I have been assigned a really thrilling topic today. I'm going to talk about sensory and motor physiology and strobismus and ophthalmology in general. They like to ask lots of these questions on the boards and on the OCAPs and things. A horopter is the locus of points between, you know, in space, so the locus of points in space that fall on the same part of the retina, so, you know, where you will have singular vision because they're the same, you're gonna see the same out of either eye. However, Panem's area, whoops, I'll go back, is a little bit bigger and it's the area, it's the area where the points may lie on a little bit different part of the retina, but you're still just gonna see one because the eye can kind of move that way and bring it into one. So anything within Panem's area or within that horopter, you're just, you're gonna see one. Whereas things outside of that, you're gonna, you're gonna see double. This is just a little bit different way to diagram that where the horopter here is just this line here, so that's the area where you're looking at something that's gonna lie on the exact same part of the back of the retina. Whereas Panem's area is a little bit bigger and it's the area wherein you confuse your eyes together to bring one image together to get stereoscopic vision. So what is fusion? So fusion is the ability of your eye to see one.  They have to be similar in shape and size, which is why sometimes, you know, which is why when somebody's really anisomatropic it has a lot of myopia in one eye, especially if it's new after cataract surgery, they're gonna see two because they can't, their brain can't pull those images together. They also can't tolerate much dissimilarity between the images, which is something you would see in something like macular degeneration where the image out of one eye is gonna be a little wavy because they've got, you know, some exudate or something or diabetic retinopathy where their retinas are making things, you know, they look out of one eye and they, when they look at the Amzler grid, you know, they tell you there's wavy things. So the images are not the same with either eye and they can't pull them together and this can make it tough for people. Sometimes when they start having that, they start to get a little bit of strabismus, but even when you fix their strabismus, they're still intermittently diplopic because they can't pull those images together because they're not the same shape. And the receptive fields in the periphery are larger. I think that that means that the, that in the, in the periphery, your vision's not as clear in things and so you can, you can tolerate a little bit more dissimilarity. So sensory fusion is the relationship between the retinas and the visual cortex whereas images on corresponding retinal points combine to form a single image. That's kind of what I was talking about with that Panem's area. Even though they can be a little bit off, they can pull it together to make it one. Motor fusion. So sensory fusion talks about how they have to, you know, kind of be similar to be able to pull it into one.  So their eyes can move to pull those images into a similar part of the retina so that they can make it one. Stereopsis is what we test with the TITMAS or with the RANDOT and it adds unique quality division, you know, binocular vision. What is that? So when you look at these, you know, here, the top dot in the, you know, usually, I can't always remember because I get these two confused because we have one in the clinic with nine and one in the clinic with ten and they're a little bit different. But these, the glasses that they wear are polarized, you know, for one eye and the other eye. So this top one, the right eye sees it a little bit differently than the left eye. But when their brain looks at it, it pulls it together, but gives it kind of an appearance of coming off the page. So it's, it's what, you know, the same, same concept as seeing a 3D movie.  It's kind of a quick and easy way to tell if somebody, you know, hasster business, if they have amblyopia and things, because you have to have two good eyes to be able to see this.  Unless it's an intermittent strabismus, they're not going to be able to see these because they don't see well, you have to have two good, two good eyes to be able to see things in stereo. This is another thing I use in my clinic, the other guys don't use it so much, but it's a, you don't have to put glasses on and the kids can kind of see these and they're different. This is like 600 arcs, so it consists of 1200 arc seconds. Sometimes it's a little bit easier for the kids. Sometimes I like to use it in kids who have intermittent XT just to make sure that they do have stereos, a lot of those kids with intermittent XT do not become amblyopic. And so I just kind of follow them over time, especially if their control is pretty good, but just want to make sure they have stereo. Also, it's, you know, an easy way to see if somebody, if a kid has, before you dilate them, if they have amblyopia. Gross stereo is just the, you know, the fly usually 3000 seconds.  You can't ask him to the wing that wings pop up because most all kids will tell you that anyway. But if they really kind of go to try to grab the wings or if they kind of try to scoop up the wings, we say it's positive. If they just put their hand on it and go straight down into it, we usually say it's negative, but sometimes it can be a little tricky to know exactly if they're seeing it or not. Because somebody doesn't see things on that, on the, on the stereopsis. If they don't have stereopsis, if they don't, if they can't see any of those images popping up, it doesn't mean that they don't have depth perception and parents always get that confused. There are lots of other things that can contribute to depth perception. You know, these kids can still be, you know, still be athletes and do those kinds of things. They probably won't be like a major league baseball player or something because I think that there's something that goes with seeing that spin on that ball or things that, you know, you have to have really fine stereo. I mean, I think it'd be an interesting test to look at, like, major league baseball players or look at really good tennis players or things. I bet they all have an excellent stereo acuity. But, you know, it's not synonymous with stereopsis.   So when a kid comes in and, you know, the parents say, oh, they don't have any depth perception, they do have some depth perception. It's maybe not the same. And I think some of these kids are slower to walk, are slower to get some of those stereo skills. Probably aren't going to be a stellar athlete either, but it doesn't mean that they don't have depth perception. Because what we're talking about with that, you know, that stereopsis test is just this binocular sensation of relative depth perception caused by that tiny horizontal disparity. You know, you can see it when you look with one eye or look with both eyes. There's a little difference, but it's not a huge difference between them.  And the truth is, after you get out about 10 or 20 feet, you're really relying on monocular cues, not so much that binocular vision.  So, you know, those radiations have to travel a long way, which is why most kids who have any kind of neurologic issue often have strabismus, because anything that affects, you know, the brain, sometimes those radiations don't get all the way to the back and they don't have great binocular vision, and I think that's why, you know, where they start to drift in or out. They also, you know, have this decensation where the outside fibers do not cross and the inside fibers usually, you know, do cross. One area where they don't is albinism, and those kids usually do not have great stereo vision. You know, some of them do have some stereo vision because they're varying degrees of that. You know, there are some kids with albinism who have pretty close to 20-20 vision, and then there are other kids who have 2200, and I think the amount of decensation goes with the severity of the disease, but they usually in general don't have as good of a binocularity because those radiations don't travel the same way. And as you know, those, you know, goes through the eye, through the lateral genica nucleus, through, you know, through the brain to the back, or to the visual cortex where things are interpreted. I never think about these, but they always like to put them in those books. I never saw, I remember seeing any questions on any of the tests about any of these, but the magnocellular cells are represented in peripheral retina. They're especially sensitive to moving stimulant. They're insensitive to color, whereas the parvocellular ones are the ones that are usually located more in the fovea, which have your high-res info about borders and color. Important for seeing detail and the conial cellular are the ones that they don't know much about, maybe related to seeing the color blue. When you're born, your vision is not normal. Some of that is because your fovea is not totally formed, which can make some of these tests kind of difficult, especially, you know, Dr. Creole has that test where he uses the fact that those kids with albinism, those fibers don't decussate, the nasal fibers don't decussate in kids with albinism. And so he measures the time from, you know, stimulus to the back of the brain and he notices a difference in that wavelength in these kids with albinism. But some of these kids, these tests are not usually are often not conclusive when they're in really young kids, because things are still developing right after birth. So the fovea is covered by multiple cell layers, you know, you can't often see a great foveal reflex, which can make it even tougher to diagnose things like an albinism because you don't see a fovea in a normal kid, so you don't know that you're looking at an albinism, especially if they're really young, because you haven't developed any of that in a stagmus yet. Some of those kids with albinism don't develop in a stagmus. But the photoreceptors move around a little bit and the cones really concentrate in that foveal area. The white matter, you know, starts myelinating during the first two years, which is why those kids then can be able to walk neurons in the lateral geniculate nucleus, lateral geniculate body, increased in size, and things continue to change through the first few years of life. While this is developing and changing, any disruption of that can lead to amblyopia, so a cataract, anything that blurs the visual axis, anisomatropia, that's significant or strabismus, that's significant. They've also found that in monkeys that have had their eyelids sutured to simulate amblyopia, their lateral geniculate lamina shrink mildly. So it is, you know, and this is kind of something I sometimes say to parents when they don't understand why the glasses aren't fixing the amblyopia. Because amblyopia is a brain disease, so they can actually look at those monkeys and see that those kids with those monkeys with amblyopia don't have the same brain on either side because it hasn't grown and they can see that microscopically. You know, and they start to narrow these ocular dominance columns start to narrow. What happens in these amblyopic monkeys is that the open eye starts growing neurons to occupy areas that were usually where the neurons from the deprived eye usually are. So the amblyopic eye, I mean the strong eye starts taking over the space where there usually was, were neuronic connections from the amblyopic eye. But there's no real benefit to having more, you know, to having these neurons grow because the visual acuity, I mean although it's usually 2020-2015, it doesn't seem to have the bionic or any better than a normal eye. They've also shown that, you know, PET scans have shown that there's increased blood flow to and glucose metabolism during stimulation of the amblyopic eye.  So in a normal eye, with a normal patient with two eyes, you know, the cells are, are, both eyes are driving it, but in the amblyopic eye it's only being driven by one eye. So this critical period is the time during which, in the monkey studies, so they've done lots of studies on monkeys and kittens where they suture one eye shut, they leave it shut for a few weeks and then they open it up and then they look at their brain and see what is this exact critical period. So it's the, it's the time during which they can open up the eye that they've sutured and try to get normal vision back. We don't always know what this is. In kids, you know, they used to think it was about eight years old that we couldn't treat amblyopia past, but now they did a study a couple years ago where even kids up to 13 years old when they treated anisopatropic amblyopia with glasses or patching if they hadn't been treated before they could improve the vision.  The vision in that amblyopic eye, even in adults, can improve a little bit. When they've done trials to try to do that improve it by patching in adults. Usually they can improve it a tiny bit, but when they stop patching it goes away. So there is some plasticity even in adults, but we don't know exactly what this critical period is in kids and that can always make things difficult because parents will always want to stop patching, but you never know when you stop patching are you out of the critical period or not. As they get older it gets less, but you don't really know exactly what that is because it varies with the kind of amblyopia they have and the severity of the amblyopia they have. So you often kind of have to stop, try tapering off and then and then seeing, but you know it's somewhere between 8 and 13, but some of those kids where they come in with dense, dense amblyopia because they've had a cataract removed and they didn't patch after they lost the contact for a long time. That critical period is closed even sooner. So this is always a difficult thing because we don't know exactly when this is. So what is amblyopia? Like I said it's a brain disease. So it's decreased visual acuity in a normal, when you do an exam on a kid and they have decreased acuity in one eye and versus the other eye, but there's nothing structurally going on that explains it and and then you deduce that it's from the brain. Usually in those kids you can explain it though. You know I have a couple of kids where I you know they have amblyopia and I don't know why and you know you assume they've probably had some anisomotropy or something that they grew out of but sometimes you just really don't know. But the biggest causes are strabismus where the eyes aren't aligned so they choose one and ignore the other. Anisomotropic and it's much more in hyperopic kids than in much more when you have a hyperopic difference than if you have a myopic difference you know if you have a kid with a plus 1 and a plus 3 they're much more likely to develop amblyopia than that minus 1 minus 3 kid and high bilateral refractive errors. So these are people with high plus prescriptions less likely high minus prescriptions but can happen with that too and then kids who have four five six diopters of the stigmatism. So anisomotropia why does that cause why does that cause amblyopia?  Has a later onset critical period than than strabismic amblyopia that's like what I was saying the kids with cataracts you know their amblyopia usually if you don't treat it in the first you know months to years of life there they're never going to develop normal vision whereas this you have a couple more years even those kids that were 13 years old who had anisomotropic amblyopia you could treat at that age and usually a stigmatism doesn't cause amblyopia in the first year and may not develop until age three this is kind of a funny one because now insurance companies are reimbursing for the use of those vision screeners in the clinics and they always pick up a couple diopters and stigmatism and send them to you but when I see kids one or two or three of just the stigmatism I just watched them because a lot of these kids have a stigmatism their eyelids are tight so they're pushing on their eye causing that I'd have a stigmatism especially at 90 and but it's not going to be amblyo amblyogenic at this age and those kids are going to want to keep their glasses on and their vision is usually going to develop normally and oftentimes they'll grow some of that of stigmatism so even if it's anisomotropic I usually sit on it for a little while they use it like in the nine month old but it's often wrong because the kids don't look fix it on that target so it's kind of a bad test because then the just sends more kids out right that they usually don't have anything and the truth is when they have even when they have anisomotropia I'm not going to do anything about it I usually sit on it for a while and the pediatric ophthalmology group doesn't have like no no we haven't gotten together to make it of that you know and those vision screeners are a little bit different in terms of I have had some practice at least one practice that's emailed me their cutoffs to tell me what they would do for it and I just kind of said well I wouldn't do it in the young kids because it's just not accurate but no and there's no consensus nationwide I don't have to do those either but everybody's doing it now because they're going to pay for it so they take a check of that reimbursement so they like using them now but the truth is these young kids when they pick up I've only had a couple that were good or even if they are there I sit on them for a while and don't do anything it's in the map for a while. Strabismus you know those things are supposed to pick up on Strabismus too but if they're not fit you know and how do they do that they can tell that there's a different reflex when one eye is crossed but you know the pediatrician should be able to pick up on that but honestly in my experience parents are better than pediatricians. I mean pediatricians send me a couple students to do Strabismus a day and usually the parents are better than the kids on the student Strabismus but you know Strabismus why do they get amblyopia because they're not their phobias aren't lined up you know they're using one eye and phobias lined up and the eye that's crossed is not using that phobia and it's critical periods earlier too so and Bob always says this too that these anti-symmetropic amblyopia are much easier to treat than these Strabismus amblyopia so when they have a mix of that you know patch patch patch patch patch and you're still not sometimes can't get it can't get that vision 2020 it's just really hard suppression is what happens you know it's an adaptation really you know when it's when your Strabismus evolutionarily you would want to get rid of the image that's giving you double vision so those kids who are born with Strabismus they're starting to turn that eye off which leads to amblyopia so you know why why do they get amblyopia well it's it's an evolutionary adaptation but doesn't it's not always a good one if we can treat it so they start to turn off that eye so those kids have an area where they they aren't able to they turn off the image and they don't see it the thing that's weird is why with crossing ET do they get amblyopic and with XT they rarely get amblyopic I don't know but most of those kids with bad XTs still are 2020 each eye and still have stereo vision but those ET's don't so patients with Strabismus and normal retinal correspondence without Diplopia suppressed so this just means that if you've got a kid with Strabismus who comes in and tells you they don't have double vision it's because they're turning that one eye off so you want to try to treat that treat that suppression and usually with kids with amblyopia we start by putting them in the right glasses if they're still not equal in their vision that we start doing patching and or atropine trouble you know atropine seems easier but for those dense cases you wonder like the atropine is only blurring them up close unless they're you know got a high hyperopic prescription and if you are blurring them enough to make it you know to make the good eye the bad eye you know it may not be working although they've shown that even when it doesn't blur it enough so even when they look up close with it when they were they're using atropine and their good eye is still clearer than their bad eye they still do have some improvement in their vision other trouble with atropine is you can't flip kids and so if you don't see it back enough you can make their good eye their bad eye and if they keep using that atropine it's just gonna get worse and worse and worse and then you know there is some thought even these kids when you haven't fully treated the amblyopia the thought is if you do surgery to try to get their eyes straighter is that going to treat the amblyopia is getting rid of that strabismus to make them straighter you know usually the general teaching is treat the amblyopia make that vision better and and then you know the straighter they're more likely to stay straight after surgery but you know the flip side of that is sometimes doing surgery makes that eye closer so you know a kid who has a huge esotropia that takes him a lot of effort to flip between the two eyes if you get him pretty close and they're only flipping a little bit they're going to use that amblyopica a little bit more treating that suppression is a little bit tougher on these kids that aren't able to fuse because they're always these are kids who even when you do surgery they still have a little bit of a tropia and like I said those are the ones that are harder to treat because they really never use their eyes together and almost retinal correspondence just means that they when they when they're at when they do when they are using their eyes together their retinas aren't corresponding with the same spot so they're the phobia and one eye is not matching up with the phobia in the other eye and so it acquires an anomalous common visual direction with a peripheral retina element in the deviated eye so the deviated eye there's a little area off the phobia that you know that corresponds to the phobia in the other eye and these are like the people who you know some have like mono fixation or things like that so it's an adaptation that's an evolutionary adaptation to restore some amount of binocularity despite their stir business and sometimes it can make things a little bit tricky after surgery when you line them up they see a little bit of Diplopia but usually it kind of goes away you can test for this so by putting a red lens in front of you know in front of the oh so if their love phobias are so this is their pseudophobia and this is the phobia here and somebody who has this you have them look through a red lens here and they see this light as pink whereas you know this would be somebody who has an almost retinal correspondence because they're looking at their pseudophobia and their phobia whereas this is somebody who you know they're using their phobia and their phobia and you put you know a prism in here you put a base out prism to make them exotropic and then you put a red lens here as well and so what you're finding here is that they have crossed so they're gonna have crossed the phobia they're looking with their real phobia so this is this is an official this is one with a lot less retinal correspondence I have to think about these things too because we never really use them but this is the red glass test that looks for anomalous retinal correspondence and somebody with ET so this is somebody who's looking at an image here they've got a right ED of 20 prism diopters they're looking here with their phobia here and they've got uncrossed diplopia which you know corresponds with esotropia or they they suppress depending on which side they're looking at if you correct some of that esotropia with you know five prism diopters but you know that they're really 20 then they start to see one so you're only correcting some of it but they're you know they're starting to they aren't the public at all whereas if you correct the whole 20 prism diopters you know which is sometimes why you should you know when you're testing these people you know you do a cover-on-cover test you do the ultimate prism cover test you're trying to build up as most the biggest number you can because you're trying to figure out what you should operate on for surgery you you get up to a 20 you put the 20 there and and then they start seeing crossed diplopia which is you know make means that they're XT so this is just somebody who you know they're 20 prism diopters esotropic however when you put a 20 prism diopters when you put a 20 diopter prism in front of them you know you make an exotropic so that they're when you're lying when you line them up with their actual physiologic phobias they're having double vision this is just the same thing telling you that so and usually crossed diplopia is exotropia and uncrossed is esotropia is somebody with normal retinose correspondence and so when they're looking off their looking off their phobia they're seeing things correctly worth four dot is something I like to use in clinical act especially in adults and things you want to know if they can't use if they are a fuser and you know you put these glasses on the red over the right eye the green over the left eye the right eye they see two red with the left eye they see three green and then you just ask them what they see usually for these kids who you know and they should see four up close and for a distance where as these ambiopic kids are going to see you know whichever if their right eyes crossed they're going to see three green up close and far away some of them are a little bit intermittent some of them is kind of hard because they'll tell you they see all of them but they don't really see them all at the same time they're suppressing and alternating between the two the other thing you can figure out too is if they have a mono fixation syndrome so if they have some amount of where their phobia in one eye lines up with a little bit of the peripheral phobia in the other eye and they will usually fuse up close but suppress far away so that's the way you can tell about mono fixation so if they see five lights they don't usually have suppression but you have to figure out are they seeing five lights at the same time or they crossed and flipping between the two eyes and they see three you know they see two red and three green three green and that's kids that's usually what it is they usually are not to pull the kids are not usually to pull pick if they're to pull pick there's a problem because it means it's a new it's a new sensory service mess and you know to pick up on mono fixation syndrome they usually suppress a distance of fuse in here and some of these are kind of tricky because sometimes when you do the alternate prism cover test they often won't like move so you can't tell but it's you know kids are coming in like a 2020 2030 40 in the other eye they usually don't have that battle flip of ambiopia they usually have some amount of you know peripheral fusion with a little skatoma they usually sometimes have stereo cutie but it's usually reduced they have a little bit of ambiopia it's considered a good outcome after stir business surgery so these are the kids that you operate for congenital E.T. of 40 or 50 and then after they have an E.T. of like eight to ten they aren't straight but their brain can't make them straight. This is what Bob likes to use I don't really ever use these but they have these dots here and they usually put the right eye at 135 and the left eye at 45 and then you know in the people who are normal they'll see an X if they're suppressing the left eye they're only going to see the one you know the right eye that goes this way I don't know how you would tell this I don't know that people would really be able to tell you this but I've never really used this test so I don't know but you know in those mono fixators where they have that compression skatoma in one eye they might tell you that there's a break in that eye in the middle then you know if you have esotropia with normal retinal correspondence you're going to have uncrossed apopia and a V here whereas if you have exotropia you're going to have crossed apopia you know so you're you're seeing your right eye over here and your left eye over here these tests are kind of hard because unless you use them a lot you can have to sit and think about it for a minute and then you when you're seeing them on a test you kind of will overthink them sometimes so but they do like to ask them after image testing is another way of doing the same thing where you you know Shina you label the phobia by shining some lights and then have them you know see the after image in their eyes in somebody with normal retinal correspondence they're going to bring it cross here these are from your book your those AAL books but this test this one's a little bit funny so these are people with anomalous retinal correspondence where you know they have they they are seeing things off here but I don't like this image because I never like to think about things in terms of anomalous retinal correspondence but this is somebody who so if they are right over here this is really they're seeing an exotropic but they are esotropic so it's just off amblyoscope we don't have one of these sometimes on the boards they like to show you weird devices and say what is this but it's a way that you can have somebody sitting there and dial things in to really figure out what their ocular alignment is it can be really helpful for torsional diplopia and you know you you have that you dial them in to figure out exactly you know what their eye alignment is in a certain direction of gaze and you can also use it for some people use it for like building up amplitudes in terms of fusion or divergence amplitudes so it neutralizes the torsion it can tell why somebody can't fuse you know in some of these cases is it because of their retina or is it because they've got a huge amount of torsion torsion can be tricky because people you know they can have you like especially for the bilateral superior obliques you can be looking at them and they can have you know you do a cover-on-cover test and they have no deviation in down gaze maybe they have a tiny ET of three or four but they tell you that they you know something's off with their vision and sometimes they can't even tell you that it's double vision or anything but the reason that they're not seeing is because of torsion so you know you really do need to check for torsion especially in cases where you have a little bit of a hyper because the torsion may be the problem and sometimes they cannot tell you that they can't verbalize that ambioscopy like I said you can use it for some exercises to overcome suppression which can be a bad thing and some people some people are not able to fuse and they're suppressing and if you get rid of that suppressant scatoma then they're going to be very angry at you because they can't you know they're always going to be diplopic don't matter this is one I usually like to use you know you usually use a red lens and a white lens and then have the person dial in things to make things parallel with the ground or you know or this I usually do parallel with the ground and parallel with each other sometimes that they're fusing it together you can put a prism in there to make them you know based down prison to make one higher than the other and then you just make them parallel with each other so that they're not fusing it together and then what you read off there is what they are so if this lens is this way you know in this side they're x-cycletorted in this side you know if they're x-cycletorted in this side and in cycletorted in this side those are going to be parallel so it's not an issue but if they got a bunch of x-cyclo in both eyes you know that's where your problem is you can die you can tolerate somewhere six seven diopters of torsion usually but much more than that starts to be a problem Lancaster red green these are this is a test where you this is the person giving the test and this is the person taking the test you know they have these lights on here and she she shines a beam on on a wall and then you you know the person taking the test should line it up and make it you know make it on top of each theoretically make it on top of each other but it's a way that you can tell you know patterns you can't really tell how many diopters somebody's off but you can tell so this is somebody that's fixing and usually the red is the red and the left is the sorry the red is the red and this was the left eye so you can see that this person's misalignment is much more in down gaze and their torsion also you know up here they're not so tortued down here they have quite a bit more torsion and quite a bit more isotropia and this is actually patient with it so it's a v pattern bilateral superior bleak policy so this is somebody were in primary gaze they aren't looking you know and these are the different directions of gaze they aren't so bad but when they start looking in down gaze they get really tortued and in and horizontal misalignment and that's it a lot of talking but in general if your eyes are lining up you know you're either going to get double vision or you're suppressing and you know these are different ways to kind of try to tease out what's going on you know you are going to see these people with head trauma that tell you that something's off and look at them and think oh they're they look pretty straight I don't know what they're talking about but you know sometimes if you aren't measuring in all positions of gaze they may have a little you know quite a bit of torsion and just trying to figure that out can be a little bit tricky so these tests that sometimes help us tell that you know in general we don't do a whole lot of these tests because you know even the suppression tests so much there's so much of a element of Cosmesis in strabizma surgery so oftentimes we'll do surgery and try to get them straight and if they have a little bit of almost retinal correspondence that we try to deal with that after so that's about it


As you'll the breakfast in plus TV Africa, a first conversation I beg your pardon is that the governors of the Federal Republic of Nigeria have decided that they will increase funding for primary health care, I mean that sounds like you know Santa Claus coming quite early but a bit of it to what led to all of this is that at the launch of the primary health care center leadership challenge in the state house Abuja, the Nigerian governor's forum pledged to increase funding for primary health care. Now governor Kayo Defaemi who spoke on behalf of the 36 state governors promised that prompt release of approved budgets to the state PHC that's the primary health care institutions. The state also pledged to recruit requisite health workforce to ensure that all primary health care facilities have the minimum staffing required for their level in line with the state's minimum service package. Now on behalf of all of us the 36 states governors and members of the NGF this is our statement of commitment to strengthen the primary health care system in Nigeria. Following the induction to the Seattle Declaration by the 36 states governors in November 2019 hereby affirm our commitment to strengthen the primary health care system in the country. We therefore adopt and confirm our commitment in line with the Seattle Declaration as that line it includes improving the governance of primary health care system at the sub-national level by fully implementing the primary health care under one roof policy and providing active leadership for primary health care through regular engagement with relevant primary health care stakeholders and quarterly primary health care performance review at the state executive council meetings that we could requisite health workforce we talked about that prior to now to ensure that all primary health care facilities have the minimum staffing and what have you are the levels that he should and so these were the consent and thoughts of this governor's as they were represented. Now institute the culture of use of evidence for decision making by ensuring that data quality across the primary health care facilities is approved. We have Dr. Tuyi Mabawandu who is a public health expert all the way he joins us right here via Zoom in Lagos. Dr. Tuyi it's good to have you join us. Thank you for having me. How do you respond and how do you react to this development by the governors although not entirely because 22 of them were present and so it felt like not everyone but what's your response? Well let's be clear the greatest requirements in business environment in our strategy and development plan you know of course on the other hand there are five pillars there are 15 priority areas. The first pillar speaks to the issue of governance and leadership and then the issue of governance and leadership speaks to how the most commitments the political leadership is bringing into driving the primary health care system. A political leadership represented by the president or the governor will determine what's going to be the basic health care provision funds they're going to determine how to start they're going to determine how to drive the primary health care system. So rightly so we need this kind of conversation to enhance and improve the primary health care system in Nigeria. Don't forget out of the 30,000 primary health care system all over the country barely 600 of them are functioning and of course you know the challenge is one fund money money money we're not having money to do a lot of things I don't know if we equip it appropriately. The basic health care provision fund which is a 1% of the potential revenue it has been decreasing in 2018 it was 55 billion now in 2021 it came to 35 billion I mean you can see how it is reducing Nigeria's financial challenges. Thank God for partnership okay from some of those partnerships I want to call Bill American but that gets financial dissent with the variation trying to incentivize our performance at that level. But it's good to speak we just hope that speaking them trusted to action and we see that this primary health care system has started functioning and functioning under the primary health care under one roof PST core which means that one management one land one monetary and the radiation one authority. I hope we're going to see that happening with this variation. Alright Dr. T you can you talked about because I'm not sure that I got you and I'm also sure how many persons had what you said but did you did you say that out of how many thousand health care centers that are functioning that is the data. Why? Well you know fund is an issue and I tell you how the funds are in short supply. Puberty sources is another issue monetary and evaluation is another issue so there are a lot of gamut of issues that confronted the primary health care system for them to be able to provide the basic services the basic plan for the nation. So now if you have this kind of coming around and saying that in terms of Bill and Bill Foundation coming around and incentivizing good practices you know giving incentives for the primary health care system. We should embrace it but I can assure you that because money is involved the governors are talking now we hope they can sustain that speech. Okay because all talks that's in the website action is also. Dr. T let's also look at you know the structure and scope you know of the primary health care if you look at the the structure of the health care system in Nigeria it cuts across the tier of government so you have the federal you know the state and the local government and so why do we still have the the governor's you know meddling in the affairs of the local government because if we say that it cuts across the three tiers of government then the local government should be solely responsible for the administration of the primary health care you know at the local government level so I like to get all of that. Of course we expect the action to be at the community level okay now the primary health care system are actually the most basic health provision when we have the community participating and then of course it is implemented by the national primary care development agency and also this which is also do me side in the state primary health care development agents who ensures that the basic officials the social services are to be right for emergency at the short funding reset and being streamed into the primary health care at the local government level okay now yes we see that every day very funding but that they really come from different sources one of the major sort of funding is the basic health care fund which is which that cruise from up to set cost on the same revenue from the federal government and some of these donors okay and normally we expect the state to actually put money into the primary health care development at the local government level we expect donors to also put money but what we're seeing is that we've seen shortage of funds from different level from the federal government from the state government and the donors are actually being careful what the fund so that has led to challenges still challenges in terms of delivery of services at the primary health care level so what we're seeing now essentially is the commitment because leadership is very keen if you want to actually get results in terms of the you know art comes in primary health care at primary health care level leadership is key leadership will determine the fund that comes in that will determine you know how we fund it to like how the places start now the other key thing is that human resources you know for health and just level there just in 90 quid how do you want to drive primary health care services without human resources just what are just in the quid now we need fund to do on the stage now we see governors making commitment we love the commitment we love the way the partners have to certifies the performance at that level announcing grants announcing awards for those who come in that perform at 30 awards we love those things but we just hope that the governor can actually move last money move last money sources to drive function at that level that is exactly what it is now you you have mentioned you know the responsibility of the federal government but once upon a time about in 2018 the former minister you know the minister of health Isaac Adewale says that you know the primary health care is not really the responsibility unit of the federal government so yeah he mentioned that it's not the responsibility but out of the local government is so why should we be talking about you know the federal government being responsible here now I don't know what I was talking about let's get the streets there are three types of government of health care system in Nigeria the first one is primary health care okay and then the primary health care no speaks to the majority of the population of Nigeria okay the policy framework the controls of that family care is determined by the national council of health okay the national council of health involves a lot of people federal government, commissioner of health, family sector, different state instead of their donors they come together and do a framework who is now to supervise it. The supervising role is based in the national primary health care development agency. They receive the control data level from 1% they receive it and then this person down to the state primary health care development agency and then define actually the kind of packages that supposed to be rendered. Now everywhere you are going to do national strategy, health development, monitoring and evaluation or you are going to do your internal review or mid-term reviews. It still have to come from the federal government trying to look at those indicators that you need to use to try those things. So like I said I don't know what I was talking about. Do you work how to ensure that the primary health care system works inside primarily of course essentially with the federal government funding. Now the state will not take the team for that now by monitoring, evaluation and I bring those data and send those data right straight you know to the federal government which will be the input in assessing where we are as far as the system is concerned. You know what that would mean if I do what it says that the primary health care is not the responsibility of the federal government. Different states, different government will have different indicators, different methods of preventing anything. I don't know where that is done in the world. Okay that means that the individual have priority to understand different confirmed legal system, different laws of state or for example. That means that we have a disjointed system and we cannot be able to monitor. So I don't know what that provost was talking about essentially. Sincerely when you are talking about policy direction, the primary health care under one policy came from the federal government, okay. The primary health care system of the basic health provision came from federal government which has to do with domestic state. What I was talking about is that looking at that the actual activities that should reflect should be happened under government. But in terms of policy and direction it has to come from the federal government. Well because if you look at it, I mean the way you have the primary health care being organized or being structured, I mean you say it's part of the three-tier system of government. So you have the federal government, you have the state government, and you have the local government. And that's how it is and that's why you have you know the tertiary, you know you have the secondary and you have the primary health care, okay. So whichever comes first. Maybe it's based on that premise that he's coming from that there's some level of administration. If something goes wrong then you need to ask you know those who are at the hem of a first of controlling it. Local government, state federal government, and you know state government. That's what that I'm sure that that the argument is coming from that premise. But on the other let's also look at the budget allocation because maybe we have to talk about the financing. Not that I'm holding brief for the former minister here. But if you look at you know the budgetary allocation every year at the time you should trickle down you know to what happens in different strata. And so whatever is allocated you know to the health sector should also affect you know the state and the local government. And we haven't really fed well with our location with the budget for the health sector. We have not really met you know the 15 percent Abuja declaration as it were. So we're still dwindling between five, six, seven percent in terms of budgetary allocation. Do you think that this might also be the issue or it's also the issue that the former it's also the issue that's you know our stake here. And it's also the issue that the former minister is also addressing in terms of how the lean resources are being managed. Well, my professor told me if you want to change the health system, follow the money. You need money essentially to mobilize where it succeeds, to boost infrastructure, to maintain the infrastructure, to do monitoring and validation. Health system is heavily money dependent. Again, it's not due when I talk about health and health. First and foremost, we're doing five percent and very sad. We have been basically at the wrong time. Maybe it's the same about eight, nine years ago for health budget. And most of those budgets actually require expenditure. It's not on TV. But we have seen some support, a lot of support from the donors, okay. And then continue to pass the health act bill, the health bill, the national health act. Putting one percent of cost on the revenues and federal government into primary health care. One percent primary health care. In 2018, that one percent was 55 billion dollars. You have 25 billion dollars to get that for 30,000 primary health care transition. White, you know what that means. And it's not all the money. Yeah, because part of the money could be used to maintain some other things, response to emergency, you know, that's the health and money structure. And then, secondly, by the year 2021, the money had gone down to 55 billion, okay. So we have seen dwindling revenue from that regard. People have suggested so many things, including increasing that cost of revenue to two percent and not even that one percent. One percent is two mega, of course. And then looking at how to raise funds, actually formula taxes, you know, like taxes on smart taxes, like tax tobacco, taxing alcohol, and then put this in the consolidated fund for health. And then we're starting to think of it to also contribute to that consolidated fund and the donors and partners. But what we have seen is that state government can nearly, you know, pay the salaries of their health workers. I know how to get them to contribute to their primary health care, to that basic health fund. It is challenging. So that's why, for instance, without that direction from the federal government, without that funding from federal government, without leadership, without governors, without that partnership that can work, you know, a functioning primary health care system would be a difficulty, but at the starting point, the first pillar is for us to create a liberal environment for health to function. And without that liberal environment, governors, leadership, partnership, community participation and ownership are very, very key. Dr. Tsuyu, so do you think that, you know, these governors will leave up to the expectation of a statement? Because at some point, I'd like to describe, you know, what was said, and you have the governor of the state fire me coyote or coyote fire me, putting out a statement as a policy statement. It's just a policy statement because we're not sure of implementation of the latter. We remember that with this, you know, salary increment, and we're talking about the minimum wage, some governors have not really settled up until this moment with paying the $30,000 minimum wage that was agreed because of, oh, we don't have resources. We don't have what it takes to sustain all of that. And so do you think that it's a thing that these governors will be able to, you know, follow suit with that statement that was put, having some sort of increase, even though it wasn't really stated, it was just said that there will be an increase and it probably would just fly as a statement, a policy statement. Right. But do you think that the 36 states' governors would follow suit with increasing funding for the primary healthcare? Well, we hope so, but let's get to the point. How did this statement come about? It was trying to fulfill this year to declaration primary healthcare of the world, you know, to move funding, governors, one of the key things in governance, it tells us what we call another official plan called AOPs. AOPs are supposed to actually, you know, structure the health system and look at the budget and everything and then you put that AOPs to the budget. The AOPs should come, which one of the other official plans should come before the budget step. Okay. So what the Bill and Melinda Gates Foundation and their partners are doing is to say, okay, look, guys, if you can follow through in this regard and follow all these clear indicators, I will score you and follow that you are so, I'm going to give you additional money. Okay. We're going to support you furthermore. We're going to give about 13 awards, looking at different geopolitical zone. Okay. Nice. That's what they're telling them. And of course, when this governor hears about money, it's okay, you have to make policy statement. But the point is this, a policy statement does not actually translate into time use, until you work the plan. And working the plan means that you have to get committed people, get the website, human resources, company, you have to get the monitor and the evaluation, you have to get the website funding. So we hope that the governors will look at this and it will be funding to actualize these things. So you have to get the right contribution and ownership. You have to be able to get the feedback from those communities. Some of those things involves ordinary meetings. If you look at some of those things, they will have partnership meeting for a long time. If you don't have partnership meeting, how do you monitor? So in reality, that is what we have been saying, looking around the health system in Nigeria. So ordinary AOB and other operation plan for health, it's not done. Under the national state, in fact, the state council has to be in health care. So how do you now assess health system in that kind of state? We just hope that it will be just a statement that we will be seeing. I hope something comes out of it. Well, we have to go on. I wish we had more time to talk about this. But thank you so much, Dr. Tuyi Mayba-Wandu. He's a public health expert right here in Lagos. Thank you for joining us. Thank you for having me. All right, then. That's the size of a conversation. But fingers are really crossed. Every other time, it feels like it's very convenient for us to put out statement chunk out policies. You have these governors. Governors who have really not been in agreement with the payment of the minimum wage will also there be an agreement to increase funding for the primary health care, which is very, very important for our economy. That's the size of our conversation. We take a break when we return. We'll be talking spots. Stay with us.


Thank you everyone and welcome to our talk closing the gap in short We're basically here to tell you how to build a good reputation for customer support when support isn't your main role or your main job So just another little introduction, I'm Pam cokey I've been working at automatic for about two and a half years doing support there Before I worked at automatic I was with a large nonprofit and I've been blogging at the jammy calm Since about 2001 and I live in New Orleans and the mom of eight-year-old triplet boys And I am Erica. I don't have triplets, but I have a dog that he can see I've been at automatic for about five years now and like Pam I was working in nonprofit field before that and also writing so Kind of a mix of customer support in a way in my own kind of mix it up recipe And yeah, we're excited to be here today. This is our first time in Vienna So thank you So before we talk about how to provide great support, we just want to talk about how we do support at automatic So engineering happiness at wordpress.com it happens via three main channels email Public forums and live chat So our teams are divided based on the products So we have wordpress.com support jetpack support WooCommerce support and then the dot org premium services like a kismet involved press Another interesting Okay Another thing we do at automatic that's unique is support rotations So every non-support Automation starts by doing a three-week stint and support whether a developer a theme designer even accountants They all start with two days of training and then they're just they dive into support They do tickets and then in the third week they'll do live chat It's really great for them It helps them learn it ends out to the company and the culture of the company and most all gets to know our users Which is really valuable when they take it back to their Real job and turns out they usually love it or that's what they tell us anyway, so And then that's not the last time they do support Every year each team does a week of support and happiness as well to keep things fresh So why does great support matter? So you've created a plug-in or a theme a new website and your work doesn't end there So you think about all the time you've put into it I mean you want it to be Usable when it's done you've been brainstorming and coding and designing and all this work and now it's time for people real people to use your product and For them, this is just the beginning and for support it is for you too So to answer the question why does good support matter because of your customers? So if you're building a plug-in and it's for free and it's just in the plug-in Repository or if you're working with clients, it doesn't matter at the end of the day You want people to use your product so when people start using your product They're going to use it in ways maybe that you didn't envision or they will come up against a bug or some sort of Incompetibility and they're going to need help and if they reach out to you and the support is subpar or worse yet There's no support at all. You have to ask yourself. What's going to happen? So think back we live in a service oriented world So we've all had good customer support experiences and bad customer support experiences So of course if you can just think in your mind of your worst customer support experience I always think of calling my cell phone provider or internet service provider and just sitting on the phone and You're talking to the automated robot thing that never understands what you're saying And it takes like an hour to get nothing resolved In those circumstances a lot of people will leave you look for a different provider that will provide the service that you need And will help answer your questions and help you do what you need to do Now on the flip side of that We've all had a really great customer support experience and I'm sure it stands out because it seems kind of rare unfortunately In those cases, I think it helps build a sense of loyalty an example I love from the book exceptional service exceptional profit they talk about the Ritz Carlton hotel chain and how Customers who stayed with them they would note down their preferences. So each time that person stayed they would remember okay, this person always had an extra pillow or this person always wanted a late checkout and through that the customers realized that they weren't just a number they were meaningful and They were meaningful to the company and the custom the company valued them as a client and that's what builds loyalty and trust and helps you grow So how do you get in the right frame of mind for great support when you're when sports your background you've been doing support for a long time Like we do it's just instinctual. You just you know how to approach customers You know how to get in that right frame of mind But for people who aren't as used to doing support It's helpful to talk about how to get into the proper mindset for helping people with technology So we've come up with three ways to put yourself in the shoes of your clients and get into the right frame of Mind to really help people and get a sense for what they need So do a little audience participation by a show of hands How many of you either when you first got started or maybe maybe recently ran into an issue with a WordPress site that you didn't know How to fix no, but that is never so at some point you've probably Ran into something new you've turned to the forums to documentation for some help We've all been there, you know, you can only know so much as you learn So when you're working on your own support philosophy Remember that you made your product for a reason whether you started freelancing whether you made a theme There was a reason you got started why it was interesting wise why it was exciting for you And as you approach the questions that your customers come to you with try to keep that in mind Remember that they're trying to learn to and remember that feeling that you had when you learned how to overcome it So you can approach your customers with that same sense of curiosity and excitement and I think number two So I think a lot of us think of support as like kind of a call center where you're sitting at a desk nine to five And it's not very exciting and you're answering the same questions over and over But that doesn't have to be the case we can certainly say that that's not necessarily the case If you are a developer or any other role that's not directly involved in support all the time We encourage you to find what works best for you So consistently carve out time during your day that works well for you when you're going to come to your Customers questions and issues with a sense of curiosity and clarity Whether that's in the morning if you're a morning person or at night when you've finished your other work Just do so consistently and experiment with whatever works best for you. You don't have to be chained down in that sense and Lastly whether it's just you or if you're working with others make sure that everyone who's supporting your product is actually empowered to help I think If you were to go to the mall or something or a store and you need to return something you get in your car You bring the item you drive all the way to the store and you go up to the desk And you tell the person I need to return this if they were to tell you you went to the wrong spot Or you have to drive somewhere else or give like ten reasons for why you want to give it back You'd be frustrated because you already went out of your way. You're already unhappy It's the same when you're approaching your own customers You want everyone in your company to be able to help from start to finish So that might mean providing tools so they can debug certain issues or even just giving them the power to provide refunds or credits So that they don't have your customers don't have to be shuffled around in order to get one thing fixed And it's much more efficient that way as well So as Erica just mentioned get it so you mentioned how to get in the right frame set The right mindset to do great support as so How do you do that and we know you need to so we have seven tips that'll help you get on track and Make sport easy and painless doesn't have to be hard and help you build a reputation for excellent support, which is key So an example I like to start with is that when I first started at automatic I came across a ticket with a user who she was she had just activated a new theme on her site And it just wasn't displaying right and she had gone back and forth with a few of us happiness engineers trying to help out And we couldn't quite get to the root of the issue So the more we went back and forth the more frustrated she was getting which is understandable because she had an issue that we weren't resolving And at some point in her email history I just I had a hunch that she had resized her browser, but didn't know so I sent a screenshot of how to resize the browser She clicked on it She figured out how to do it and that solved everything and to us it was really simple We assumed that of course everyone would know how to resize their browser but for her it was completely new and for us at some point everyone in this room it was new at some point so we had made this Assumption and because we weren't stepping back to see what assumptions we might be making it took that much longer and she was frustrated so Bottom line be very generous with basic knowledge and try to meet your users at the level that they're at So that they can start with that solid foundation A Second thing you would want to answer the actual question that the user is asking you not the literal question Something we get a lot at WordPress comm is you'll get a user saying I want I want to put these links on my site So you think okay? I want to add a URL to their you know their post or whatever And then you go look at their site and they already have your you know links in their posts So they know how to do that Well, 99% of the time it means they want to create a menu a custom menu They just don't know the words or the you know terminology So before you you know just suit over a support doc for you know creating links read between the lines You know do ask cleric find questions if you have to if you can on live chat. That's really easy Look at their site if they don't have a menu set up, you know, you know, that's probably what they're asking And so as like Eric was saying think back to the time when you didn't know all the lingo and you didn't know all you know the things that we take for granted and That will make their a lot less frustrated Make the support interaction a lot smoother So along the same time same lines sometimes you get big questions Intentionally or unintentionally where it's like how do I add those links? Take the time to go above and beyond in every support interaction. So if it is a big question Go with the information that you have if it's how do I add those links? Offer information on how to add links to a post or a page and also offer information on how to create a custom menu Or maybe a widget based on the context But once you've done that so once you've given all the accurate information that you do have based on the information That is available to you think ahead to what you're going to need next as well So asking questions about what browser what browser are you using? Are you seeing an error message? So that way when the user replies you have all of that information ready and it cuts down on the back and forth Which again is going to make them happier And if you do find a truly tricky issue because we will always find bugs at some point give yourself enough time to work on it It's really easy to want to be optimistic and say I'll get back to you tomorrow I'll fix that up in a few hours But sometimes it just takes longer and don't put that pressure on yourself Set your expectations accordingly with your customers We like to say under promise and over deliver So if you tell someone it's going to take a week, but you get back in two days That's a much much different experience than saying it's going to take a day and then getting back to them in a week Next you want to respond promptly to your customers questions You know we we try to always answer questions in the order we get them You know when tickets and everything but sometimes there are issues that take priority So you want to consider a triaging issues you see coming in for WordPress comm support a lot will see issues in the public forums and Twitter first and Those are the issues that might be affecting thousands or even millions of users So those we have to handle immediately and we put those fires out And then we can go back to the users who are trying to add menus to their sites This is my general life advice to you We often ask for feedback at work. You know we always want to get better We always want to improve whether it's a side project that you're working on or if it's your main business it's important to always be improving and Your customers are essentially giving you feedback either for free or they may even be paying you for it So it's important to appreciate that and recognize that relationship for what it is and when someone asks for something It can be tempting to give a brush-off answer like you know, I'll pass your feedback along or maybe someday We'll add that to the roadmap. I'm not sure But that builds a poor expectation and you want to be consistently improving and building that trust with your customers in order to Have that wow customer support experience So it's important to find a system that works for you, especially if support isn't your main job If you're a developer or a designer, it's easy for those things to fall through the cracks because you're human So find what works and experiment and make sure you follow up on those issues and along the same lines If you can't pick something don't promise to It's your users are a human on the other side of the screen, too They're reasonable people if you're reasonable with them So it's important to be honest and respectful of them So again setting that foundation for trust and then once you say that's that's not really possible You're putting yourself in a position to help them find an alternative which again goes back to that great customer support experience Next you want to meet your users where they are so Are they on Twitter? Are they in the public forums? You need to know where they are and likewise they need to know where you are. So don't hide or anything you might For instance, it automatically had a bit jetpack beta group Actively reaching out to users to find out what they need and their opinions and influence the product cycle So they can have a direct result, you know with your product So don't hide from your users. Don't make it hard to find the help Your email address or your live chat link or whatever it is. However, you're gonna provide support be proactive and Another part about meeting your users where they are is not just physically meeting the where you are But you know using the language that they understand And again jumping off Pam's point of meeting your users where they are and finding out what works best for communicating with them Again in life, it's very easy to get stuck in your comfort zone And you know you've always done support via email or always done support via forums and that's what you're used to But that's not necessarily the best way to do it either for your customers or for you You might find that you like something else An example that I think not a lot of people know of at wordpress.com for a while a large part of our support is about domains expiring and We wanted to make sure that users weren't accidentally losing their custom domains that they had registered through us So we started calling them manually to let them know as a courtesy call that their domain was about to expire And we saw that we had a lot fewer domains that were lost people were renewing more so we were we we were able to Fix what we saw as a problem and then as we did that and the more we called people the more we realized that in 2016 or 2015 at the time no one really uses their phone for phone calls So we were primarily leaving voicemails, which meant that we were able to experiment with Automated voicemails, so we recorded a courtesy call that we sent out automatically and we found that it was about the same as when we called Manually versus automatically, so we switched to the automated one. So we were able to Try something new experiment analyze the data and iterate on that Which freed up more time for our happiness engineers to do other kinds of support and meet support needs in other areas as well So you can apply the same thing to your own work Whether you try Twitter for a week for support the forums for a week for support, whatever you think might work better and see how your users respond Along the same lines of getting out of your comfort zone It's some don't box yourself in if you have customers that who've been really loyal or you just really love working with them You could surprise them you can send them a handwritten thank you note or Credits or something like just some swag to kind of let them know that you really appreciate their business with you people in general very I think we're used to being loyal to brands like being a WordPress evangelist, but We don't really expect the same in return So you can always Kind of flip that around and really make an exceptional experience for any of your customers or clients All right, so what we want you to take out of the whole talk is if you don't do anything else respond to your users Just be there for them. It doesn't have to be perfect We know you have a lot going on just take a little time out of your day to help your users They'll appreciate it and you're gonna get great feedback in return and have fun because it is fun


So people I am back with another Riders Republic video and today I'm going to showcase basically bike riding gameplay, bike racing gameplay. Now if you've seen any other Riders Republic videos on my channel I'm just giving you guys a lowdown on what this game offers and I want to do individual gameplay videos on every form of racing transport in the game. So yes expect to see if you can click on my channel you're probably going to see not only downhill mountain biking which I'm going to do now. Actually am I going to do downhill mountain biking now? What is this? Is this? I don't even know. We'll see, we'll see but the title of the video will explain that. What?   This is a road bike, this is a road bike race that's what we're going to check out today. Now I did actually record videos already of what I've already done but I forgot to turn off the copyright music so I've got to do it again. Yeah you can see my road bike right there.   What I will say is if you've seen the trailer and you're interested in it, it does play as good as it looks. I mean I did struggle a little bit at first with the bikes and especially the the jet pack thing is so hard to control because for me it's inverted controls. It's what I'm used to. I tried to put it back to normal, it did not work for me. So yeah I had to play on inverted controls, it's just so hard to get used to but I'm much much better now riding my bike. We had a game, it does, it plays as good as it looks. And like I said the trailer, when I first saw the trailer to this game, it was like everything I wanted as a kid all rolled up into one game and it was that, it was Matt Hoffman's BMXing. It was Snowball Kids, which I absolutely loved. Oh shi, I did not meet, get up, get up, get up. There we go, there we go. Yeah Snowball Kids, my favourite snowboarder game ever. The SSH Trikula was pretty cool. I mean this is so much. But it just plays, it feels good. I've done it right, they've done it right. Oh shi, I mean like this is a, this is a road bike. This ain't made for going down those mountains. So what am I going down a mountain on this? I said mountain or hill. I think those tires are one jump and this bike's folding up, especially my fast on it. No two which ways I'm about that.  Easy as that, easy as that. Yes, finish top three using a folding bike. Oh they're secondary objects.  For that XP earned, new reward, what'd I get? Oh, let's see this downhill mountain bike. This is what I should have been on then. This is what we like to see. I'm equipping that. Thank you, thank you. Okay, so what else have we got? What else have we got? We've got a few, we've unlocked a couple more, we've unlocked a couple more. I'll keep this to the, this kind of road race bike though. That's bike race, that's downhill you can see there. Is that what I just did? Where am I? You've reached maximum level for the career in this better test, that's fine. That's fine. We're good. We're good. Down hill again. So that's where we're going. That's the one we just did. Any more roads? Don't think there's any more roads. I'm seeing here. Do a downhill. Do a downhill. Why don't I go downhill? That's more sports. Can I zoom in a bit more? I think that's it guys. I think that's it. That's basically all we got for the road race bike. We really don't have to see another race to be honest. You get the gist of that road race. So yes guys, I'll just leave the video there. Short but sweet one, but if you enjoyed the video, leaving a like really helps. If you want to see more riders Republic, do click on my channel. Plenty of videos there for you guys and hopefully I will see you soon on the next one.