So, far we have discussed what is a contestry grammar and the languages generated by contestry grammars that is contestry languages and certain examples to get the familiarity with the contestry grammars. Let me give you one more example, if you consider the set of strings of the form a power m, b power n say c power m plus n such that you consider this language. You can give a contestry grammar to generate this language by taking the clue of the sum of previous examples. For example, if you recollect the grammar for this language set of 0 power n 1 power n such that n greater than equal to 0, the grammar that we introduced to generate this is 0 s 1 and s can be epsilon. These two rules generates the language 0 power n 1 power n n greater than equal to 0. Now, if you look at a typical string in this that is a power n b power m c power m plus n what we have to generate the number of a s followed by the number of b s is equal to the following number of c s. So, now what you can do is if we first generate so many a s corresponding to those many c s for example, you have generated here k s generating k c s that you can do using this type of rules. And since n can be greater than or equal to 0 if n is 0 in which case it is the language the string is precisely of the form a power m c power m that is the strings in this language of that form or what you can do you can continue to produce. Now, b s in between these two certain number of b s and corresponding to which you can produce again this kind of using this kind of rules certain number of c s, but here we have to keep one thing in mind that after producing a s once we start producing b s we should not again go back to produce a s here. For example, if I just simply introduce s goes to a s c and s goes to b s c this will not do the business the reason why after producing using first rule for example, or second rule here you I do not have any restriction that once I have s here at a given point of time I may produce b c or after producing b c once again using this s I may produce a c in between. So, that way there may be a mixture of a s and b s, but we have a restriction that a s followed by b s then c s. So, we have to choose one more non terminal symbol which restricts after producing s first you want to produce as many as you produce using the first symbol here you may call for example, here some s and then you have to give a connection to another non terminal symbol once we go to the non terminal symbol new non terminal symbol there you can introduce this kind of thing producing b s and c s, but non terminal symbol will not give you back to come to produce producing s. So, now, let us use this information to define the grammar as just mentioned you can take this rule s goes to a s c this produces as many s as as many c's on the both the sides and then you can terminate because we are asked m n greater than or equal to 0. Now, I give you a non terminal symbol for example, s goes to a and this non terminal symbol a will produce b s and once we go to the non terminal symbol we do not have a connection back to coming to s. Now, this a goes to say b a c and now a you can terminate again now the order is very clear that this s is connecting to a for example, if this m is 0 we need not produce any s then the string is of the form b power n c power n. So, in which case you can directly choose this rule come to a and produce this b's and c's and terminate the derivation or in case if you have to produce only a's and c's where n is 0 then you will not come to this rule to produce b's and thus these rules will precisely give you the a language l. So, now you can prove that take it as an exercise if I call the grammar g which is having these production rules prove that language generated by this grammar is as desired. Similarly, you can take one more that say a power m now in between b power m plus n c power n such that m n greater than equal to 0. You can try a context to grammar which generates this language to show that this language is context free. Now, I will introduce a concept called a derivation tree which is useful to understand more about this context free languages. Because the context free languages are generated by context free grammars and this context free grammars using a context free grammar any string in the language you are generating through a derivation and to understand more properties about the derivations this derivation trees are very much useful. In this context let me consider the following example. Consider a context free grammar which are having precisely these production rules s goes to s star s or s plus s or bracket s or little a or little b. What is the language generated by this grammar? If you do a little homework you can quickly understand that arithmetic expressions with the operations star and plus over symbols a b can be generated using these production rules. That means the grammar this context free grammar generates arithmetic expressions over a b with the operations plus and addition and multiplication. Now, what do we do? Let us observe the following three derivations for the string a plus b star a.   So, using these production rules I have one derivation which produces a plus b star a similarly, I have the derivation two here and derivation three here. There are three different derivations you can clearly see that although first rule here is same, but here the second in the second step it is differing and in the first step itself this is differing with any of these two. So, that way these three derivations are different, but there are some common features that you can understand between the derivations one and two. What are the common features that you can understand here? What is in a particular step if you find a non-terminal symbol at a particular place the terminal string produced by that particular non-terminal symbol is same as the sub string of this produced by that non-terminal symbol. For example, in this two derivations one and two the second s if you consider here in the second step this is producing a the term the sub string a of a plus b star a and there is a contrast to feature between one and two with three that is this second s in the step one the non-terminal symbol s it is producing b star a these two are producing sub string a whereas, this second non-terminal symbol is producing b star a now, so this is the contrast to feature that I have explained. Now, to talk about this kind of the equivalences between derivations the common features that we have mentioned are contrast to feature to distinguish this kind of feature we make use of the notion called derivation tree. Now, let me define formally the notion of derivation tree let g be a c f g as given here with v is an union sigma.  Now, a derivation tree or a parse tree of the derivation given here is defined iteratively as follows for the tree we take this non-terminal symbol as the root and there are finitely many rules that you have applied to produce alpha here. So, if you consider the rule b goes to x 1 x 2 x k if this is applied in the derivation what do we do then new nodes with the labels x 1 x 2 x k are created and made children to the node b from left to right in that order. That means, for example, a a b we have applied and once again I have applied this a a b b and applying the rule if you consider this derivation here the rules I am using in this rules if I consider this derivation what is that I we have introduced what is we have defined a is a root of the tree this a is root of the tree and now we have applied the production rule a gives a a b this production rule. So, we will create these three as labels of the children of a like this and create the connections like this and then once again I have applied the rule a a b. So, this non term now for this we have these three children and then the rule a goes to epsilon is introduced now in the same order we are making this children from left to right because if you apply the rule b goes to x 1 x 2 x k in the derivation at a particular step for b we make x 1 x 2 x k as children and we keep them in the same order as just explained with s a here the derivation tree for that is here. And if you consider this derivation s goes to a b the rule is applied and then in the next step we have applied the rule a goes to a a b capital a b and then once again we have applied the rule this and if you consider this derivation the corresponding you can verify that this is the derivation tree for this derivation. Now, using the concept derivation tree or parse tree we will talk about equivalence between derivations. Now, we say two derivations are said to be equivalent if their derivation trees are same precisely again I recollect these derivations. Now, if you draw the derivation trees for these three derivations you can see that for first two derivations for first two derivations these two trees are exactly same. And for the third derivation the tree is different from 1 and 2 and thus you can understand that these two derivations that derivation number 1 and 2 are equivalent whereas, the third one is not equivalent to any of the first one and 2. Now, this concept related to equivalence you know we can capture through the notion left most derivations. So, that means essentially here what we have understood in the previous case to talk about the equivalence two derivations are equivalent if they have same derivation tree and that means the concept of derivation tree is uniquely assigned between equivalent derivations. Now, can we have any derivation a canonical representation of a derivation which is unique in some sense for equivalent derivations. In that context we are introducing this notion called left most derivation. So, this left most derivation is defined as as follows if you consider derivation a gives x x is a terminal string infinitely many steps through a contrast free grammar. Now, we say this is left most derivation a derivation a goes a gives x we say it is left most derivation if the production rule applied in each step is on the left most non-terminal symbol of the sentential form when you are getting a derivation you have applied rules in each step. Now, what is the condition here for example, this derivation when you look at of course, here in each sentential form you have only one non-terminal symbol you have only one non-terminal symbol. So, thus whatever the production rule that I am applying that is on the left most non-terminal symbol, but if you consider this example if you consider this example in this derivation you have choice there are two non-terminal symbols in this step a and b. So, if to say a derivation is left most derivation the production rule that you apply at a particular step you have to apply in the non-terminal symbol in the non-terminal symbol that is occurring first in the sentential form first from left side the left most non-terminal symbol. For example, in this step we have applied on the first non-terminal symbol a. So, this step is satisfying that and if you continue like this now you see there is a non-terminal symbol a here and the non-terminal symbol b here in this step. So, in this step we have not applied production rule on this non-terminal symbol whereas, we have applied production rule on this non-terminal symbol b. And here also you can observe that on b we have applied the production rule to produce this b b c. That means, this step or this step is violating the condition of left most derivation because in the left most derivation as we have mentioned that in the at each step when you are applying a production rule we have to apply the production rule production rule on the left most non-terminal symbol then we say that is a left most derivation. So, in that sense this is not a left most derivation. So, a derivation if we say that is left most derivation that is denoted by a subscript l for example, as I have explained in the previous case also this derivation 2 is a left most derivation because this is s star s we have applied production rule on this s you have got s plus s here. Then this s is terminated and then this s is terminated here then this s is terminated. And derivation 3 is also left most derivation because we have applied production rule on the first s here and then after this this is the non-terminal symbol. So, on this non-terminal symbol we have applied the production rule and now here is a non-terminal symbol on that we have applied. So, this derivation both the derivation 2 and 3 in the previous example both are left most derivation whereas, the derivation 1 which was not left most derivation. And now a similar concept called right most derivations can be introduced that means a derivation a gives x infinitely many steps a terminal string x we say this is right most derivation if each production rule if the production rule applied in each step it is on the right most non-terminal symbol of the sentential form. In which case we say it is right most derivation we see the similarity between left most derivation and right most derivation in case of left most derivation we are applying production rule on left most non-terminal symbol in each step. And in case of right most derivation we are applying production rule on the right most non-terminal symbol in each step you see the similarity between these 2 and because of the similarity between these 2 what are the results that we give for left most derivation we can one can similarly produce for right most derivations also. So, in the following we simply consider only left most derivations and a similar results can be produced as an exercise for right most derivations as well. Here is a notation similar to left most derivations if it is a right most derivation we use the subscript r for the derivation for the for the derivation. Now, let me give you a theorem that every derivation every derivation that produces a terminal string is equivalent to a left most can have left most equivalent left most derivation. What I mean here if you take a derivation a gives x where x is a terminal string then you can produce x through a left most derivation starting from a and conversely of course, you can quickly understand that this if part is straight forward because every left most derivation is anyway derivation therefore, if you can produce a terminal string x from a infinitely many steps through a left most derivation of course, you have produced x infinitely many steps and thus if part is straight forward. Now, let me look at only if part. So, what we do you consider the derivation a gives x infinitely many steps let me call a is alpha naught and that gives alpha 1 in first step and in the second step may be alpha 2 and so on in n steps you are producing x. Let me consider the derivation as this what we do we have to show that there is an equivalent left most derivation there is an equivalent left most derivation for this that means which produces x using in each step on the left most non terminal symbol that we are applying production rule. If what is the derivation that you have consider in which you have this kind of property that means on the left most non terminal symbol only you have applied the production rule in a particular in each step then it is a left most derivation then there is nothing we have to prove otherwise at a particular step we have not applied production rule on left most non terminal symbol and produce alpha i plus 1 that means there is an i alpha i produces alpha i plus 1, but not through the production rule applied on the left most non terminal symbol that is this. Now, what do you consider let k be the least for which this is satisfied that means till k we have alpha i produces alpha i plus 1 through that which is a part of you know applied on left most non terminal symbol in a sentential form alpha i and there after particularly at this place we have the condition failed. Now, what do we do we will show you a mechanism which can make which can give you a derivation for which this k plus 1 this is k plus 1 step because in the first step you are getting alpha 1 in the k plus 1 step you are getting alpha k plus 1. So, in the k plus 1 step also how to make this derivation which is applied on the left most non terminal symbol. So, if you if I can give you a mechanism which can convert the k plus 1 step also as a left most as a part of left most derivation then you can apply induction to produce an equivalent derivation that means a derivation which produces x in n steps.  So, what do we have in the information alpha k gives alpha k plus 1, but it is not obtained by applying production rule on the left most non terminal symbol that means alpha k is of the form some terminal string y and a 1 is the first non terminal symbol in the sentential form that is a left most non terminal symbol is a 1 and after that you have some beta 1 that is an element of v star some non terminal symbol a 2 and some beta 2 that is an element of v star. I can see here two non terminal symbols just to mention that in alpha k a 1 is the left most non terminal symbol whereas, you have applied production rules to get alpha k plus 1 on the non terminal symbol a 2. This does not mean a 2 is a second non terminal symbol from left side there may be non terminal symbol in beta 2 as well.  Now, what we have to understand here in this derivation eventually we are getting a terminal string x alpha n is terminal string. Thus at a particular step in the derivation you have to apply a production rule on a 1 because a 1 is a non terminal symbol to convert it into a terminal string you have to apply somewhere a production rule. So, let me assume that is on the p'th step thus and in the p'th step suppose you are applying the production rule a 1 goes to gamma 1. Now, what do we do? So, in this situation the derivation looks as follows alpha naught that is a gives alpha 1 in the first step and so on till alpha k these are all applied on left motion non terminal symbol and yet k plus 1 step you have this situation and so on you are producing x. This is the form of the derivation that we have with the situation that alpha k is of this form as I have explained and you have applied production rule on a 2 to replace gamma 2 there that is what is alpha k plus 1. Let me call this as psi 1 this beta 1 gamma 2 beta 2 let me call psi 1 and as I had mentioned this is a terminal string y you are not going to apply anything a 1 is a first non terminal symbol and that as I had mentioned that we are applying production rule on a 1 in this step only in the p'th step only. So, that way the production rules in between these steps that you have applied that you have applied on psi 1 to produce say for example psi 2 and then psi 3 and so on at this stage you have got psi if you you know enumerate the indices you can quickly understand that this is psi p minus k minus 1 the p step that you have and now on a 1 you have applied the rule a goes to gamma 1 and the p step to get this alpha p there after whatever you have that is alpha p plus 1 and so on.  Let me now set alpha k plus 1 dash is y gamma 1 beta 1 a 2 beta 2 that means I have applied production rule a 1 goes to gamma 1 in this step k'th step itself k plus 1 step itself and then what do I do this I will set now alpha k plus 2 dash to be I will apply in place of a 2 gamma 2. So, that means this step is postponed here and this step is preponed to this place and there after whatever is there I will adjust that means anyway this is psi 1 alpha dash k plus 3 the next step from psi 1 I am getting psi 2 that you will get here and then if you continue here I have already got gamma 1. So, what I call alpha p minus 1 dash to be y gamma 1 and whatever is here psi p k minus 2 because 1 that is preponed and now alpha p dash is this two are same because we have just preponed within these steps what are the number of steps the number of steps are same.  So, if I set these strings and you can clearly see that alpha k produces alpha k plus 1 dash through a production rule applied on the leftmost non terminal symbol.  So, I will move this string here to get this derivation and as we understand through this derivation alpha k plus 1 dash produces alpha k plus 2 dash and alpha k plus 2 dash produces alpha k plus 3 dash and so on and there after it continues. So, what do I have is this alpha k plus 1 dash I can move it here and alpha k plus 2 and the other things. So, that I have a derivation in which I have applied leftmost production rules on the leftmost non terminal symbol till k plus 1 steps. So, that means this mechanism by pre poning this step I could produce from till k plus k steps if you have applied leftmost production rules on the leftmost non terminal symbol to k plus 1 steps how to do that I have explained. So, now you can apply induction to extend this to k plus 2 k plus 2 steps and here you one more point you have to understand that the number of steps is not increased or decreased the same number of steps are there. So, thus what will happen till n steps one after another you can produce and this bound is fixed and thus within this limit that means next you will do for k plus 2 the same mechanism and then k plus 3 and so on till n these are the fixed number of steps by applying this means inductively you can produce a derivation that is a left most derivation to produce x from a. Thus we have the theorem that means any derivation which is of the form a gives x infinitely many steps corresponding to which we can give a left most derivation which produces x that is same terminal strength from a and conversely of course. Now, let me give you one more a small result that is 2 equivalent left most derivations are identical. So, that means here what we have to show that equivalent left most derivation means you have same derivation tree and their identical means you have to say that in each step whatever is the production rule they are applying in the first derivation the same thing that you are applying the second derivation. It is easy to understand because these two are considered two derivations left most derivation d 1 and d 2 since they are equivalent you have a common tree let me call that as t. Now, understand that in the common tree tree is same understand the children of each node represents a production rule applied in d 1 and d 2. So, since they are since we have common derivation tree the production rules which you have used in d 1 and d 2 they are essentially same and now the production rule applied in the both derivations are same because of this. Now, you understand the order of application of the production rule is also same the reason is both are left most derivations. And on each in each step you have to apply production rule on the left most non terminal symbol and the production rules that you have applied they are same. And thus you understand that the order of application of production rules in d 1 d 2 are also same and hence they are identical. So, two equivalent left most derivations are identical. Now, I use this result to give this following important theorem what we are looking for every derivation tree whose yield is a terminal string represents a unique left most derivation. So, that means the derivation tree concept when the equivalent between derivations is defined through derivation tree and the canonical form in derivations is a left most derivation as I had mentioned that is expressed through this result. That means the unique left most derivation that you will have for each derivation tree which produces a terminal string of course. The proof for this suppose t is a derivation tree as a derivation a gives x infinitely many steps. Now, we can find an equivalent left most derivation because the theorem one what I have explained now for every derivation you can have an equivalent left most derivation. Now, if you have two equivalent left most derivation they are identical that is what we have observed through theorem 2. So, by theorem 2 we have unique left most derivation represented by this t thus what you have every derivation tree which produces a terminal string represents a unique left most derivation. Now, I will introduce a new concept called ambiguity this is an important application for left most derivation the concept left most derivation. And the concept of ambiguity has very much practical importance particularly in the context of compiler design. Because in the compiler design the grammars that one expects is an unambiguous grammar context free grammar. Let me define the concept ambiguity of a context free grammar a C F G G is said to be ambiguous if G has two different left most derivation for same for some string in L of G otherwise we say the grammar is unambiguous. That means for every string there has to be unique left most derivation there cannot be two left most derivations for a string in the language to say an ambiguous. So, we have expressed this definition through the concept left most derivation as I had mentioned one can equivalently say a grammar is ambiguous if it has two different right most derivation or derivation trees. Because the concept of derivation tree and unique left can be you know captured through left most derivation. So, that way one can see equivalently if a string has two different right most derivations or two different derivation trees then we say the grammar is ambiguous this is an equivalent formulation. Now, let me give you an example let us recall the grammar that produces arithmetic expressions. Now, as you understand as we have already mentioned that a plus b star a this string we have two different left most derivations and thus the grammar given here the grammar given here is ambiguous. If for one string if you have two different left most derivations then we say that it is ambiguous. Now, the grammar given for a power n b power n n greater than equal to 0 for this the production rules that are given to you are this. Now, since there is only one non terminal symbol on right hand side of this production rule what is the derivation that you have here which is of this form after k number of steps may finitely many steps you can produce like this. And then when you are terminating after finitely many steps you may whatever you want a power n b power n for some n. So, in the k step you will have this and finitely many steps and you observe the sentential form in this derivation it is a power k s b power k and you have only one non terminal symbol. And if the derivation is continuing that is a because of this rule one only and the rule two is only used to terminate the derivation. So, the typical sentential form in any derivation of this grammar is of the form a power k s b power k and you have only one non terminal symbol and on which only we will be applying production rule this. Thus this is a left most derivation and this is only derivation possible for a power n b power n a string of this language. And thus here you can understand that this grammar is unambiguous grammar and now one can think about an unambiguous grammar to produce arithmetic expressions. Because here the syntax the grammar is given in this way, but the problem where it is coming this is a plus b star a we have you know two different derivations first producing this s star s or s plus s. So, this operator whatever that we are getting here star n plus we do not have any precedence here you can produce this first or this first and we have interchanged and the because of this both are left most derivations either this rule or this rule we have applied either of this rule and to get two different left most derivations. Now, if you insist on the operators so called operator precedence what is the operation that you have to apply first that is how in programming languages one considers that without when I write this is a plus b star a if you look at the semantics of this the meaning of that if you add a and b then you multiply with this whatever is the resultant value the meaning it will differ from when you take first multiply b and a then you add a that means a plus b star a. So, these two meanings they differ so that way in this syntax if you can take care of that situation that means when the two different one expression if it cannot have two different meanings if it has a same syntax then such a grammar will the ambiguity can be avoided. So, if you can give such a grammar that means operator precedence can be followed, but in the syntax we cannot say that this is to this has to be applied first or this has to be applied next that you can do only by introducing certain parenthesis. So, here you can produce that kind of arithmetic expressions also for example using the same grammar you can produce a plus then in the bracket b star a, but the operator precedence if you want to introduce everywhere you should have the brackets. So, thus one can try to give a contested grammar by choosing this concept operator precedence, but of course here you have to introduce brackets to give an unambiguous grammar to produce arithmetic expressions. So, you can take it as an exercise that construct unambiguous c f g that produces that generates arithmetic expressions over two elements set say a b of course with the binary operations with the operations multiplication and addition one can consider that is with the operations plus and star you can try this as an exercise. Now, you know already regular expressions in the context of regular languages these regular expressions are introduced to you they are similar to arithmetic expressions. You can give a contested grammar that produces regular expressions over some alphabet and operations there are you have union, cleanly star and concatenation. So, give a grammar so another exercise is that generates regular expressions that generates regular expressions over some alphabet may be I consider the same a b and in this context you can look for a c f g which is ambiguous and further you can look for a c f g that is unambiguous grammar c f g that is unambiguous to produce regular expressions try both the versions if possible the versions which is ambiguous unambiguous. In case of arithmetic expressions what you understand that we have an ambiguous grammar, but we can also produce an unambiguous grammar that gives arithmetic expressions, but what is the situation unfortunately there are certain context languages for which you may not be able to have any context grammar that is unambiguous. So, now that the notion inherently ambiguous language is essentially the one for which you cannot have any unambiguous c f g these are called inherently ambiguous language context languages. I give you an example without proof at this point of time that is if you consider this context language a power m b power n c power n d power n for m n greater than equal to 1 union a power m b power n c power n d power m for m n greater than equal to 1 you can quickly understand that this is a context language you can give a context grammar for this. Because we have already discussed languages of this type now you have two components here. So, consider this component and you know how to produce this component because using the philosophy that the production rules given for a power n b power n are in the beginning of this lecture. You can give production rules of context we type to produce this component and similarly this and understand that this is a context language. And what is the grammar that you have produced you can try understanding that it is ambiguous grammar as well because as I had stated here that it is inherently ambiguous this language is inherently ambiguous language, but proving that this is inherently ambiguous we require you know little more details that will be further introducing. So, at that point of time you will see why this is inherently ambiguous, but for the time being you just take this as an example and as an inherently ambiguous language.


So, a couple of things, I think always, they always seem to come up on clinical examination.  With a 60 degree lens, the height of the slit equals the disc diameters and millimeters right directly from the scale, right? So, you've got a 60 degree lens and you're looking at the optic nerve and you dial down the slit to match up with the optic nerve. It's a one-to-one relationship. Okay? With a 78-degree lens, it's a 1.1. And with a 90-degree lens, it's what we usually use, it's 1.3. And those numbers just seem to come up a lot. So, you know, Super 626 is the one I'm asking about now, I think. Is that right? Yeah. Okay. So, that's like the closest to 60 diodes to that. So, that equals to 1. Yes. You just say 1. Yeah. Yeah, 60-degree lens. That's an old lens. But that's Super 66. Okay. So, that's a good point. So, maybe that's the reference now. It's the Super 66 is the one that works. But the 90-degree is 1.3. Okay? So, it's 1.3 times what you read. And the normal sized optic disc is approximately 1.5 to 2.2 millimeters. So, the other thing that they say is that, like here, you're looking with a direct ophthalmoscope, the small aperture is about 1.5 millimeters. So, the small aperture on the direct is about the size of a smallish, kind of the small end of the optic nerve. So, most optic nerves are just a little bit bigger than the small aperture on the direct ophthalmoscope. That's another thing that comes up sometimes. And, let's see. What comes up is, as far as the vertical cup to disc ratio, the normal, quote-unquote normal is considered somewhere between about 0.1 and 0.4. But as many, as 5% of individuals without glaucoma will have a disc size greater than 0.6 or a cup to disc ratio greater than 0.6. And another question that I see a lot is that a cup to disc asymmetry greater than 0.2 is found in less than 1%, you know, 1% or less of individuals. So, that's really a breakpoint when you're looking at cup to disc ratio about asymmetry. More than 0.2 is pretty unusual. I think those are some things that seem to come up. I know that the size of the optic nerve relative to the 90 diopter lens is a specific question on my MOC. Okay, let's see. I mean, if you guys have any questions, of course, ask me a bit. So, in terms of the number of axons, in a child, it's like 3.3 or 2.2 million. And it's pretty much like 1.1 million. 1.2 million is the number that I have. You know, about 1.2 million axons. And then diameter, I guess it's a moving world. So, diameter, kind of like the worst thing is like 1.5. And then the posterior, it increases. It's just going to, like, with the sheath. Yeah. I actually don't know that. It's not my area. But, yeah. Yeah, those kind of things always, they always just kind of keep coming up with those kind of size questions and stuff like that. What was the thing with the direct, if you're looking with the smallest aperture, that size? That's about the size of kind of the small end of the normal optic nerve range.  So, the idea being is if you look at the, look at that, and your optic nerve is smaller than that, that would definitely be a small optic nerve, because that aperture size is kind of the smallest end of the normal range. So, I think another thing that, again, we're just all over the tests that I took were questions about the major clinical trials of glaucoma. So, I thought we'd go over that just a little bit. So, this is a table, I don't know if I, if I show that little graph right there, do you recognize that graph? Yeah. So, that's a very famous graph from the ocular eye prevention treatment study, okay? And what that shows is that the way that you're able to stratify risk based on corneal fitness, right? And, you know, I did it once, but if you, if you take these numbers here, because on this side is pressure. So, if you take this table and you collapse it, all right, and you collapse it so that you no longer have the stratification that you get from corneal fitness, and all you get is the stratification based on intraocular pressure, right? So, if you collapse that onto one side, the only variable you have is intraocular pressure. And it's really pretty amazing because if you collapse it down and do the numbers, and you look at individuals with a mean pressure greater than 25.75, which is basically 26 or above, right? And you look at the risk based only on intraocular pressure, the risk of developing glaucoma over that five years is something like, as I remember doing them, is it something like 21 or 22%. But the thing is is that you would have no idea that some in that group actually have a risk of near 40%, whereas others have a risk of less than, you know, 6%. And so that's, does that make sense? So that's the power of what that added stratification of corneal fitness brings is it separates that group, you know, any of those groups based on if the only variable you have is pressure. The idea being is that it just shows the power of the predictive value of central corneal fitness. In fact, as you remember on that table, they don't have it in here, but on that multivariate analysis of the ocular hypertensive treatment study, central corneal fitness came out number one. It's amazing, you know, even more than pressure. So that just says that, I mean, central corneal fitness is just a number that when you're treating glaucoma patients, you just have to have it. It's absolutely as important as measuring pressure. You only need to measure it once, really.  So it's always right there on that report that you can have because it comes up every time you make decisions. So the idea of this table is just to show the power of the predictive value of central corneal fitness.  Overestimate, right? Thick corneas. And what would you say, and this is a little bit arbitrary, but, and I think if they ever asked you a question on this, they would make it obvious, but where did you think that a thick cornea kind of starts? What number do you have in your mind? Is it all the k? That's kind of a thick cornea. What's that? 560? Yeah, something like that. Again, it's kind of arbitrary. But hopefully if they ask you a question, they would say they would show it like a 620 or something. Over 600 is definitely there. But yeah, I kind of think of the, in my mind, kind of the normalish range is, you know, 520, 530 to 560, 570, you know, kind of in there. Less than 520, I definitely think of that as then, less than 500 definitely then. And the same going up, you know, 580 and above is definitely, definitely greater than 600 is definitely big. Okay. So you over or underestimate the minimum thickness? Yeah. So for men and women, how much does that differ? Men and women? Yeah. Not that much, really. I mean, that probably does. But in the clinic, it really is not very similar. Okay. So then going on here to some of these clinical trials, and you know, they've been coming up for years. So the SIDGET study or the collaborative initial Welcome to Treatment study, there's about four big ones here that you really, you definitely ought to know. And they are the four, I think there's four listed here. So the SIDGETs is one of them. And what did that study look at? What they're actually lowering IOP? What's that? What they're actually lowering IOP? Yeah. So it's basically the SIDGETs is surgery versus medicine. And it is the U.S. equivalent of the early Morfield study, Morfield in England, published a study when I was a resident, so that would have been about 93 or something like that, that indicated that surgery first seemed to be very effective in halting visual field progression. So they really started advocating surgery first. And so in response to that, and it was a very good study, but in response to that, the National Institute launched a study here in the United States that kind of met the modern day criteria of a kind of a practice of the flying study. One of the most important variables of which is that it's multi-centered. The Morfield study, great study, but it came out of one institution that you know that the major, major studies now that really define the way we practice multi-centered. So they started recruiting, I think, at about 93, which is about the time that the Morfield study came out, and they recruited 607 patients all with open-angle glaucoma, but they did allow secondary open-agles and humanitarian exfoliation disease. Multi-center randomized all the buzzwords you need. And basically the bottom line of this study is that they found and they were randomized, you know, right off the bat, right? They were first diagnosed right off the bat, surgery or medicine. And if you look at the results, although the IOP was lower than the surgery group, initial medical and initial certain therapy resulted in a similar visual field outcome after nine years. Okay, so that's pretty impressive. Early visual acuity loss was greater than the surgery group, no surprise there, but the differences between groups converged over time. Okay? The quality of life impact reported by the two treatment groups was also very similar. The overall rate of progression of open-angle glaucoma in the cities was lower than in many clinical trials, and that's an important thing about this trial and another question that comes up. So they were randomized to surgery or medicine right off the bat, and they did about as well, and the visual field, excuse me, the visual loss was worse in surgery early, but they kind of converged over time, and the quality of life was rated about the same between the patients, which is interesting. One very important part about this study is that the rate of progression in this trial was lower in both groups than in most trials, and the reason for that is probably that in both arms of this study there was very aggressive pressure. I think the surgery group was like 48% lowering from baseline, but the medicine group was 35%. I mean, it was really excellent pressure lowering, and the reason was on the medicine side is that there was a very set protocol, but they allowed the use of prostaglandins, so there's the biggest difference. Many of the other studies didn't have use, either they weren't available or they didn't allow them, but they allowed the use of prostaglandins and they allowed multi-drug therapy. So that's really interesting study and basically it kind of didn't change then what is typically done in glaucoma and that is restarting medicines. Now the only thing about that is that some of the very latest and more recent publications by the Sages study seem to say that people with very advanced disease early on that got surgery early on and probably didn't do any better. So there's an argument there. So, what does that mean to me? Well, sometimes when you have a patient that comes in and it feels already wiped out or it's super severe and maybe you might be seeing it for the first time or they just recently got diagnosed so it kind of fits the Sages profile. One of the things I do on them is I just kind of max out their drugs right off the bat. They come in at a pressure of 35 their field looks terrible and rather than just start them on a prostaglandin and bring it back and then start them on this and bring it back, I'll just start them on at least two agents to start with like a prostaglandin and dorsal mix and wall or something like that. And just get an idea are we going to get there with medicine or not and try to make that just and move to surgery. So, doesn't this say that it seems like we just have someone who's new and we start someone who's showing a mild visual field defect and they just started at a pressure of 21 and it seems like we're starting people on one drop and not decreasing them by 36%. I mean, that's really what we should be doing. Well, yeah, I mean I would say that when you start treating on anybody there's always exceptions.  But if you've got a classic glaucoma patient new or just starting treatment or maybe just brand new you're deciding to start treatment. Yeah, they've got a pressure of 22. I would say at a minimum when you start a drop you're looking for a 20% drop at a minute. And if you don't get that I would stop that drug and try something different. But I agree with you.  Yeah, you'd like to see about a 30% drop and it's not unreasonable especially if the visual field defect is, you know, moderate or so. You've got a teeny little nasal step out there or maybe you'd accept a 20% drop but if their visual field is significant I'd say you're looking for a 30% drop to kind of start out. So that's the city side. Very important study. You know, it's 20 plus years old now but still very, very important. And the other thing about that is that, you know, they lowered the pressure and the patients did it really quite well and they got the pressure down a lot. Okay, so then the ocular hypertension treatment study super important, that table that I was just showing you is from that. So this is another, all of these studies I saw almost every one of them recruited in the early 90s. The advance one is a little bit earlier than that but so ocular hypertension by definition they didn't have glaucoma right they just have high pressure recruited a whole bunch of patients and they were randomized comparing observation with medical therapy. So they either randomized to either observation or treatment of medicine. And they got about in their study they got about a 22.5 decrease in pressure. Now there's also in all of these studies it's interesting whether you're not using placebo or whatever in the control group there's always some lowering and in this group also in the control group there was about a 4% lowering a pressure right kind of a regression and here's where this number comes in and those that were treated there was about a 50% reduction in the risk of developing glaucoma that's the number to have in your mind there was about a 50% reduction in progression to glaucoma at 5 year follow up. So the untreated group was about 9.5% conversion to glaucoma and in the control group in the treated group it was 4.4 so there's your about a 50% difference. So that's a there's just an important number to know and that's again established some of the treatment parameters for treating antibiotic retention. The risk of glaucoma glaucoma was increased with these are the factors that are important to remember age, vertical and horizontal accompanist ratio the pad of standard deviation on visual field and the IOPF baseline and then central corneal thickness kind of came into the equation so just as a historical note when this study was first organized and randomized central corneal thickness was not included in the screen and some of the study participants some of the physicians just argued we've got to do this and thankfully they did and then they actually went back and measured central corneal thickness on these patients and it turned out that that was the most powerful predictor it was. So that's where this kind of idea of this really powerful risk stratification for glaucoma for ocular hypertension came about which is the older the patient the greater the accompanist ratio initially the worse the visual field in terms of the pad of standard deviation like there's a little bit suspicious there and then there's there IOPF baseline and there's central corneal thickness you can weigh those factors out so I kind of think of it if you look at this table right here I think of the people that's my up and left people that are up and left have higher pressures thinner corneas and increased baseline accompanist ratio so you've got a patient with a pressure of 26 corneal thickness of 480 and accompanist ratio of 0.5 the first time you see them even though their visual field is normal their risk of developing glaucoma in the next 5 years is 47% so that's I kind of think of them in that category thin cornea, higher pressure higher accompanist ratio and then down in this corner you've got the lower pressure still after the hypertension so their pressure is not 26, 22 their central corneal thickness is 600 and their accompanist ratio when you first see them is 0.2 their risk of developing glaucoma in the next 5 years is probably less than 2% so those are kind of the categories, so I don't actually calculate out the risk although you can, I mean you can plug in the numbers and actually generate a number but I kind of think of them in those groups and everybody else falls somewhere but those are really the critical things out of the octalagra tendetry study and this is really an important study that we refer to all the time so just a couple of things that have come the original paper with that data, with the risk association and the 50% decrease of post 2002 subsequent papers in 2007 the same predictors of the development of POEG were identified independently in both the oats observation group and the same study done in Europe so those two were found to be equal including baseline age IOP, central corneal fitness and cup to this ratio and then the visual field the thing about the visual field for me I'll be honest with you the visual field for me you know it doesn't factor into my kind of just thinking and the clinic that much because if you start to get a visual field that looks a little funny you're kind of almost talking about glaucoma so I'm talking about the hyper tens if their visual field is stone cold normal and their OCT might be stone cold those are the ones I'm talking about but their pressure is 26 how do you stratify their risk? well that's when you really go with age the older they are, the more likely they are their central corneal fitness is huge in that setting and then what their baseline cup to this ratio is those are the main things for me and of course the pressure and then here's another very important thing so in 2010 they published and they said the subjects in the original observation group received medical treatment for a median of 5.5 years after their period of observation subjects in the original treatment group continued to receive medical therapy so basically you had this ocular hypertension group that got therapy right off the bat then you have the second group that were followed in the observation arm for 7.5 years and then some of them started treatment based on their own choice or they met certain criteria that their risk was higher now that they had the information that they knew their risk was higher so some of them were elected to be treated so you've got these two groups that have been treated for 13.5 years straight they worked for 7.5 and then treated for 5 5.5 the proportion of subjects who developed POEG was .22 in the original observation group and .16 in the original medication group the primary person of the follow-up study was to determine whether delaying treatment resulted in a persistently increased risk of conversion to glaucoma although the two groups diverged with respect to the development of the original study period there was no further divergence in the capillary curves after both groups received out of glaucoma treatment the bottom line being it did not hurt these people to observe them it didn't mean that then once they started on treatment that their risk was still 50% higher right? it didn't show that at all so it justified the idea that these very low risk patients observing them is perfectly acceptable and did they stratify the thin CCTs again or? I'm not sure exactly I think they just kept the same I think they just kept the same risk profile going forward and when they treated those I think they were treating more of a higher risk group but it didn't affect the final outcome in terms of how many of them converted during that five and a half years where the previous observation group is now treating okay trial number three which is also very important is the early manifest glaucoma treatment trial this is the one that is to compare immediate IOP lowering with observation so the difference about this study is that these folks had glaucoma they weren't glaucoma suspects but they had glaucoma they had all the diagnostic criteria of glaucoma and they were stratified to either be observed or be treated and I think I've mentioned before when I give this lecture this is the one that was done in Sweden it was a national institute study, US funded study done in Sweden because you'd never get that through an IRB to observe people with glaucoma in a trial there's too much data to say that but they needed to answer the same question and so it's newly diagnosed patients who were 50 to 80 years of age had early glaucoma were identified there was exclusion criteria it was multi-center and they were randomized to either no treatment or treatment this is a different treatment protocol to receive batoptic and laser trapeculoplasty that's how they were treated now the one thing about this trial different than SIGIS is that the treated group here only got about a 20% pressure lower so in this group at 6 years 62% of the untreated patients showed progression whereas 45% still a really big number of the treated group progressed so the treatment did reduce the progression by 25% but it's argued in this study the reason why so many of the treated progressed is that the pressure lowering was modest at best there's only about 20% but it again showed it just helped to establish that even in a glaucoma patient treatment does make a difference okay I've said this to you before even when I was a resident that had not been clearly established there were still papers being published I started my residency in 1991 there were still patients papers being published in the late 80s early 90s arguing that treatment glaucoma did not have that lower pressure and that's why several of these states so early medicals glaucoma treatment trial treatment helps even if they've already gotten glaucoma and then the last one that's listed here is the advanced glaucoma intervention study and this is a study that had kind of a weird start because I was wondering what worked best to do laser trap and then more laser or laser trap trap now that seems like an odd question to ask but this was the earliest of these this actually started recruitment way back in 88 and so we were just trying to find out how to treat these advanced patients with this disease and you know this is the really this study has produced a whole bunch of papers it lists gosh 14 of them here but the one that is the most important is ages 7 so if you're going to learn one of those, learn ages 7 and ages 7 is the one that showed and I've talked about it here the pressure the patients do better these are eyes with average IOP of 14 or less during the first 18 months or eyes of pressure of greater or 18 at all visits those that had pressure of 14 or less at all their visits did better it's a simple conclusion that seems pretty logical but it never really did show the pressure lower at every visit versus those whose pressure was higher at every visit those with the lower pressure did better and the average pressure amongst that group was 12 so that's kind of where the idea came about getting the pressure down around 12 and these advanced patients seems to be there's another one that you might hear about is that in 2009 ages reported that IOP fluctuation was an independent predictor of progression meaning that if the pressure was kind of variable at inter visits that that seemed to result in more progression that's actually been a little bit reputed by some other painters so that's not a super hard fast finding but it certainly wasn't important any questions about those studies that they are all the time they're very important the other thing that I would encourage you to go over on your own and I'll guarantee there's a lot of it going to be on your and that is the table of glaucoma medications and you know basically it just breaks it down into the various pharmacologic types of glaucoma there are basic mechanisms of action the usual kind of percent decrease that one can expect and major side effects okay and if I could just point out I know you know all the basic things but I could just point out a couple that maybe you're not aware of or maybe not thinking about that are very very real and in analogs one of the things that they list under systemic side effect is flu-like symptoms or joint and muscle pain or headache I've heard all three of those many many many times they feel like they've got the flu or maybe a little more common is that they feel like they have a cold I've been stuffy I've been stuffy all the time and they won't necessarily associate it with the initiation of the eye drop but joint muscle pain I've seen that be just shockingly profound you know and headache so those are all very real of course you know all the ocular side effects you know the lash growth etc etc those systemic side effects of prostate planets are very very real and I'll guarantee it you'll hear about it the Bay of Walkers you know and they're all real you know I've heard them all one thing about the the Bay of Walkers is that the topical tolerance of the Bay of Walkers is really outstanding I mean Timmelwald almost never causes an allergy irritation is minimal so that side of things is great but the side effect profile on the systemic side is significant and the absolute at least in my mind the absolute contraindication of Bay of Walkers is asthma or reactive airway disease you can put somebody in the unit with the drug Timmelwald if they are found asthmatic or something like that so that is absolutely real and then the other one that we can't underestimate with the topical Bay of Walkers is the depression low mood very very real I always watch for and the other one is sexual dysfunction so I always watch for a patient of mine who I know is on a Bay of Walker if suddenly they appear on a new antidepressant or an ED drug I think those are two things to watch for and if I see that many of my patients and they're on a Bay of Walkers I should talk to them about let's try coming off this and see if it makes a difference or if they are on those drugs to start with I definitely think twice about adding a Bay of Walkers to that because so apriclonidine and bromonidine is what we use for alvegan now again the overwhelming thing is the topical of those drugs especially the bromonidine there is absolutely in my mind absolutely no doubt about it the difference between the generic bromonidine and the brand name alveganp in terms of allergy I wish we could get the alveganp but it's incredibly expensive for so many but there's just such a difference bromonidine 0.2% is so much more allergenic than the alveganp is alveganp the normal alvegan that's the brand name it's almost always I don't even think they have the right for alveganp which has a different preservative that's the pure right plus the concentration is half it's 0.1% but the other thing to absolutely remember about the alphabetic magnets is the fatigue and dry mousin those are huge in terms of systemic side effects and both of those can be profound the fatigue can be profound of course you know it's contraindicated in infants right we published that paper first here the first I think index case was one of my patients here a little baby that didn't know had been a one after the NPA just got super lethargic and so we collected a few cases one of them was from Hyderabad actually put a baby in the evening with respiratory suppression incredibly less common if not unheard of with apricline or alveganp because it just doesn't cross the blood brain barrier there's a real difference I know up in the neuro clinic they won't even test a border cocaine for kids for testing for like a border so that's probably not necessary probably not, yeah there's a very different penetration of the blood brain barrier but the apricline seems to do fine and then the fatigue so it's contraindicated in kids but you'll hear it in adults you have to be aware of that when they talk about fatigue I put an older lady on Bremonidine to start with and I got a call about a week later or something from the family and they said you know Grandma we so tired since starting these drops I said well it can happen she said well you know ever since she started these drops she hasn't gotten out of bed and we're just opening her eyes to fit her drops let's stop that but that's how profound it can be but some lady in the bed for a week it's real okay a couple other things you know about dimox I really think of dimox as a temporary drug nowadays to get into surgery however you know I've got a big practice with lots of glaucoma patients and I've got a number of them that are on chronic dimox because they're either a super high surgical risk and they do okay on it so yeah okay they would absolutely prefer to just keep taking that and maybe risk their one eye to have surgery or something like that and again you know remember when I started in glaucoma everybody's on dimox we didn't have anything else you know they're on timelol, pylokarpine and dimox how's that for a reaction I mean we have the most unhappy patients in the world but that's what we have so that's what we use I have a long history of people being on chronic dimox so I'm not afraid of it but obviously it's got a long list of side effects and mostly we think of it as a temporizing drug to get the pressure down immediately and get it in surgery but I have a number of patients who are on a long term how hesitant I feel like a lot of times we see all these really bad diabetics and they have bad renal function and they need to be on dimox how much of a contraindication is that I'm not afraid about it and someone like that I truly think of it as a temporizing drug but someone with good renal function and otherwise relatively healthy it is something to keep in mind as a potential chronic therapy and again 25 years ago it was the therapy everybody was talking about we have a bunch of people in the VA last year putting them on chronic dimox but I think that's partly because the system there is that we're changing, we're not checking creatinine levels and potassium levels so it's a viable option to consider sometimes the one thing I think of also about the topical carbotic inhibitors dorsolomide dorsolomide as you know is the generic dorsolomides azopt azopt is more comfortable there's no doubt about it but I really think about those as darn near the safest topical drugs from a systemic standpoint maybe even safer than the prostaglandin not only because of the bad but those are really I think systemically very very safe treat babies that's usually the first drug I pull off if I want to try a topical agent or a pregnant woman for example so that's I think that's the thing to know about polycarpene and we sell music that it's on here I guarantee you got to know about those things that's where they test you from I think I've said before when I took my my bores which back when I took it was exactly the same as the OCAPS and it was just the same test there were like three questions on a drug garanite garanite was like some old oral carbotic inhibitors not even on the chart anymore I don't think I remember looking it up and the only place it was was on this stupid chart in the book just know these even some of these kind of orphan drugs like phosphine iodide understand a little bit about that and manitol I have never given manitol it's always on try the phosphine iodide the thing to remember about that it's it can be a very very useful and helpful drug in kind of complicated aphaking glaucoma so it is a drug that in a child with aphaking glaucoma can be like a home run drug so it is I mean I have several patients on phosphine iodide and it was not available for a long time but it is now in the pharmacy so the last thing I wanted to mention and we'll go a little bit early is about about endothelitis following filtering blood surgery you know we hate it but it is real but I think the thing to note the incidence of post-operative endothelitis with glaucoma surgery with or without any fibrosis drugs has been reported to range from about 1.3 to as high as about 8% so that's kind of how I think about it 8% is too high these days but to say 1 to 3% is probably fairly legit I think ours is lower than that here we have the day to improve that but it's a real risk most commonly it's caused by those high thin blebs certainly the presence of a leak increases the risk to eradicate so every time I see one of my patients back that has a bleb looking for a leak as part of it I don't pain the floor seeing every time in the strictest sense you should but I just put in a drop of fluoresce right off I just used their eyelid to kind of paint the bleb you know how you do that right you kind of move it up and down over the bleb and it kind of paints the bleb with the fluoresce that you put in and that does a good job of detecting the leak but I look every time every time I have a patient that has a bleb I check for a leak just kind of kind of do it because that is a very different perspective and what's the most common organism to cause a late bleb associated endothelitis I was thinking it was a strep species I mean some of them are the strep the strep for it that's what I think is the most common cause acute post cataract endothelitis it's usually a staff species of some sort right the layout set of bleb associated is usually a strep species most common age flu is actually fairly common what's the difference between a blevidus and a strep or a bleb associated endothelitis what do you look for vitreous involvement that's the number one if you've got vitreous involvement by definition you've got an endothelitis so you've got to get on that if it's just cell in the anterior segment you're walking a little bit of a fine line there but I think you can treat them as a bad blevidus and very carefully and if it seems to be strictly limited to the conjugal the anterior segment is totally quiet of course the vitreous is quiet then that's kind of a pure blevidus you can treat that top the one thing though is that if you do have what you think is a blevidus you have to treat them pretty strongly with antibiotics you can go right to fortify but you can also go to just frequent you know kind of broad spectrum topical and when I think of broad spectrum topical I might put them on a like a ophoxicin or bigamox type drug and then maybe polyture and use them together in a bad blevidus but if it looks really bad especially if you've got any kind of anterior second inflammation putting them on fortified antibiotics is not a bad idea and sometimes I just use like bigamox or something frequently in a fortified bank and I usually do that we fortunately don't see it that often and you know a lot of the I truly believe that that this modification of the modern trapezolectomy where we broadly apply the mitomycin has absolutely made a difference in terms of the frequency of the infection because it just changes the morphology very much that is really an important change just since I've been on these so and does the tubes don't have the same rate of ophthalmitis? it's significantly less but it's not zero but almost always when you have an endothelmitis associated with a tube there's an erosion I would say I have not seen one an erosion present so that's the other thing anytime you've got a tube patient you've got to look for an erosion every time and if you see an erosion you've got to fix it I don't think you can just watch it so if I see an erosion I start it on antibody topically just prophylactically and then get them scheduled to patch it up with a blem leak I've known people and I've followed I have sometimes followed a little blem leak on antibiotic hoping that it'll seal up put them on an aqueous suppressant put them on an antibiotic see if we can get it to seal up I'll watch it interestingly I'll watch that one more than I'll watch a tube erosion a little bit the tube erosion has just seen destined to get infected because you've got hardware in there so it's just asking to get infected so I usually patch those really quickly and then I've watched a little bit and I know some I can say some have watched a leak for a long time alright so those are the things that I wanted to talk about with Trevor based on my recent history


Hey guys, what's going on? In this video, you're going to see a live training that I've done with my team. As we train over 210,000 salespeople across the world, I never really share the meetings that I have with my team as we go out and crush it. I've got 30 people on my team at this point. This is a special training that no one has ever seen before. Check it out. It'll change your life. You know what can happen if you can put yourself in someone else's shoes? You're dangerous. Now, let me explain the second part. Right? Look, you don't just find out along the way. By the way, right now, consciously, you might not even be thinking about who this person is or what they're like because you're so interested in making yourself that you're not even thinking about being in their shoes. I'm going to give you the easiest terminology possible. Do you want to put yourself in their shoes so you can understand them? Watch. When Ian was talking earlier, did you guys feel his heart? The words don't mean anything. They don't feel your heart. Can you make someone else feel your heart? Yes. Okay. Well, how do you get your heart to play out? Well, number one, you start actually using your heart to play yourself so you know how to play it with someone else. Anytime you're getting off the track, guess what? They lose interest. All right. Everybody, watch. What happens? Momentum. I want to explain something to you. When I start the phone call with you, my goal is to create massive interest with you, with me. I want you number one to know I'm a person you want to stay on the phone with so I can get to here. Am I right? Okay. So, how do I have to sound right out the gate? I have to sound like somebody that you want to be. Okay? Somebody that you want to be. Okay? Think about it. We're going to put ourselves in their shoes. Do you think that every person in life wants to be fired up, wants to be energetic but also wants to be a great speaker? Yes, they want to be. They might not even know that they want that yet. Okay? But they want to do that. Are you sure? Do you think they want to provide for the family massively? Do you think that they want to be able to prove everybody wrong? Do you think they want to be able to prove to themselves wrong when they doubted themselves? Yes. They want all of these things. Watch this. Now, here is the point that most people will never get to. Let's say you do understand your person in 30 seconds. You predict and it's right. What's the second thing that has to happen? You have to inspire them. You have to motivate them. You have to encourage them. Okay? You have to move. What does move mean?  It means to go to one place to another. When you speak to somebody on the phone and explain something. I'm a firecracker. Okay? I'm dumb. Dumb. Dumb. Dumb. Dumb. Dumb. Hey, what's up, man? It's Andy. How are you doing? Boom! I'm ready to go. Look, the fastest way for me to stay alive is for someone to answer that You know what?  Look, let me explain this. When's the best time to sell a car? Right after you sold it. Right after you sold another one. We all do the answer to that one. You know what? When's the best time to sell somebody on something? Right after you sold another one. Look, never take the bad call into the next call. It's just a bad call. It doesn't matter. Can I ask you a question? Do you believe in the power of timing? The right person shows it at the right time and the right person gets the right life. Do you believe in it? That's how my life got changed. Someone showed up for me when I needed them to. They gave me a way out and that was it. And it was in sales. You need the skill. You get the skill. It fixes the money. Does that make sense?  And I want you to do this right. Build them up. Let me show you a f***ing special cheat trick.  Look, no, I mean it. Guess what? Hey, man, how you doing? What's going on, man? How you feeling today, dude? Listen, I wanted to reach out a little bit. You start right out the gate. You're talking to them.  Does that energy have to be there? Yep. I can envision this person sitting there talking to me on the phone. They're like, Oh, I'm just hanging out. You're like, do me a favor, man. Walk away from everybody for a minute. I want to talk to you. As you're talking to something, can you feel them getting built up or staying the same? If they aren't getting built up, you're not doing your job. You need to know when the switch happened. Look, I want you guys to be so good. Look, it's called chess. It's not checkers. It's called chess. I'm going to tell you this. You're getting on the phone with them. What's chess? Knowing what your next move is. Your next move is to build them up. You build them up, they'll give you a yes every time. I think right, but asking for it at the wrong time will also get you a no. I want you to write this down.


Okay, so just a session to follow up on any questions from Thursday afternoon, from the previous FOIP session, so I'm keen to find out what experiences people have had as well if they've tried anything after the last session, whether it worked or not, if people have tried Lumicall on their device, is it working or not? Any questions? Okay, let's do a survey. Who's got an Android device? Who has Android? Okay, yes, we've got one Android device at the back. No, that's not an Android device. Yeah, who's, I mean I've heard various comments over the last couple of days, like someone mentioned the DSAE team looking at at running a SIP proxy, there are questions about mumble. Is anyone interested in any of those subjects? Okay, I think everyone's already at the pub. Okay, so we wrap it up there, so that was the shortest session of the week. It was one minute and 15 seconds.