The heart of protein synthesis is the translation of nucleotide sequence information in the form of codons into amino acids. This is accomplished by tRNA molecules which act as adapters between codons and the amino acids they specify. There are many types of tRNA molecules but each is attached to a specified amino acid and each recognizes a particular codon or codons in the mRNA because most tRNA recognize more than one codon. So, every tRNA will be attached to a special type of amino acid and will identify a specific or two or three types of codons. tRNA molecules are between 75 and 95 nucleotides in length. Although the exact sequence varies, all tRNAs have certain features in common. First, all tRNAs end at the 3 prime terminus with the sequence 5 prime CCA. So, every tRNA end will have CCA sequence. Consistent with this absolute conservation, the 3 prime end of this sequence is the site that is attached to the cognate amino acid. A second striking aspect of tRNA is the presence of several unusual bases in their primary structure. These unusual features are created post-transcriptionally by enzymatic modification of normal bases in the polynucleotide chain. So, the second striking feature is that some unusual bases are found in them. And where did these unusual bases come from? Because in normal sequences, these unusual bases are not found. So, these unusual bases are post-transcriptionally modified and created in them. For example, Pseudo uridine is derived from uridine by an isomerization in which the site of attachment of the uracil base to the ribose is switched from the nitrogen at ring position 1 to the carbon at ring position 5. So, the uracil attached to the ribose in the uridine is switched from the nitrogen at ring position 1 to the carbon at ring position 5. And this becomes Pseudo uridine. Likewise, dihydro uridine is derived from uridine by enzymatic reduction of the double bond. Between the carbons at position 5 and 6. So, in this, you can see that this is uridine and in this uridine, ribose is attached to this position. And when Pseudo uridine is formed from this position, this is changed. Now, the ribose attached to this position is attached to this position. Similarly, from uridine, there is a double bond in carbon number 5 and carbon number 6. And when dihydro uridine is formed, this double bond is removed. So, in this way, these unique types of bases are found in this. Other unusual bases found in TRNA include hyposanthin, thymine and methyl goanine. These modified bases are not essential for TRNA function. But cells lacking these modified bases show reduced rates of growth. So, if their reduced rate of growth means the role of these bases is in translation. Because reduced rates of translation means reduced rates of growth. This observation suggests that the modified bases lead to improved TRNA function. For example, hyposanthin plays an important role in the process of codon recognition by certain TRNS.


My name is Antonio Heia, I'm working at Google, I'm here for Signal World and I want to talk to you about a new feature that we developed and it was released in 1929 about managing multiple service items but to try to explain why we need this feature is because when you talk about Kubernetes classes you always used to think in terms of I need so many so much CPUs so much storage but IP addresses is always something that people don't realize until they hit the program. You see the map of internet there are only a few ranks where you can get IP addresses for your cluster right you are not going to use public IP addresses as they are super expensive and for getting these IP addresses this means that you need to carve out from some these private ranks and some value right you need IP addresses for your nodes you need IP addresses for your pods and you need IP addresses for your services the main problem is that we try it from Signal World to try to standardize this problem but all the node IPs are provided by the network infrastructure provider then for the pods you need to there are different plugins so it's not easy to standardize so the only thing that we can control is the service side right that's the one that you assign in the in the API server so the problem with services is that the services is as I said it's a flag in the API server so you need to hard code that when you start your cluster the way that it works is when you create a service it gets allocated one IP from this server right and once you have this IP this is immutable so you cannot remove it or from a service that is already allocated also the size of the service side that is limited right because this for implementation details this is hardcoded in the in the ecd database and and you cannot modify it when it's running and this creates several problems to the user right then if you are greedy or you are conservative and you start your cluster and suddenly you start to grow you may hit limits and you cannot resize your cluster the other problem is is that you cannot use ipv6 because the this this size of this branch is limited or you cannot have you can deal with problems on upgrades you just try to modify the flags in different AP servers at the same time so one of the possible solutions we are talking about exhaustion is can be okay we why don't we use ipv6 right I mean that's that's how I started in this project in 2019 I will start working with ipv6 right I was with this mindset of okay let's let's try to get ipv6 in kubernetes so everybody can use it right but ipv6 is a long right is the first specification was written and published in 1996 the war ipv6 launch was in 2012 kubernetes made ga in 123 in 2021 ipv6 and dual stack and we see that there is a trend of adoption right but every year is the ipv6 there right so what I started to do is to start to prepare I'm not confident I'm going to be able to see a full ipv6 cluster so I started to prepare my son to say okay you need to take on this and work on work on ipv6 but jokes aside is how this kept work right how this feature work what we did is okay less the people have the capability to define this service branch that they need to increase the the cluster size during runtime so what we did is we created two new objects that says service slider and then they have pools of IP addresses to the cluster so in this case the IP address is is seated as a fungible resolve right so do the with the same way that you add these to store us to this capacity you add new rights so if you want to play with this feature you can use kind you need to enable some of the feature based on runtime config and in a quick demo we can see that a cluster created with a small service slider that only is able to allocate 16 services you can see that if you try to allocate more than the services is not possible then you increase the capacity and now you are going to be able to create this additional services right so simple you don't need to restart your cluster and you get it working new services with new capacity is in the same case we have a protection so you cannot break your cluster if you try to delete this new service slider meanwhile all the services has these IPs and are allocated you are not going to be able to to remove and that's it


My name is Jeremy France. I am an operations manager for an aerospace manufacturing facility here in Laconia, New Hampshire. Born and raised in Westboro, Massachusetts. Moved up here about nine years ago and just loved living in the woods and being at peace. I spent the first three quarters of my life internally battling with who I was and you know, dealt with crippling fears, doubts and insecurities and I never really knew why. Growing up I was brought up in a wonderful home and in a wonderful area in Massachusetts and you know, had everything that I ever needed. For whatever reason I just was never satisfied. I always needed more and I always needed to look at others and what they had and I spent a lot of time dwelling on the fact that what they had was better than what I had and how they felt was better than how I felt and what they looked like was better than what I looked like. That was mostly internalized. On the outside I looked, you know, as well adjusted as anybody would be. I was, you know, socially accepted, I was outgoing and you know, I never really let on that there was ever an issue and part of me never really knew there was an issue until I got a little bit older into my teenage years and once I started doing things in my teenage years like, you know, going out and partying instead of, you know, concentrating on schoolwork or athletics, things quickly started to escalate, you know, without my permission and, you know, to fast forward a little ways, you know, by the time I was in my 20s things were really spiraling out of control and I started to experience things like depression and anxiety and a level of fear that I had never experienced before and when that occurred, you know, I started to live in pain and for me, you know, it just got to a point where the pain was unbearable and you start to give up and that's an empty feeling that's a scary and dark place to be and, you know, the circumstances that occurred were vast and they were frightening. When you have that feeling of less than and you have that feeling of complete worthlessness, it just seems like there's just no way out and not knowing that there was a solution to what was wrong with me, you know, I just kept falling deeper and deeper and eventually, you know, I had an opportunity that came about just because it came about and, you know, for the first time in my life I was able to out loud speak up and ask for help and that was the hardest thing that I ever had to do because that fear was just too powerful and I didn't want people to know that I needed help and I didn't want people to know that I wasn't able to take care of myself. I was either going to die or I was going to, you know, at least have an ounce of willingness to change and try a different way because I had been trying my own way for so long. I was driving the bus my whole life and every time I got to a fork in the road it seemed that I took the wrong turn and the day I decided to throw the keys away and let somebody else, you know, drive the bus, that was the first day that I felt salvation and, you know, I had an opportunity to move up here to New Hampshire, get the help that I needed and I live a life today that I didn't know existed. I live a life today that I know is limitless. I live a life today that when I do what I'm supposed to do on a daily basis and I make sure that I'm spending time loving outside of myself, knowing others need it more. It's a day of satisfaction and it's a day of fulfillment, you know, for my father to tell me that he's proud of me. It's, you know, that's better than any song I've ever heard on the radio or any landscape that I've ever had an opportunity to photograph. You know, when I started running about a year ago, I was able to tap into a totally new feeling of peace and meditation that, again, I didn't know existed and I'm afforded these opportunities because of what I do on a daily basis to maintain my health, not only mentally but spiritually and physically and, you know, I never set out to be a marathon runner. Folks that are closest to me, you know, they laugh and we joke about, you know, about Forest Gump and how we just started running it but that's the truth of it. I just got up and I started running and the next thing I know I'm running three miles and five miles and then eight miles and then ten miles and a good friend of mine said, hey, you know, I'm running in New York. I'm running for the New York Roadrunners and a charity called the Run for Kids and you have, you know, an opportunity to raise some money for some kids in need and that started just an absolute new way of thinking when it comes to reflecting back on my childhood and how I never really wanted for anything when it came to athletics. I didn't have to worry about where the equipment was coming from. I didn't have to worry about having coaches and trainers that were experienced and, you know, and mentoring young kids and it got me thinking that all these kids out there that just don't have that opportunity and I wanted to be able to be a small part of being able to provide that for them and in the meantime I'm running mile after mile and feeling better and better about myself and why I'm doing it and you get to a point where, you know, your feet aren't even hitting the ground. You're just kind of floating and you're going and, you know, I'm blessed to, for whatever reason, to have, you know, enough endurance to keep that up and keep it going and growing up ten miles from the start line has just been always been, you know, a dream to run Boston and those dreams faded, you know, as my life started to take a turn in a different direction but that spark was still there and I reached out to a couple people that I knew had run Boston before and they got me hooked up with a wonderful woman, Susan Hurley, who then got me in touch with the Pedro Martinez Foundation and that was just blown away just even at the thought of being affiliated with Pedro and his wife's Foundation and what that would mean not only to me but to my network of family and friends and also what I could do, you know, to help that foundation, you know, raise money for kids not only locally but around the world and to represent Pedro Martinez and his wife Carolina it's just a dream come true. Growing up an avid Red Sox fan, you know, my father had season tickets to the Sox. I spent so many days in that park and when Pedro came to the Red Sox, you know, it was it was a godsend and, you know, I looked at Pedro and just admired him for so many different reasons being a guy of smaller stature like myself. I loved his fearlessness and I could relate to it, you know, when I grew up playing sports especially, you know, playing hockey I certainly wasn't the biggest guy on the ice but there wasn't anybody there that I was afraid of and, you know, athletes and men like Pedro Martinez, you know, they just set such an amazing example of not only hard work and training but also knowing the mental aspect of athletics and how he would outthink, you know, the opposing batter and what he would do, what his pitch selection was for each and every opponent that he had. You know, I have so many amazing memories of not only watching Pedro live but also, you know, the run in 2004 was, at that point in my life, one of the greatest experiences, you know, that I've ever had. I bring people upstairs and put on the 2004 Faith Rewarded DVD because there's a scene in that amazing movie where after the World Series is over and their parade was going through the streets of Boston, I was fortunate enough to be in one of the buildings right next to FAO Schwartz in the McGryhill Publishing Building and the camera actually zooms in on me hanging out of the window while Pedro was going by and, you know, the video is grainy but if you look close enough you can see the tears in my eyes and, you know, the amount of pride that that brought to Boston and just all the memories that, you know, it brought up from me being a kid going to the Fenway with my father and, you know, what it did for the city at the time and, you know, you fast forward 15, 16 years and all the championships that we've been able to be a part of is just amazing.  I try not to envision crossing that finish line because I don't want to, I don't want to set expectations that I'm not going to be able to live up to but I just know that, you know, I've been given a gift and to be chosen out of so many folks to represent such an amazing foundation is an absolute blessing and I couldn't think of a Boston icon more fitting to represent than Pedro Martinez.


Hello, everybody. Really, really welcome to the Community I Health Journal webinar. I see we've got attendees arriving. We've got... Beloved, if you could put in the chat where you're from, welcome builder, Dorothy just said, Ruchi Mohammed, I'm seeing Ruchi Priya, Sandy Bhutan, Tulsi's here, hello Tulsi. Ruth, welcome everybody. Gosh, we're up to 29 attendees. Anag, welcome. Hi, Anita. Anita is a member of the journal team who's joining us. Benson and Gure, Bildad, Darman Diwalia. Welcome, everybody. Hello, Dorota. Wonderful. Oh, we are 32 attendees. So it's just a couple of minutes, three minutes past 11. We'll give you a few more minutes. Hi, Daksha. Daksha is also a team member here at ICH. So yeah, from the International Centre for Eye Health and the London School of Hygid and Tropical Medicine, welcome everybody and a special welcome to our panellists here today. This is our, I think, our fourth Community I Health Journal webinar. Here, would you say hi, open up your turn on your camera for us? That would be great. Thank you. Here is our communications officer here at ICH and without his technical wizardry and communication skills, these webinars would never happen. So we're really grateful to you here. Thank you so much. Great. Yeah, welcome. So we're going to start today. So today's webinar is a combination and I've got the two issues here. We've got our community engagement journal and then we also, we followed up a couple of issues later with the catrat. I think it might be a mirror image if you're looking at a catrat issue. And the reason we decided to combine them is because there was so much overlap and catrat being the biggest cause of preventable blindness in low and low income countries worldwide. You know, and you can't really, you can't provide catrat services without the community being involved and engaged. People need to know about it. They need to want to come forward and customers who are satisfied will go and promote the ICS service and convince others to come for surgery as well. So we decided to combine these two issues. And without any more introduction, I'm going to ask Fatima Kiari, who's an ophthalmologist and also an ICS colleague. Fatima, please introduce yourself and then give us a brief overview of the catrat issue. Thank you. Hello everyone. Good morning. Fatima Kiari, I work as an ophthalmologist at the University of Abuja Teaching Hospital. And I'm also an associate professor at the London School of Hydrogen and Tropical Medicine. So I would like to share my screen now. And okay. So we're just going to be talking about the improving catrat services issue, which was talking about better access, better outcomes and better value. I would just like to acknowledge two of my residents who I believe thoroughly read the journal and came up with a summary of which this is what I have, I am presenting to you. So the focus of the issue is a balanced approach to outcomes and outlay together with strong partnerships to create a catrat service that puts patients at the centre and deliver eye health for all. And when we talk about partnerships, what are we really talking about? So it's not just about the hospital because it's patient centres, we need to know what matters to them, ask for their feedback, know what they want. And then the community can also be very useful in terms of service delivery and also in identifying catrat patients because they live among themselves, as well as after care following surgery. Then of course the hospital management, where the hub of the service is, increasing the scope of sustainable service provision with a balance between income generation and cost containment. So in this issue we talked about, how can we balance the two? We know that we would like to increase the services but it's always at a cost. And then the hospital management is always trying to cut cost or at least contain cost. So we need to know how else we can do the income generation and that gives us the sustainable service. Then of course the eye care personnel is very important to the system, the roles, the responsibilities. And then there has to be respect within eye care personnel and team. And there has to be a transparent and fair human resources policy. So the issue talked about this and gave examples of how teamwork can actually increase. So these strong partnerships can help to produce a high volume, high quality and affordable catrat surgical service. Okay, so we can't really talk about a catrat service in this day without talking about effective catrat surgical coverage, which is the ECST. It's the new global target recommended by the World Health Organization and it's not only talking about measuring quantity but also measuring quality. So both are measured. In the previous catrat surgical coverage measure it was just about quantity. How much of people that need catrat surgery actually have it compared to those that need it? So in terms of who are the people that have, how many people have had catrat surgery and how many people actually need it, including those that have had it and those that haven't had it, which is the denominator. So this is the new global target. So it's not just about numbers. It also increased the, it also stated the visual outcome of catrat surgery as a parameter to consider. And here there's a cut-off point of a presenting visual activity of 612 or better, which is really a high bar. In the previous WHO recommendation of what is good outcome is 618 or better. So this is quite a high bar, which means there has to be an improved quality. There has to be increased output. And then of course equitable access. We have to consider children. How do we, how do children access the service and how do women access the service? Older adults, even though catrat is mostly for adults, but we also need to pay special attention to how older adults access the service and of course people with disabilities. So I'll just mention a few key highlights of how these were discussed in the journal. So there are articles that focused on the patient-centred approach and we'll see the article that discussed patient feedback and how that feedback was integrated into the system to improve the service of that hospital. And then the patient reported outcome measures. So we're not always fixated on visual outcome 612. You know, what does that mean to patients and how does that affect their daily living activities? For example, look at the photo I have here, which is out of the journal as well. So acknowledgement to the photo, the journal for the photos. This is just the lady who has had catrat surgery not I guess this her first day post up and she's already back to her usual work and she's happy with it. And then there is an article that also talked about service operational policies being friendly to patients to improve access. We have to think about how we can engage patients, how we can make them happy in the environment. So there's a journal article that talks about that. Then of course the focus on patients needs. Then we have a few articles also that talked about teamwork and efficiency, where we have highly organised an efficient team-based approach. That could be in terms of efficient operationalisation of the system. Like what we see here is the two-bedded theatre. Even if it's one surgeon, the surgeon can swing quickly between the two tables. Like finish one before the next one is set up. It started on the second table and before the first table is set up, the surgeon has started on the other table. So it's quite efficient. And then we talk about bulk purchase. This has been a long-term strategy. You put resources together to buy a lot of consumables, for example, to reduce the cost. Quality monitoring and improving the process shifting. This article talked about shifting from biometrics, ultrasound biometrics to immersion ultrasound biometrics, which improves the IO power prediction accuracy. And that just changed the outcome of the cataract surgery in terms of surgery-induced refractive errors. Then taking advantage of economies of scale by sharing infrastructure and salary costs between more patients. So this teamwork and these strategies to improve efficiency are all discussed in the journal. And then finally, its equitable access is also discussed in the journal. We have to think of how we can address those that have barriers, that face specific barriers. Here we have an example of women by enhancing the experience of care, increasing their awareness, and reducing their non-medical costs. Because oftentimes when we talk about cataract service, surgical service, we think of the medical costs. But we do have non-medical costs and largely women affected. Then increasing demand and uptake. I think I was glad to see that systematic review showed that outreach cataract surgical services are really still very much needed. And in some communities, in some countries, that is what will really scale up demand and also uptake. Then reducing financial barriers, which is another key component of cataract surgical service. You have to think about multiple sources of funding. So this is it. We talked about all these three important parameters in the journal. The patient approach, the teamwork, and increasing efficiency and ensuring equitable access. Thank you very much. Brilliant Fatima, thank you for a really thorough overview of a really complex and in-depth issue covering a huge amount of ground. Really grateful to you. I was just thinking, we were going to go on with Serona next to talk about the community issue. But I just very quickly want to give a couple of minutes to our participants. Are there any urgent questions that you have about for Fatima on some of the topics mentioned? I might be able to take two questions and then I'll ask you to just jot down your questions for when we have a little bit of a longer time. So I'm just looking. There's no hands up just now. But yeah, so if you can, I think there's a way to add questions here. Can you just take us through how participants in the webinar can post their questions? There's a Q&A function, isn't there? Yeah, if everyone wants to put any questions in the Q&A option at the bottom, and then we can ask those to the panellists either now or later when we have a bit more time for questions. That's also the chat option as well, if you just wanted to put anything else in the chat that's not a question for panellists. But you can raise your hand as well if you'd like to speak and we can put your audio on as well. Fantastic, yeah, because I'm just a way there's such a lot of ground that Fatima's covered. So yeah, we welcome your question. So yeah, get your questions prepared for the next session. So Fatima, thank you ever so much. That was brilliant, really, really great. Serana, can I ask you to unmute and put on your camera so we can see you? And then Serana was involved in putting together our community engagement issue. So would you take us through some of the key findings and principles in that issue? Thank you. Thanks so much, Elmine. And hi everyone. Hello from Pakistan. I'm Serana Yasmin. I'm Deputy Technical Director for our iHealth and Reflective Error Portfolio at Sitesavers. Also work very closely with World Health Organization and IAPB in the field of vision care. So referring back to the issue on community engagement that Elmine talked about, in this issue we explored why engaging with communities in the work that we do is crucial to ensure access to eye care for all. I'm going to share some key learning and messages that emerge from different articles. So as part of this issue, we applied a health system strengthening lens to community engagement and explored what needs to be done to ensure universal iHealth coverage with a very specific focus on identifying challenges of reaching the most vulnerable population groups and then how we can work with communities to find the right solutions. The issue also highlighted why it is important for us to involve the community, not only in the design and planning and implementation processes but also making sure that they are engaged in monitoring the quality and impact of eye care interventions and then their role in advocacy that cannot be underestimated. The choices of making sure that we have the right advocacy messages in place and the chances of advocacy success are always high when communities are part of it and they own it. So we all know that health system strengthening lead to equitable access to eye care and one key message from the issue is moving eye health for all is critical to making progress towards universal health coverage. This would give access to all individual and communities to the health services that they need, where they need them, when they need them, without making sure that without incurring any financial issues. So for this to happen integration of eye care in universal health coverage and delivering integrated people-centered eye care for all is central. So making sure that we apply a health system strengthening framework that's the way we'll be able to address the barriers that we face in terms of inclusive service delivery, eye health workforce, data and evidence, governance and quality of care. The need to embrace technology and innovation is also highlighted and you'll find really good examples about it that we can learn from and also integrate into our work. The article on demand-side financing mechanism also share really good examples and tools that can help us to increase access while making sure that we are effectively using our resources, improving the efficiency of service provider and empowering communities along the way. Next slide please. So there is no doubt that meaningful engagement of communities is really important if you want to maximize the impact of our work and a strong starting point is to better understand what a community means and that means including people with disabilities, women and girls and other vulnerable groups. So active and continuous engagement with communities going to help us to understand their need so we can plan and deliver eye care services accordingly and this then is going to have a ripple effect in terms of generating demand and improving uptake of services and we are going to hear about it from Suresh apparently shortly. Social behavior change communication also been identified as a key strategy that support communities to make long-term change in their behavior and that includes how they look after their eye health and how and when they seek eye care. So we need to factor that into our work and also make sure that we invest in this area properly and last but not the least accountability for us as a sector to be accountable to our respective communities and then also making sure that we empower communities to hold all eye care stakeholders accountable including national and local governments. So in some way community engagement and integrated people-centered eye care has a tremendous potential to ensure equitable, inclusive eye care that meets the need of our communities. Thank you very much. Back to you, Elmi. Hello, Simran. Thank you so much for that amazing overview. It's such an important topic and actually when both you and Fatima were talking and you know I'm always learning so much both in putting together the issue editing the articles learning what all the authors are writing and then when we have a chance to reflect at the webinars you know I'm really thinking I think I was even at the beginning of this meeting I was thinking that you know the more we engage with the community the more we can kind of get people to come in for services you know I'm thinking from the community as a resource but actually with community engagement it's about serving the community it's about being humble as eye care workers and actually I would like the panel to please put on your camera because I think this is a really good place to start our panel discussion so if everybody can in the panel please feel free to turn on your cameras you as well it'd be lovely to see you as well yeah it's how do we serve so maybe the first thing that's required and perhaps everybody who's here will already think like that it's only me who's got a slightly mercenary approach to eye care and health care but it's to think that we are really here to serve the community and you know in all aspects so you know women people who usually marginalised as well so how do we reach out beyond that the eye clinic and make sure that we are engaging with community so Simrana maybe first question to you how does this work in practice because it all is there's lots of big words and there's lots of concepts but taking it from that United Nations World Health Organisational Level down to as eye care practitioners what should eye care practitioners do you know do differently how does it look in practice I think as a starting point Elmen really important is the context so we talk about community engagement from this bigger lens which is looking at it from global perspective and then kicks in your regional perspective and then national and within national then you have your state or provincial and district level settings and socio-economic cultural dynamics are really different from context to context so just making sure that we are aware of those sensitivities when we start engaging with communities is really important like from my perspective if we manage to make sure that we have a really good understanding of the respective community let's say for example we want to start an eye care program or service then having that insight that what works for this community and making sure that we connect with all the relative stakeholders in the community to get their feedback in what works for them rather than coming up with the you know blueprint recipe that works somewhere else is important and then identifying within the community community champions who are our allies and help us to take this agenda forward is also going to be really critical so if we manage to check these two boxes in the best possible way I think we will be on a good start fantastic fantastic thank you so much anybody in the panel faith I see you are nodding there because that's your area of speciality and we'll hear from you a little bit more later on but just to respond to that point from Simranna please unmute yourself and come in on that thank you good afternoon so I just want to I agree so much with Simranna when she says that you have to take a program that works for the people in that particular area and not duplicate something else it may not work in another place yes so you have to consider so many other things before you go and implement a project in an area yeah absolutely absolutely and thank you and Demisi I'm just looking at you because you know the article you wrote for us in the journal and the cataract issue was about taking an eye unit and just completely increasing massively increasing the cataract surgical output and that had so much to do with community engagement so where do you start and practice you know as an eye health practitioner which seems like sort of a chicken and egg you need the community to do the eye care and you need good eye care to get the community so where's a good place to start yeah thank you Elmin no I completely agree with what Simranna said and phase added you know the community context is very important and it is different with different communities if you're working in a pastoralist area or in a different area the culture the you know the way you address the community the way you reach the community is different from my perspective to your question I worked there and I was sharing my experience at Sabati hospital in western Kenya where I worked for six years as a hospital director assigned there and looking at the potential the huge catchment area the hospital service and the need around what we did was we looked at two approaches one was institution based that you know the service that we provide at the center for those who come looking for the service at the center like any other hospital the second approach was also to reach out to the community 50, 60, 100 kilometers away where the services are not there and we try to address their needs by going out there so the two approaches are a little bit different the hospital based approach worked very well first we worked on ourselves on the institution no building systems bringing the capacity in terms of looking into our equipment our staff our working environment our patient flow no making trying to make a patient center from the moment that patients come into the the compound to be properly communicating with them addressing their needs respectfully managing them and so on and improving the efficiency of the system on the ground in a way like where we even went to the level of probably operating patients who have come from far almost the same day if they are ready and if they are you know preparing them counseling them because usually we lose patients if we return them back they put a lot of effort to come from 60 kilometers you know a blind bi-laterally blind person with the help and probably sometimes they come selling their resources an hogs a cow and returning them back is like sending them or condemning them to not to have service or not to come back and so on so we worked strongly in improving the capacity the systems on the ground worked on our staff in the way they handle our patients more effective efficiently and not giving appointments no sometimes you know patients coming in the morning sitting out there not being attended well all that you know brings in a negative impression by the patients and a negative you know word of mouth to the community and so on so we improved on that and that improved the institution based service both in numbers in quality and in outcome as well the second approach with the you know the outreach service that we expanded and there as well is where the especially the community engagement the community issue comes in outreach services usually work strongly if you have people on different communities where you go people who reach out and who know the community who know the culture who know the tradition who will reach out to them influence them that we are coming as a team there is a service they should be also a good organization on the ground in terms of know where you do the consultations where do you do the surgeries and in a very strong you know using local radios or the churches the public gatherings and so on so that they reach out to the people so that people are informed people are informed that there is a good service coming to them so they benefit from that that is an important component of the outreach service good mobilization sending out good information and then again still your quality of service provision you shouldn't be minimizing it as much as possible the quality or the standard of service that you have been offering at your center you still keep that quality sometimes when you are out of your center there are challenges that will hold you back a little bit and so on but we still try to maintain that quality service and also work with schools other centers where the operative environment is also good enough not substandard and so on so it's mobilization it's reaching out working with people influencing the community on the ground they can be alliance clubs they can be community organisations women's organizations and so on we did work with various community level organizations in terms of doing our outreach and reaching out to the needy in the outreach service so what we did was a little bit different for both aspects of service delivery you admitted it oh yes thank you thank you I just noticed thank you so much thank you so much that's really helpful to see the perspective both are usually needed aren't they and Hannah I was just looking at you you were involved very much with the community issue and you wrote about the last mile you know reaching people at the last mile and I think that probably dovetails quite well with what Demacy was saying that you know having to reach so hospitals and centers need to reach right out into the community so I just wondered if you have some thoughts and thoughts to share and tips and some you know approaches or principles on that I think much much of what we did has been mentioned but let me share very practical examples a lot of us are in it we would probably be an ophthalmologist or a nurse at the hospital and I would draw from my own experience of what I had to do in the Gambian one is to take care of the team at the base hospital and one success factor was to have a person responsible for that community engagement that we had a nurse who knew the culture and everything concerned with the community to lead on that aspect within the hospital base then the second point was to make ourselves understand what the community is so at the community level who does the patient go to who do they consult what are the systems what are the traditional so we educated ourselves first to understand what that's led by this lead person at the hospital then we designed a way to contact the community using this person as the lead person so in bite size you cannot do the whole country at once so you would select a geographical area and then use that person to transmit or change or understand what I have in is with the traditional systems the women's groups the community health workers just shaking hand and making friends with the community first so they understand us and we understand them and we made that the third aspect was that whoever was working at the community we helped them in a bite size with we understood that they would be taking care of 5,000 population area so the work is not too much for them and then the next level would be 10,000 and whatever they were doing the integration is so important that eye health is not seen as an asylum it is seen as whatever else is going on in the community and because that person is working in all other areas the success is that if they are talking about the child they would mention eye health if they are measuring blood pressure they would mention so integrating into whatever they did so that was so to summarise half the person at the institution who would be responsible have a team that person as some runner said is context familiar context knowledgeable and then that person would guide the rest of the team at the main hospital and then that person would transmit and be a bridge between the institution and the and the community the when you think of community most times we think of that last mile as you say but the last mile could exist in the prison the last mile could exist in schools the last mile could exist in the markets so that concept of that person who is not being reached is the last mile and how do you do that you can integrate eye health into anything they're doing in health but you can also see them as a resource so the health system would be a resource so whatever resource they are using to see the child resource they're using to see the non-communicable diseases you would then push in eye health into that so that you use that resource because in eye health you may not have the resources but if you piggyback eye health into them any other program or any other captive population we piggyback and that has to be an objective a set objective with strategies and plans and people who would be responsible for integrating into those resources the third resource that is very good is the community development they are responsible for water or agriculture or nutrition or the non-health government system so integrating into that I cannot overemphasize the point of the people at the third level or the institution having a team responsible for making this happen a bridge person that would link the tertiary to the community and a way of measuring that actually absolutely being successful in in in those areas so apart from measuring the quality and the quantity let's also have a way within the team of measuring whether we are achieving that last mile whether we are achieving the integration absolutely Hannah thank you so much those are powerful words and I'm really glad we're recording this meeting because we're going to post the webinar online and we can listen back and take notes I'm definitely taking notes thank you so much and what you're saying about measurement is so so important and that links back to what Demisi was saying and far too much to you as well I'm so glad you highlighted the effective cataract surgical rate concept when you when you spoke because it actually that's a really good measure not only of the of the actual visual outcome the usable visual outcome for the patient so it's not about just the number of cataract operations it's about cataract surgery that gives people good usable vision but it also measures that against the need then people in the community who still need surgery so actually now on a national level it's it's now possible actually everybody's now being encouraged to use that as a measurement by the World Health Organization Fátima, I'd love to hear a bit more about that from you I'm just aware of time we're going to be hearing from serration from faith as well we've got a video recorded an interview with faith but that's maybe unless there's other questions we can come back to that issue at the end of the next two rapid fire presentations so hold that thought and I think if I'm correct the next would be faith if we're going to hear will you show us the video of faith thank you so much we're not hearing the sound yet so my name is Fátima Langarth I work in Thernwick Hospital Bormett County as a project manager coordinating vision impact project in Bormett County our role is to ensure that we link we are actually like a bridge between the patient and the healthcare system so we strengthen the health the health system we use the existing health systems at a time phase and we are lucky here in Bormett that our health community health strategy is very bright vibrant we have all the community health volunteers in all the community units it's well structured it's well managed it's well supervised such that if you go to a community unit right now and call for the 10 community health volunteers they'll all come so our our role there is to link that to the to our health so for example we through the vision impact project we need screeners and we use community health assistance to screen so our role here is to ensure that the community health assistance gets the best and very high quality training on identification and prevention and referral of eye problems or eye conditions so we take them through a rigorous three days training on primary eye care and disability inclusive development training and we also do a five days training on PIC because this is the system that we use in referral in identification also and in data collection and referral of our of our patients so we ensure that they are well trained we also train them to mentor the community health volunteers because we don't train the community health volunteers so we train them so that as they work with the community health volunteer he mentors them so that once they live then we have a sustainability plan so that the community health volunteers will also be sensitive that we need to refer patients who have white spots or patients with allergies or the tiari red eyes or children who have screens we need to refer them so um so we ensure that they get good training we also train a OSUP or a family skills upgrade cost to nurses and clinical officers this also maintains this with our staff who will work in the dispensaries and health centers so we take the services closer home to the people so we also ensure that they also undergo a three months training here in general hospital and by the time they go back to their facilities they are able to identify treats and also refer cases too either the secondary facility which is our country referral hospital or to terminal hospital they also of course conduct the treatment outreaches together with staff from the county referral hospital and the tertiary facility terminal hospital so they also conduct the treatment outreaches so by providing them that quality training then in the treatment outreaches we don't we minimise the chances of missing out on very important critical aspects yes Brilliant thank you I'm so glad you can be with us today as well Faith that was great um I think just a very quick question I'd love you to elaborate on I mean you do a huge amount of training and ensusing people in the community to engage and train it must take a huge amount of energy so how do you motivate community members um sorry these different volunteers and and you know role players as Hannah was talking these different people who are already engaging with communities how do you get them enthusiastic about iHealth and and um you know achieve what you do please unmute yourself yeah there we go thanks okay so um for us uh iHealth here in Bomet county it's like something that is new we know of course there is high health but to the community volunteers it's something that is relatively programs that have not been done if I can say so so people are really still very excited very enthusiastic about it you teach somebody and already they are saying that they can relate to a person they saw in the community or even their own relatives so um we are not having a bit of a challenge getting them interested also in the community people are really interested they come in very large numbers to the treatment outreaches and so it's very important that we maintain very high standards of trainings both for the screeners and also for the health care health staff yes fantastic thank you so much faith brilliant i'm going to move on quickly to Suresh to talk to us about because Suresh your article was really kind of started off during the pandemic yes and so please introduce yourself take us through what you've done and then I'm going to open up the floor for the panellists to ask any questions of both faith and yourself for both of you about your work and then also open up to our our participants and attendees at the webinar so please start jotting down your questions you can start putting questions in the Q&A as soon as you're ready and but Suresh please take it away yeah yes thank you thank you very much this I'm carrying my slide so good evening to all and thanks for the opportunity for sharing the work that has been done by partners of LICO and LICO is also a part of the member because this is a collective work done by roughly 14 high hospitals so along with me there is Mr Eson Eson who was a part who was a principal author of this article so this basically was an initiative that was been started during the time of COVID when all of us have been stuck with the COVID lockdowns and we are not doing any outreach programs to reach out to the communities to take care of their ICANNs this is when it started so as we all know I saw Hannah from Madam talking about the demand side challenges and Fatima talking about all those aspects so during the time of pandemic it was much worse and because we were not sure when we will be when the demand will rebound and when we will have access to all these patients to take care of ICANN and we also don't know when we will be organizing outreach program and we are also not sure whether the during the time of lockdown whether the patient perspectives and expectations from the providers also might have changed so everything we had only the questions in our mind but we never had any answers to those questions when we started this program and all of us in this forum will agree that that outreach program is another key strategies that we all apply in a day to day situation to reach out to the community members but the outcome of the program which you will see is that there is a lot more people that needs to be served so in a way or other we need to identify an alternative strategies are an supplement to an existing ICANN activities so thanks to COVID which has pushed us to think of some supplement to an existing program that is a community outreach program so really we must thank the COVID for giving us this opportunity so as Dhanafan madam was telling I like the words he was reaching the last mile so also taking that into the context also like if you want to provide an ICANN to the community somebody needs to own it so whether we can make that community organization within the community own the ICANN problems of the community whether the students ICANN whether the students can where the schools can own the high health of the students whether the industries because you want to with the the industry wants to be more productive their employees needs to have a good vision whether they can own the ICANN problems of their of their employees and also how do we best build the referral network among all these organizations as always within the community if all these people taken ownership in their own community then almost like what Hannah madam was telling that we will be able to try to reach the last mile in the community so this was the big challenge that we had we were thinking of having it so still now if you see everybody we have been talking about the all the outreach program what we do is most likely is driven by the hospitals so can we make a shift instead of having in hospital driven outreach program to a community driven outreach program so that there is an ownership within the community so that they can drive the outreach program irrespective of the providers whoever is there so this was the approach which we have taken during those periods and it was an it was a collaborative program so there were 14 high hospitals who came forward during that time to pilot this initiative and there are 11 high hospitals from India one from Bangladesh one from Kenya and one from Nigeria and even though we have taken seven approaches in this pilot but in the paper we will see we will we have reported only six approaches which is related to the community related programs one approach was extremely on the secondary secondary cataract surgery which you are not reported because it is not exactly related with the community engagement program that was the only reason which why we will see only the six approaches mentioned in the paper and in this program Aravindai hospital was a part of a learner we also our hospitals also engaged in this program Allah and in the 11 hospitals there are two high hospitals of Aravindai hospital if you see this outcome really we are very much happy because in the 8 because it started everything started in the February 2021 and it ended in the September 2021 if you see during this eight months period all these 14 high hospital has performed a total surgeries of 20,900 cataract surgery and interestingly 18 percentage of the cataract surgeries which is close to 4,000 surgeries came through the approaches what they implemented during this eight months period so I will go through this in brief considering the time I will just briefly go through what are these seven approaches we try to implement which the partners try to implement in their hospitals if you see the first one which I told we have not reported in the article which is on the other eye cataract surgery because we know that if that's a sort of a kick patient if it's coming from routine eye examination the other eye can be operated so that is the first approach we have taken and then the second approach is that as Demisi was mentioning about in his things the patient should be satisfied so that whether it is within the hospital or outside the hospital so we have taken that as a known of the thing the patients those who are satisfied by receiving the services in the hospital whether they can be motivated to refer further for the patients in their community to the hospitals so how do we liberate the existing satisfied customer of our own services whether it can be an outreach program or it can be a hospital based program so how do we liberate the existing satisfied patients those who can refer patients and then in the during the pandemic we are not supposed to conduct a huge gatherings to undertake an outreach program so there is a hospital will undertake an this approach of having a mini they termed as a mini screening program where they will target only one village in a day whether it can be in one village or a two village in a day where it is only minimum two or three people goes like for an example an ophthalmic assistant and a driver and a counselor so three member team will go they will they will not do mic announcement publicity they will mobilize the patient with the help of the community members and then they bring the patients not more than 15 to 20 in a they like maximize 15 is there what minimum 10 to 15 is what they bring in a bus with the with all social distancing so they used to organize small small camps in each villages even though it's a time consuming but they used to get a good outcome out of those programs then as we all know that the the the hospitals those who have been engaged already with the community partnership or with the community members they have a very very trustworthy community members so again how do we leverage these community members are philanthropists or like for an example any school teachers are a priest go over there in the community who is a well-wisher of the organization how do we leverage them so that they can refer directly patients to the hospitals so in this also we have done a lot of referral because we don't want because during the pandemic we don't want the patients to come for an eye examination and go back without surgery because of any systemic problem or some other thing so we had a very good referral card where the patients before coming to the hospital they will undergo they will they will measure their blood pressure they will measure plus random blood sugar if needed they will get their physician opinion then they come for the surgery so that there is a drop out of the patients who has come for the surgery has not been sent back without any surgeries and also it was full freedom given to the community members to to let us know in the referral letter whether this patient will be able to pay for the surgeries or the hospitals need to treat him for free of cost because of the trust that the hospital and the community has all the hospitals has accepted whatever been recommended by the community members if the community members tells please treat this patient as a free patient he was given free surgery if he was advised that please try to collect only the subsidized charge it was adhered so those who need a feco-surgery are something then they used to give us a paying surgery so that the trust that between the community and the hospital had a huge impact on this then there is another program which was exclusively implemented only in Kenya which is a door-to-door training by a cataract finder in this program what they did is typically they have enrolled engage two community members it is persons from those community who have been trained in a primary eye care in visual acuity understanding eye problems and they have given and also in addition to all this examination kit they were given a motorbikes so they used to you will see the photographs in the article also so they used to go in the motorbike in the community screen the primary screening they will do the primary screening and try to identify all the cataract patients and also refer them to the base hospital for the surgery if in turn they were not if the patients are far away they are not able to go on their own to the hospital once in a week they have to collect the patient those are identify the cataract surgery the hospital used to send the vehicle to pick them up for the service and also drop them back and then the one more approach which worked very well in the eastern and the western part of the country of India is here I really I accept that that way that all the service what we provide it needs to be customized as per the community so this program was very successful only in the eastern part and the western part of the Indian country where the hospitals tried to tie up with the already practicing optometries in the community so they were already selling glasses dispensing glasses to the public so the hospitals made a very good memorandum of understanding with the optometries so that the people coming over there if they have any cataract and any other if the patients need any other eye services they refer to the particular hospital for eye surgeries in turn this opto in turn this optometries just finish your thought thank you go first yes yes yes in turn this optometries were benefited by the follow-up because the poor property glasses was been given by this optometrist fantastic that's that's such a good time with the existing system I'm going to unfortunately have to stop you there because we we wanted to have a bit of time for questions and I know some of the panellists will have to leave in one minute but thank you so much there's a lot more information on that article in the journal itself so please have a read and it very much stuffed us with what everyone else has been saying about working with those existing systems so well done thank you for sharing sharing that with us and sorry we had to cut your short and before we open up for questions I'm very very quickly just going to share a link in the chat as soon as I can work out how to get to the chat we have a very quick few minute survey that I'm just going to share with everybody it's a link so let me just see if I can hold on a minute it's not working anyway I'll share it as soon as I can we would love you to fill out a survey just to give us some feedback about the webinar and you know any feedback on that but they start with the questions there's a comment from Tulsi to agree that he's also experienced some challenges there and then Boniface Madishona says community driven outreach is an interesting innovation it brings a sense of ownership of the program to the community and is really keen to have details of the findings of that collaborative research effort so thank you for sharing your email address there Madishona so I think that's probably a question something for you Suresh yeah so please Taig we'll share that details it's really really fantastic research so please raise your hands I'm just thinking Hugh would you come back on camera and just see how we can ask people to to ask questions how what's the best way so we've got just raised our hands in the at the bottom with your reactions you can raise hand and then we can allow you to speak yes I'm not sure if I'm saying anyone right at the moment and I've just put the link in the chat it's a bit dug it's bit.ly forward slash C E H J Web and we'd be delighted if you could pop in there and and ask you know and just let us know what you sort of the webinar and and what we can do so any other questions anything I'm just I do me see thank you for putting up your hand please go for it yeah yeah no it is interesting to to hear from Fatma on on the patient reported outcome quality you know measures which is prom which is interesting which probably measures not only like we're routinely doing the visual acuity and compares the vision of the patient but it tends to measure the quality of life that cut that cataract surgical outcome has brought to the patient if there any comparison or any correspondence done between the two because that one tends to be more objective and if there any correspondence or like matching in terms of analysis of how do the two come together in reality if there any study done to prove that because I read on the article that I didn't get to that level of a detail to understand it better yeah yes and demisi thank you for bringing this up actually I was also going to talk about that you know the effective cataract surgical coverage really talks about visual acuity in relation to the quality of the cataract surgery and we have things like patient related outcomes there has been I haven't really seen a study that compares the two or maybe to correlate the two more to say but what I have seen is studies that even with poorer visual poorer visual outcomes patients are still happy and satisfied you know so I think there's a lot more to patient satisfaction and patient related outcomes more than just the visual acuity so that is one of the things that we actually look at when we're discussing the effective cataract surgical coverage because it's focusing more on the visual acuity but there are other outcomes just like I was going to even mention like the sabatiya eye hospital there are other outcomes that have actually improved the experience the patient experience and even the post-operative you know patient experience not just the visual acuity so there are so many parameters that need to be considered but I think it's just about setting a standard and setting should I say a consistent perhaps parameter that can be measured across board so we give the visual acuity in terms of effective cataract surgical coverage notwithstanding that it's actually gives some kind of pressure on the system especially in the systems where we cannot really produce that kind of output like in Nigeria I know I've only seen one survey one documentation of where they actually reached the WHO recommendation for good in 80% of those that had cataract surgery and now we're even raising the bar we're making it 612 rather than you know the previous 618 so it's really going to be a bit of a pressure I think we need more support not just in terms of skills but also in terms of resources the kind of resources that would how do we measure the prediction of the post op you know visual outcome how do we get the intraoclern lenses that that person requires gauged on the ultrasound or the recommended IOL so these are really things that we have to put in place before we can actually say we need to have that effective cataract surgical coverage if not we'll continue to have those quality gaps you know reflecting on our books so I think we should also delve in other other outcomes that really help the patient Fantastic that's brilliant Fatima thank you so much and Nasiru I would like to invite you to to speak please you've got a question thank you very much not necessarily a question really but to add to comment just raised by Fatima that it could be a pleasure raising the back we currently support a state IPA program to implement our patients file the program then it's human resource capacity in one of the states in India quality was a watchword from the beginning back in 2018-2019 and our quality measure then was 618 and then with the effective coverage now it's back to now a higher threshold of 612 and I recall we started without biometri and our quality was around 50% or there about so resources have to be fooled enable us have biometri now we do biometri and then you have the IORL challenge you do biometri you don't have the actual range of powers sometimes we have to contemplation because the IORL are completely off what ordinarily we provide for an outcome so we have to be sharing them too and at the moment we are around 70% first day post-op too it is really a pleasure but like you said we are trying to build up the resource insist on skills support each other because you generally have a team of surgeons you need to support each other to see each one improving over time and happy we are all reasonably happy that we are growing so that's my continuity with you fantastic fantastic Fatima did you want to just comment on that no I absolutely agree with him you know and that is just what I'm saying he just brought out you know from the field experience which is actually what is going on and on all that so I think resources you know supporting the practitioners to provide the resources I mean to have the resources to provide that quality is very crucial yeah fantastic thank you so much and on that point we've gone slightly over time but I hope you'll agree that was really worth it now Sirius thank you so much was really good to hear from you and a huge thank you to all of our panellists and all of you for attending I hope you saw the link in the chat I posted one last time we'd love to hear feedback from you about the review and if you have any further questions there's some free text please feel free to add them there and all of your input in feedback will you know either go into future journal articles or journal topics or into future webinars so we're really keen to hear from our readers about your needs and a final huge thank you to Hugh our comms officer if you never have your title rights sorry just for arranging the webinar and yeah for keeping everything going and all the technical side so grateful for your time and again thanks to the panellists and all of you please keep reading the journal tell your colleagues about it tell them about the webinar we'll send out a link I think Hugh to all the everybody who's registered you'll get an email with the link you know to all the recordings and so on it will be on our website as well so yeah keep on keep on going and thank you for all the work you do to improve eye health globally really appreciate all of you have a lovely rest of your day and a good week bye bye everyone bye bye thanks Elmi bye thank you bye bye


It is that time. I don't need these headphones anymore because there's no audio. Welcome back to REACTS. They released a shooting guard episode or article. We did point guards yesterday and y'all seemed to enjoy that. I saw some of the comments again. You can agree or disagree with what we say around here, but it seems like everybody kept a civil in the comment section. That's all we really care about. So, link is in the description to the actual article. It again is Andy Bailey and Dan Fevelle. And I still don't know if I pronounced his name right, so no disrespect if I'm not saying it right. But these are the top 15 shooting guards this season. Forget your resume before. This is strictly based on this season. That's the way I always see it when somebody says this season. Okay? So, let's get into it, man. Number 15, Danny Green. Tim Hardaway, Jr. Evan Fornier, Buddy Hew, and Marcus Smart. Shout out to Marcus Smart for making this list. That makes me so happy. Danny Green. Danny Green is, I mean, one of those players that every NBA team would love to have. He plays his role so well. There's not many people that play their role to the extent that he does, right? He's going to knock down that shot when you give it to him. He's going to play elite level defense. He's going to be one of the best. What is he very good at? Getting back on defense on like a fast break. Fast break defense. Danny Green is elite. Why? I don't know. I mean, he may not have a crazy chase down like LeBron James, but as far as just like preventing another team from scoring where he's the only guy back, great. He's amazing at it. And of course, again, he's older too. So maybe his impact may be not as good as it was last year or the year before that. Overall though, Danny Green is such, such a good player. And that's why he continues to get these contracts. Tim Hardaway Jr., man. I always see Tim Hardaway Jr. as like a flamethrower type of player. We're like, when he's on, he's on and he's looking great. And I guess I'm thinking about a microwave, right? And when he's off, sometimes he can look really, really off. But more than not, this season, he's been on, right? He has been on. The 2019-2020 season may be the best of Tim Hardaway's career. He's supposed to career highs and threes per possession, 3-point percentage, true shooting percentage and win shares. And you're hitting all of that in a single season. You're looking good. The Dallas Mavericks have been plus 12.7 points per 100 possession and 98th percentile when Hardaway is on the floor with Luca and a plus five when Luca is on the floor without Hardaway. So there's the big difference, right?  Tim Hardaway and Luca has a nice connection on the court together. Actually, on my podcast, we actually talked about that today, which is very weird that it's coming up. Evan48. Evan48 is one of those players that made you overlook because he plays in Orlando and overall, Orlando's like a good but mediocre team at the same time. But this year, he has been very, very good. He isn't just a catch-and-shoot option either. He's done plenty of damage off the dribble. Shay, Chris Middleton, Kimba, James, Lillard are the only players in the lead who match or exceeded his field goal attempts and affect the field goal percentage on pull-up attempts this season. Legendary. See, I didn't know that. I mean, that's a great company to be in with Kimba. These are all-star players other than like Shay, but these are all-star players and he's in that same conversation on that one statistic that is also a very important statistic for a wing player. Buddy Hill. We know Buddy Hill is good at that thing, you know? Prior to seeing Steph Curry four times and Steven Novak, the only player in history with a season that matched Buddy Hill's three-pointers, you already know that. Then Marcus Smart again, bro. Oh, Zach Levina, 10. We'll get to that. We'll get to that. But Marcus Smart. I mean, if I'm picking a guard player to build my team around defensively, I have to pick Marcus Smart, bro. I have to.  You know what I'm saying? He is ridiculous on the defensive side of the ball, so I'll take that at 11. Number 10, Zach Levine. I would have to see who's above him, but I think I usually put him around Adish personally because I get to watch him every single night and I know the type of burden he has with playing with the Chicago Bulls. I know a lot of people don't like him because he is like, hey, I'm going to get me points and people see that as empty stats. But one thing I can say about Zach Levine, he's never been in a situation where his team should be good. You know what I'm saying? So I hope that the Bulls eventually get good enough with Zach Levine or that we trade him to a situation where he can be seen differently because I hate the idea of empty stats like Maté Ellis guided a bunch, just players like that, that, yes, I'm great at scoring the ball, but I've never been on teams that are really good, so my stats are considered empty to the general public. When I know that if Zach Levine was not on the Bulls, we are the worst team in the league. I honestly believe that. Without Zach Levine, we are the worst team in the league.  And over the course of the year, he's been to Chicago. His defense is getting better. His playmaking is getting better. His decision-making is getting better. Have to remember, he's still a young NBA player. But him being at 10, I'm not going to fuss about. I'm not going to fuss about. Depends on who's above him. And that's, yeah, I'm not going to fuss. I'm not going to fuss. CJ McCullough, man. I'm not going to fuss about CJ being over Damien Lillard at this point of their respective careers. I would hope that eventually when Zach Levine is CJ's age, he might be higher than nine. But CJ deserves a lot of credit is what they're saying when viewing his game through a lens of a conventional stardom. CJ is probably never going to make an all-star game. And he'll probably always be second fiddle to Damien Lillard. But he's like one of the best second fiddles you can have in the NBA. So I agree with CJ being at this point as well. Next, Don Vimichu at eight. Wow, that feels low. That feels low. But I have to see who's above him. Especially when you think about Don Vimichu. Again, we're only testing off this season. Keep that in mind. With the offensive burden that he has a lot on, you know, especially with Mike Connelly coming in and not being the Mike Connelly that we hope. And I hope that Mike Connelly was great. I am a Mike Connelly fan. I don't have many like, you know, those Jersey shirts with like a shirt, but it also got the name on the back. I have a Mike Connelly one. I have three. I have three of my entire collection. And one of them is Mike Connelly when he's with the Grizzlies. So like, I really love Mike Connelly. So when I saw him ended up in Utah, I was like, yes, let's go. And he just didn't end up that way. So Mike Connelly being bad, Don Vimichu was like, okay, I got to do more than what I did last year. Luckily they have by Donovitch and Joe Wiggles to come in and help as well. But okay, I can agree with him at around eight. Shea seven.  He is my guy. But seven over Dono over Zach seven. Oh, hey, I believe he will be there. Seven. I mean, it does. It does. That's actually very interesting. Okay, I can see, again, I don't say I agree with it, but I can see you putting him over Zach Levin over CJ McCullough. Putting him over Don Vimichu is what's really curious to me. Because I mean, the knock on Zach Levin, of course, the team can't win. Don Vimichu's team has always been in the playoffs as far as he's been in his career. And Shea's on a playoff team as well. But you get what I'm saying? And I think Don Vimichu holds way more of an offensive burden than what Shea does. Considering Shea has the best closure in the NBA on this team this season. And everything like that. But it is okay. Let me see. All the tricks Shea, Gilgis Alexander, Flash as a rookie have proved to be a prelude. First of all, I must say I was very early on the Shea-Gilgis train. I saw him play his first game of Summer League and I was like, that's going to be my guy. I'm going to just say that. I'm just going to say that right now. He's no longer a young prospect ahead of the schedule. He's one of the NBA's most underrated scorers. Shea-Gilgis Alexander has made great use of the extra licensed O.K.C. Thunder, the 10%. It's very weird to see him. His all-star peak isn't yet in play. It feels inevitable. I do think he will make some all-star games in his career. It's very weird to have him over a guy that was literally an all-star this year. You know what I'm saying? I don't get it. But I can check the web for it. That just scared the absolute. My soul jumped out of my body. Next. Six. Jaylen Brown. I like Jaylen Brown at this point, man. Jaylen Brown acquired a lot of the doubters when he got that paycheck this offseason. They were like, max contract with Jaylen Brown. He didn't really accomplish anything on the offensive side of the ball. We knew his defense was good. And then this year, he's like, I'm an average of dub. I'm an average of dub. I'm going to shoot it very efficiently. 38% from three is very good. And then 55% on his twos. I can knock your plane about Jay Brown because he is a two-way player. And I'm saying if I'm picking a young up-and-coming guy, and I still consider him up-and-coming even though he's been in leave for what, four years now. He is also on the short list of young players that I would want to build a team around just because of his two-way ability. Still feels weird that he doesn't have his flat top anymore. Next. D-Book. D-Book at five. That's probably the highest I've seen him because D-Booker's another guy similar to like Zach Levine where people saw his numbers as empty. So I'm happy that he's getting some respect as the fifth best shooter on the league right here. Some of y'all may say that he deserves to be higher, but I think five is a good spot. We know him to be one of the best offensive players in the NBA. His team's front office hasn't been able to really build a team around him to be successful. But they're heading to the bubble, man. Anything can happen in the bubble. Four. Drew Holiday is really high. And again, I agree.  I'd probably put D-Book above him, at least about one. Personally. Personally. And I know Drew Holiday has closed out a few games this season, but again, the offensive burden may be not as high as it is here. And in reality, their teams are kind of close in the standings anyway. I understand Drew Holiday being a two-way player. I mean, he can garf three and a half positions and stuff before seems a bit high. And I love me some Drew Holiday. Acting Drew Holiday is the second out of those three shirts that I have. It's my college Drew Holiday. And D-Rose. You know what I'm saying? And D-Rose. Bradley Bill at three. Bradley Bill's average at 30 points per game this season. He's been incredible. People were saying that once John Wall comes back, he won't average great numbers, but like, come on, bro. Bradley Bill is a bucket. He's turned into the star of that team. I don't care. Like, John Wall's great. Don't get me wrong. And I don't know if he'll be great once he comes back. But Bradley Bill is the star of that team, is what I'm saying. Three Bradley Bill, two Paul George. All right. Is there a more plug and play superstar than Paul George? I would say that for some reason, and correct me if I'm wrong in the comment section, this feels like a down year for Paul George. Maybe because last year he was an MVP candidate and that's kind of what I expected this year. It's an unrealistic expectation. I know he's been good this season, but for in my brain, it feels like a down year. But overall, great player, great player. The number one y'all know is going to be James Harden. Who else could it be at the best shooting garden NBA? All right.  There are some things that I don't agree with, but that's the best thing about being a fan of sports is that you can disagree respectfully and just have a dialogue. Leave a like if you enjoy. I'll be back. Peace.


Next Gen That's a term that you might have seen us mention recently on our social media or our blog and you're definitely going to see it on the website. If you're not totally sure what it means, then the short story is that when you see Next Gen, what you're looking at is one of our revised packages or maps that have been specifically crafted to adapt to the changes that fall in line with our green speed initiative while still offering similar if not even better tuning options than the previous packages you're accustomed to. So to make sure nobody's confused, green speed is Cobb's continuous effort to evolve our entire tuning approach to protect and advance the industry. Next Gen is a name specific to new or revised packages and maps that result from green speed changes. Now that the vocab lesson is over, let's get to the fun part. Introducing you to the Mazda Speed 3 Next Gen Stage 2 and Stage 2 Plus power packages. The Next Gen Stage 2 package includes the access port of course, along with the tried and true Cobb SF intake and air box which will mate to our beefy reinforced silicone turbo inlet hose. Plus one of the most important modifications you can ever apply to a tuned Mazda Speed 3. The upgraded high pressure fuel pump internals required for the extra high fuel pressure needed in direct injected engines. And the biggest change for the Next Gen Stage 2 package versus the previous Stage 2 package is the addition of our front mount intercooler in place of the downpipe which doesn't currently have a path toward emissions compliance. In order to produce the same performance within a convenient Stage 2 package that maintains the OEM downpipe it was obvious that the most effective approach would be to optimize airflow and temperature by ditching that inefficient stock top mount in favor of a front mount intercooler as early as possible which allows this package to run aggressive boost in timing to increase power just as much as before with a safe and consistent tune. Lastly, in order to handle the increased boost pressure and torque output the Next Gen Stage 2 package also provides the Cobb LF bypass valve that we've tested up to 100 psi as well as our much stronger rear motor mount that every Mazda Speed owner needs to keep the engine from dancing around under the hood and the front wheels from hopping down the road. Also, I did mention a Stage 2 Plus version of the Next Gen package. That option includes the Cobb 3 inch stainless steel cat-back exhaust. On some cars an upgraded cat-back does little more than improve sound and style until you're making a lot more power but even with this relatively modest setup we did discover while creating the all new Stage 2 Next Gen off the shelf maps that adding a better cat-back even on the stock downpipe along with the other included upgrades does produce a small but noticeable increase in boost and power versus the stock exhaust on the same setup. We know a lot of folks already have an aftermarket cat-back on their car so pick the package that makes the most sense for you and enjoy. Lots of things are changing in the tuning world but it's not all doom and gloom. Necessity is the mother of innovation and that's the mindset that we're applying to this and other offerings soon to come. So check out CobbTuning.com to keep it on our blog for the latest updates and to get your hands on the latest goodies from Cobb.