What's going on, everyone? Sam here with latent sports cards, ripping 22, Panini Obsidian Football hobby at 12 box, full case break number one, random division style. There's a look again at your random results. As always, you can find these on the website under the results tab, as well as the link that's in chat. So good luck. Let's do it. I'm wicked clean right there. Box one. See something nifty come out of here. Gonna be a Jalen Thompson to 75 going to the NFC West as well as a Cooper Cup Supernova 299 going to the NFC West. There you go, Shane. Stacking up on some numbered parallels. Base, Michael Carter. First hit, unbreakable rookie patch. It's going to be going to the AFC North, David Bell. That is 30 of 50. David Bell. You've got going to the AFC West, 41 out of 100. Russell Wilson in the Equinox gear, followed by AFC North again, 79 out of 99 is Jalen Warren. Jalen Warren. Come back to this next one. It's going to the NFC North with Steven A, seven of 10. Nasty, Christian Watson. Two colored red RPA. That is sick, dude. Congrats on that, Steven. There you go, buddy. Nice Watson coming your way. Red Watson coming here. We pulled the base red and now the RPA. Very nice. That's my fantasy team legend right there. He's actually really good. Yeah, I love Aaron Alley. I remember he was so hyped up in the prospects too. He's like the number. I mean, I'm not saying like he hasn't lived up to it or anything. I just remember how hyped up he was. Michael Carter, Orange to 75. Coral Patterson, 55 out of 100. And Avelis Jones Jr. That's one here, AFC South, 68 of 75 is a Trevor Lawrence. Two-color, two-color, one-color. Try to back the material. That's one NFC West. That is three of 10. It's a Matt Stafford, two-colored patch. Look at that, Shane. You just had a card of my celebrity look like. Were you here when that happened? Oh, I've had like at least 10 people on stream say I look like Matt Stafford. I'm like, I'm fine with that, dude. 34 out of 50, Matt Corral. I don't see it.  Tell me I don't look like a less athletic version of Matt Stafford. Actually. Yeah. And yes. Actually, yeah. Thank you. That's what I'm saying, exactly. And we've got a Wanda Robinson, rookie Jersey Auto's electric etch orange. Thank you, Sauer says it too. I'm so okay with that, dude. Opening cards. Nice one there for the NFC East. I'll go, we can switch. I'll go play quarterback for the Rams for $100 billion. I'll miss half the year and still get Romeo Dobbs orange. That is the 75 NFC North. But it's nephew from Connecticut. That's fair. There's 31 out of 99 is Travis Kelsey for the AFC West. I just look like I'm related to Matt Stafford. We got rookie is going to be Desmond Ritter. Six out of 50 NFC North is Vilous Jones Jr. on the three color patch. Nice one there on break. Good to get a Halloween caster now. That's what I'm saying, dude. 42 out of 100 Tyreek Hill. Nice one there for the AFC East. Excuse me. Definitely blood related. Thank you. That's all I'm going for. 64 out of 75. That is a Hassan Haskins going to the AFC South as well, only Orange Auto. And 100 out of 175 AFC East Garrett Wilson. Nice one there. Wow, he just goes like if Matt Stafford decided to play Matt instead of be in Madden. Oh, that's good. That's good. Jared Goff to 75. Trevor Lawrence to 100. Right, exactly. Matt Stafford lost all of his athletic ability and got shorter. Malik Willis for the AFC South, the 125. Nice one there. AFC North 65 out of 199 is going to be Charlie Kolar for the Ravens and the AFC North. 36 out of 50 NFC North is going to be Amonra St. Brown on the lightning strike. Amonra St. Brown. Absolute beast and fantasy for me this year. One of the reasons two of us won the league. And then 98 out of 100 matrix material is going to be AJ Brown. Nice one there for the NFC East. Again, 98 out of 100. Very cool in the Xbox. That's what I'm doing. I'll tell you that right now. I'm going to bet on that. Red Chad Mooma. It's a big card for Caleb Super Collection. Six out of 10. AFC South. And Max Crosby AFC West 250. James Robinson. That is 96 out of 125. Trey McBride on the Unbreakable Jumbo Rookie Jersey. NFC West. Got AFC North. It's going to be George Pickens. That is three-color, three-color and one-color trifecta material. 57 out of 75 AFC East. James Cook. We got a Cook Rook. Nice one there for Eric P. And finally we got 92 out of 175 for the NFC East. Brian Robinson Jr. Ben Robinson Jr. Bo Melton. NFC West 200. And Joe Burrill Volcanics. 10 out of 99 for the AFC North. Got James Robinson. Nice going to the AFC South. Joel B. We got a color blast. That is going to be Malik Willis. Second one of the day. Very nice. Congrats on that. Color blast. Very cool. Very nice. Congrats on that again, Joel with the AFC South. Got 15 out of 75. Is a Kyler Murray. Two-color, two-color, one-color going to the NFC West. 20 of 25 for the AFC North. That is David Ajabo. David Ajabo on the Rookie Auto. 13 out of 50. Chris Olave going to the NFC South. Chris Olive. And last but not least, two of 10 going to the NFC East. It's going to be a Jalen Tolbert. That is two-colored, nice red RPA. We've got Cavante Turpin Rookie for the NFC East. And contract Trent McDuffie. Nice one there for the AFC West. Turpin also was two-fifty. That's what I thought, I'm agreeing. Nealish Jones Jr. Rookie. NFC East, that is 53 out of 75. Dak Prescott. That's a good case so far. Got another red coming up here. Seven of 10 going to the AFC West. Rookie Auto. Leo Chanel. Nice color match there. I'm trying, Shane. I'm trying. We've got 46 out of 199. There's a Sauce Gardener. Sauce Gardener. And 104 out of 175 going to the NFC North is Romeo Dobbs. Romeo Dobbs. All right, Cortland Sutton. Purple to 100 going to the AFC West. And a Orbital. NFC East, seven of 50 is Jalen Hertz. Furious. George Carlaft as Rookie. We've got points in here really quick. Just going to take them out. Two-fifty. Two-fifty points. Random to all at the end. 78 out of 100. Zach Wilson for the AFC East. On the Equinox gear. And NFC East, 56 out of 125. Is Brian Robinson Jr. Try Fecta Materials. Try Fecta Materials. And 35 out of 50. We've got a Matt Corral on the Green Rookie Jersey Auto for the NFC South. NFC South. Shane McClanahan starting for the Rays. That's a loss. Really? Is it? Central Sy on there. He's playing in Tigers, so I hope it's not a loss. Yeah, it shouldn't be a loss. Sharers are in Alcantara. That's pretty nasty. In New York or in Miami? In Miami. Hermon Marquez. They always get like open guys. Fancy football legend Hermon Marquez from baseball. We've got Aaron Rodgers. That is 14 out of 50. NFC North. And NFC South. How about it? Tom Brady. Vitrious. Jersey number 12 of 15. There you go. Congrats to Cooper Jay. We'll get that mag for you, buddy. That is awesome. Vitrious. Tom Brady jersey number on the insert. We'll take it. We'll take it. Absolutely. We've got Tyler Smith. Nice one here going to the AFC West. 124 out of 125. Patrick Mahomes. 115 out of 199. NFC North is a Thai Chandler. Another red, dude. We've got AFC South. Five of 10. That's an Adam Vinitieri. Nice one there on the red Aurora. Kyle Gibson versus Corey Kluver. Showdown will be the best showdown. Oh my lord. That'd be so cool if it was like 2017. Former AL Central aces right there. Yeah. No kidding, dude. No kidding. And we've got 38 out of 50 for the Ravens. Two-colored RPA, NFC North. Kyle Hamilton. Kham. Got a gold. It's going to be a Jermaine Johnson. Rookie for the AFC East. Seven of 10. Very cool. Gold flood. Followed by Kyron Williams. 55 out of 75. Going to the NFC West. DJ Moore. 24 out of 100. Rookie Eruption. Eric Azucanma. Going to the AFC East. AFC East. EZE. Nine of 25. Rookie Eruption. Christian Watson. Two-colored patch. Congrats on that one there. NFC North. AFC West. 18 out of 75. It's going to be a Marcus Allen on the Aurora Auto. Very cool. And 66 out of 99. Johan Dotson. NFC East. Johan Dotson. So the follow there got, y'all need God. Chigo Zem. Aquanquo. Two-100. AFC South. And another red. This time, Jordan Davis. Five of 10. Going to the NFC East. Zeke Elliott. Got Josh Allen. 42 out of 50. Four-colored patch. Going to the AFC East. Very cool one there. As well as AFC West. 104 out of 199. Leo Chanel. AFC West. Leo Chanel. 42 out of 100. That is going to be a Derwent James Jr. Magnetic Auto. So I'll be y'all. And nice one here. It's going to be 20 of 50. Trey McBride. Two-colored, two-colored RPA. NFC West. There you go. Shane. Nice one coming your way, buddy. Like I said, I think he could be a potential, like, not breakout candidate, but like a very solid guy out in Arizona. Last box. Good luck, everybody. Could consider that breakout. Yeah, true. True. He's breaking out from this thing. Trey McBride. Kyle Hamilton. Orange Rookie for the Ravens to 75. And Supernova Travis Kelsey. 10 of 50. AFC West. Ryan Robinson Jr. Rookie. NFC East. 43 out of 75. Jalen Tolbert. What is that middle one from? Two-colored, two-colored, one-colored. You try to tell me where that middle one comes from. Four out of 100. Well, first off, we got points. I'm going to show that now. 400 points. Again, random to all at the end. Rookie Eruption, Traybon Walker going to the AFC South. Is that a glow? Must be. And 54 out of 99. That is going to be Jamo Jamison Williams going to the NFC North. Let's do a quick points random here, everybody. Again, we've got 250 and 400. So the top team in the random will get 400, and the second division in the division will get 250. So let me get that set up. All right, guys. Going to roll the dice. Whatever division is on top, after six times, we'll get 400. Whatever division is in second, we'll get 250. So here we go. One, two, three, four, five, and six. NFC North getting 400, and AFC North getting 250. Here it is on six and six. No problems. Do a quick recap. We've got Malik Willis, Patrick Mahomes, Brian Robinson, Tray McBride, Erica Zucano, Traybon Walker, Tyree Kill, Zach Wilson, Russell Wilson, Dak Prescott, George Pickens, Jaylen Tolberg, Kyler Murray, Trevor Lawrence, Josh Allen, Vylus Jones, David Bell, Christian Watson, and Matt Stafford. Got non-magged autos. They're going to be Wondale Robinson, Leo Chanel, Ty Chandler, Soss Gardner, Charlie Kolar, Brian Robinson Jr., Romeo Dobbs, Garrett Wilson, E.J. Brown, Derwin James, Jamison Williams, Johan Dotson, Marcus Allen, James Cook, Hassan Haskins, Jaylen Warren, Chris Olave, Tray McBride, that is Kyle Hamilton, Matt Corral, Matt Corral, Amon Ross St. Brown, David Ajabo, Leo Chanel, Adam Venetieri, Jaylen Tolberg. Magged cards, we had a Christian Watson, numbered seven of ten. Yeah, I know. I'm sorry, Shane. That was not a great case for the M.C. West. I apologize, man. League Willis, Colorblast, and a Virtuous, or Vitrious, excuse me, 12 of 15, Tom Brady. That is Jersey numbered, Brady. We'll do it for the break, guys. Thanks again for the fill. Next up, we got nothing. It's all done.


And so I'm all about creating those experiences where it's like, wow, that was incredible. And I'm not at creating anything at the same time. It's more of this idea of putting together the perfect location with the perfect food, with the perfect, like, you know, medicine and group of facilitators that are going to really bring people through a deep transformational experience that starts with the preparation all the way through the end with the integration, usually working with 5MEO DMT as well as EBOGA, but both separately. So those are two different retreat formats. Like, for instance, with the 5MEO retreat, we do purification rituals to prepare the person to go into this deep work with the Bufal Alvarius. And that includes doing to miss call, so sweat lodge, traditional sweat lodge, to really help them, you know, kind of cleanse some layers off to allow them to surrender deeper into the work.


What's going on y'all today in this video? We're gonna go over a few things on bitmex I was getting a lot of bitmex questions I had a video on this before but for some reason YouTube said that it abused the Community terms. I don't know whatever. I'm gonna make it again 2020 version so let's get right into it man So the first thing that we're gonna talk about is entering positions So if you're entering a For example a breakout entry the way we enter breakout entries is we use a stop market orders Or you can use a stop limit order All right, so you can see them right here. You have your limit order. You have your market order Got your stop market stop limit trailing stop take profit limit take profit mark market All right, so When I'm setting up an entry If it's a breakout entry I Usually like to if I'm at the computer and I'm going to be around Then I will use a stop limit order because I can watch it I'm I'm gonna be here, you know what I mean? So if it doesn't trigger if it doesn't want to triggers if it doesn't go off then I will You know update the order at a new price if I'm not gonna be around the computer then I'm using a stop market order because The thing with the limit order if the price moves too fast and it moves right past where you're Where your limit order is after it triggers that you're not gonna, you know, it's not gonna fulfill The order won't execute so that's why you want to use market or stop market orders in that situation where you're not around So for example if I want to set a stop market order above 12,000 the way that I'm gonna set it up is I'm gonna hit stop market Whatever amount of contracts you want to do here being going to change the price here to 12 You know 10 or something. I don't know some random number. You'll see that this goes off So you can't click this anymore Because this is you could only do along with this All right, make sure this right here is not checked because if that's checked then this is Order just to close the You know the triggers only to close it will not it'll cancel, you know if it's on and you'd have a position Here you can this is what's going to trigger your stop So you could do either last Price the mark price or the index price. I usually leave it last If you're doing a market order you might want to do mark But if you're doing limit then definitely last So I have it on last Then the next thing is your leverage. I always recommend no more than 10x leverage I think I believe anything above 10x you're more on the grounds of gambling versus, you know really trading With cuz the next thing up is 25x now That could you know get you liquidated very very easily With 10 with 10x I feel very comfortable This is what I've always traded with if you're new I don't whatever I say here If you knew I recommend splitting that in half So if you're new I don't I don't recommend going past 5x. All right, so I'm gonna do 10x Like I said my whatever amount of contracts you want you set your stop price You said at the order this is gonna come up is basically just telling you, you know The position is going to be opened in isolated margin mode Isolated margin will use your selected margin preference with just 10x This will limit your loss watch your liquidation price carefully. So Here's is gonna show your order value The cost at 10x and you're available balance Position size after execution. So we only put one one contract there The mark price where it's currently at your estimated liquidation price So check this out if right now our liquidation price is ten thousand eight hundred sixty four Which is a 8% drop? All right, so if we go up to 25x, let's see what how that changes that price Look at it. Look at the liquidation price now now estimate the liquidation is 11,493 Let's take it a step further go 50x Look at that liquidation price 11,719 and of course if you Go 100x which is I recommend just going to the your local casino At that point and betting it all on red or black Your liquidation price is 11,836 and the price is currently at you know 11,869 that's only 0.28% drop away. So you're gonna get liquidated most of the time Do not mess with those numbers. I'm telling you guys Years and years of experience doing this do not mess with those don't go beyond 10x Do not get greedy greedy is what kills your bankrolls So 10x is what we're doing We see our liquidation price is $1,000 under Either way it will never reach that because we're gonna have a stop losses set We hit buy boom that contract is set up. You can see here on this You see can I make this bigger? Trying to see what I could tick off so I could Make this chart bigger Here we go. Yeah, so for those of you don't know you could actually move all this stuff around So you see you see our orders right here is gonna trigger right right at that line Now if I want to set a stop loss I can't set the stop loss on this order because it has to fulfill before I can set a stop loss So when you're doing prices in the future that are it's not there yet. You can't set stop losses on it Now if you're doing a entry, this is a different type of entry where you're you know The price where you want to enter is lower than the current price. For example, right now the price is 11,912 The price I would like to enter if we look at this Chart I would say. All right, let me see. This looks like a decent support area right here, right? 11845 so I'll put here 11845 45 and guys do not take this trade this I'm just giving you guys an example So you see how now it doesn't let me set a stop market order on that Yeah, you can't do it because what the way that you enter a support entry when the price is currently higher than where you Want to enter it's you have to do a limit or a market order. Well, no, you can't do a market where I'm sorry Yeah, just a limit order so limit we said 845 Everything's good 10x leverage always make sure that this the trigger is not checked here and that you only have 10x leverage Double check it triple check it. Trust me. I've seen a lot of people make mistakes and blow their entire account by clicking the wrong thing You can look here at our position Mark price, this is estimated liquidation will be 10,000 under where We're gonna be entering so we don't have to worry about that Hit by boom. Our order is there Now if we look at our active orders, we have an order at 11 845 so that would be the support entry if the price goes down to that To it here where it's gonna go off unless it drops really fast and it won't fill It'll fill out a different price though as long as it goes under it's gonna fill and Then our stop order is right here So this is our breakout entry breakout entries always have to be stop market or stop limit orders. All right now Let's stop market that's entering a position now the way to close out positions. Let's just enter a position right now I'm gonna just mark it by so it could just enter me into whatever position. All right, so I just did a market buy So I have one contract Entry price is 11,912 You have your mark price right here This is the price that the mark price is currently at for some reasons way down here But the last price is 11,912 Liquidation price is again a thousand dollars under our entry so we're comfortable with that We don't ever have to worry about liquidation because we're gonna be using stops so for example if we want to say if it goes under 11,900 we want to sell right so the way you set that up is You go back over here to the stop now you could do it you can set it up as a stop limit or stop market Like I told you guys so we're just gonna do stop market for now We're gonna say that we want to sell at 11 899 because we don't want we don't want to hold under that right So we're gonna set it's a stop market. We're gonna hit here.  We're gonna close the position here We're gonna hit it boom now that's another stop order that we have set here, and it's at 11 899 All right, so now let's say we don't want to sell Well, the other thing that I that I'll say is take profits So if we're taking profits when this position right now, we want to set up some stops to take profit, right? So let's say our first Target is eleven thousand nine hundred and fifty dollars So eleven thousand nine fifty you could either do a stop market or stop limit You could also do take profit limit take profit market We're gonna do for now take profit market And we're gonna set this price at nine fifty We're gonna take the one contract at that price, right? So you just hit close on trigger one And you sell Boom you have now you have three stops Set up right Now let's say that you have multiple targets, right? You have for example the way I trade I like to have Three targets usually And then I'll show you what it is that I do so let's let's buy three more contracts here I'm gonna just mark it by again All right, so now we're up to four contracts Now we have three different Targets right so Our we just set it to market. It's just easier our Targets are gonna be nine fifty which I already have set up to take profit there nine fifty We're gonna say it's nine seventy five and twelve thousand right, so I'm gonna just do the same thing. I just did nine seven five We're gonna sell one more contract Right so now we're taking Let's hit close on trigger remember always check that boom Sell all right, so we have the different cells now We have nine fifty nine seventy five we still have even if we hit both those Targets we're still gonna have one more contract because currently we have four contracts, right? So we're gonna do one more at twelve thousand remember that was our third 12,000 that was our third target. We're gonna make sure close on triggers on Take profit. We're gonna sell one more contract. Boom All right, so we have it set up to take profit three times nine fifty nine seventy five twelve thousand now What's gonna happen? We're gonna have one more contract even if we hit all those all three of those contracts, right? All three of those targets, so what I like to do is I like to Split it up into four always. I take 25% profit at each target, right? And then the last contract is the one that I let just is what I call a runner And I let it run for as long as possible if I see that it stops dropping back down Then I'll close it if I see that it keeps going up Then I'm gonna just let it run and you can trill it with a with a trail stop or whatever it is you want to do If you want to do it with a trail stop, let's say where we've sold we've hit all three targets We've sold everything. We have one contract left. It's at twelve thousand two hundred And we want to make sure that we're trailing it, right in case the price starts to drop again So what I'm gonna do is add put a value to this The trail value is going to be how far Below the price it's gonna trail, right? So let's say I want to trill it by a hundred dollars Then I'm gonna do that right there boom a hundred dollars Trilling stop it's not letting me hit a sell. I think it's because Trigger twelve thousand I'm not sure I'm trying to see why it's not letting me trill it So it looks like 12,008 would be the trigger for the trail stop. I Don't know guys The way I do it either ways manually. I I never really use that I use stop limits stop markets And I just trill it man manually you slowly move up as the price goes up So if when they pass this 12,000 I'll move it up Under 12,000, you know once it gets to twelve thousand one hundred I'll move it, you know just under twelve thousand one hundred Guess it's twelve thousand two hundred, you know, I'll move it up a little bit more And I just keep moving it up little by little trailing it basically Until until it comes back down and I take profits and that's it I think that's basically it we covered Limit orders we covered market orders we covered Stop markets stop limits take profits And that's basically it guys We're 16 minutes in Hopefully I was able to answer most of your questions I know you guys had a lot of questions about this a lot of people asked me on you know making a video about this So if you have any other questions to leave it down in the comments I'll be more than happy to answer them if I can if I have the response if not, I'll see if I can find it And that's basically it man. There's not much to it what I always suggest do not get greedy do not get greedy That is the number one reason New traders are not profitable because they're greedy they see the money and instead of taking profits They just leave it in and they don't use stop losses You lose all your profits you lose your bankroll and you stop trading That's what happens to 90% of traders don't be part of the 90 be part of the 10% peace out guys


ny questions about spacing of injections in a single limb this spacing is a recommendation and not an absolute rule considering the number of injections needed at each visit in the first two years of life there may be circumstances where separation of each site by one inch or more is not feasible we are not aware of any evidence that less than one inch separation between injection sites reduces the effectiveness or safety of a vaccine but you should try to put the most reactive vaccines tv containing vaccines and pneumococcal conjugate vaccine into different limbs if you can you should also develop a system so that everyone in your office can get the same vaccine into the same anatomic location this way if a local adverse reaction occurs anyone can easily determine which vaccine is most likely to be responsible a standardized vaccine administration map can help you do this here is an example of such a map it suggests the anatomic area for each injection this version was provided to us by the michigan department of community health and the alliance for immunization in michigan they have graciously allowed us to show it to you and to post it on the resources web page please consider using this site map or one similar to standardize the vaccine administration procedures in your office aspiration is the process of pulling back on the plunger of the syringe prior to injection to ensure that the medication is not injected into a blood vessel aspiration is not required before administration of a vaccine although this practice is advocated by some experts and most nurses are taught to aspirate before injection there is no evidence that this procedure is necessary there are no reports of any person being injured because of failure to aspirate in addition the veins and arteries within the reach of a needle in the anatomic areas recommended for vaccination are too small to allow an intravenous push of vaccine without blowing out the vessel a 2007 study from Canada compared infants pain response using slow injection aspiration and slow withdrawal with another group using rapid injection no aspiration and rapid withdrawal based on behavioral and visual pain scales the group that received the vaccine rapidly without aspiration experienced less pain no adverse events were reported with either vaccination technique a link to the study results is included on the program page we have been downplaying the need for aspiration since the issue is addressed in the 2002 edition of the general recommendations on immunization we have been impressed with the passion with which some nurses particularly nursing instructors defend this procedure but I will repeat that we consider aspiration an option or preference not a requirement if you prefer to aspirate and blood appears the needle should be withdrawn the dose discarded and a new needle syringe and vaccine dose used to administer the injection at a different site one way to avoid the need to discard an expensive dose of vaccine and possibly minimize the patient's pain is just not to aspirate in the first place many people particularly healthcare personnel claim to have latex allergies latex allergy is most often a contact type allergy we have been one published report of an anaphylactic allergic reaction following vaccine administration in a patient with known severe allergy to latex a person with an anaphylactic allergy to latex should not generally receive vaccines supplied in vials or syringes that contain natural rubber persons with latex allergies that are not anaphylactic such as contact allergy to latex gloves can receive vaccines supplied in vials or syringes that contain dry natural rubber or natural rubber latex with the number of injections that we are giving in immunization practice today both healthcare providers and parents are concerned about adequate pain control comfort measures and distraction techniques may help children cope with the discomfort associated with vaccination remember that pain is a subjective phenomenon influenced by multiple factors including a person's age, anxiety level previous healthcare experiences and culture a variety of measures ranging from topical anesthetics to diversionary techniques are discussed in the general recommendations on immunization another event to be aware of is fainting referred to medically as syncope this may have come to the attention of providers because most of our newest vaccines are recommended for adolescents a cdc fda analysis of recent VAERS data indicates that females aged 11 to 18 years contributed most to an increase in the number of post-vaccination syncope reports although rare serious injuries occurred to reduce the risk of syncope and injury resulting from syncope the acip recommends that providers strongly consider observing patients for 15 minutes after they are vaccinated in fact we recommend that you have patients and adults seated during vaccination and the observation period to decrease the risk of injury should they faint Donna? We would like to end our discussion of vaccine administration with a few words about non-standard vaccination practices and vaccine administration errors we have become increasingly concerned about the growing number of questions we receive asking what to do when the wrong vaccine or the wrong vaccine dose has been administered or the wrong route was used the first type of vaccine administration error is administration of the wrong formulation since the approval of Tdap and Zoster vaccines we have heard of several instances where the wrong vaccine was administered when young children receive Tdap instead of DTAP they do not receive adequate amounts of diphtheria toxoid and pertussis antigens young infant who has not completed a primary series of DTAP at increased risk for pertussis if an adolescent or adult receives DTAP instead of Tdap they are at increased risk for an exaggerated local reaction because they have received excess diphtheria toxoid and pertussis antigens even more concerning is when we hear about a young toddler receiving Zoster vaccine instead of Varicella vaccine this exposes the child to a dose of vaccine virus 14 to 15 times the prescribed dose another concern related to administering the correct vaccine is using the correct diluent with vaccines that require reconstitution we frequently receive questions about the effectiveness of a vaccine when the wrong diluent has been used vaccine safety and efficacy data are based on using the prescribed diluent vaccine manufacturers and CDC do not test vaccine using the wrong diluent to find out what will happen we almost always recommend that doses reconstituted with the wrong diluent be repeated you must not only carefully check the label on the vaccine to administer but also the diluent to ensure that the appropriate product is used remember standard medication guidelines require that the medication label is checked at least three times before administration similarity in product names and packaging also increase the risk of medication errors we suggest that you do not store products with similar names or packaging close to each other in the refrigerator or freezer a third administration error we hear about is the wrong route of administration earlier we discussed several factors involved in ensuring that a vaccine is injected into the correct tissue the first step in this process is verifying the route that should be used for a particular vaccine for example a common error we are hearing about is inadvertent administration of meningococcal conjugate vaccine by the subcutaneous route meningococcal polysaccharide vaccine should be administered by the subcutaneous route but the newer meningococcal conjugate vaccine should be administered by the intramuscular route we also have received several reports in which purified protein derivative or ppd used for tuberculin skin testing and td have been confused resulting in intradermal administration of td administration errors like these not only increase the risk of adverse reactions and suboptimal immune response but they also diminish the trust and confidence that parents and patients have in their healthcare provider be sure that staff are adequately trained in standard vaccine administration practices and are oriented to the proper administration of new vaccine products remember your patients are counting on you Don and Andrea as you know we receive many many questions about vaccine administration issues one of the most common Don I'll point this one at you do you have any questions about vaccine administration or if it's an open lesion or if it's an agency policy so if you if you do wear a large clinic when you're like a big flu clinic when you're giving a lot of vaccines the thing is that you know ACIP says you really only need to wear vaccines or wear gloves I'm sorry if there's a risk of exposure to blood so if you do wear gloves you still have the whole issue of hygiene and so it would we would say yes you need to wash your hands between patients and if that means you know changing the gloves then that's what you have to do okay better maybe just not to wear gloves in the first place if you don't have to another very very common question is partial doses if a patient moves his arm and somehow manages to dislodge the needle before the whole vaccine dose has gone in do you have to repeat it do you repeat it then what do you do it's really a judgment call on the part of the health care provider if a provider feels like that there was vaccine loss during the procedure then this is counted as a partial dose and the vaccine must be repeated general rule is if partial doses are given they are invalid and you should repeat the dose one more quick one for Donna is there a risk for pregnant staff people to administer live virus vaccines no a pregnant person can administer any live virus vaccine except smallpox vaccine this question comes up a lot with rotavirus and influenza vaccine like the leiv vaccine and there's no problem there for one thing the health care provider should have been vaccinated already against influenza if they are administering influenza vaccine and that should not be an issue and rotavirus is not a concern either they most likely have antibodies to it very helpful thank you very much Andrew and Donna thank you the success of efforts against vaccine preventable diseases is attributable in part to proper storage and handling of vaccines exposure of vaccines to temperatures outside the recommended ranges can adversely affect their potency and reduce the protection they provide storage and handling errors can cost your practice thousands of dollars in wasted vaccine and revaccination they can also result in the loss of patient confidence in your practice when repeat doses are required vaccines are fragile and must be kept at the temperatures recommended by the vaccine manufacturers at all times it is better not to vaccinate than to administer a dose of vaccine that has been mishandled live vaccines can usually tolerate freezing temperatures in fact all vaccines that contain varicella virus must be stored in a continuously frozen state at the recommended freezer temperature until administration MMR vaccine is usually stored in the refrigerator but it can also tolerate freezing temperatures live attenuated influenza and rotavirus vaccines must be kept at refrigerator temperature live virus vaccines deteriorate rapidly after they are removed from storage on the other hand inactivated vaccines are damaged when exposed to freezing temperatures inactivated vaccines exposed to freezing temperatures should not be used however they can tolerate short times out of refrigeration although potency can be adversely affected if left out too long vaccines must be stored properly from the time they are manufactured until they are administered to your patients the cold chain begins with the manufacturer and continues with the transfer of vaccine to the distributor transfer from the distributor to the provider's office and administration to the patient proper storage temperatures must be maintained at every link in the chain all healthcare providers who administer vaccines must evaluate their cold chain procedures to ensure that vaccine storage lines are being followed each office should develop and maintain a detailed written storage and handling protocol assign storage and handling responsibilities to one person designate a backup person and provide training on vaccine storage and handling vaccine storage units must be selected carefully and used properly refrigerators without freezers and standalone freezers are usually better at maintaining the required temperatures however a combination refrigerator freezer unit sold for home use is acceptable for vaccine storage if the refrigerator and freezer compartments each have a separate external door any refrigerator or freezer used for vaccine storage must be able to maintain the required temperature range throughout the year it must be large enough to hold the year's largest vaccine inventory and must be dedicated to the storage of biologics food and beverages should not be stored in vaccine storage units keeping food and beverages in the storage unit leads to frequent opening of the door which leads to temperature instability the CDC discourages the use of small single door or dorm style refrigerators like this this type of unit may be used for storing small quantities of activated vaccines or MMR rotavirus or live attenuated influenza vaccine but only if the refrigerator compartment can maintain a constant temperature it is impossible for the freezer compartment in this type of unit to maintain the required temperature range and must not be used to store varicella, MMRV and zoster vaccines most vaccines require refrigerator storage temperatures of 35 to 46 degrees Fahrenheit which is 2 to 8 degrees Celsius with the desired average temperature of 40 degrees Fahrenheit or 5 degrees Celsius vaccines that are stored in the freezer must be kept at 5 degrees Fahrenheit which is minus 15 degrees Celsius or colder both types of influenza vaccine, TIV inactivated vaccine and live attenuated influenza vaccine must be stored in the refrigerator LAIV no longer requires freezer storage all vaccines that contain live varicella virus must be stored in the freezer at 5 degrees Fahrenheit or colder this includes single antigen varicella vaccine, MMRV and zoster vaccine MMR may be stored in either the freezer or the refrigerator if you're using both the refrigerator and freezer vaccines be careful not to make the freezer so cold that the refrigerator temperature drops below the recommended temperature range Andrew proper temperature monitoring is key to proper cold chain management check the temperatures twice a day once in the morning and once before you leave at the end of the work day post a temperature log like this on the door of the refrigerator or freezer and record the temperature readings twice daily it is important to keep temperature logs for at least three years unless state statutes or rules require a longer period as the refrigerator or freezer ages you can track recurring problems or identify how long problems have existed while it is important to document the temperatures, documentation is not enough equally important is taking immediate action when the temperatures fall outside the recommended ranges remember any mishandled or incorrectly stored vaccines should not be administered it is especially important that inactivated vaccine that has been exposed to freezing temperature not be administered if you discover that your refrigerated vaccine has been exposed to freezing temperature even if the vaccines do not appear to have been frozen you should segregate the exposed vaccine so it will not be used and contact the manufacturer or your state immunization program for advice temperature rises above 5 degrees Fahrenheit during other than the normal defrost cycle both the refrigerator and freezer compartments should have their own thermometer here are some examples of thermometers that can be used including biosafe liquid continuous graphic and minimum maximum if you are using a continuous recording thermometer even though it is recording the temperatures for you it should still be checked twice each day to make sure the temperatures are in range thermometers are a critical part of good storage and handling practice the CDC recommends using only certified calibrated thermometers for measuring vaccine storage unit temperatures more information about these thermometers is available on the updates and resources web page to keep the refrigerator and freezer cold the unit must be in good working condition and it must have power at all times there are several things you can do to prevent problems your refrigerator should have a plug guard or a safety lock plug so that it cannot be inadvertently pulled out you may want to install a temperature alarm to alert staff to after hours emergencies particularly if large vaccine inventories are maintained label the circuit breakers to alert janitors and electricians not to unplug the vaccine storage unit or turn the power off you can do this by posting a warning sign like this at the plug on the refrigerator and at the circuit breaker box you can help stabilize the temperature in the refrigerator by keeping containers of water inside this liquid bulk helps keep the temperature stable particularly when the refrigerator is being opened and closed all day remove the vegetable bins and shelf and put your water containers in their place as you see here the same principle applies to the freezer store extra cold packs or blue ice in the freezer not only will they help keep the temperature stable with frequent opening and closing of the door they will also help keep the temperature stable in the event of a power failure providers should also never store vaccines in the door of the freezer or the refrigerator or in the vegetable bins the temperatures in these areas are not stable use these areas to store liquid bulk and cold packs we are frequently asked about storing biologic specimens such as blood and urine in the same storage unit as vaccine we prefer that vaccines be kept in a dedicated storage unit but we understand this is not possible in some offices if you must store biologic specimens in the same unit as the vaccines be sure the specimens are stored on a lower shelf than your vaccine supply this is to assure that if a specimen leaks your vaccine will not be contaminated another common inquiry we receive concerns pre-filling or drawing up doses of vaccine before they are actually needed we strongly discourage filling syringes in advance for a number of reasons the most important reason to avoid this practice is that filling a syringe before it is needed increases the risk for administration errors once in the syringe it is difficult to tell which vaccine is which pre-filling syringes also increases vaccine wastage unused syringes you have pre-filled should be discarded at the end of the clinic day finally pre-filling syringes may result in bacterial growth in the vaccines that do not contain a preservative such as vaccines supplied in single dose vials as an alternative to pre-filling syringes consider using manufacturers supplied pre-filled syringes for large immunization events such as community influenza clinics syringes other than those filled by the manufacturer are designed for immediate administration and not for vaccine storage however if you have a reason to draw up more than one dose of vaccine you should only pre-fill a few syringes at a time which you will administer yourself any syringes of vaccine other than those filled by the manufacturer should be discarded at the end of the clinic day vaccine inventory control is a critical part of vaccine quality management as part of inventory control providers should conduct a monthly vaccine inventory to be sure they have enough to meet their needs however avoid stocking excessive vaccine supplies because this can lead to vaccine wastage when vaccines become outdated also include diluents in the stock control procedures and ensure adequate diluent supplies are available vaccines may only be reconstituted with the specified diluent diluents are not interchangeable except the sterile water used to reconstitute MMR varicella MMRV and zoster vaccines providers should monitor the expiration date of their vaccines and diluent supplies rotate stock to avoid waste from expiration expired vaccine and diluent should never be used it is critical that every clinic have a written emergency vaccine retrieval and storage plan the most important part of this plan is to identify a location with a backup generator where a provider can move their vaccine in the event of an emergency such as an equipment failure or power outage consider contacting a local hospital the Red Cross or a long term care facility is a backup site information to assist in developing a written plan is available on the CDC vaccines and immunization website there are also useful storage and handling resources in an appendix of the course text including temperature logs vaccine storage requirements and warning signs for your electrical plugs and breaker box other helpful tools are available at the CDC a vaccine storage and handling toolkit with detailed storage and handling guidelines videos, forms, posters and an interactive game is available on the vaccines and immunization website this is the main page of the online toolkit a CD version of the toolkit is included with this DVD set and is also available from our online catalog check the updates and resources on the page for information on how to order a copy for your office in order for patients to be protected by vaccines vaccines must be stored and handled with care with a few simple steps and good practices to maintain proper vaccine storage and handling we can ensure that the full benefit of immunization is realized Donna could you comment on aging is there a time that they should be arbitrarily replaced or does CDC have a preference for say stand-alone units as opposed to combination units for households well the CDC requirement really is that you know as was mentioned earlier that you've got external doors on the two different compartments if you're using a single unit that has freezer and refrigerator that it can maintain the temperature year-round in each compartment and that it can handle your largest amount of vaccine stock that you have in a year some states now do have tighter requirements than that and frankly because of problems that they've seen I will say that if you're storing varicella vaccine it's tough in a single unit to make sure that you've got the temperature that you need in the freezer without getting the vaccines in the refrigerator compartment too cold so usually you know stand-alones are better because then you don't have to worry about the temperature of one compartment affecting the other if you do have a stand-alone it's not only good I mean if you're using the one that has refrigerator and freezer you not only should think about external doors but the fact that they have separate thermostats for each compartment and of course that you have certified calibrated thermometers in each compartment as far as aging you know sometimes we're asked we're not allowed to use units that's you know more than 10 years old well the thing is older units just may not maintain the temperature as well but check with your state immunization program especially if you're a VFC provider thank you Donna, thank you Andrew this brings us to the close of this session of epidemiology and prevention of vaccine preventable diseases we would like to remind you of resources that you can use to get more information or to contact us here's the companion book for this program the public health foundation is the sole source for a printed copy the book costs $35 plus shipping and handling and is a useful resource for any office that administers vaccine to persons of any age you can contact the public health foundation through their toll free number at<PHONE_NUMBER> you can also order materials online from their website at bookstore.phf.org if your patients or their parents have immunization related questions you can refer them to the CDC Info Contact Center you can reach the contact center toll free at 800-CDC-INFO the CDC Info Contact Center is staffed 24 hours a day 7 days a week if you or your staff have questions you should direct them to us at the National Center for Immunization and Respiratory Diseases by email our email address is nipinfo at cdc.gov throughout this program we've mentioned additional immunization resources available to you on the updates and resources web page the address is www.cdc.gov front slash vaccines click on education and training then the self study link choose this program from the list to find all the materials we've discussed during this program we want you to have the most current immunization information at your fingertips an easy way to do this is to have the information available on your computer we've compiled all the current ACIP statements, vaccine information statements the course text and much more on a CD called immunization works the CD is a great way to have all your current immunization information together in one place immunization works is distributed free of charge by the CDC the updates and resources web page has a link to order it continuing education credit is available for viewing this program details and instructions can be found in the continuing education chapter of the DVD or on the updates and resources web page thank you for joining us for this session of epidemiology and prevention of vaccine preventable diseases please join us for other programs in this series when we discuss specific vaccine preventable diseases and the vaccines to prevent them until then goodbye


Hi, good morning and welcome to these products from focus. I guess what many traders are currently looking at today is the 7% move down and crude oil overnight and Those wild price swings are what's giving West Texas crude the nickname of the widowmaker Right now because if you're on the wrong side of it heaven help you if you're able to call it right However, it's a very very profitable product. There's not many other Major commodities out there that has such wild price wings, but it does make it problematic to trade Especially if you're not utilizing stop losses in that regard as well So what's caused those well price swings? Well, it's news that Iran is not going to play ball They're not going to cut their production as as many commentators were were hoping obviously It's all about market share right now and it's still so incredibly political And what makes that move and crude oil even more impressive is the fact that the the dollar has actually lost a fair amount of value Yesterday we're not fair amount of value, but it came off slightly yesterday Which had it been the opposite direction you'd have seen an even more exacerbated moving move and West Texas crude as well So it has been a bit of a tough one to trade But for those that are feeling quite quite brave, it can be quite lucrative as well I guess what we're seeing in other markets is equities I've kind of pretty much just stalled after their big rally that had there on Friday slowly just slightly drifting down Not that much activity on there just now I think most markets are probably waiting for ADP private payrolls on Wednesday But of course, it's non-famperals this Friday Which many people will be waiting for for more clues as to interest rates in the US Gold as well is also quite interesting. So gold briefly touched $1,100 yesterday. Not that much momentum We are actually kind of had hope that would have pushed up that little bit higher And when you consider that we might be talking about low rates for longer in the US And we actually had another Fed member come out last night basically down playing interest rates in the US You've got more market uncertainty at the moment And also we briefly talked about the fact that the dollar took a bit of a back seat last night Gold's not really had that momentum to break up that much higher So basically should we see an instance where the markets then recover like stocks then push up The thing to watch out for is gold might have an exaggerated move down Because it's not pushing up quite as high as you would like when everything's going in its favor So those are pretty much to come and themes so far today Oh, and also the rating agency standard and poor perhaps unsurprisingly in this environment have downgraded US oil firms So that's weighted slightly on the US markets, but not that aggressively shell in particular They're a little bit hard hit. So let's push on to the technical analysis portion and we'll start off as ever with the US 30 So as you can see there, this is our Friday move pushing up higher a little bit of indecision yesterday But still moving down more indecision again. We're off the session lows Still negative territory 82% of CMC markets clients are currently short Moving on to the UK 100 the moves are slightly more exaggerated We're closer towards potential support round about 6,012 and we're not a far away from there just now We did push that a little bit lower yesterday Obviously commodity prices way a lot more heavily on the UK 100 than the US 30 56% of CMC markets clients are currently short Moving on to Japan 225 just keeping its head bouncing off 17 6 35 The other technicals are relatively neutral run between two ranges This is a level that is going to be strategically important in the short term next potential resistance 18 531 I move below 17 6 35 opens up a potential move towards 17 181 And as I said 56% of CMC markets clients are currently short Moving on to dollar yen dollar yen has not managed to capitalize on that on that move that we saw there on Friday Even though we've had negative rates in Japan basically Japanese yen is kind of bucking the trend from from gold It is a little bit more of a safe haven aspect than that than gold at the moment though We have had a bounce off 120 spot 36 96% of CMC markets clients are currently long and they're target dodgerbanger targeting 125 The next potential resistance is actually at 123 spots 60 Then moving on to West Texas crude aka the widow maker And you can just see the severity of that move yesterday closing the bottom of his range closing below the 21 period SMA Longer term potential support 26 spots 69 a failure to break anywhere near 35 dollars to be honest 31 spot 53 will be that potential resistance level in the short term 53% of CMC markets clients are currently short showing a difficulty in picking a direction right now Moving on to gold as you can see their gold is briefly managed to get to 1100 It's not managed to to break through that much more bigger, but one 1131 is a potential resistance the next potential support 1113 should things retreat ever so slightly other technicals are relatively neutral 79% of CMC markets clients are currently short as I said if we do see a recovery in stocks, you might see an exaggerated move back down towards 1113 Finishing up with the FX pair is your dollar still trading within this symmetrical triangle formation It's not remotely interesting until it breaks out either this side or breaks at this this side And the there's big question marks over the March meeting for the ECB will the embark on more QE will they buy more stocks? Will it be an interest rate cut? That will be an interest to move for For the euro and that's what we really maybe the markets is waiting for more clarification in that regard But we're not seeing a huge amount of volatility In your dollar obviously we had this big move there on Friday But we need to get outside this triangle before we can get some further momentum 81% of CMC market clients are currently short with cable cable I had a great day yesterday, but breaking through potential resistance one spot 43 Trading above that 21 period SMA has failed to fall through capitalized this morning I think one spot 43 51 could be a potential support level to be aware of and 83% of CMC markets clients are currently short So if we keep our eye on the economic data, we do have employment data from Germany today and from the Eurozone fast forwarding on to Wednesday more PMI data and crude oil inventories You do have ADP private payrolls as well on Thursday you do have the industry announcement and employment claims that shows from the US and on Friday Of course gives you your known farm perils figure and unemployment rate as well So that gives you better an idea of what to expect in these markets Well guys very good luck with your trading and join me again tomorrow to find out what happened next. Thank you very much and goodbye


Hi, Dr. Jared here today's Friday flop is on a crown. I did we performed an MTA topotomy here on Tooth number 30 here We are checking on this and you can see a nice result a nice healing around the apex there And we can see that my crown is not fully seated This is gonna have to be cut off and we'll have to redo that so that is my plan for this and To avoid this you can take a bite wing before you submit the crown and make sure that you have it adapted all the way Have a great weekend


Singer John Mayer has a song called Daughters that discusses the importance of fathers being there for their daughters. Mayer wanted to emphasize the message that daughters have to be nurtured well in their childhoods because those actions will affect the relationships they have when they become adults. But not every girl gets the treatment they hope for. Some of them grew up with hardships and only understood the unstable, fragile love they received from the person they called their dad. Here are six types of unhealthy father-daughter relationships. Number one, the lost father. The lost father is someone who is physically present in their daughter's lives but abandons her emotionally. He never praises her daughter for her accomplishments or notices the changes that she's going through. As a result, daughters with a lost father often feel confused about their self-identity and have trouble identifying their strengths and talents. They also typically suffer from low self-esteem issues and usually look for the love and affection they crave in their romantic relationships. Number two, the abusive father. The abusive father often has unstable moods and exhibits unpredictable, destructive behavior. He usually has a hard time controlling his anger and takes his stress out on his daughter, which results in verbal, physical, or sexual abuse. The abusive father only cares about his own needs and fails to treat his daughter right. Daughters of abusive fathers often grow up with no true identity. They are fearful, timid, and prefer not to be noticed by others. In romantic relationships, daughters of abusive fathers expect to be mistreated by their partners and struggle with vulnerability and intimacy. Number three, the pampering father. The pampering father is the opposite from the abusive father, whereas the abusive father takes the pampering father gives. He doesn't set healthy boundaries and treats his daughter like a princess. Consequently, she often grows up being manipulative and self-absorbed. In romantic relationships, daughters of pampering fathers usually seek to be served and puts her needs first over their partners. Pampering fathers have a hard time saying no and allow their daughters to be spoiled. They worry about being mean and controlling and thus mistake their giving nature to be supportive when they fail to teach their daughters to treat them with respect. Number four, the toxic father. The toxic father creates a co-dependent relationship with his daughter. He often exercises helicopter parenting and has a hard time letting go of his daughter as she grows up. Even when she's capable of taking care of herself, he clips her wings off so she can rely on him for support. The toxic father fails to teach his daughter the proper life skills she needs to grow. He often dominors and makes decisions for her, thinking he knows what's best for her. As a result, daughters of toxic fathers have a hard time living successful, independent lives. Number five, the ruined father. The ruined father constantly relies on his daughter to survive. He may suffer from an addiction, severe depression, or be unemployed and needs his daughter by his side in order to function. He often guilt trips his daughter into doing favors for him, which can lead to bitterness and anger down the road as she tries to make it out on her own without having to look out for him. Daughters of ruined fathers tend to be selfless and have a hard time setting healthy boundaries with others because they have to play the role of a caretaker all their lives. As they reach adulthood, they may enter relationships where they end up baby or giving their partner special treatment without receiving the same love and attention. Number six, the anguished father. The anguished father constantly lets his daughter down. As a result, she reacts to his perceived faults, failures, and indifferences with rebellious behavior and unhealthy lifestyle choices such as eating disorders or risky sex to demonstrate what's bothering her. Daughters of anguished fathers take part in unhealthy choices hoping that their self-damage will influence their fathers to stop or quit their own bad habits. They are willing to hurt themselves because they don't know how to address the concerns they have for them that will reach them. Although daughters of anguished fathers might feel like they are free to do as they please, in reality, they are actually trapped by the feeling they have towards their fathers that are strongly expressed in their reactions and behavior. Which type of unhealthy father-daughter relationship do you resonate with? We know how hard it is to talk about toxic family dynamics and want to be a safe, non-judgmental place for you. Please share your story with us down below. Also, don't forget to subscribe for more content from Psych2Go and check out our Patreon. Thanks for watching!