It's a much better presentation in person, but hopefully you guys can pick up some pearls and things from the lecture that will be helpful for both boards and for your career, whether you're going into glaucoma or not. Pediatric glaucoma is a fun topic. It's a very small niche area, but there's a lot of crossover with a lot of different specialties. Those of you that are going to be even doing plastics or neuro, you will encounter pediatric glaucoma in your career, no matter what you do from comprehensive corneal to neurophthalmology. So let's just start and feel free to stop and ask any questions. And then we'll keep going. Okay. Now I can't see everybody. I know some of you are still probably getting up, but maybe I'd like to have some participation. Otherwise, this is going to be a pretty quick lecture. All of this is going to be question format. And we'll just kind of talk about different things, different features and things that you might find interesting, some questions that may come up. And then I'll show a video. Some of you have seen some pediatric glaucoma surgery. And so I'll just show you kind of a classic case, kind of my go-to surgery for most cases of congenital glaucoma. Okay, question one, which of the following is not a classic feature of congenital glaucoma in large cornea, also known as buphthalmus, obstrea, myopia, conjunctival injection, epiphora, photophobia, and blepharospasm. So I'm just going to start picking on people that I see in our group. Let's start with who's here? How about Cole? I think I see you're on Cole. This is just kind of an open discussion. What do you think about this list? What things are not classic features of congenital glaucoma? The classic triad would be the last three, epiphora, photophobia, blepharospasm. You certainly can see obstrea, buphthalmus, and kind of progressive axial myopia. So I think congenital injection would be too broad. Yes, that is correct. The answer is congenital injection. That triad is what you alluded to at the bottom, epiphora, photophobia, and blepharospasm. And then in large cornea, buphthalmus, everything else is pretty much classic features for congenital glaucoma. Now, is there an age range? Have you come up with some sort of scheme for determining what is congenital? How do you categorize these? How do you categorize pediatric glaucomas, in other words? I guess thinking about age range. I know juvenile is like four to 35, I think is the BCSE. So I kind of think of congenital, I guess, is earlier than four, but usually within the first couple of months to a year of life. Yeah, I think congenital glaucoma is at birth, and then there's infantile, which is in that range after birth or after a year. So, and then yes, you're correct in terms of juvenile open-angle glaucoma is a very broad, large range. Essentially in your BCSE book, I think it says what, four to 35. And just realize that anybody who presents with glaucoma at a young age is in that broad category of juvenile open-angle glaucoma. Okay, let's see. So this is just a picture of hopstria. Do you guys remember, Abigail, do you remember hopstria in terms of this is a path question that may come up? It's a crossover question between glaucoma, pediatrics, and pathology. But do you remember, these are hopstria that you see here in this photograph, but what exactly at what level are hopstria occurring? Say it again, Abigail. Sorry, this is better. I think it's at the level of the endothelium. Close. Oh, decimates, sorry. Decimates, that's correct. So, breaks and decimates is why hopstria occur, and then that's what leads to potentially corneal demyelopaspidation. Okay, all right, very good. All right, question, next question. Which of the following age ranges portends a better prognosis for patients with primary congenital glaucoma? You know, this is a more detailed question, but this comes up all the time. In fact, this came up last night. We had a patient who presented with primary congenital glaucoma at birth. The several UA's prior to today or yesterday were reasonably controlled pressures on medical therapy. And now the kid was four months old. And mom had a question about this. Which of the following age ranges portends a better prognosis? So, why don't we go with, this is kind of a, I think a senior level question. How about Ariana? You're going into glaucoma. This is going to come up a lot next year. Okay, I actually don't know the answer. I guess I would think older age, but I'm not sure. Yes, so this is the magic window that I want you guys to remember for primary congenital glaucoma. It's three to 12 months. Okay. And the way I think about it is if someone presents at birth with congenital glaucoma in signs of congenital glaucoma, that's pretty severe. This has been going on in utero. And it's often a more difficult case, very challenging case. If they present older, that also could present some issues as well. But in that three to 12 month window where they're in that they're still their eyes developing quite a bit there, even their plumbing maybe still developing, that tends to be a ripe time for response to surgery. So if they present in that three to 12 month range, they usually do pretty well with angle surgery. Okay, next question. This is just a picture of buphthalmus, just to realize that it can be unilateral or bilateral. This is a bilateral case of cloudy corneas and buphthalmus. Okay, next question. Which of the following are not distinguishing features of Axanfeld Rieger? Bilateral, autosomal recessive and autosomal dominant inheritance, sporadic, around 75% association glaucoma, posterior embryo toxin, maxillary hypoplasia, hypospatias and pituitary abnormalities. So Mike, I think Mike, you're on, you're on with us, Mike Murray. What do you think about this list? Let's just kind of go down the list and see if you can recall some of the features and then we can kind of by process of illumination figure out the one which is not a distinguishing feature. Alrighty, so let's go through these. Looks like, so pituitary I know, yes, the hypospatias that would say yes, maxillary hypoplasia, I would say yes, the posterior embryotoxin, I'd say yes, 75% association. I am not sure about that one. I think it might be a little lower, but I'm not sure. Sporadic, I would say no because a lot of them are, well, I think they can be sporadic, but a lot of them are autosomal recessive autosomal dominant. And then bilateral, I would say no. That it's not a feature? That it's not? Yeah, most of them are thank-you lateral. So actually most of them are bilateral. Okay. And axinfel reger can be inherited in many either autosomal recessive and or autosomal dominant, but actually most cases are autosomal dominant. And so that's just some, and I want you to think about this. If you guys have ever rotated on pediatric glaucoma service or pediatric service, we have groups of families who are coming in for axinfeld regers. And so that should let you know that this is a very strong gene and very strong inheritance pattern. And so most of the cases are autosomal dominant. When you see groups of families with axinfeld regers, you can kind of remember, oh yeah, for Mendelian inheritance, most of these are autosomal dominant, but you can have some sporadic cases. The other theme that I want you to take away with, and this is kind of throughout glaucoma for many things in terms of risk for when they talk about things like pseudoxfoliation, pigmentary glaucoma, axinfeld regers. The general ballpark, if you have to guess for your test is about 50%. So all of these are features, bilateral is a feature, autosomal recess, autosomal dominant, most are autosomal dominant, some sporadic, around 50% are associated with glaucoma. So the answer here is around 75% associated with glaucoma is not a distinguishing feature. I know, tough question. I'm just picking some things out with some nuances, but otherwise might be picked them out really well. Okay. Okay, so here's a classic picture of a posterior embrotoxin. This is a very traumatic case. Sometimes it's very subtle. And sometimes you may not be able to see this until you actually do gonioscopy, intraoperative gonioscopy, like with a microscope and a gonioprism where you can actually see all these different features. And sometimes it's very subtle, just a little bit of purling around Schwab-based line. So you may not see this kind of dramatic case. It's just, you know, very, very overt. Why is that important? I'll go back to Catherine. This is a great cornea question. Posterior embrotoxin, why is this, what's the pathology of a posterior embrotoxin? And why, what types of features may you see in a posterior or an axinfilt regress patient that is related to the posterior embrotoxin? It's mostly, I know it's basin, just anterior segment dysgenesis. That's the basis of it. So I'm not quite sure. What are some other features other than, what are you, remember that this is a common entity that we confuse with ice syndrome, but what's the dead giveaway in demographics between axinfeld versus ice? Ice syndrome is in a female and it's unilateral. Okay, but what about age demographics? And I'll give you a clue. We're talking about pediatric glaucomas. Ice is in adults. Yeah, young adults. You guys remember vanilla ice, that's kind of the picture you should have in your mind of young adults who present with ice syndrome, but axinfeld regress is a pediatric glaucoma. Okay, you're going to pick these up early on. And there's a whole spectrum of anterior segment dysgenesis that we kind of lump in here with axinfeld regress because of incomplete penetrance. So what types of things are, can you see though, in terms of the physical exam, let's say you don't see a posterior embrotoxin, what are some other classic features that you can see on an axinfeld patient? Anybody can chime in. Choreotopia. Okay. And how that might, how might that be related to the posterior embrotoxin? Oh, I'm not sure how it's related to the embryotoxin. I thought it was just in general for axinfeld reger. Okay. Anybody else want to chime in? I mean, iris atrophy, polychlorio. Yeah. So this is, this is a, an abnormal membrane that can start to pull on the iris and the angle structures. So hence you see choreotopia and hence you see perfluentia synegia. Okay. So the idea is, is that this abnormal membrane that you see the posterior embrotoxin has contractile features on it. Okay. Similar to an ice membrane that can cause contractile features and pull on the iris and where you can get choreotopia as well. Okay. Okay. Next question. Which of the following are not distinguishing features of a Peter's anomaly? Catherine, go back to you here after I'll read the list and then you can just kind of work through this list. Leucoma, corneal and ticular adhesions, erotocorneal adhesions, sporadic inheritance, unilateral and around 50% glaucoma risk. So which of the following are not features of a Peter's anomaly? Let's see. Not distinguishing features. Yeah. So which ones are first? You can do process of elimination here. Yeah. Um, is Leucoma, is that corneal winding? Yeah. Okay. So yes, that is a feature. Um, corneal and ticular adhesions. I'm not quite sure about that one. Um, erotocorneal adhesions. I'm not quite sure about that one. I think yes. And I think it is sporadic and unilateral and actually not quite sure about glaucoma risk. Okay. Sounds good. All right. So yes, Leucoma is the white lesion that you see of the cornea.  Uh, you're thinking it's just trauma, but you know, usually these cases are bilateral. Okay. So the answer here is actually unilateral. It is not, it's not unilateral Peter's. Most of the time it's bilateral Peter's. Gotcha. And that's kind of the dead giveaway. And if you remember that the Leucoma is really a Pandora's box, if you were to lift off the Leucoma, there's a lot of badness typically underneath that Leucoma. And that's where you get into the lenticular adhesions or the erotocorneal adhesions. And so sometimes it'll just be these sprouts, these, um, roots that come off the iris that go right to the Leucoma. And they can be very difficult to deal with, um, during surgery, especially for cataract surgery, where you have to kind of lice all these adhesions off. And obviously your view is terrible when you have a giant Peter's anomaly too. So some of these patients may have to undergo a corneal transplant, but it is kind of the Pandora's box on the top of the cornea. So this is a typical feature. Well, it doesn't look too bad, right? But if you were to do UBM here or OCT, you would see that underneath this are strands of iris tissue coming up to this Leucoma. So it's not simply something that you can just scrape away or do a limited PKP in that region. There's usually going to be adhesions underneath. And if you remove them, there's going to likely be some anterior segment disorganization. And so you might need some anterior segment reconstruction after this. Okay. And once again, 50% glaucoma risk. So if you have to guess on your test about the risk for glaucoma, guess 50% for most of your questions. Okay. All right. Next one. All right. A parent with a one year old aneridic child is wondering about the long-term risk of glaucoma, which statements are not true about aneridia and glaucoma? So why don't we go with who's been on pediatric glaucoma service? I only want to pick on those that those of you that have actually rotated on service so far. Sean, have you done pediatric glaucoma service yet? I mean, I've been on pediatrics. I guess some there's maybe saw a little bit of glaucoma, but I'm not sure that's going to help me with this question. It's okay. So, so which is not true about aneridia and glaucoma? I mean, you know, you've got that 50% number there. I would imagine that it's higher. I think it's higher than that. The risk of glaucoma and aneridia. I think the second one, well, let's go with yeah. Yeah, yeah. I think I'm really not sure, but I think that the mechanism is this genesis of the angle rather than sneak you'll closure. And I think that glaucoma probably could develop after birth. Although that would probably indicate something more like sneak you'll closure. But I really actually don't know. Okay, that's okay. I think the risk is higher than 50%. Yes, you're correct that it's around 50 to 70% risk for glaucoma patients with aneridia. Now, there's a theme here in pediatric glaucoma that I want you guys to remember in terms of when children present with glaucoma. If they're fairly young, okay, it's usually just genesis of the angle. Okay, now aneridic patients are interesting because they can develop glaucoma over time. And the second decade, sometimes that may be their chance when they develop glaucoma doesn't always have to present at a young age. But I think what's important is here is gonioscopy and figure out exactly what's going on. As you remember in aneridic patients, there are sometimes often some residual stump. It's not like they're completely aneridic. And so by doing gonioscopy, that actually helps to determine what your surgical approach is. So if I have a patient who presents at a very young age with aneridia, one year or less, then I'm going to do a gonioscopy. I'm going to check and most of the time when I've examined these patients, there is no anterior synechia. And so I'm going to give it a chance. We're going to perform angle surgery.  And you've got to be very careful that you don't nick the lens and cause a cataract. But it is possible to do angle surgery in these patients. And they often do pretty well. But over time, if the patients progress, and you start to see perforants here, synechias, and that stump starts to rotate and really close off the angle, then you're going to be moving into a different type of procedure like a bypass, either a trapecolectomy, a zen, or a tube trend surgery. So the mechanism can be either of those two. Early in life, it's this genesis, but if it occurs later, it's more synechial, more likely. That's right. Yeah. And so, and that's true of all glaucomas. You can pretty much, if someone comes in with an early type of glaucoma, it's usually angle dysgenesis. But once you, for primary glaucoma, if you've already ruled out of the causes such as trauma, et cetera, steroids, these cases are going to be dysgenesis of the angle. So we're going to give it a try. We're going to do angle surgery in these patients. All right. Next question. All right. An infant with Sturge Weber syndrome presents with congenital glaucoma. Which of the following is not correct? Why don't we go with, Abigail, you're going in the plastics, you'll probably be seeing a lot of these cases. Can you hear me okay? My audio's weird, sorry. Yeah, I can hear you. Okay, perfect. So, infant with Sturge Weber presenting with congenital glaucoma. Which of the following is not correct? I think eridotribecular dysgenesis is the right thing to do. You feel that that one is not correct? I think so. So I'll give you a clue. And the last question, we just talked about these themes that you'll see in pediatric glaucoma. If kids present early on, it's usually due to eridotribecular dysgenesis or angle dysgenesis. Okay, and this is an infant, so that would be the reason. Yeah, so the clue here, this is an infant. Oh, is it the lower eyelid? So, now we're talking about just the lesion in a Sturge Weber syndrome patient, right? And the port wine stain is actually in the upper eyelid. It's more likely if it involves the upper eyelid. That showed up on my board's question, and I couldn't believe it, but ever since then, I've remembered that it's the upper eyelid. It is more likely to port 10 glaucoma if the port wine stain is on the upper eyelid. I don't know why, but it's just one of those things that you kind of tuck away a little pearl. Okay, is anything else not correct here? An infant with Sturge Weber? The tube shot is preferred over angle surgery. So this is a tricky question, but what I'm trying to tease out here for you guys is to understand that. Is it the first one? If it's congenital glaucoma, because it would be higher EVP would develop later. That's correct, yes. So what I'm trying to get out here is another theme, or there's a theme just kind of reiterating the same thing. If you have an infant that presents with glaucoma, angle disgenesis is the most likely cause, right? Even though this patient has a port wine stain, you're thinking, oh yeah, elevated episcopal venous pressure, but in this case, because it's an infant, the things that are not true is that elevated EVP is the most likely mechanism of glaucoma. That's not true. That's true later in life, okay? And then the other part of this is that a tube shot surgery is preferred over angle surgery. That is not the correct approach for this, because it's an infant, because it's angular disgenesis, we're going to do angle surgery as a preferred approach, even in a patient with a port wine stain and Sturge Weber syndrome, okay? So I'm not really worried about the risk of a crudal effusion and crudal hemorrhage. Those are the things that we worry about in patients with elevated episcopal venous pressure, okay? Does that make sense, that question? You guys have questions about that? Yeah, I have a question about angle surgery. Is it that angle disgenesis? Is it that we're targeting the trabecular mesh work and doing TM surgery, or we're doing something else in the angle that addresses something other than the TM? No, I mean, at present, I hope one day I'll be able to intervene in collector channels, but as of right now, the only thing I can do is either strip or stent the trabecular mesh work. So, I mean, we could, you can viscodylate, I guess, but usually we're doing viscodylation in the setting of doing a trabeculotomy, okay? And so, when I refer to angle surgery for kids, I'm referring to basically doing either a goniotomy or a trabeculotomy. Okay. Yeah, I have yet to put any stenting devices in kids, and I don't know if anybody has done that before. I think the most progressive thing that people have done is a co-hook dual blade, or they basically just peel off the TM, right? But most of the time, we're just doing a cutting procedure and doing an otomy of some sort, either goniotomy or trabeculotomy, okay? All right, next. Dr. Triad, just to clarify, you said a tube chin is not preferred over angle surgery in this case. Yes, because it's an infant. Okay, gotcha. Okay, so again, just that pearl, that clinical pearl that you guys are going to see throughout your life. Infants with glaucoma, angle dysgenesis that should just come to mind, and we're going to try to do angle surgery. Right. Even though I threw in these confounding things that, oh, this is a patient with Sturge Weber, and you're thinking, oh, Port Weinstein elevated episcletal venous pressure, that's something that you want to categorize for patients when they're older as a possible cause, right? So for example, I might have a patient that we follow, or you guys might have a patient that you follow with Sturge Weber and Port Weinstein, and they don't have glaucoma as an infant or as a child, but maybe later as a teenager they present, and how would you decide, should I do angle surgery or should I do 2% surgery? I would be cautious to do a 2% surgery in a teenager or in a young adult patient with Sturge Weber because of the risk of paroidal hemorrhage. When you rapidly decompress the eye, you put them at risk of having a paroidal effusion and paroidal hemorrhage. So these are cases where we typically would put a tube in, in a stage process, or we would ligate an almond valve in order to kind of stage the decompression. So if we were doing, the way we used to do is we'd put an almond valve in just sew the plate in and not actually put the tube inside of the eye. Then we would wait for maybe six to eight weeks and to allow a capsule to develop over the plate, and then we'd come back for stage two and then put the tube actually into the interior chamber or the sulcus. And the idea being is that if you have a biological valve, the capsule, the tenons it forms over the shunt, you're going to reduce the risk for kind of rapid decompression, right? Absolutely. So because if I just put a tube in immediately, it's going to start working from day one. And if you drop them too fast in a patient with elevated episcovial pressure, there's a larger risk for cortifusion and hemorrhage. Okay, next question. All right, which of the following is true regarding a fakia after congenital cataract surgery? Which of the following is true regarding a fakia after congenital cataract surgery? Cataract surgery 15 to 50% or more developed glaucoma. The patient is only at risk of developing glaucoma within the first, sorry, within the first three years after surgery. Irritable trabecular dysgenesis is the most common cause. Removal of all residual cortex during surgery may reduce the risk. And small coronal diameters are risk for developing glaucoma, and cataract surgery in the first year of life is a risk factor. Okay, who wants to take this on? A lot to cover here. And there are multiple answers. I can give it a shot. So 15 to 50% or more developed glaucoma, I think that's true. The patient is only at risk of developing glaucoma within the first three years. That's not true there. I think they're at risk the rest of their life.  I think that the mechanism, I think it's not like definitely known, but that the patient had a cataract. And so anterior segment dysgenesis is considered possibility because something led to their cataract in the first place. And so their angle may not be normal either. And then removal of all residual cortex reducing the risk, I don't know, a small corneal diameter as a risk that seems true to me in like that anterior segment dysgenesis category, but I'm not sure. And then cataract surgery in the first year of life is a risk factor. Yes, that's true earlier surgery is a risk. Okay, great. All right, so we'll start at the top. There's that 50% rule again shows up a lot in on your on your questions. If you have to hedge, you can usually say around 50%. The patient is only at risk of developing glaucoma within the first years, three years after surgery. That is false. Okay, you can, as Arianna said, this can be something that can develop, you know, within the first few months after surgery, or could be developing later in life. Okay, so iridotrabecular dysgenesis is not the most common cause. And you really have to do a good exam to figure out exactly what the cause is. But many of us in glaucoma understand that, or we don't understand truly how the exact mechanism, but there is something that seems to be very important for the development of the angle for a patient to retain their lens. When you remove that lens, there's either some postulated theories about stretching of the scleral spur, and how that relates to the angle. So really, we'd like to think of the lens angle as a complex, and there seems to be something that's really detrimental to the development of the angle, if you remove the lens early on. As you know, the eye is growing. And so there's some, there seems to be a role in terms of a beneficial role for the lens to be retained in the development of the angle. So by removing it very early in life, you definitely put them at risk of developing maldevelopment of the angle. But it's not really your classic example of an iridotrabecular dysgenesis, where there's maldevelopment early on. Now, you have to do good gonioscopy because if a patient presents with the history of cataract surgery as an infant, you need to figure out what the mechanism is. Is it truly open angle? If it's truly open, then I would consider doing angle surgery to see if removing the trabecular mesh work may help to decompress the eye. However, these patients may develop synechia, and you can get kind of a creeping crawling peripheral anterior synechia. And so if I have an angle that's completely zipped up in a patient with a history of infantile cataract surgery, we're going to be moving on to a different procedure. I won't even try to take these down. I think it's kind of a mess to try to take down these types of synechia. If it's limited, you can, and then do some angle surgery. But usually we're moving on to a bypass surgery. Okay. So, and then removing all the residual cortex, why is that helpful? You guys know the kids are very pro-inflammatory. And so if there's a lot of postoperative inflammation, that could cause disruption or to the angle and to the trabecular mesh work and cause dysfunction. So it's important to be meticulous. When you do a pediatric cataract surgery, you really want to remove all the cortex used by manual. If you have to get out to the phoenix and really search for cortex, removing the lenticular material, the core nucleus and epinucleus is a piece of cake. You just slurp it out. And really, most of my time spent during infantile or pediatric cataract surgery is removing the residual cortex and polishing the lens epithelial cells, which I'm a big fan of, particularly for pediatric patients. Because these kids, if you don't, they end up with huge cell rings rings that become problematic later, either as adults or as either as juvenile adolescent or adult patients. In small corneal diameter, that makes sense. Microphalmia, micro cornea, these patients have a tight angle just by sheer volume. The anterior chamber volume is small. The iris is closer to trabecular mesh work and at risk of developing a significant closure. Okay. Okay, next question. Which of the surgical approaches is the preferred method of treatment in a one-year-old with primary congenital glaucoma and cloudy corneas? I'm going to give this question to anyone who's rotated. I think, Cole, have you been on the pediatric glaucoma service? Right. So hopefully, now here's some clues as you read this question. It's a surgery question. It's a one-year-old with primary congenital glaucoma. So we already talked about angle dysgenesis as being the primary mechanism. And this patient also has cloudy corneas. Yeah, so we're certainly not going to put in a tube. And to do agoniatomy, you need visualization of the angle. So you can't do that with the cloudy cornea. And so I think then you need to do a trabeculotomy or ectomy. And the trabeculotomy abexterno I think would probably be the first choice. Yes, that's correct. So these terms are confusing. And I want you, if you're going to remember this for a test, agoniatomy requires you to use a gonioprism. And hence, you would need to have a clear cornea. So you answered correctly that for agoniatomy, you need a clear cornea to be able to visualize the angle. Now, sometimes you get lucky. Last night, we got lucky. We had a patient with a cloudy cornea. And the view was marginal. And I had one small window. If I tilted the patient far enough away from me, I was able to look between the cloudy central cornea and the limbus, which had cleared since birth. And so I had a very small window where I was able to do agoniatomy. Now, you guys have heard of the GAT technique. The GAT technique is gonioscopy assisted transluminal trabeculotomy. And so this is confusing because for this type of procedure, for the GAT procedure, you do need to have a good clear cornea, relatively clear, because you are using agoniatomy or gonioprism. Now, in the classic sense, for this question, a trabeculotomy, before we had angle surgery techniques and before we had catheters and sutures and things that we could use to cannulate slumps canal, we were able to do a trabeculotomy ab external. And that's where we do a cut down. We do a pyrenomy. We make a flap or a slit. And then we basically dissect our way from external to internal into slumps canal. It's probably the one of the most challenging but one of the most fulfilling procedures to be able to do because once you get down to that anatomy, you really have to, there's clues to know that you're in the right space and that you're unroofing slumps canal. And one of them is the scleral spur is a very, the scleral fibers that represent the scleral spur become parallel right at the limbis. So if you're wondering, am I there yet? Am I there yet? What you're doing is you're looking for the fibers. If you see a very irregular fibers going in every different direction, you're not at the spur yet. The fibers become very organized and parallel to the limbis once you reach the spur. So once you've identified the spur, you just keep unroofing a little bit more and getting through those corneal layers until you're literally right just above slumps canal. And you have to use a Utrata forcep or a non-tooth forcep, something that's not too sharp and just basically peel off the layers as you unroof slumps canal and then you just start to see aqueous fluid percolate into the canal or into that space. And from there you thread the catheter or suture and you may be able to achieve 360 treatment by doing an otomy. Or we have something that we rarely use. We have these in our toolbox. We were almost ready to use it last night, but it looks like a pitchfork. And this pitchfork is called the harm's trabecula tome. And the pitchfork works by you put one part of the probe and then you essentially just tear through the trabecula meshwork. And you can do that for 90 degrees or 180 degrees. We have probes that go to the left and probes that go to the right. But that's an approach where we would do it as an ab external technique, a trabeculotomy ab external. Trabeculectomy is actually the right procedure if you're in other parts of the world. When I've traveled around and I've seen how people have managed pediatric glaucoma, they've done a trap-trap. And what a trap-trap is, is you do a trabeculectomy along with a trabeculotomy. So they'll dissect a trap flap and then they'll do a trabeculotomy with a harm's trabeculotome. And then they'll make a punch and then convert that into a trabeculectomy. And so, but these are tough. Why do we not do, at least why do I not do trabeculectomies for kids? You can imagine if we're going to manage your trap in a child and we're going to have to cut stitches or do suture lysis, that's pretty much impossible in a young child because of cooperation. And that would require you to take them back for an exam under anesthesia every time you wanted to adjust the flap. Now, there are ways to be able to do it where you leave the sutures a little bit loose, but then I think you also risk hypotomy, etc. And so I'm not a huge fan of doing trabeculectomy in kids unless you absolutely have no other choice.  I think that's a reasonable approach for congenital glaucoma and for kids because you don't have stitches to manage postoperatively. So the answer to this question is the first choice would be a trabeculotomy of external or the cornea is too cloudy. We can't use a gonioprism that's why goniotomy is not the correct answer. And trabeculectomy is the right answer if you're other parts of the world. But I think for your board exams, the answer that you would put here is trabeculotomy. Dr. Chai, a quick question. If you were trying to buy a kid time, would you ever do an ab-interno Zen or would it just scar off so badly with all the tenons there? Does anyone do that just to buy time and say, oh, this might scar off, but we want to get the pressure down so that our trap will work better in the future? So because you're saying that if I do an ab-external and do a pyromede that I'm just potentially causing more scar tissue and why not do an ab-interno, is that what you're saying? I'm just meaning if often in adults we say, oh, their pressure is high and so the trap will be unpredictable in healing. And so sometimes we say, oh, we're going to do an angle surgery like a hydrus or whatever just to bring down the pressure and make it a little more stable. And I think I'm not like super up on the data, but I think even when you put in like a hydrus in an adult in which they're going to get a trap, they do better if they've had some sort of mix. So I was wondering if you ever do that with a Zen in kids to like prep them for their future trap? That's a good question. I will tell you that my general approach is to start on the angle for patients with congenital glaucoma. If that fails, we move on to a bypass. My first choice as a present would be a Zen and I would do that as an ab-external technique. I'm not a huge fan of the ab-interno technique for the Zen. That's how we were all trained how to do it, but particularly for kids who have very thick tenons, I think it's ripe for failure. And unless you can get that Zen in perfectly in the subconjunctival space, well, let me, I'll tell you my bias. I don't think the Zen in the subconjunctival space is a very safe place to protestant. And I've seen several cases of Zen erosion, conjunctival erosion, where they're placed simply under the conjunctival, which is how we were taught to place them if you're not opening the conch. I prefer to do an ab-external technique. We'll bring back the conjunctival, we'll pull back the tenons, and then we know exactly that that Zen's going to be placed under the tenons' tissue. Now, can that patient get a trap later? Absolutely. If you're careful with your dissection, you're not too aggressive, there's still multiple tissue where you can put a trabeculectomy in later in life. Now, my new approach for patients who, let's say, fail a Zen surgery, and now I'm forced with the decision to put a tube shut in this patient, I like the approach that Sharon Friedman has espoused. Sharon Friedman, some of you know her, she's a pediatric glaucoma specialist trained both in pediatric ophthalmology and glaucoma, who runs the Duke pediatric glaucoma service. She's a huge fan of, if you have to put a tube shut surgery in, or a tube in a patient with congenital glaucoma, or even a pediatric patient, a juvenile patient, is to put the tube down in fear and nasal quadrant so you can save some superior conjunctival for a future filtration surgery. I don't know if that answers your question, Mike. No, that makes sense. Yeah. Yeah, so I'm always thinking about the next plan, the contingency plan. In fact, when I see parents, when I counsel them for congenital glaucoma, I often tell them this is not going to be their first rodeo. This is going to be the first of many interventions over their lifetime to be able to control the disease, right? Now, in the future, I hope that we'll have pressure flow. Pressure flow is a new device that has not, unfortunately, about three weeks ago, the FDA ruled that they are not going to approve it here in the United States. It's a long, complicated story. I won't get into it, but we're all disappointed. So presently, it's only available in Canada and Europe and parts of Latin America. But I think that material has an advantage over the zen material. The zen, as you know, is a gelatin-based stent. It tends to degrade over time. I've seen it in some adults just completely melt away, almost disintegrate. But the pressure flow is a special type of polymer made out of a polymer called SIBS, which induces less tissue reactivity. And our hope is that we can make this available one day for patients in the United States with all types of glaucoma. But I'm particularly excited for patients with congenital glaucoma. Are they putting this in kids internationally? Yes, yes. Ike Ahmed has done probably, he hasn't done a thousand kids, but he's done a lot of kids with glaucoma juvenile open angle and primary congenital glaucoma, and they've used it successfully there in Canada. He has about, in his cohort, he has over a thousand patients, but that's all comers. That's adults, children, but he's had some great results with pediatric glaucoma and the pressure flow. Okay, next question. We talked about this a little bit, but let's see if we can have an answer, because parents are going to wonder, the parents of a six month old child with PCG, primary congenital glaucoma, want to know how successful angle surgery will be for their child? What's the appropriate response? 50 percent. 70 to 80, 50 percent. Better than 95 percent. Wow, that sounds like almost like cataract surgery, or 25 percent. So who wants to take a stab at this based on what we talked about? Remember, we talked about that magic window, right? Is this patient in the magic window? Yes. Yes, three to 12 months. 78 percent. That is correct. So pretty good. I mean, I'm optimistic. When I see a patient who presents in that magic window, I am very bullish with the parents, and I will tell them that there's a very good chance that this first initial surgery is going to do really well, and hopefully we won't need another major surgery for a while. Okay. Okay. Next question. All right. Which of the following class of medications should be avoided in infants with glaucoma? I'm going to give this one to Tony. Beta blockers, CAIs, alpha adrenergics, PGAs, or myotics. So definitely right off the bat, alpha adrenergics. We don't use them. For beta blockers, we do want to be careful if they have bronchospasm, if they're very small. For CAIs, I think you can use them, but just to be careful to check their electrolytes and make sure they're not having like lethargy. For PGAs, I think you can, but they're not very effective. And myotics, usually mostly just used for, I think it was I think aniridia. Okay. So you're correct about alpha adrenergics. That is one class that we're, so the clue in here, though, is infants. Okay. We're talking about really young kids here. And why is it that we are avoiding alpha adrenergics? So they can cause CNS depression and apnea. Yes. That is correct.  And this is one where you could kill the patient. So alpha adrenergics, that's definitely on your board's question. It will likely maybe even show up on your orals. Those of you guys that are going to be taking your orals soon. I don't think, mainly this is for our fellows, they've got orals coming up this weekend. But should we avoid alpha adrenergics for all pediatric patients? Let's say I have an eight-year-old. We put them on cosopt and a PGA. And is it okay to use an alpha adrenergic for a patient who's older? Yeah. I think by eight would be okay. That was kind of where I was thinking of cutting, having a threshold. Yeah. And so I think the youngest that I've used it in is probably a six-year-old. But I was very careful to tell parents, you need to watch the patient when you first start this medication. And if they're very somnolent, we're going to have to stop it. And so it's appropriate to use in older kids, but definitely avoid in your infants because of CNS depression. Myotics, I don't know how many of you guys are familiar with myotics. These are becoming a dying class of medications, but can be very powerful for patients. The one that I'm thinking of that is commercially available, actually, this is a medication that was recently sold by Pfizer. Pfizer was the main producer of phosphiline iodide, colonist-race inhibitor. And by doing so, you allow the pupil to constrict and you really put some tension on the spur. And myotics tend to be the magic drug for patients with Afakic associated glaucoma. We don't really use them for most patients. I mean, we use them in practice. If a patient has angle surgery, I will definitely put them on a myotic agent for a few weeks, but usually I'm not putting them on a myotic agent for long-term administration. The one caveat is patients with Afakic glaucoma. It is a magic drug.  And you put a patient on phosphiline iodide with Afakic glaucoma, and it can be just remarkable the amount of pressure lowering that you get. And again, this has to do with the role of, you know, by putting stretch on the skeletal spur, you may be able to open up the trabecular mesh work and improve the outflow. So as I think about Afakic glaucoma and the role of the lens and the development and the angle, by removing the lens, I think you actually reduce the contraction on the spur. Give me just one second. Let me turn on this alarm. Okay. All right. Sorry about that, guys. Some of you may know my grandmother lives with me now, and that's a bed monitor. Every time she gets up, I got to go make sure that she's not going to fall. So apologize for that delay. Next question. You have decided to use a beta blocker in an eight month old with PCG, PCG patient status post-goniatomy. Which of the following are important considerations? Beta blockers are contraindicated in kids less than one year old. Punctile occlusion can be helpful. 0.25% Timolol or a beta blocker is the preferred concentration and should be avoided in patients with asthma or significant cardiac disease. Anybody want to take this one? I can take this one. Okay. So should be avoided in patients with asthma or significant cardiac disease? Definitely. 0.25% is the preferred concentration. So I think 0.5 is the adult. So sure, let's go with it. Punctile occlusion can be helpful always to prevent systemic absorption. Beta blockers are contraindicated in kids less than one. I believe that is not true. So that is correct. In many of you that have been on the pediatric glaucoma service, we love COSOP. That's actually 0.5% concentration. If you have a choice, it would be ideal to start with a lower concentration in kids just because of the risk for bronchospasm and stuff. But it's not an absolute thing. I mean, we use 0.5% even in infants. So you just have to be careful. But we do encourage family members to do punctile occlusion for their children after the administered drops. Okay. So for this one, punctile occlusion and should be avoided in patients with asthma or significant cardiac disease are the answers for this question. Okay. All right. Which of the following is not true regarding juvenile open-angle glaucoma? Presents between ages of 4 to 35, autosomal dominant, most common inheritance pattern. The angle can appear dysgenic, like in PCG. And progressive myopia can continue to develop until 10 years of age. And buphthalmus and obstrea are common. I can take this one. I think that the angle is not dysgenic, like in primary and congenital glaucoma. And then buphthalmus and obstre would be more common in congenital glaucoma. So I feel like those are two are not true. And I'm not sure about inheritance or progressive myopia. But I don't think that it's actually I do think it's autosomal dominant. Correct. Okay. Yes. So you answered correctly. The ones that are not true for this question. The angle can appear dysgenic, like in PCG. No, that's not true.  But when you look at a patient, if you've ever seen a case with a primary congenital glaucoma, it would be described as featureless. You can barely see any TM and there's no spur. It just looks like iris. And then it kind of just blends into cornea. And you might see Schwalbe's line, but that's it. You really don't see any obvious features of the trapecular meshwork or the spur. Okay. We talked about obstre, or I'm sorry, buphthalmus. This is a very important question or just an important clinical pearl. You guys remember when buphthalmus stops? Say by three years? Exactly. Yeah. Around three to four years old. So if you have a patient that's older than that, that's not going to be a dead giveaway clue for you. But myopia can be. So, but realize that buphthalmus is something that we typically only see in that setting. We're only going to see in younger kids. Buphthalmus is really that corneal stretching that really occurs only early on. And then after age of four, so there's really no longer any stretching of the cornea. Okay. All right. Next question. We're just about done. The role of CCT is well established in pediatric glaucoma and should be routinely measured in all children with glaucoma. True or false? False. That's correct. We don't do pochimetry all the time for kids because there's no established norms. Is it helpful? It might be. We have a patient who's now a teenager in our practice who has pressures of around mid-20s on max drops with dimox, nurse local K. We took her for an EUA. She has axon felts. I believe she has axon felts. And her corneal thickness is like 700. And so maybe that's why her pressures are a little bit on the higher side. The reason we're concerned for this patient is that she's had a previous history of having much lower pressure. So there's been a very dynamic change. You know, one of the things about glaucoma is it's really changed over time. And so realizing that a patient who has thick corneas, if you're measuring the pressure consistently over time, if they have suddenly a dynamic change, you have to take that seriously. Just because they have a cornea thickness of 700 and their pressures 25, that may be a cause for panic. It really depends on historically where they've been. If their pressure has always been 25, then maybe that's totally normal for them. But if they at one time were well controlled and now pressures are getting out of control, I don't really look at that corneal thickness as a thing that's going to sway me and to dissuade me and to say, oh, you know, corneal thickness is elevated, a patient's going to do fine. Okay. All right. Let's see if this is the last question. I believe the normal corneal, corneal diameter of a full term newborn is which of the following nine, 10, 11 or 12. And why is this important? Because you guys are going to be called to figure out, Hey, is this you Thomas or not? What's abnormal? I'd say 10, 10, nine, going to vote for nine, two for 10. Anybody else? I don't know. But this is the OCAPS question like directly from this year and I probably got it wrong. So it was on OCAPS this year. Yeah, it was on OCAPS. This is like was on OCAPS this year. Okay. Well, here you go. Here's a free bonus point for next year. It's 10. Yes. So 10 millimeters for a normal corneal diameter of a full term newborn. Okay. Just tuck that away because it might show up on OCAPS maybe not next year, but it seems like they alternate years and they cycle around. This was definitely on my OCAPS though. Okay. All right. Let's see. These are just some things to tuck away. I save this for last because I really despise genetics and having to remember all these little things, but these might be important. And I'll try to tease out some threats here that might be important. What are the two main genes associated with PCG? Anybody know? CYP. Yep. There you go. There's the CYP1 or cytochrome P450, family ones, subfamily B, blah, blah, blah. But if you have to guess, if they give you this, GLC3A locus, just remember that GLC has to do with all these glaucoma loci and just guess GLC something 3A, 3B, whatever. The next one that's associated with it is the LTB2 gene. And I can't even remember what it stands for, but I think it's some sort of transport gene or it's a transforming growth factor gene, I believe. Okay. And so that has to do with development again, that transforming growth factor is important for development of collagen and different structures. And so that's why I kind of tie it in with this association of primary congenital glaucoma and dysgenesis of the angle. Okay. Which gene is associated with Joag? Anybody want to take a stab? Anybody remember? Tiger Myok. There you go. Okay. Tiger Myok is the one to remember. Okay. Which gene is associated with aniridia? This is definitely on your boards at some point. I got it at least once or maybe even twice during my O-CAPs. AX6. That's correct. All right. Which gene is associated with AXmFeld Rieger? AX3. AX3, AX2. You're close. AX5. No. No. Pitex2. Okay. Or Foxy1. I like that one. Sounds kind of cool. So those are the two that you need to remember for AXmFeld Riegers. Is Pitex2 or Foxy1? Okay. Now there is a large spectrum of some crossover. And so we get this kind of waste basket of associated genes and anterior segment dysgenesis. So why don't we just do a little drawing here? So which one is for Pitex2? AXmFelds. AXmFelds. Which other one? Foxy1. Foxy1. Okay. How about for Peter's anomaly? Also Pax6. It's actually, I believe, all three. Okay. And then Pax6. Aniridia. Okay. And then now PCG. So 1v1. That's right. Okay. So the one, you know, if you have to remember one to remember, I would say the Pax6 and Aniridia. That's shown up multiple times for me over my career. Let's see. Is that Pax6 dominant? What's that? Is that Pax6 dominant for Aniridia? Oh, you mean in terms of versus sporadic? No, no, versus recessive. Oh, good question. I don't know. I don't know. Okay. My final public health announcement to all of you. Big eyes are not cute. Okay. I think Disney has done a disservice to humanity and in most of their characters having really big, beautiful eyes, but big eyes are not cute for pediatric glaucoma. So that is all I have for today. Do you guys have any questions though? Just in general about pediatric glaucoma, remember some takeaway themes, kind of that 50% risk is a big deal. Remember the magic window for primary congenital glaucoma, three to 12 months, and those patients do well with angle surgery. Pediatric glaucoma surgery rarely shows up on boards. It showed up once for me, and it had to do with that issue about what the best surgical procedure was. And you had to know the difference between agoniotomy versus a trabeculotomy. Remember that agoniotomy requires agonial prism. Hence, you need a good clear corneal view. Okay. Medications. Oh yeah, medications. I was just going to ask, in somebody with anterior segment dysgenesis or I guess more corneal pathology in that sense, do you ever avoid like CAIs? Because I know that we use a lot of co-sobbed in kids, but has that ever led to more endothelial dysfunction that you've seen or cloudiness? I have not experienced that. This is, I think, something that might see more in adults who have kind of corneal decommunication with chronic CAIs, but I have yet to see it. And I think our options are more limited with kids in terms of what we want to. There are some things that we have used, some newer medications such as Visolta that might be helpful. And we are using some rock inhibitors now for kids too. So some new classes of medications that we've had experienced with adults, we've been able to use them in kids as well. But in general, I don't avoid CAIs in kids, unless I guess I were to see some sort of significant corneal and deep compensation. Yeah, I was just wondering, out of curiosity, because I haven't seen that either, but just wondering if in your experience, cool. Thanks. Yeah, I know our corneal colleagues frown when we're putting CAIs on their transplant patients, but you know, you got to do what you got to do. You got to save the nerve. I mean, we can always replace the cornea again. I can't do it, replace the nerve yet. Any other questions? Okay. Well, I hope you guys have a great Memorial Day weekend, short lecture today, but please reach out. I look forward to having those of you guys that have not rotated on service yet, so that you can see some of these surgeries. And we have some great pathology here at the Moran in terms of big groups of families of Acksenfeld's and Sturge. And it's fun to be able to kind of tie these things in together. And to really educate your primary care colleagues to let them know, you know, to be able to screen for patients with congenital colicoma and refer them early. Kids do better if they're referred early, you know, rather than what you see oftentimes in low and middle income countries where the cornea is completely scarred over already and very tough recalcitrant cases.


Gyda afternoon everyone. I hope you're all having a fantastic first day at Drupalcon-Lill. I'm Alice, and typically I a senior delivery manager for a Drupal Agency called X produz adres, but today I'm going to be your Project First Day trainer. Firstly, hands up if you've ever worked on a project that didn't go quite to plan and maybe went over budget, maybe you didn't meet the deadline. Nobody. I see almost everyone's hands were up there and you're all in fantastic company greedy for the PMI, the Project Management Institute found that 70% of projects failed. Even the most successful project managers or agencies or developers amongst us will likely have been on a project that didn't meet its promised timeline, budget or scope. But the good news is that project failure isn't inevitable and there are things that we can do to avoid it. So, in today's session, I am going to be, if I can work the slide, there we go. Talking through, apologies, just lost my cursor, through, I'm going to stock up your proverbial first aid kits with some practical tips and strategies to spot the symptoms, there we go, of a project in crisis, giving it the best shot at survival, some tips for making sure your project recovery plan is realistic, and then finally, some strategies to keep your project out of the emergency room for good. Okay, firstly, let's stock up on some preventative medicine because some more good news, projects don't generally descend into chaos overnight. Instead, there will be often be tell-tale signs that something isn't quite right. And the earlier you can spot these signs or symptoms, the better. Early detection will not only provide you with the maximum opportunities for recovery, but it's also going to prevent even bigger setbacks, significantly improving your project's chances of success. But how can we spot these tell-tale signs? So, over the next few slides, I'm going to talk through three fantastic diagnostic tools, metrics, milestones, and honesty, and how each of these can help you spot the symptoms of an unhealthy project as early as possible, ensuring it stays track. Many of you might have a smart watch. You might be wearing it today. I'm definitely wearing mine because I think I'm going to be getting a lot more steps this week at Rupercon than I normally do sat at my desk, thanks to all of these lovely stairs. Tracking a handful of simple things such as how many steps I take or how many times I stand in a day really helps me stick with my fitness and health goals. And the same can definitely be applied to projects too. When it comes to metrics, there are a few things to bear in mind. Firstly, simplicity is king. Avoid at all costs by too much data and tracking things just for the sake of it. This can actually obscure problems and be unnecessary overhead to manage. Instead, I'd recommend sticking just a few critical indicators that are easy to track and easy to understand. Consistency is also very important as it will allow you to spot trends and therefore potential problems. I found that setting a regular time to check my projects metrics works really well. For example, every Monday. Metrics are pretty useless if they're kept in a report that no one's read. I'm sure we've all been guilty of this at one point another. So make sure you're encouraging the team to engage with those metrics by including them in things like retrospectives and planning meetings and share them visually as this will help improve understanding. Also, don't forget to make sure the team and stakeholders not only know that your velocity is 7, but also what does that number actually mean for your project so action can be taken. Here's a little snap of me on a previous project. As you can see, my project journey was marked by a series of checkpoints on milestones and these milestones aren't just there for decoration. They actually make great indicators of project health. For example, imagine you were going to break down a website redevelopment project into smaller milestones. One of your early milestones could be client approval of designs and if this design milestone isn't met when you expect it to be then straight away really early on in the project, you have a clear signal that something isn't quite right and action is likely required. To get the most out of your milestones, I'd recommend focusing only on the ones that directly impact your overall project goal. This is going to make tracking your milestones and spotting any slippages much much easier. Again, visibility is really key here. So make sure you're adding your milestones to your roadmap and updating it and sharing it with the team regularly. This is going to boost accountability and responsiveness. When it comes to projects, challenges are definitely a given, so it's really crucial to be able to discuss them openly. So when you encounter an issue, resist the urge to stick your head in the sand like these guys and make sure you're having that conversation early on when you hit the road bump rather than staying in the lead up to launch. The earlier in the project you can get your issues out of the open, the more you're going to be boosting team confidence and creating a space of psychological safety where hurdles can be discussed honestly and tackled effectively. One way you could do this is to add a section to your next retrospective where people have the chance to raise any concerns that they might have about the next sprint or the project as a whole. I recently actually had a really lovely client who was super excited about raising their first bug and I loved that. That's the exact kind of attitude that we should be looking to cultivate in software development because bugs are an integral part of development process. I'd actually be really concerned if I saw no bugs raised at all. I don't think that would be realistic. So I think it's time we reframe how we perceive bugs being raised and issues being raised and actually see them as a positive sign and celebrate their successful resolution. Embracing challenges is not only going to lead to better project outcomes, but it also forces a culture of continuous improvement and innovation. Hopefully using some of the tools that we've just discussed will have caused any issues before they sparred out of control, but in reality your project might already be in critical condition. And if that's the case, then don't worry because you're really not treading uncharted territory here and there are loads of great online resources on how to put together a crisis recovery plan. Over the next few slides, I'm going to talk a bit more about some practical tips for crafting a realistic and achievable plan. A realistic plan is absolutely critical for re-securing team and stakeholder trust, which is likely going to have taken a bit of a hit in a crisis, curbing any further complications and maximising your chances of successful and permanent recovery. In particular, we're going to talk a little bit about the importance of accepting and acknowledging the issue, some key things to bear in mind when it comes to resetting your approach, and some tips as well for fueling buy-in and enthusiasm for that plan. Before any pros can be made in resuscitating your project, it's absolutely crucial to recognise and acknowledge that that actually is a problem. While this step sounds obvious, it can actually be one of the most challenging as understandably it can be pretty daunting and uncomfortable to live with the bad news. But until the true nature, extent and implications of the problems are acknowledged, it's going to be very, very hard to get the necessary resources, support and level of urgency required to effectively resolve that issue. And it's not only important to acknowledge the problem, but it's also key to do this swiftly as possible, because delaying the news is only going to make the situation much worse and a road trust even further. So when you're informing the stakeholders, be honest about the extent and implications of the crisis, the actions you're going to take to resolve it, and also what support you need from them. The key here is to make sure you're involving the right people, i.e. the people have the keys for the emergency equipment, the additional resources or the power to move launch dates. It's really crucial that you're honest about what happened, but avoid playing the blame game. Instead, focusing on the issue at hand is really key, and make sure you're taking time to listen to everyone's concerns and questions. This is going to help foster a shared sense of responsibility, which will ultimately increase everyone's willingness to help the recovery. You're going to need everyone's hands on deck in this instance. Once you've acknowledged and communicated the crisis to the team, it's time to administer some CPR, some critical project recovery. The next step involves assessing and stabilizing the situation, and then collectively defining your immediate care plan. It's really worth considering at this stage, whether you need to temporary downstool tools or at least apply some partial anaesthetic to some work streams so that the team can focus in on the recovery planning. If the team continues to deliver work while also trying to take stock, it's essentially a bit like trying to change a car's tyre while the car is still moving, and this could result in re-work and increased costs. It sounds counterintuitive, but it's really worth considering. To stabilise your ailing project further, it's also worth considering whether you should temporary free scope. This will allow for a more predictable and focused period, and it's going to give the team the space it needs to address current concerns without distraction and with new complexities. You can also use this break to re-evaluate the remaining deliverables, so make sure you avoid falling into that sunk cost fallacy by parking anything that's not absolutely essential to the project's goal. To keep the team and the recovery focused, I'd also recommend defining a clear recovery goal. And then, focus on addressing the most pressing issues first, i.e. the issues that will have the biggest impact on the project and the recovery goal. Unfortunately, when it comes to recovery, there is no plan B. This is it, so avoid committing to a new project schedule until you can create one that's achievable.  So also make sure that you're over-communicating throughout the recovery phase, so establish regular and clear communication channels and control the flow of communication to stay ahead of any concerns. A warning sign for me would be if people are chasing you for updates, it's likely your communication isn't effective. And just as important as providing updates is ensuring that any old information is removed too, such as outdated plans to avoid any confusion. A successful recovery ultimately hinges on your team's commitment. Dupal projects are, of course, software-based, but ultimately they are driven by us, they're driven by people, and without those people's trust and buy-in, it's going to be very difficult to move things in the right direction. Chances are your team's trust and morale is going to be a bit low, and if this is your situation, there are some potential antidotes to this. Firstly, prioritising honest and timely communication. Poor communication can be a bit of a silent killer, pun intended, so share your discoveries with the team while also highlighting what's working well to help build confidence. Involved them in every aspect of the recovery that you can. This will not only rebuild trust and commitment, but you're going to get better recovery plans overall because you're going to be drawing in everyone's expertise, and they will feel more ownership of that plan. Another way to encourage commitment is a generous dose of high morale. Be sure to recognise and celebrate achievements, both the big ones and the small ones. This is going to help boost motivation and enthusiasm. Taking the time to say thank you, both publicly and privately, and acknowledging people's contributions and hard work in patients can go a really long way. Once a project has successfully navigated its crisis and is back on track, it's essential to implement some strategies to maintain stability and to keep your project out of the emergency room for good. Some things that I found a key to preventing crisis relapses are firstly, carrying out an in-depth root cause analysis of the crisis. Secondly, ensuring that you're not repeating any past behaviour, and finally, monitoring your project very closely. A crisis can actually be a fantastic learning and growth opportunity. So once your project is in a more stable condition, I found that conducting a thorough analysis to better understand the root cause is key for long-term recovery. Make sure you're documenting those lessons learned to prevent similar situations in the future and use this deeper dive as an opportunity to validate your recovery plan and corrective actions in the longer term. It's absolutely essential to avoid going back to what you were doing before the crisis. Repeating the same behaviour and expecting different results is as good old Einstein says here, insanity. So think about using some tools you might already be using such as retrospectives as an opportunity to stay accountable and to evaluate whether you've actually changed your approach and behaviour. And finally, just like a doctor would keep a closer eye on a poorly patient, keep a very close eye on your project post-crisis. So firstly, increase the frequency of your monitoring and reporting activity and don't forget to factor in the human element too by paying close attention to team dynamics and metrics, not just focusing in on the numerical side of things. I'd also recommend considering tracking progress using inch stones. Inch stones are essentially goals on a smaller basis, a daily or weekly basis. This level of admin is probably a bit excessive if you're working on a smooth running project, but I found for a trouble one it can make a huge difference. So if you only take one thing away from today, I hope it's at least that you can rest assured that if you've ever had a project go off the rails, you're really not alone. And it's not all doom and gloom. There are some tangible things that we can pack into our emergency kits to prevent, turn the tide and even thrive in the face of project failure. So yeah, thank you all so much for listening. Please do feel free to share any feedback about this talk or the conference via the Apple QR code and to help out our lovely open source community by checking out the contribution opportunities and workshops. Thank you again.


We need we need Nick to just open. Yeah, that's it. Okay. We've got combat. Okay. There's the the rogue Is he gaging? Yes Okay, this is a good piece Nice, we've got the dispel on the VT as well before the silence. That's huge. All right, let's see what Nick can do with this Now we've got the the I fell down. I'm himming. Okay. I don't want to talk about it Oh my god I don't want to talk about it. Okay. All right. Here we go.  Here's the scatter easily.  He flares as well doesn't get him, but he gets opened on that's fine We're trying to get the proc. Nope. No luck today full clone. I'm priest gonna come nastily out of it But we do have fair wards. There's gonna be a fair ward jewel. Let's see who gets who first We get the fair ward off and we fear always lucky and Cp is trying to pump this feral down But at the moment he's taking more pump than he is delivering But we should be able to see some pressure coming out surely priest is off DR soon We have a scattered trap in about five seconds And I believe we should see our next go then we hold on to a trinket wisely And we haven't been feared quite yet Roura sack comes in as well to negate some of the damage that circuit's already been used This is kind of trapped is gonna land surely has to be drink it out of here And it is indeed full clone coming in and say we've got a huge urban here Yeah This barrel needs to be trying to eat a few traps to be honest at the moment He's just a waddling about open this priest could dodge a trap out of a scour relying heavily on the triggered time To pull that one off, which does sometimes fuck them But as if you take a lot of damage here landed a full clone.  I thought he was running for the trap full.  I'm trying to stay with you. I still have my fill. This is huge Fear both scatter me Love it. Love it. He's I don't feel just a fear 9 sec for my fear silence on me Silence on me take care If you get the aimed off, it's nicer There he wills and feel me just line line line line line. I don't know Willis. I don't want to drink at this Sorry, I'll PSU now Got your pin silence on me. He wants to scatter me. Okay. Come to me. Come to me Milded it. Milded it. It's it's okay. I got fiend. I Hit me. You got it. You got it. You got it Fair priest. You got it. Did you drink it?  I don't know Topping you topping no aimed cleaning Hunter scatter me. I'm lying fear me.  Don't lie me. Don't lie me fearing Got it Big damn. I get the shoot Isaac. I still want to go in. Okay sure you can cross me back in ship. Actually, I'm gonna try I Got it. Send this guy. I'm not you Yeah, yeah, please if you have that yeah, yeah


Welcome to Jenkins governance meeting. It's the 17th of November 2021. Remind everyone that we abide by the Jenkins code of conduct. So be nice to each other. Agenda topics that I had include news, election status report and Gavin will put you on that one highlight from the mailing list and community forum. Anything else that needs to be on the list. You're way ahead of me on that one because I forgot to do that this week. Oh, actually, I wanted to thank you for creating the draft draft agenda it made my life much better by what you did so thanks very much Gavin also wasn't me but thank you. Oh, whoever created it that it's really marvelous that we've got it. Super. So news and election status report and mailing list highlights for the three topics I had. Oleg any topics that need to be added to the agenda. So, yeah, sorry, I have been a bit disconnected over the past weeks. Last time we had some discussions related to ownership, but it was brought up to the introduction team yesterday. So I'm not sure whether it makes sense to discuss it today until we get some clear details from the Linux Foundation about what they actually expect. This is the story about. So the Linux Foundation would like to have the admin GitHub account registered as owner for all project repair is it or is it organizations. Got it. Okay. Well, so let's let's at least put it there. We've got it as a topic and we'll make sure we actually maybe let's just put it as a top level topic because it's really not a mailing list topic right that's a, that's sort of an independent thing on its own. Great. Okay. Anything else that needs to be on the agenda. Okay. And so news 2.321 has released with new table layout, very attractive it's looking really good actually. And a new plugin manager some private plugin manager layout improvements and fixes to a number of regressions that had crept in to 2.320. Thanks very much to Jan Farachik and to Tim Jacome for their work there and to Uli Hoffner. It's, it's, it's really pretty cool to see what's happening in in the Jenkins UI, the 2.319.1 release candidate has arrived. It needs deeper testing I think than usual because it's got six back ports that were six different porous changes that were back ported, and has some some thing major improvements like the inclusive naming changes that we've got to be sure we have a great guide and well described in the change log. Kathy Chan is a release lead this is her first time doing a release lead she is in the same team that works she works with Bea Munoz and in the phone so who have both been released leads before so she's got good mentors. And last news item the Jenkins infrastructure costs look good for being in within budget. Congratulations to Damien de Porto and the rest of the infrastructure team for bringing costs down significantly in the last month. Any questions on any of those news items. Okay, Gavin you want to give us a status report on the election. Sure, a status is it's ongoing. We debated whether how much information we want to share publicly but I think we can safely say we have about 40 or so we have about 50% of the registered voters, voters have now read. Let's try that again. 50% of the registered voters have now voted. So we, we still have another what two weeks for everyone to vote. So we should be nudging probably again remind people to vote. This year was there was a snag that we have you have to activate your email with Concordia for your PC reasons so just another, you don't get an email saying to vote until you do that. If you don't get, you don't get any if you hadn't done it before we started the election, you don't get an email saying to vote. So now but could can we, or could the election committee send email to the registered voters, I assume we've got that list what we don't have as we, we have no association to know which voters have actually voted. Yeah, I'm, I'm only peripherally on the election stuff so we can bring it up with Olivia, if you want. I'm not concerned the next meeting is two weeks away I can not jump, but I think we'll stick with traditional methods, I don't know. Yeah, so I'll, I'm going to certainly be actively encouraging people to vote that that I'm aware of where I know their email address looking at looking at their names on the voter list. Great. Yeah. If they get spanned and have already voted it's no harm. Yeah, they've already voted they can't take their votes back. Exactly. Anything else on election. No. Okay. So then, like anything else you need to share want to share on the repository ownership. Well, I don't have much to share. So there is a kind of abstract request is quite clear justification that in the event that current maintainers and things become unavailable. The Linux Foundation would like to have an opportunity to take over the repositories so that the projects could continue, which is generally a good safeguard. And that's what the Linux Foundation seems to do for all the projects. But your engine source are on board it wasn't done for Jenkins. And now it's a kind of reasonable question but we want to have such recovery plan B, especially since we have a lot of confidential information. Security fix some private repositories and Jenkins in front. And of course, if we give owner access to GitHub organization to account with unknown number of users having access to that. Basically it means that any of these users can potentially exploit our continuous delivery pipelines and release something just by direct push for example. So security wise there are concerns we need to figure out. And again, yeah brought it up with Tracy Miranda. We still don't have information how it would be implemented what is the expectation, etc. And why just eat how why don't we do the same for Docker how social media, or probably should do it, but there is no guidance for that. So this is just a topic that concerns me because I do not expect us to easily build a consensus on this topic. Once we have clear guidance, we will need to have a conversation about it. That makes sense. Thanks. Anything else on repository ownership before we go to the mailing list highlights. Okay. So we've had, we had discussions, I think I started the discussions roughly two weeks ago on the docs triage team. I was there when I talked to the docs office hours participants Monday, late, late Monday, they felt like hey let's go ahead and put them in the triage team, even if they don't have assigned continue assigned CLA, because the permissions are so light on the triage team, no real risk there and we hadn't previously mandated it. So we, in some future day promote them to become a copy editors then they must have a CLA. So, so it'd be good for us to get the easy CLA implemented but it's not a it's not an urgent or emergency kind of thing. Yeah. So, I should be able to enable easy CLA quickly. If we present with a grid plan that we just reach the current flow and basically easy CLA is enabled only for our facility repository. So basically, if you need to say I'm silly, you just submit a request today with your metadata and then the board requires you to sign. It's straightforward. If there is meeting that I can enable that. Great. And I think, I think we had plus ones all around for. Yes, it was okay to go ahead. Had it been discussed, I thought it had been discussed in the devilist. Do you feel like there needs to be more discussion or you're looking for more plus ones or Let's just. Okay, my to the list. Perfect. Great. All right. Next topic was end of life plan for Java eight Bolivia. Lami had noted that jetty 9.4. 9.4 will end of life in the next one to two years. And that's not exactly a surprise. Right right no shock at all right it's. It's, they've already got jetty 10 and jetty 11 so no, no surprise that they would eventually stop supporting 9.4. When that happens that would be very, very significant to Jenkins because it's, that's where when when stone depends on that right so and jetty 10. So the 11 do not support job eight. So there's there's definitely a sometime before jetty 9.4 and it reaches end of life. Jenkins should be stopping its support of Java eight. The question is when and what process discussions are happening. Okay. Also the question is whether we go straight to Java 70. Oh, so one of the options potentially. Yeah. For me what I mentioned that the minute is the reaction to questions, whether we explicitly deprecated Java eight. And whether we have support for it. And so the current warnings are not are not an official deprecation, but they are they are there are current warnings and so your notion, the question was, shall we explicitly declare Java eight is deprecated with some targeted end of life date. Maybe without targeted date. So some great spirit. So we can say that we declared deprecated in one year, we might remove it or might not. But you can say that for at least one year it will be supported in terms of security releases, etc. Plus, we still have a question whether we would like to allow plugin maintainers to release Java 11 plus only plugins. Because we have all the support inside the Jenkins core for that. We have all the support inside the update centers. We just need to make a call and allow to release Java 11 only plugins. But obviously for Java eight users, it will cause some destructions. Most likely they will be sharing non core tools, for example, plugin installation manager for sure. There will be other tools relying on data direction. So, before we do that action, I would rather prefer to have Java eight explicitly deprecated. Makes sense. Okay. But I don't have strong opinion when we should do this. Right. Good, good insight. So, and I don't I'm in terms of. Gavin, I think you highlighted for us in our last session. This section of this meeting is really noting things where the board does not define these things and is not necessarily responsible for them. The community will choose, choose that probably based on an eventual JEP proposing some some plan of action. So I think this is for our information. We should also do the road map, I believe. Oh, right. That makes sense. So that is something that we manage in the would be managed through the government's board. Good. Good point. Thanks. All right. Next topic on the was managing GitHub access through repository permissions updater and Gavin, do you want to give us a how that's going what your experience is etc. Yes, so prototyping is going decently. We can read all the teams relative to quickly I think we figured it was less than a minute to read all the teams and all the members. The next steps would be kind of defining a format. There's some debate right now, because the RPU was designed for one purpose and it's slowly migrating for another purpose and that means some of the schemes are a little scheme is a little bit confusing. I admittedly haven't worked on it in a couple days, but the next steps for me is to find an easy way to identify when a new users added so we can validate that new user instead of trying to validate all users. Maybe I don't know if I actually care. Okay, because it could be fast enough to validate all the users we don't care. So, research is coming along. I think it'd be a positive win. Yeah, thanks so I'm, I'm certainly interested in it. That I think it sounds very promising. Yeah. Any questions for Gavin on managing GitHub access or related to it. The biggest problem is edge cases because we have many repositories that include external collaborators. There are some repositories which have different permission model. Yeah, I kind of don't care about those. I'm only doing teams and all repositories have access or should have access by teams. So I'm not going to manage the individual repositories. I'm just going to be managing the team so that people get invited properly and everything like that. And teams are a lot easier to get data back out because any for we have a JSON file that lists every user and what teams what repository they have access to and amends just can't be listed there because technically they get returned for every repo. I think we should fix that by having a very concrete this team has this users, knowing and made or not admit these teams have these members so I think we're going to stick with teams. And then we don't have those nearly as many edge cases. And at least to start I don't intend to delete anyone from them. We're adding new ones, members, and then we can get a report of what you need to be deleted. I don't know if we have even the bot, I don't think the bot can remove members either. So, you know, at this point we can only add them. And then, you know, if that works well and smooth then we can start having it be the source of truth so the team members get added removed from this but that's a longer project. But I think doing as teams makes it very clean and neat. Last item was just a word of note that FOSDOM is going to be virtual this year so the FOSDOM conference in Brussels will happen in February. And Olivia Venane it's stated that he plans to assist with others and again having a CI CD dev room. Those are all the topics I had. Anything else we need to cover today. Yeah, I might have some topic for the next governance meeting. But yeah, right now I'm still a kind of onboarding ported when your job, you know, my personal stuff. Well, and thank you for being here, Evelina calling in from a hotel room in Oslo so thanks very much to everybody being here. The next meeting will be with the new board or does that we usually wait another week or two. The next week will be with results preview I guess. So effective date for the new board is December 3rd as listed. Okay. So basically we'll have board members elect or something like that. Because by this time the poll will be closed you'll get the immediate results. Though there will be some period where people basically can do last considerations. But yeah, taking the number of candidates, I don't think there is much things to consider. Cool. So next meeting won't be just like normal except we might have more people. Right. Hopefully we'll have more people. Hopefully we have every meeting we have more people so Exactly. So all right, you should just a topic list for this Jenkins for Jenkins 11. We skip Jenkins 6 and go straight to JN 11. To see what people say. I see what you're doing. All right. Well, then why don't we do with Jenkins 360. Okay, I'm going to take off then. Thanks everybody. Bye.


YouTube team keep it clean. What's going on? It's Aang Raven here with another video and in this video, the Baltimore Ravens are signing Demarcus Robinson. You know, he was actually somebody that I was wanting them to sign a little bit a couple of years back, but hey, better late than never, right? And with them signing Demarcus Robinson, what are they getting? He's a six one speed receiver. He's a yak guy. He's a playmaker. I mean, Ravens fans should definitely know about Demarcus Robinson from them chiefs games because he certainly made enough plays on us. But he was, he had been behind, obviously behind Tyree Kill, behind Travis Kelsey. I'm not sure where his spot was on the roster compared to like guys like Pringle and whatnot, but he was one of the chiefs supplemental wide receivers. I appreciate that Sarah Ellison brought up his stats for the past three years. 2021, last year he had 25 catches for 264 yards and three touchdowns. The previous year he had 45 receptions for 466 yards and three touchdowns. And then the year before that in 2019, he had 32 catches for 449 yards and four touchdowns. So nothing overwhelming, but he also wasn't a starter. What his role is gonna be with the Baltimore Ravens, I have no clue. I'm not mad at this signing. It's not a signing where it's like, all right, yep, that's the one that's taking us over the top, buddy. It ain't nothing like that, but it is still a decent move. Now, you know what I should have done? I should have actually looked to see why.  What I was getting ready to say is I wonder why he got cut from the Raiders. Cause obviously they got Devonte Adams. Obviously they got Hunter Renfrew. Obviously they got Darren Waller, but I wonder why he got cut from them. Cause I know they signed him, but I guess I'll look that up a bit later. But now with this DeMarcus Robinson signing, again, solid signing, solid signing. I ain't mad at the signing at all, but it just makes you think. It makes you think and it makes you wonder, okay, so what's really going on? And with them signing him, we should know over really the next 24 hours, maybe the next two hours, but definitely over the next 24 hours, the status of certain Ravens receivers. To me, this sounds like Tyler and Wallace may be going on injured reserve. That's what it sounds like to me, unfortunately. We'll see though. We'll see. Hopefully I end up being completely wrong in Tyler and Wallace. He can still salvage this season, but that's what it sounds like to me. Cause he got a knee injury and Tyler and Wallace has had leg injuries and knee injuries before. So it's just like, I don't know, man. James Pro Shae, what's going on with him? What's his status? Harbaugh gave us that infamous soft tissue injury and it's like, ooh, okay. Well, we heard that one before. He said, two weeks, we'll see. We gotta wait it out. Cause I don't know, man. I don't know. But this does give me a little bit of a concern for some of the guys that are on the roster already. But with Demarcus Robinson, it gives you somebody that can help out and can help out right away. Again, we talked about the speed factor. He does got a good amount of speed. He'll go up and get it too. He ain't afraid to go up.  So now it's gonna be up to him and Lamar to sort of just build that chemistry.  And where he would be on the depth chart. If I'm thinking about it right here, right now, especially given the injury situation, Rashad Bateman, I think he would be the opposite outside receiver. Opposite Rashad Bateman. James Pro Shae, Alpha now, Devon Duvenay, I figured like they may put him in a slave even though he ain't really shifty like that. DeMarcus Robinson, he got a little wiggle to him there. He got a little wiggle. So that's a good thing. But one of the things I really am looking forward to from the receiver room this year that can, it's small things that can make such a big difference. And DeMarcus Robinson, if he stays around and the Ravens keep him, he can add to this. And that's Yack. That's Yack. Yack can play such a big role in Raven's offense. In their passing game. Because it makes stuff easier, just obviously extends plays. It gets you closer to first downs and touchdowns. You accumulate more yards and it just helps move them chains. So many times over the years, we've seen where Ravens receiver will catch it and then there wouldn't be much Yack attached to it. And that's been an issue with the Ravens for a while now. But hopefully this year, this will be the year, hopefully, where that Yack, it just helps take the passing game to another level. Along with a lot of other stuff that we've been talking about today. Today been busy ain't it? Steve Young and RG3, then the Ravens like, you know what? That's been all that unofficial Raven though. Let's get to some official Raven though. Let's go ahead and bring in a wide receiver. But this continues to be the Ravens way. The Ravens way when it comes to a lot of wide receivers, it's really cast off guys. Guys that ended up, and I know a lot of Ravens fans were expecting something like this, because whenever we brought up the conversation about wide receiver, it was like, oh man, who are the Ravens gonna sign? Because they ain't trading for no premier guy. Okay, so that was out the window. So who they gonna sign? Julio had been out there for a while, then he just recently got picked up by the Bucks.  He not healthy yet, I don't think. There was T.Y. Hilton. Whenever I heard that, I was like, nope. There was Cole Beasley. Whenever I heard that, I was like, nope. And who else? There was Emmanuel Sanders and I was like, oh, that would be very Raven-esque for them to get somebody like Emmanuel Sanders. But this is just like that, because he, well, he's not old. With the Marcus Robinson, he was cut, he was cut from the Raiders for whatever reason. And you know what, let me see, let me see exactly how old he is. Okay, I know he not old. Oh, he 27. Wow. Ravens, you got your young one there, buddy. So it's some new territory for y'all, but because they had got Seth Roberts back in 2019. So, but yeah, this is a little out of the ordinary, man. And Sammy Watkins, even though he was young, like it felt like his body is like old and you feel for him, cause he was young. And his body just banged up a lot and he just, he couldn't hang, man. So poor guy, hopefully up there, hopefully that cold weather up in Green Bay, hopefully it helps. I don't know if it will, I don't know where to see. But yeah, man, this continues the Ravens, their strategy at the wide receiver position. Oh, somebody got cut. Okay. All right. And this year, this obviously, they ain't been worried about no compics. So that got thrown out the window a long time ago because none of the guys like that, none of their free agents qualified them for compics. So they, they wasn't worried about no compics this year. But I mean, hey, let's see, man, let's see. I, my expectations are not good.  I would love that. I would, I would love it. But I just expect him to be just a, in every once in a while, a playmaker. Now, if he could be, is a consistent playmaker, a, even better, if it can be some, every game, every two games or every other game, whatever it may, if he can be, could bring consistency, great. I'm with it all day. Because you can never have enough playmakers. And him, he had been so used to playing with Patrick Mahone.  Hey, Lamar Jackson, yes. Yeah, it's going to be a lot of that too. Just, just don't drop the ball. So different, so, oh my goodness. It's kind of painful when you think about it. It was so many plays over the years when Lamar Jackson, he does this and does that. Then he throws the ball and he, it's like, oh man, this is going to be something crazy. He do all this crazy stuff in the backfield. Then he throws the ball and then pulling it gets dropped.  So anyway, yeah, that's cool, man. I just, I'm just, I guess we'll just wait it out to see what happens with any of the Ravens, other receivers. And again, to me, it just, it makes it sound like something's going to go down with one of their receivers. Mainly I'm thinking Tyler Wallace, but I'm just, I don't know. It just, this is not a needle-moving wide receiver. It's not like, oh, okay, yeah, I'm cool with it. It's not needle-moving, but I mean, okay, cool, cool. Ravens wide receiver groups still got a whole lot to prove. They still got a whole lot to prove. So we'll just see how it goes. And then we roll with it, roll with the punches as they come. And let's see how these Ravens do, man. Super exciting year though, to be a Ravens fan. I mean, as is every year. But yeah, that's that. I love y'all team, keep it clean. I appreciate y'all. I know there's been an influx of videos today and it's just been, it's been a lot. It's been fun though, but it's been a lot of work.  Maybe it's finished downloading by now. We'll see, but I love y'all and I'm out. Y'all be good to yourself.


Hi, I'm Kuber Shirazi. I'm a program manager at Acquia. And I'm here at Drupal Camp London. And it's fifth year. And I am presenting this year again, which is awesome. So I'm doing a session on empathy-driven content strategy. So contents evolved. A lot of people within the community need to know where it's going. So we usually have our head down in delivery. Occasionally, we forget to inform our customers and clients and ourselves. In terms of how content development, content consumption has evolved. So I'll be sharing a few tools with the community that I've been researching over the years, including empathy maps, sentiment analysis, touch point analysis, emotional intelligence. And I want to briefly touch upon the topic of alternative facts. So this is my fifth year. It is Drupal Camps, London's fifth year as well. So this is my home camp. So I'm here year in, year out. I'd like to think of myself as part of the furniture here. It's the attraction for me of Drupal Camp London, really, is we are, obviously, London is the center of the US. And hence, everyone does aggregate to evolve around London. So for instance, today I've met community members from Egypt, India, Pakistan, Bangladesh, in London. And they've traveled from their respective countries to be here. So it's an amazing opportunity outside of conferences to meet and get the community's perspective, not just from Great Britain, but from across the world, from wherever people are from, mainland Europe, far, way, way, far further than mainland Europe. One of the exercises I'm doing, not running above, but it's a bit of an exercise. I've got a empathy map up on the wall, not too far from us where we are right now. And I'm trying to get the community's perspective on Drupal 8. So I've been asking community members from far, far places on what they're hearing in their ecosystems about Drupal 8, what they're observing, how's it making them think and feel, how's that impacting their behavior, how are they, in turn, impacting the behavior of their customers towards Drupal 8. So I'm quite excited to find out what I get at the end of the two days on the empathy map. Already there's some really interesting material there and the idea is to then open that up to the community and say, hey, we did this exercise in London and this is what the community thinks.