care delivered with a particular philosophy that optimizes normal processes, strengthens women's own capabilities and uses interventions only when indicated. And then finally we get to who are those care providers and they are practitioners who combine clinical knowledge and skills with interpersonal and cultural competence in a division of roles and responsibilities based on need, competencies and resources. What we're arguing based on the evidence and over 500 pieces of evidence went into building this framework is that every woman everywhere needs care that consists of all of those components. It's not just what people do, it's how it's done, it's how it's organized and who's giving it. We then define the scope of midwifery so if you look at this framework, that blue line that goes around it, midwifery is everything in the framework except those special medical obstetric and neonatal services at the right hand end. You could if you like to find the scope of obstetrics and people are now doing that, or you could define the scope of community health work, but whatever you do you can use the framework to think about all of the components that are in there. So what are the key messages from the Lancet series on midwifery? There's a lot of very dense academic talk in those papers and I know that it sometimes takes a while to read them and digest them and some people have to read them several times to really get the messages and we're aware of that, they are academic papers. Let's distill down the essence of the key messages. Now I'm going to say to you here, the symbol of the Lancet series on midwifery is this key, it's a double sided key. Now I'm going to come back to it in a minute, but while I talk for another few minutes I want you to think why the symbol of the Lancet series is a double sided key. So the first key message I've said it several times I'm going to keep saying it and I will keep saying it whenever we talk. You start with women and babies why is that important? Why is that different? I think midwives get that midwives do that anyway but when people plan systems and the way care is provided they often start with the system. Here's a hospital, how do we make the hospital work? We have to plan community services, how do we make them work? Every time you start planning something you start with the needs of the woman and the baby and not the needs of the system and not the needs of the care providers. The second key message from the Lancet series is we managed to measure by this reanalysis of all the evidence, the size and the breadth of the impact that midwifery creates. Now just look at what midwives across the world are doing every day. Over 50 outcomes improved by midwifery. Midwifery reduces mortality it reduces preterm birth and low birth weight it reduces morbidity really importantly it reduces interventions in labour that are unnecessary. It improves those important psychosocial outcomes attachment, parenting increases breath spacing and family planning use increases breastfeeding and for the system it brings shorter hospital stays improved referrals increased attendance with a known midwife and universal implementation of midwifery could reduce maternal and newborn mortality and stillbirth by over 80% that I think midwives should feel very very proud of themselves. It is astonishing it's a huge intervention and where it to be introduced universally and to its full scope it would be completely transformative. This information is having a huge impact on a lot of people's knowledge and understanding at global level and at government levels across the world. But another key message is it's not just what we do it's how we do it. We're talking about skilled and compassionate care for all with preventive and supportive care throughout not just birth but across the continuum done with continuity respect and understanding focusing on normality and keeping processes as normal as possible and interdisciplinary working and partnership working the how is just as important as the what that we do and the who provides it absolutely essential midwives are essential midwifery was associated with more efficient use of resources and improved outcomes when provided by midwives who were educated, trained, licensed and regulated and midwives were most effective when integrated into the health system in the context of effective teamwork and referral mechanisms and with sufficient resources there are few benefits from relying on less skilled healthcare workers that doesn't mean they have nothing to offer of course they do but it means that if you want the most efficient and effective health system you need the primary caregivers for women to be midwives another key message is midwifery is an integral part of all care for all women and babies and all families. There's been several Lancet series published since the midwifery series one on maternal health, one on stillbirths one on newborn deaths and one on breastfeeding for example and the fascinating thing is that in every single one of these midwives and midwifery are right in the middle of the page in terms of actually implementing the action and creating the change that will make a difference it's integral for all women and babies and families. Another key message is that midwifery is a vital solution I started with that message it's really important the other people's words here have said the Lancet series in midwifery is pivotal in not just valuing midwifery but strategically positioning midwives as integral for achieving healthcare reform and global stability. Wow not just catching babies but actually making sure that health systems work well and in balance midwives are the single most important cadre for preventing maternal neonatal deaths and stillbirths say the healthy newborn network and Margaret Chan the director general of the World Health Organization is not given to hyperbole and overstating the case and as she said we need midwives we need midwives we need midwives the message is absolutely coming home another key message is midwifery brings balance to the system do you remember that slide I showed you a bit before about mortality versus health and well-being or women versus children well all midwives know that it's not either or if you're caring for women you're also caring for her baby if you're trying to prevent her dying you're also looking after her health if you're trying to use the right interventions and not the wrong ones you're having to support and optimize her own normality if you're wanting her to have the best birth you have to look after her in pregnancy and so on these are not dichotomies and choices between each other actually we need all of them and it is the balance between these things and of course choice matters those are not in opposition to each other we need all of them and we need balance so I'm going to take you back and remind you of that double sided key and the reason we have the double sided key as the logo for the series is first of all the key is the solution the key is the vital solution it is the key that opens the door to the balance between these things it's making sure we keep a focus on mortality and on health on women and children on birth and the continuum so it's that balance that double sided key that helps us and as we look at this side again of that relentless trend upwards in cesarean section rates that's now mirrored right across the world midwifery is the answer to this it tackles over medicalization and brings back balance to the system so that the women who need interventions get them and the women who don't need them don't get them and a huge message from our series is it's not just midwifery what we could say from the evidence is these findings support a system level shift from fragmented maternal and newborn care focused on identification and treatment of pathology to skilled care for all midwifery is pivotal to this approach midwives should indeed feel very proud of themselves because this is the care that they give and are capable of giving and are capable of giving more midwifery can indeed rebalance care and transform lives and just in the last couple of minutes of this talk I want to bring you back to the global strategy for women's children's and adolescents health that I mentioned earlier on with its strapline of survive and thrive and transform there's work going on now in a number of global organizations to make clear that midwifery sits in the middle of this global strategy and that it has such a huge contribution to make to survive and thrive and transform across the world all these organizations on this side are now working together to bring this evidence and other relevant evidence into action they're working together to promote advocacy the white ribbon alliance for example a fantastic organization they have a great website if you want to go looking for them are coordinating an advocacy effort that's bringing all these organizations together to promote midwives and midwifery for every woman and every child across the world there's lots of collaboration going on there's work together to tackle the barriers hi Mary hello is that Sarah yeah hi, yes it is I'm just giving you a 5 minute warning thank you I'll only be a couple of more minutes for that so all this partnership working is tackling barriers it's working with governments across the country to improve political will is midwifery being brought into Bangladesh for example the Indian government is now in talks about bringing midwifery in there and other governments across the world education it's really important evidence to bring into education of future midwives and we're really seeing that here in the UK as we're reviewing our own midwifery standards and we'll be using this framework to inform that work to base the new standards on the work on quality of care the World Health Organization is developing standards for quality of care where midwifery is absolutely fundamental and all of that evidence is being used new research priorities that were mentioned earlier but here we are with all these organizations working together WTO, UNFPA, ICM, UNICEF White Ribbon USAID CHIPIGO that's the UK's department for international development for example and the Swedish international development agency lots of governments, professional associations many many midwifery associations around the world and lots of universities, academics, researchers and educators all working together on this tremendous alliance partnership all focused on rebalancing care and transforming lives so let me go back to that slide just for a minute and remind you of Fran McConville's film that I mentioned earlier that Sarah put the link up to I think that will talk about this in detail and tell you more about the world collaboration that's going on now and you can also find a series of YouTube films and I think we can post that link for you as well called Midwifery Action where you'll find people from different organizations talking about the importance of this evidence and how it's being used in practice and in policy so thank you very much for patiently listening tonight it's great just for this hour to have this partnership with you and I think that theme of partnership and of evidence is so important to all of us working with women, working with others each other and working with other organizations to bring the best possible quality care for all women and all babies in all countries thank you very much now look forward to your comments thank you very much Mary that was a fascinating presentation and you do wonderful work for all mothers and babies so thank you for that and there's lots of comments going on down the chat box now there was some interesting comments earlier on I noticed that Elizabeth Bannon commented that language is so important in Midwifery and it's discussed a lot at the moment and how the definition of the midwife reflects the breadth of the role that we do and Sheila Clough also commented that it's talk about care for people with complications rather than high risk and Linda commented that it's more like individualized care rather than discussing people with high risk do you work a lot do you have trouble with definitions when you're sort of creating these things thanks Sarah and thanks to everybody who made those comments because you're absolutely right language was one of the most important things for us because we found that everybody was using language and concepts differently and that's why that slide I have of the dichotomies of the people focusing on different things actually was so important because we discussed the language we found that some of our colleagues were really focused on some parts of the story but not on other parts and the language reflected it so people would talk about risk people would talk about women and not talk about babies and so on and so forth a huge amount of her time was spent discussing language and that was even before we discussed different languages and translation because actually translating the word midwifery into different languages is surprisingly difficult and so that has been a real discussion that's also run and run as people have tried to translate it into French into Portuguese and other languages and discovered that actually there isn't a word for midwifery those languages have words for midwife but not what that midwife is doing and what the health system needs to provide and that's the really important thing about the concept of midwifery not just the work of midwives but what does the health system need to make sure that is in place for women and babies to have the best quality care and to enable midwives to do their jobs to the best quality that they can do so yes language is really important it's also quite fun to have those discussions okay we've got time for one more question Deborah Davis asks what do you think is the best strategy to deal with the way midwifery is contested the best strategy to deal with it being contested well there's a huge amount of work going on at that at the moment we had a meeting about that last year in Washington and the top strategy that came out of that we need to work at many many different levels but the top strategy that came out of that meeting I found interesting and it was to make sure that there's more midwives at senior senior levels of the system so I don't know what it's like in your countries but often midwives don't get right to the top of the health service planning often it's nurses who are taking responsibility for midwifery or it's not even nurses it's maybe medical doctors who are making the very very senior decisions and so the very top strategy that came out of that meeting which had people from different countries different organizations was we have to work really hard to find out where midwives are in senior positions and get them into decision making positions right through governments through the health service and so on so I don't know what you think about that there's many many other strategies which is making sure that midwives have good terms and conditions they have adequate pay for example they can work in safe circumstances and that's about working with governments to make sure that there's adequate funding and adequate support for midwives because if you think about the slide I showed you where it said you know who's the best person to provide midwifery let me go back there what we didn't just say was the midwife what we said was midwives who are educated trained licensed and regulated and integrated into the health system with teamwork referral and sufficient resources that's really important so it's another reason why we have to talk about the kind of quality of midwifery care that women and babies need because midwives need these things so they can provide that quality brilliant thank you for that Mary Deb says that's a great one thanks and we've got a hand up by Sue Sue would you like to speak I'm going to give you a microphone and let's see where have you gone Sue there you go you've got a microphone so if you want to go through your audio set up let's see if we can hear Sue I've lost her no Sue's gone okay one last one very quickly Jane asks can you say why it is a double sided key okay did you get that Jane did you miss it let me try again so it's about it being a vital solution this vital solution and the key is if you like the vital solution I'm trying to look for finding the key at the moment but it's also I need to go back I'm sorry I'm fiddling with my slides trying to find the right one it's also about the ands and not the verses it's so here we are the vital solution key but it's about mortality and health it's about straight forward and women with complications it's about women and children it's back to my slide with all the dichotomies on it it's about how it's not dichotomies it's about how these are ands and so it's the balance between safety choice it's the balance between women and children so it's about the vital solution and the ands that's it balance it's also balance between interventions when you need them and avoiding them when you don't once you get your head into it you find it's all sorts of different things and everybody then uses balance finds their own double-sidedness to the key so that's what it's about okay thank you Mary so much we really are going to have to stop here because we've come right to the end of the session and we have to set up for the next one so we have got two sessions running consecutively now we've got Maggie Banks in the workshop room so I'm just going to put the link up for that now and then the next speaker is in this room I should have saved this earlier there you go so I've put the link up for the workshop for those that want to come for the Maggie Banks um breach birth one please follow the link and I will stop the recording


That was great, Aparna. So we've got a few closing remarks before we depart. So come check out the Security Hub, starting at 11 in rooms W0607. So today and tomorrow, this is going to be a designated area where attendees can engage, exchange ideas, and also explore the latest security best practices and tools in the Kubernetes and Cloud Native ecosystem. We also have our Wellness Lounge opening right now at 10.30 in the sponsor showcase. That will be chair massages, a sense zone if you need quiet time, and a creative corner if you want to let your inner artist emerge. We also have open space sessions again in the solution showcase today, where you can informally join others, become an interest to discuss topics and projects that promote community growth. So check out sketch.com if you're interested. Lastly, we invite you to join our Diversity, Equity, and Inclusion Lounge, sponsored by Intel, starting at 12.30 PM. And like always, breakout sessions will start at 11, and we hope you have a great second day here at KubeCon, Cloud NativeCon, and we'll see you back here tomorrow for our last set of K-Notes. Thank you. Thank you.


Hi, I am Dr. Ashwin Rajgopal. I am the consultant surgical oncologist at Manipal Hospital, Whitefield. There are a few warning signs in cancer which everybody should be aware of. If any person is has any lump in the body, if they are having any sore throat or having any sore ulcer in the mouth or any person having a few bleeding well passing motion or having any bleeding in the cough on the sputum or any lady who is having excess spotting or excessive bleeding while having their cycles and person who are having excess weight loss even though they are eating regularly, these are the few warning signs which any person should be aware of and they have to come to their oncologist immediately.


Welcome back to my channel, everybody. For those of you who are new around here, my name is Michael, AKA Dr. Chalini, and I am in my sixth and final year of training in New York City. So before we start this video, please make sure you smash that like button. It really helps out the channel, it helps out the algorithm, it helps me get exposure, and it helps me be able to make amazing content like this. So hit the like button right now before we go any further, and also subscribe, because there's still a lot of people watching these videos that aren't subscribed, and I see you. Today's video I wanted to make for some time now, finally sat down and wrote out all the stuff I wanted to talk about today. So as I just mentioned, I am in my last year of training as a physician in New York City, subspecializing in interventional radiology, and I'm going to kind of hop on this trend, which everybody is doing across YouTube right now, and that is to talk about everything we spend in a week, where we live, according to our job, and all that stuff. So I wrote out every single thing I spent in a week while on call in New York City, so let's get into it. So before I start this video, I wanted to do a quick disclaimer, and that is I live in New York City. New York City is notoriously very expensive. It's expensive to live here, it's expensive to work here, it's expensive to even leave your house. I always say you can't even leave your house in New York City without spending $100, and that pretty much holds true. So with that high cost of living in New York City, these salaries are also inflated in New York City, so you have to kind of take everything with a grain of salt, because you'll probably be surprised about how expensive or how much I spent in New York City in one week. It's quite alarming, even as I was putting this video together, so let's go ahead and dive in. All right, so like I said, this is from the last week I was on call. This was the seven day straight on call video. I took everything I spent that week and wrote it all down, and this is a normal week on call for me, so here we go. Starting with Monday. So Monday I made a cup of coffee at home, and I did a little math, because I'm one of those people who doesn't like to pay for coffee in the morning every single day, because that cost adds up pretty quickly. Three or $4 here or there. You end up spending $25, $30 a week just on coffee, and coffee is pretty cheap. So I did a little calculation, and I usually buy a one pound bag of ground coffee, and it yields about 24 12 ounce cups. I usually drink about a cup a day. So if you do the math on that, each cup is about 42 cents. So I spent 42 cents on coffee Monday morning.  So what I usually do is like to fast until at least 11 or 12 if I can. Sometimes if I know I'm going into a long procedure, I'll have a protein bar, which is what I usually have for breakfast, and that is about $2. Next I had lunch, which happens to be free, because my hospital pays for it, which is one of the perks of being a fellow at a New York City hospital. And they don't pay for all of it. They give you like a stipend, like $500, I think twice a year. So you have $500 to spend over six months, and then it refills the following six months. So the food at the hospital is surprisingly pretty good. So I take advantage of the free lunch. I always bring snacks with me as well. And I always have an afternoon snack around like three or four p.m. just to kind of get me through the hump, especially if I have to stay through six p.m. or seven p.m. or even later. This comes from the grocery bill, which we usually do like a grocery run once a week. And I'll add that at the end of all this when it's all said and done. So I came home around six or so p.m. that night, I believe, on Monday. And luckily I have the best mother-in-law in the entire world. And whenever I'm on call, she decides to make a home-cooked meal and bring it over to my house Monday or Tuesday night of my call week. Because having a home-cooked meal after working 12 plus hours is the best thing ever. Trust me. Well, home-cooked meal is good anywhere or anytime, but when you're working this hard, it's even better. And my mother-in-law brought me over a poony and a paprika. How do you say it? Okay. And it was delicious. And for those of you who don't know, that is Croatian for stuffed peppers. And it is my favorite dish of all time. She always makes it for me when I'm on call. So dinner was $0. So if you remember from my video, I did get called in this night and I had to stay in the hospital till about midnight. And when you get called in, you have to take an Uber to the hospital. Again though, my Ubers are paid for by the hospital when I'm on call. So anytime after normal business hours, the hospital or my department will pay for my Uber while I'm on call for the week because a lot of times we're covering multiple different hospitals and this is no different. So it was $0 for a there and back trip in my Uber, which usually costs around $12, $15 depending on the time. Now onto Tuesday. Again, I had a 42 cent cup of coffee made at home. And then I had my normal breakfast protein bar after my first case, which is about $2. So on this day, I was actually so busy I didn't even eat lunch. So I ended up having my late afternoon snack down in the cafeteria, which was again free. I had stuffed peppers again for dinner, which was also $0. And then I got called in that night at about what 12 or 1 a.m. And Uber'd there back to the hospital, which was around almost $30 actually and was $0 for me though. Now onto Wednesday. So Wednesday morning, I got only a few hours of sleep since I got called in overnight and I ended up paying for my own Uber to go to work that morning. And it cost me $12.85. And I usually don't do this. I don't like to take Ubers to work unless it's like a blizzard outside. But I was so tired. And honestly, I didn't feel like walking like 20 or 25 minutes. I just, I couldn't, I didn't have it in me. I'd only got a few hours of sleep. So sometimes you gotta do what you gotta do. And they don't pay for Ubers during normal working hours. So I had to put the bill for this one. But best $12.85 I ever spent. So I also spoiled myself a little bit here. Because I was so tired, I ended up having to sleep in a little bit to like eight or nine and had someone cover for me. So didn't have time to make myself coffee. I was rushing to the hospital and I ended up getting a very large, binty iced coffee, which ran me $3.55. Now, I carried on this treat session throughout the breakfast now because I went and did my first case. And then it was about 11 a.m. The lunch wasn't being served at the cafeteria yet. So went outside and grabbed an omelet at a local restaurant. And that was $8.78. I was racking up the bill on this day. But this is what happens when you're on call and you're tired. You just want fast, easy, convenience and you pay for it all. So then I had no lunch because I had such a large, late breakfast. And I ended up having my protein bar at about three or four p.m., which was $2. Now, at this point, this is Wednesday night and all the stuffed peppers were gone. My wife and I both ate them over the last two days. But with those stuffed peppers we also got a whole bunch of chicken cutlets and also courtesy of my mother-in-law. And we had those for dinner. So that cost us $0. Now onto Thursday. We had 42 cent coffee in the morning, $2 protein bar for breakfast. I had the normal lunch, which was free at the hospital. Had the afternoon snack, which we'll go over at the end of the video. And then we had no dinner left after that and Endurana worked late on some of these days throughout the week and we didn't have time to make anything. So we ordered salads for the both of us, which costs about $33.14 in New York City. That is order from an app delivered to my door. So for those of you who say, how could you spend that much money on a salad? I didn't really have to do anything. It just came to my door and I just sat here. So when you're on call, I don't really have time to run around and like look for restaurants. I just order and hopefully it gets here and I don't get called in in the meantime. So money well spent. And I actually didn't get called in this night, but I did order some of my hair product on Amazon two-day shipping, which was $28. Now off to Friday now. I had a 42 cent coffee in the morning. And on this day, it was when the new iPhone came out. And if you saw my prior iPhone, it was all shattered. And this is the new iPhone 12 Max Pro or 12 Pro Max, whatever it is. And I ended up paying $124.07 for this. And that included the wireless charger, which I still haven't received yet. And since I cracked my last phone, the very first purchase I made after ordering this phone was a clear case for this phone because I didn't want to have the same thing happen. So that was $21.50. This is a speaking case, by the way. I love it clear. Shows the back. It's my favorite. Then I had a $2 protein bar for breakfast. A free lunch, the normal afternoon snack. And then I had a salad that evening, but just for myself that time because Andriana was out with her friends. And it was $15.38. Now on to Saturday morning. Our very favorite thing to do on Saturday morning is wake up and have coffee if I'm not in the hospital. And that's exactly what I did. So we had a 42 cent coffee. So Andriana and I made breakfast this morning because I didn't have to do it in the hospital or didn't get called in. And then we had some of her cousins and friends over for a chilly night. So that was our dinner for the evening. Also factored into the grocery bill at the end of this video. One thing I didn't mention is that I was hoping I wasn't going to get called in. So I made a quick haircut appointment and that was $59. Before you guys say, you can get a haircut for $10 or whatever. If you want a good haircut in New York City, you're gonna pay $40, $50 for it. Also, I've been going to this guy for like 10 years and I trust him. And honestly, I'll pay whatever he charges. So this brings us to Sunday. So Sunday we had a 42 cent coffee yet again. I did not get called in the hospital this morning either. So Andrew and I went out for bagels. We got a bagel with egg, turkey, cheese, avocado and it was $23 for two of those. And since we were just roaming around the city waiting to get called in because I knew it was inevitable, my mother-in-law came in and we actually watched around the city for a little bit and we got three coffees which was $12 and 38 cents. I did get called in that afternoon just after that but I didn't have to do it in the hospital but then I got called in later that night had to do it at midnight. And before I got called in I had leftover chili from the night before which again, factored into the grocery bill which we're about to get into. So the total of my weekly life expenses is about $1,091 and 48 cents which is probably pretty alarming to some of y'all including myself. All right, so those are my weekly expenses. Now let's get into the kind of life expenses and then we'll go into my business expenses as well because these are all kind of separate. So in terms of life expenses we have to pay for rent, we have to pay for utilities, we have to pay for my phone bills. So what I did was I just summed all those up and divided it by three and that totals to about $922 per week. And again, before you all freak out, this is Manhattan, real estate is very expensive here. The good thing is I don't have a car so I don't have to pay for a car insurance or anything like that but I do still have to pay for health insurance which again, the benefits of being a physician working at a very good hospital that covers all the stuff. It is about $5 every paycheck to cover myself and Adriana. So that's $2.50 a week to have full coverage. Can't beat that. In terms of our grocery bill we go shopping about once every week usually on the weekends and it totals to about $150 every week. We also pay about $10 a week for laundry. We don't have a washing dryer in our unit so we have to use a laundry service downstairs. Also pay for a few subscription services such as Spotify, which is about $3.74 a week and Netflix which is about $3.24 a week. So now we have to get into my weekly business expenses and there aren't many of them weekly because I feel like some of these large expenditures come on all of a sudden like maybe I'll need a new laptop or maybe I'll need a new camera or whatnot but one thing that is consistent is I pay $1.24 a week for Lightroom. For those of you who don't know what Lightroom is it is an application for photography editing. I use it for Instagram and all that stuff. I also pay a cloud storage fee of about $0.50 per week and also recently I started paying for editors to edit my videos. I just don't have the time anymore to keep up with the content and also edit the videos as well. Editing can take like five to 10 hours sometimes and I don't even have five to 10 hours extra, much less 20 hours extra which would take me to edit two videos every single week. So I've had to outsource that. I still edit some of my videos occasionally when I have time or when I want to because I do enjoy it but I've started to have to pay for editors because working 80 to 100 hours a week doesn't allow me too much time to edit my own video. So the cost of editing is around $312 a week. Now these expenses are write offs. So at the end of the year I can write these off in my taxes so it is a little artificially inflated here but the total business expenses per week are around $313.74. So that brings us a grand total for all my weekly expenses in New York City as a physician are $1756.97. Now when I first saw that number I was pretty shocked by it because I really honestly had no idea I was spending that kind of money every single week. So although this may seem like a lot of money for one person, it's actually a little inflated because keep in mind I also have a wife working full time as a physician assistant who is contributing a significant amount to these expenses as well. So it doesn't all come out of my own paycheck. It all comes from one bank account and we contribute equally with the exception of my business expenses which only comes from my account. And the funny thing with this is this is a week where I am on call. So I wasn't going out, I wasn't going to restaurants, I wasn't spending money on cocktails at restaurants and running up expensive bills around New York City. I was literally just going to work and back and thankfully my mother-in-law provided dinner for me every single night. So that was a way for me to keep my expenses down this week although it doesn't really seem that way based on these numbers. So I hope this provided some insight on how I live as a physician in training in New York City. If you have any questions, leave them in the comments below and I will try to answer them. If you have any questions about living in New York City or living in New York City as a resident physician let me know as well. Otherwise make sure you smash like, subscribe button, follow me on Instagram and TikTok which I started to post quite a bit on there and I'll see you all on the next video.


I've described the 21 Convention as being a movement, a ford process that is really sort of like rolling and moving men forwards in their lives, creating life, allowing men to achieve life, and really make the ideal that they see a reality. I learned from that. I learned a hell of a lot from the 21 Convention. There are things that I'm not familiar with, elements of it, which I knew it was about, and I've learned a lot of specifics and seeing how there are transferable skills and Fundament or elements from all the different speeches that really apply to a variety of different kind of social dynamics and areas of life. I think I've gained a great deal that I didn't expect to gain from it, and I think that's really important. I'm really appreciative of it.  Guys out there who think that they don't need to come to the 21 Convention because they think it's a pick-up convention, because they think they don't need to pick up chicks. I've got a girlfriend. I've been with her for four and a half years, but the skills I've kind of got from the pick-up guys, from the guys who are talking about social dynamics and how to relate to people, how to build on emotions, how to really sort of build these social skills. I found a lot that I can apply in my own life, in my business relationships, in my sort of academic relationships with other individuals and colleagues that I work with. I've really gained a lot, and for those guys, I think screw it, come anyway. You'll learn things that are transferrable from whether it's working with girls or whether it's working with business clients or anything. They're all transferrable skills. They're all fundamental skills that are key to achieving what you want in life.


OK, so my everyone. So if you want to say just for me to start this again, we're just going to have a little current table. And this is actually going to be a talk that's a bit aimed like that, because I don't really know what this talk is about. Like, I don't think. But the thing that it is about is, I think, quite neat and relevant to AgWare, and also very recent. Like, this all happened in the last couple of weeks. And like, the time we just talked a bit about that. So I want to talk about the Homeland 2, which is a computer. And I want to talk about some game that I made for the Homeland 2, why I made them, and why this might be interesting. So the Homeland 2 is a computer. So OK, so the story goes like this. In 1981, there were a pair of scholars back in Hungary who wanted to make a Hungarian version of the Homeland 2 computing plot. So they basically started building their own computer in their location. And the Homeland 1 was destroyed. Or like cannibalized. Like, they made it for the time. They didn't like it, and it was destroyed. Then they used the parts to build Homeland 2 in 1982. And this was an interesting machine in some sense. And also, but in other sense, it was also very similar to other machines of its time. So it's a Zenit-based home computer. OK, so does everybody know what a home computer is? Like, the category of, OK, so the home computer before PC is like in the late 70s, early 80s, home computer would be something that you would buy for home. And it could be a computer that's low cost, much, much lower cost than the other kinds of computers of the time. And it would come in usually becoming the form of a keyboard. So it's a keyboard with a computer, and you put it usually in the RTB. So you'd have to buy a separate screen. And usually it could boost to basic. Programming and using the machine was what I'm saying. So this was based on this same idea. It uses a ZEP CPU, which was a 8-bit CPU from ZIDO. It basically, you could say it's two Intel 8-bit like together, like the register files of two 8-bit and two together. And it had 8 kilobytes of RAM, 16 kilobytes of RAM, plus an extra 1-bit of RAM dedicated video RAM for this character-based graphics. And what is interesting, I think, this crowd is that other than the CPU and the memory, everything else was 7,400 series ICs, and a lot of them. So like the video signal was generally 7,400 series, the date. So because it had a set thing for storing, persistently storing data, that was not, everything was done with 7,400 series. The reason for that was cost saving. And also because there was this thing called COP on, that I don't think any material in Singapore would deliver it. But that was an export restriction treaty of the Western world or NATO countries. And I think it's even more than just NATO countries. And of course, because Hungary was part of the the other side of history, the wrong side of history. So high tech was not allowed to be exported to Hungary. So do we get anything with the simplest possible percent or the 3,400 series was reported? Okay, so then what I really like about the home lab here is how they ended up doing video. So like I said, it has no dedicated video graphics chip. So what they ended up, or video signal generator chip. So the CPU itself is basically bitmatching the file output. But if you think about the timing of the timing of the 4MHz Z8, it just doesn't work out. So what they do is instead of running a program that would retrieve data from video memory and then feedback that's output, the CPU jumps into the video memory. So CPU thinks that it's executing the contents of video memory. But the data bus is hacked so that the CPU sees knobs instead of the contents of the video memory. But there's a character wrong whose address lines are directly connected to the data bus of the video. So this way the CPU can as fast as it is possible for a CPU because the fastest way you can scan some area of memory is if you use the program counter instead of any other register because if you have any register that just loading the program to load the instruction that would implement your counter. It's already much slower. Whereas if you just execute the knob, then a side effect of executing anything is increasing the program counter. And what this means? Oh, and then, okay, just because the mouse, if you think about this, the mouse still doesn't work out. So the idea is that you read eight bits from the character wrong. It's sending the shift register, and that shift register is blocked fast enough to shift out the eight bits for the next eight bits. But that means that while the physical part of the screen is scanned by the CRT, all the CPU is doing is just racing the beam. So more than 80% CPU time is unusable for your programs. You can turn it off. That's not as understandable as that. Sinclair, did I say anything? Yeah, I don't understand anything. Not exactly the same, yes, not the same, but Sinclair was overwhelmingly pushing video out and then did everything else in the region of it. Yes, and of course, you can turn off video output and then you can... And it's very good, so like I said by the way. Yes, yes. Oh, I mean, this one you have to turn off for, because I will not just for timing purposes, but actually, but because the, basically the same address time, like so one of your address time from the video. Yeah, yes, but I mean, in practice, it doesn't really matter because you have to turn it off anyway because the cassette input is all done in software. So the timings are very important to measure how much time is passed between spikes of the... So like on the tape you have like this tiny... No, it's not what you usually get, but you said that only because you have the most patience. It's almost... Oh, yeah, that too, but yeah, yeah, yeah. Yeah, yeah. And so what is my involvement in this? I've never heard of this computer until a couple of months ago. I've never heard of this, no one really knows of this computer. So all that too, I think there was like maximum of 200 of them here, but like you keep four or no two that are the same. But that's exactly like half of them up here. Half of them was produced by a some agricultural, law and government company, whatever. And I think it's really fun that you're going to stop the time we read. They're not like just like that programs you can find for this, but one of them is a live-streamed optimizer. Like that's one of the main programs that we've ever done, that's going to be like a linear programming thing. You know, very, yeah. I mean, it's like good in the operations, we see a problem that everyone has seen in school, but it's actually you can practice for that. So I've heard of this bot and there's a Hungarian retro computing and retro gaming podcast and there they had an episode about this. That's why I heard of this. And what was interesting about it is that there was their guests who knew everything about this computer. They were saying, oh, I'd actually do to promote building software for this and to promote people knowing about it because it's such an important piece of Hungarian computing history. Because I think the first and the truly Hungarian main designs and build computer that they are announcing like the job on my computer site to announce the game development competition for this machine. And when I heard this episode it was just when I was like a week or a couple of days from going home anyway. So I had like a long week ahead of me. So, and I've never seen all that too. I've never done any assembly programming. I've never developed for this like the iPhone 65 which is like Ross kind of crazy than I am. So of course I don't talk about of course I'm gonna make a game for you, right? And then I think I had like one and a half months for the whole thing. So how do you do this, right? Like you have this computer, you never see it, you don't touch it because you don't find one and you don't just start working on one. So it is some emulation of it, right? Emulation situation was less than ideal. It actually the game development competition was so spurred improvement from that. But when I started to think into this there was no good emulator storage because some main had an emulator that was kind of working like you could do it to basic. But if you wanted to do anything that's like real time it just wouldn't make it wouldn't cut it because it didn't actually implement the video with that. So it was like running the CPU on its own and then rendering the video memory content on its own. But this whole thing about how the CPU after 15 or something percent of its time gets. Oh, and by the way, the horizontal third-wing trace not usable either. It's really just a perfect third-wing trace. So that was not implemented. And then there was a closed source windows on the emulator that was supposedly better. But I can't really tell if it's better or not. It is closed source windows on the emulator. So I ended up writing a single page web app emulator which was a lot of fun because there's not that much documentation for this machine. So a lot of it you have to kind of guess by looking at the original documentation. So you read the original 1982 documentation that has been titled someone's type writer. And then it has some like hand-drawn diagrams and stuff. But luckily you can find dumps of the wrong content. And then I tried to think that up and I got to the point where I started this video magic. But that was not re-documented. And then I figured out, what do I put on the database to make everything work? It's not as straightforward. It's not just not.  So after the right amount of reading from this video around shadow area, you have to make sure that the next top code that the CPUs is actually one of the reset codes that the database allows you to jump to specific addresses one by each. So anyway, so then, yes, I wrote this. So obviously for the Z84, I think just use it all as a library. Then I re-drawn it in Idris too. I mean the whole web version because again, I'm that kind of crazy. And then you can imagine that this used up a lot of time and then of course the deadline started approaching. So okay, somebody hadn't really done any games yet. So how am I gonna write the games? Well, kind of as a parody of myself, I decided that I'm gonna use a test code DSL for the assembler. So this is like an example of something where you can see like the back rowing capability that you get for free by being the DSL. So here, so I don't know how widespread this is, but there's no other 24, there's the same code speed coding, which is like the fancy for unrolling use. Like if you want to do things really fast then you just, you know, make it. And this one it shows you how easy this speed coding if you have a, like a host landing. Because here, you know, I and J go over zero to three and then you just, I mean assembly code, basically 16 such a, I mean the 16 times and then the address calculation and all that is completely set. It's not the end of time during the assembly. And then you just end up with the 16 times for instructions, it's like big, and then during the other plan, the fastest way of actually trying things out was to just inject the memory of the tree and then just jump it, which is a big benefit of writing your own memory. There's few tricks like that. So what did I write? So I wanted to get like some handle on the machine. The first one I wrote was snake. Actually, first one I started writing the stepries, but then I said that someone had already done the stepries and they actually knew what they were doing, unlike me. So like, okay, well, they're making other steps that I'm going to make. So let's put that aside. So let's try something even simpler. So then I wrote snake. You can imagine how we did this. Oh, so this is all character graphics. I never implemented rest of graphics because like it's quite slow and also that one is even less documented. So, and yeah, character graphics. And then the second one was a 2048 game, you know, the one where you slide the files around. So it was like, everyone was 24K. So these ones were simple, right? Like each of them was like, less than 2K, the finished game. The first one was real-time, of course. And the reason that I went to 2048 for the second game was because I had an occasion to see a real Home Left 2. There was a Home Left 2 event. So I went there and there was the actual machine on the small TV. And there are the keyboard situations really bad. Like this foil-based keyboard and it's really unresponsive and slow. And this also explains why if you try to emulate it, you get input glitches because the firmware, of course, is made with the assumption that the foil is a cheat sheet. And so real-time is not, like it's very awkward to play real-time games. And there's nothing else. It's just the keyboard. You don't have joystick. You don't have, I don't know, D-pad, nothing. So that's why I went to 2048 because that is a third-day game. So yeah. But also, what you think you can't steer is that it's nicely smoothly animated. So when you slide it in a certain direction, the tiles don't go character by character instead of block by block. And it turned out that I couldn't make it fast enough if you finished, like to re-render everything in time. So I ended up doing double-buckering, which, of course, definitely made it even slower because you have to copy everything over into the big video memory location, but it avoided bickering. So that was one of the takeaways. Yeah. Double-buckering. No, no, no. Oh, no, no, no. No, I couldn't go. Oops. So this is one bit. So you have like eight bits. So you have 64 bits, or eight bytes for each character in the ROM. And you can't even change that. So the character satisfies. And then, yeah, it's like eight by eight, one bit. You mean, yeah, yeah. But you can see here that there are, it's not just letters. You can see here, like, you have this nice, rounded corner, right? That's a character. Like these ones, like these fancy double arrows, that's a character.  So yes, there are lots of characters that are like cool for writing games like this, but yeah. Okay, and then, so what was like the big game that I made? And also why is it called adventure game? So I took this Hungarian text adventure game from 88 that was written for the Commodore 64. And I knew everything about this game because like ages ago, I was engineered this, I remade it for Android. I had the technology, I should remade this. And it's interesting part about this game, it is quite a modern design because the game script is stored in like the simple vital format. And most of the game is just the interpreter for these scripts. So instead of, which was here, like for example, this guy's previous game is the built-in Bayesian implement the actual game logic, but it's pretty elegant. It's all in memory, so you load the game once and the graphics and the text and everything is inside 64K. So we should write the new interpreter in for the Z80 for the same byte code, then we should be done, right? The problem is that like I said, it was written for the Commodore 64. So if you write the Z80 interpreter, then that takes care of the Commodore part but not the 64 part, because I've heard the 64 and Commodore 64 stands for 64 kilobytes. Of course, we have 16 kilobytes. So, and you might think that if you just throw away the graphics, which you have to do anyway, like so, yeah, then it's gonna be, it's gonna be because of course these days we're used to multimedia being the big thing that takes up all the disk space for the memory space. But turns out that even without the graphics, just the text messages and all the assets, that's still like 26 kilobytes. And then we haven't even done the interpreter yet, which came out to like one and a half K. So what did I end up doing? So, first of all, I used ZSKEEP from the, from you Pokemon for the text representation that allows you to store three characters in two bytes. And then the other, and basically in that, I'm speaking a bit with byte code for a moment, I was even getting it down to I think 20K, which is of course, like maybe 18 plus for the game itself, which of course this doesn't fit. So I ended up doing this thing, the game into two episodes. And that should, you know, you would think that, okay, well, even with the naive encoding, if it's like 36K, you split it in, now it's 13K, right, that's not how it works. First of all, because the game itself, it's like you go some, okay, so the game, does anyone care? Is anyone interested in what the game is about? Because, okay, so the game is like this guy in Uro, the future of Japan, is out to like bring water to the village and the rise of his family, sorry, in the entire village being like burned and raised, but he goes on a revenge, right? That's why he did the revenge.  So, but the problem with this story is that it's like, okay, you start in your village, you go somewhere to get trained, and then you come back. So the locations of the game, you can't really like cut it into half, because the first half of the game is basically, you know, solving all the puzzles that are needed to get to China, to get to this country master, to get him to train you.  It is a clear cut, it's a clear cut. Exactly, so narratively, there's a clean cut, which is, okay, you get trained. Like that's the halfway point, even in the original game, if you just look at how long it takes, like how many commands, or how many percentage of scores you get, it's a very nice halfway point, and narratively satisfying, because episode one ends when you get trained. The problem is that, technically, because you go, like you kind of traverse the same terrain. So it's like the same room.  And so there was quite some pruning needed to be done to, so basically turned out that, A, of course, there are parts of the Japanese setting that you can't get to before you can defeat some of these guys and you can only defeat them if you're on the train. So you can cut down parts of the mansion of the evil world war. And the other one was getting rid of this section. So this is like a map of all the games, right? So this one is like an annoying maze. I don't know if you guys have played any of these games. It's an amazing first stage of all these games, but they're really not fun, they're just there to make their time. And I think there was another one in the year. No, I think there's a man in the year. Anyway, so there was two mazes that we cut out. And then, so the results, I give you the screenshot of this, running on the phone, that too. And so finishing touches into the making sure that the walk works, make sure that the game version of the puzzles work. So I ended up writing yet another interpreter in Haskell just so I could play the game to make sure that it's winnable in this trimmed script, which was actually really useful too, because I found that there were two puzzles in the game that depends on the graphics. So of course those have to be changed a bit because you don't have graphics, you can't see the picture, you don't get the hint from the picture. And then I also came up with this idea that I could just pre-compute the word wrapping because every message is always printed starting at the first pattern. So you don't need to put any code into your interpreter to word wrap. You can just compute it ahead of time and then just put new lines. Yeah, you burn the new lines into the text that you're sorry, just replace some space with the new line. Show the word wrap becomes smaller. I've had it more than once. Sorry? Showing because the word wrap is smaller. But the new lines start for free because you replace some spaces with, like one space becomes one new line. It's kind of weird. Right? And also, like in this particular equation, you can see that this word ends of the last one and this word starts at the first. So here we were actually able to save a space. And this matter is because the final version had around 40 or less than 50 bytes of memory remaining. But you need that for the stack. So now this is a bit of an exaggeration because I could have saved another 256 bytes by not implementing saving, quick saving, quick loading. So there's like a memory saving and loading, but it's very nice to have because the game, it can be quite punishing in terms of like, it can be quite virtual. So I really wanted to include that side of it, right? That was always part of the calculation that we should have both the game state and the save game state in memory. Yeah, official results. So it came out fourth out of 13 entries. The first game, like the game that actually won was nice, like untouchable because like, I don't know who that guy is, but you know, they're looking at something like a graphical game that has like smooth scrolling. And like, oh, it's amazing. So there is absolutely no way to be in competition whilst that actually was made. Or yeah, I really prefer something to be there. But after the cut-offs for the official voting, revenge has been slowly creeping up and now it's at second place. I think what happened is that people have been playing in that scenario, actually, there's quite a lot of that. Like this is the long game, like how does this even fit into this machine? And then they're voting for it. So that's it. And then, yeah, I got a bunch of things. So Snake at home that playing 48 are already open source. The open source release of the revenge is coming soon and it's just filling up. But what's also nice about it is that it's not just a game. It also includes all the tools that you can use to manipulate the fight. So you can even make your own game the same as if you want it. And then I have a bunch of top posts about this for retrochalant, which is like this one month book writing thing where something and it just happened to be just in October and it's the contest and the new look of October. It's perfect times like double it. And yeah, and that's pretty much it. If anyone's been interested, I also have one very cool story about the last minute how I almost got screwed over in the very last minute by not being able to go try the game. Do we have time for that still there? I think it's neat. We're kind of running out of time. Yeah, okay. Talk to me after. Or next time. Next time. Actually, I mean, yeah. So yeah, okay, that's pretty much it. So it's a fun, it contains me. So it's a fun, it contains me. For a key, maybe a free. Yeah, okay. Okay. Okay.


Hi everyone, Joe for Jasper's CaseBreaks.com, doing a random number block randomizer for Flawless. Pick your team four for these three teams right here. That's how the random number block format works. If you're not familiar with it, if you're new to this, check it out. All right. Big thanks to this group for making it happen. There are the numbers right here. Let's roll it. Let's randomize names and numbers six and a three, nine times each. One, two, three, four, five, six, seven, eight, and nine. Got Eric down to J, six and a three, nine times for the numbers. One, two, three, four, five, six, seven, eight, and ninth and final time. After nine, we got two down to zero. All right. Eric with two, Matt with nine, Matthew with nine, Adam with five, Andy with eight, Peter with seven, Mark with six, Matthew with three and one, Adam with four, and Jay with zero. Let's order these numerically. Now we've got two more random number blocks to work on. Those final two also have a filler attached to it as well. So let's just keep, don't worry about what we got to do. Just keep tripping away at everything and eventually we'll get that Flawless basketball break done tonight. We'll see you for that a little bit later at jaspyscasebreaks.com.


Ready to see Rithik's shirtless. I'm ready to see Rithik in his underwear You've hemorrhaged I did in my booty and Thank you for this was a picture in a follow-up picture Twitter account today. We're doing a movie review Because we went to see the Smash blockbuster war by the way Saw a message from a stupid baby who saw we saw this and we didn't go see the other movie that released today Yes, this isn't preferential treatment guys. It's the availability of showtimes at physical schedule. There you go That's what that but we saw war the action And we will start with non-spoilers for those of you who haven't seen the film yet Yeah, most of this will probably be non-spoiler I mean if we feel if we feel like we need to give some spoiler talk and then we'll put that at the end But yeah, you know, yeah, so you know since it's a new film. Yeah Most of the films we've you're about 20 years old, so exactly We've all seen it already, but so no spoilers yet. We'll be very kind to you Do you see not side? Nice is the film follows an Indian soldier who was assigned to eliminate his former mentor Who had gone rogue who had gone? It doesn't say has had Interesting choice of words I Directed by you can go ahead and say the name for Sid Arthan and Sid Arthan and who also I believe wrote it And then it was pretty and was part of Rambo in 2020 and produced It was produced by here's his name for me Did you show prop who's a big? Yeah big time. So apparently he's directing the Rambo nose remake. Yeah starring and tiger Shroft and and Vani Kapoor who I think this was a new up issues and that backfire Yeah What's right here with Ranveer remember that you remember that one they were doing like a dance. I do a hip-hop dance off I do I do I do I absolutely do yes. Yes, but we will start with basically what we what we really enjoyed about this film I think going into this you're gonna get what you thought in in my opinion 100% we went in thinking We're gonna get a Rithik Tiger lovefest, especially Rithik and it's gonna be nothing but action dancing Modeling and visual effects and that's that's all we expected Yeah, and the the worries that you had that they was gonna be kind of a week start a week script are there Oh, yeah, a hundred percent a hundred percent That if like there's moments in the script that it's like Yeah, we we clearly can't do anything but tell you what's going on and they do that a lot a lot So yeah, those are definitely the biggest weak points of this film But I don't like I see this to see a story No, and I think most people when they saw the trailer I think we would have thought that right if you were thinking You were gonna get something on the line of like the intelligence level of an action film like the Bourne identity or Even like one of my favorite mission impossibles is the third one Where there's actually some stuff going on and electrically with the action films. No guys Yeah, the trailer kind of let you know what this was yeah Yeah, yeah, and it delivers and it is what it is And so all that kind of stuff and if you don't like if you don't like Brainless action films don't go see it. Yes, and it did have some really good actually twists It did there were some really good. There was nothing where you're watching you go. Whoa, just you're watching it and you go But definitely the best part of this which is what you think would be the action But like every single time there was some and there's a lot of action and let's clarify. Yeah, it's not realistic guys No, what were you thinking? No, this is and it's not the first bird. Yes It's if you if anybody went into this thinking I'm gonna see a real good action film It's gonna make me feel like I'm watching a real crime story No, it's it's almost like these guys are Marvel characters. Yeah, who essentially have their Marvel characters Who spent a lot of time at the Joffrey ballet Because everything they do even militarily is very bad. I can't tell you how many times Tiger and Rific do do a jump and they're like this I've never seen so many gunshots with a guy like this going Yeah, and that's what I expected of this film though laugh out loud ridiculous and I loved it Yeah, and I there was certain like the writing was definitely the weakest point of it 100% and it was almost like painful and Obviously, it's the first thing we've seen Tiger and so I'm not gonna he he's this is all I've ever seen of him So, you know, he's not a not a great actor, but you know, yeah, and he didn't do awful Like and I think actually the majority of it was actually more writing honestly true I think it was him true because some of the right Day to day Lewis can't do a lot with just nobody could do anything with the script. Yeah It's like it was just it's one of those things that now it didn't have it didn't have moments where I groaned It was like no really, but it was for the most part really amateur. I kept wanting I kept saying let's get back to the action Exactly. Don't don't try and don't try and get me into espionage. Yeah, don't get me into the crime story I'm not interested. This is what I like it would have been a great film if they would have gone the John Wick route John 100% John Wick What one kind of Reeves is not a good actor at all I like him. Yeah, no, I like him as a person. Yeah, no, no, no, I like him. I like him as John Wick Yeah, but doesn't mean he's good cuz he's not I'm sorry. I Like him as John Wick. He's believable for me as John Wick because he doesn't talk That's my point of it. I think they should have gone that route where like almost 90% of the film would have been action. Yes, and like the whole point is spoiler if you haven't seen John Wick Yeah, if you haven't seen John Wick, it's not really spoiler, but basically the whole film is him Killing a bunch of people because of his dog Yeah, I mean John Wick 3 they really are the best of the John Wicks They're best one two and three they get weaker as they go the best story is the first one Yeah, but you don't go watch John Wick for the stories You go because like when I went to see John Wick 3 we're in the theater and this guy comes walking in Before the movie starts we got popcorn and he says to the whole theater this dude coming in to watch he goes Who's ready to see some headshots?  I was like this is cool Yeah, that was like very creative action Like it was plain action there was slight slight spoiler here. Sorry slight spoiler. There's much action scenes There's much action scenes when you've seen it in the trailer motorcycle Cars on ice That sounds like that sounds like a touring ice-capade thing cars on ice Yes, but I was hoping like because they tried to insert some Kind of heart into it like for like a love interest or like stuff like that And I'm like no no actually they started it insert that I'm like please kill them Yeah, let's give just more revenge. Yeah rid of the heart strings.  Yes This was a cheesy. Yeah, but I wanted to be even more I want to know it even more right you're not gonna get any story with this You're just gonna get some epic superhero stances from Rithik. You're gonna get some now Let me tell you something Okay First of all two things about Rithik and Tiger. Okay. Yeah, first of all this movie is like the only thing they thought about Pre-eminent in their mind wasn't story wasn't even an action. It was how good can we make Rithik look? That's true every frame every moment. Let's give them an epic entrance The other part of that is guys The best part about Tiger is I don't think he's going too far down to try and pull up anything He's got a massive man crush on Rithik. Oh, he does. That was a bromance in this like it's the biggest It's bromance. I've seen since Top Gun 100%. He is his character and maybe Tiger is so Freaking in love with Rithik. I just wish they would admit it to each other. Exactly. I mean even there's some hints in the lines There's this one line that Tiger's character has I won't give it away and we were like Yeah Literally you're in love with the man. Yeah, it was obvious. I was actually hoping they were just gonna admit it I was like because that would be awesome. And they're so over-the-top these moments that are just Ridiculous and I loved it. Yeah. No every single time there was action. I was like, this is what I came for Yeah, I this is I love this and all the slow-mo walking. Yeah.  It's slow motion It was a combination of Marvel action stuff with sunglass ads and Ballet mixed with martial arts. Yeah, and that's what that's what you pay for Yeah, I didn't come to see like his love interest. I did not I don't want to see that actually and it's it is 100% it's a one-and-done. Yeah, you just you see it and you're 100% worth a watch But we did say this in India you guys have the benefit of the doubt of something we didn't have I think we would have enjoyed it even more. We would have enjoyed it even more.  Oh and someone gets shot and it's gonna get Don't look for like You know some character gets shot and survived and then two days later. There's no wound. Okay, great We're not looking for realism. Yeah, we don't expect it. Someone's head can go through five stone Pillars and we don't have or one of my favorites is one of the characters just gets beat mercilessly in the face Just pound it later that night. They've got like a little nick here and all the swellings gone down.  Oh, yeah, like I wish it could have like just nixed any of the love interest in your heart I agree and just been like almost a revenge. Yeah shoot them every single time It didn't need that and I guess they needed that for runtime. I don't know but it didn't need that and don't you know, this is not You know don't send it when this comes on DVD. We don't need a DVD. Yeah, I'm not watching that again. No It's a one-time watch 100, but and it's only for people who are in the mood for brainless action and fun Yeah, that's it and it's worth it. Yeah worth a one-time watch 100% agree with that It's It gave you what I thought from the trailers that it was gonna give you 100% And it had the worries that I had in the trailer that it was gonna not really have a story Right, and it wasn't really gonna have great dialogue, right and that's what it was and I enjoyed It's so fun to watch those guys knowing what the dream come true. This is for Tiger Shaw Yeah, you know to watch him with his idol and watch them work together He must have just been in awe working with and great because character-wise you'll see it if you see the film This is not a giveaway Clearly Rithik's gonna play the guy who's it says a mentor.  It's gonna be Rithik. So Now one thing I'd like to know Because Tom Cruise has set the bar really high for action actors Yeah, I don't think these guys do all of their own stunts. I could be wrong Yeah, probably and I know some of the CGI Yeah, but a lot of times CGI is so good They'll do like for example and do really intense motorcycle stunts and they'll CGI the actors face on the actual stunt person Because as you probably don't know this Tom Cruise does all his own stunts No matter how crazy it looks it's Tom and I would like to know how many of their own stunts They did do how many injuries maybe happened on set because that happens a lot But it's a lot of fun to watch the action sequences the way they were shot Yeah, really creative and inventive stuff. Yeah. Yeah And certain things that made absolutely no sense. But like we said leave your brain at home Yeah, this is one of those films. It is it is one of those films that you're not it's not a thinker Actually think I think they thought too much. Yes. Yeah. Yeah, I agree Yeah, they tried to overthink it a bit. Yeah, and be like all people want some hard and love and no I don't know. No, their love interest is enough for me I did think I did think they did a good job of not trying to over do they did a little bit But the espionage and spy story we had to have one and they gave us some nice little twists I agree the love up the love interest relational thing the kind of heart. I was like Show me more action.  It was really fun. It didn't really fit in the oh, oh, it's absurd There they are this military compound now Yeah, they're really dedicated to doing what they're gonna do and they turned it into a frickin nightclub spoiler You've seen the musical number, which was very cool. Yeah, but credibility No, where'd they get all the people in the middle of nowhere? Honestly, I would have rather than the clubgoers It's I I was more I would rather than put like one or two more numbers in and taken the love interest Because I would be like this is my nuts. This is fun. Let's do this one hundred percent Because it's one of those films like I don't want you to try to be a good good good film I want you to try to impress me with your action exactly and throw in a couple of really fantastic Music numbers because that number is a lot of that's that's a lot of fun Well, the other number was okay. It wasn't great. No, I would have heard more of a party number me too Just cuz that's what the film is Like a ballet between Rithik and yeah exactly turn one of their fight sequences into a musical Yeah, that's what I was hoping for like it's a dance battle. That's what I was hoping for. It's one of those films But yeah, I feel like I've said one it's worth a one-time watch. Yeah a hundred percent Especially in India where you're gonna have the crowd to go along with it Yeah, this is this is a really just fun Friday night Just go have a blast and then forget it.  Yeah, and then go see the Joker and then it'll be amazing. Yeah Oh And I can't wait to see see a rock Sorry, I'm sorry. Yeah, I can't wait to go see that. Yeah, we're gonna definitely definitely see now. I don't know when it is I'm sorry. This isn't again. This wasn't preferable treatment, but let us know what you thought of that in the comment section below and


It's not just another game because it hurts when you lose. I mean it hurts when you lose any game but it hurts even more when you lose a derby. It's not any other game. This is special. It's something we wait for for a long time. I mean this club means everything to me. I've been here for a long time now and my heart's definitely here as you can see. It's something you never really get used to. I mean walking out from that tunnel. It's something that it's a bit surreal and I think most players won't really soak in until after you retire just how big this game actually is. I think the best thing is both sets of fans just going as hard as they can in the stands and the RBB I mean what can I say they've been a massive contribution to our success. I said it this morning in another interview that the person asked is it weird that the Wanderers fans are going to outnumber the home fans. As strange as it sounds it's not rare for us. I mean everywhere our fans go usually they outnumber them and if they don't outnumber them they out-sing them. So we're very lucky, we're very fortunate to have the support that we do as a club.


My name is Lana Zoftis-Ryerson. I am a neurologist at the Jersey Shore Multiple Sclerosis Center, and I'm also the Director of Research for the Neuroscience Department. I always want to treat the individual, not their disease, and so I think what does that mean is that I really try to get to know the patient, their goals, their fears. I'm then able to provide and suggest medications that are unique to their situation. I love to get to know my patients. I love to hear how they're doing in their lives. I'm lucky enough to have seen patients diagnose in their early 20s, graduate college, start their careers, get married, start families, and being part of that journey is really what makes this job so fulfilling for me. My mom has MS, and I guess in the back of my mind that is also something that attracted me to this field to be able to intervene in something that's personal to me. Knowing that I can keep this what could be a very scary disease at BAPE is the most rewarding part of my career and what makes me excited to go to work every day.