Okay, now I want to introduce you to today's presentation presenter is Stella Nikolai. Stella Nikolai is the mother of Helen Lohenstein, who worked as a midwife in Nottingham and coordinated an in-service midwifery training program in Liberia. A retired teacher, Stella's passion was embedding global and anti-racist perspectives in the national curriculum, and even in this context, she facilitated the training of both qualified and student teachers. Her interest in the international midwifery was kindled by Helen's tremendous enthusiasm for her work and their shared commitment to social justice. Following Helen's death, Stella co-founded HLMT together with Helen's close family and friends. It's welcome, Stella, and have a good presentation. Hi everybody, thank you Elisa for your introduction, very complimentary, and for all your help and support as we prepare to do this presentation together, and hello and welcome everybody to my presentation. As Elisa said, my name's Stella Nikolai. I'm one of the trustees of the Helen Lohenstein Memorial Trust. I'm Helen's mum, and the trust was set up in Helen's memory by her close family and friends after Helen died in December 2018. I'm going to tell you about the Helen Lohenstein Memorial Trust, which we refer to from now on as HLMT. What led to its founding, how HLMT works, and our plans for the future. I must emphasise from the outset that I don't have a background in midwifery. I was a primary school teacher, but I have learned a lot about midwifery issues since my daughter chose midwifery as her career. My presentation will include information about Helen and the reasons why her family and friends decided to set up HLMT and for choosing to focus on Liberia. It will describe how HLMT's aims link to the sustainable development goals to reduce maternal and neonatal mortality, and it will outline how we have funded our work, how we've built links in Liberia and used existing Liberian expertise to provide initial midwifery training to Liberian citizens, but at the same time ensuring that all our funds are used to achieve the best outcomes and ensuring our ongoing support in the future. HLMT's mission statement is really simple and straightforward. We aim to provide funding to enable aspiring midwives who wouldn't otherwise be able to meet the costs of training to achieve that ambition, and in doing so to contribute to the reduction in maternal and neonatal mortality in Liberia. As you will see, our work fits very well with this year's VIDM theme, birth equity for all. We've been very clear from the beginning that our funding would be used to train additional midwives, and in so doing it would help to increase the number of qualified midwives in Liberia. The Millennium Declaration which was signed in September 2000 led to the eight Millennium Development Goals, and that led to unprecedented efforts to meet the needs of the world's poorest countries. Worldwide maternal mortality declined significantly, and in sub-Saharan African countries it declined by almost 50%. The Millennium Development Goals were replaced by Sustainable Development Goals, a collection of 17 interlinked global goals which were set in 2015 by the United Nations General Assembly and intended to be achieved by the year 2030. Goal three is to ensure healthy lives and promote well-being for all at all ages with two specific targets that relate to the aims of HLMT to reduce both maternal and neonatal mortality. A description of the aims and activities of HLMT would not be complete without some information about Helen herself. Helen was born in Nottingham in 1983 and she grew up there and trained to be a midwife at the University of Nottingham. As a child there were family holidays in southern Africa including Zimbabwe and Botswana, and as a young adult she travelled to India and Morocco, Zambia, Malawi and Tanzania. These experiences all made a lasting impression on her and they were the spark that led to her passion and commitment to social justice. After qualifying Helen worked as a midwife at the Nottingham City Hospital which is part of the Nottingham University Hospital's National Health Service Trust. She eventually gained a position as a midwife in the Sanctuary Birth Centre there. The Sanctuary Birth Centre is midwife led. It specialises in promoting active natural childbirth and is committed to promoting normal birth and minimising intervention in the absence of complications. Helen's experience is travelling in economically developing countries in southern and east Africa coupled with her strong commitment to equality and social justice led her to volunteer with UK charity Life for African Mothers in Liberia. Two short visits to Liberia delivering in-service training to practicing midwives and birth attendants and she was then asked to lead a 12 month training programme across the country. During that year 375 Liberian midwives, birth attendants and ancillary staff attended a series of two-day in-service courses across Liberia. Helen's experiences during this time made a really strong impact on her as she witnessed at first hand both the need for training and the hunger and enthusiasm for training. In the very first training session she delivered she realised that not one participant knew how to resuscitate a newborn baby and in another session one of the midwives came with her baby breastfeeding as she participated in the training. Such was the commitment. In this picture Helen is training midwives in the use of the Partograph which none of them had ever seen but which is used routinely here in the UK. Sadly during her 12 months in Liberia Helen developed a medical condition which prevented her from returning there. She died in December 2018 leaving behind a legacy of almost 400 midwives and birth attendants who were better equipped to manage maternal care, labour and childbirths. Following her death Helen's family and friends decided to make a lasting testimony to her determination to create a fairer world where those who are disadvantaged are given opportunities usually only available to those with greater advantage. Whilst she was in Liberia Helen had discovered that the true ambition of the young woman who cooked and cleaned for Helen's programme was to be a nurse. However this was not possible for her simply because she could not afford to pay the fees required for the three-year training. Helen offered to pay her course fees and this young woman will actually qualify as a nurse later this year. Helen's action in response to the needs of this young woman became the catalyst for the founding of HLMT. We decided that we wanted to follow her example by setting up a charity whose aim would be to provide the funding to enable aspiring midwives who lacked the necessary funding to train in midwifery. HLMT became a UK registered charity on the 16th of January 2019. Some information now about Liberia and why support is so important in order to reduce maternal and neonatal mortality. Liberia is Africa's oldest republic. It's on the west coast of Africa. Liberia ranks ninth in the ranking of the poorest countries in the world using the United Nations Development Programmes human development reports. This ranks countries not just by their gross national income but also by other aspects like life expectancy at birth, expected years of schooling, mean years of schooling and their own human development index value. Liberia suffered from a series of civil wars over 14 years which devastated the economy and destroyed an estimated 95 percent of the country's healthcare facilities. An entire generation of children missed out on any education at all. After this Liberia was also hit hard by the West African Ebola epidemic of 2014 to 2016 which infected 10,675 Liberians and killed 4,809. The Ebola epidemic left Liberia's health system depleted of qualified staff and increasingly fragile. Many healthcare workers either died from Ebola or fled the country because of fear of infection. Liberia at the moment has a population of just over five million people but fewer than 200 fully qualified midwives and most of those qualified midwives work in urban areas not in rural areas. Ebola has had a lasting impact on the livelihoods of the survivors. The World Bank's most recent survey of the country in 2016 estimated that nearly 51 percent of the population were living below the poverty line. The average life expectancy there is only 63 years and this compares to 81 and a half years in the UK. There's poor access to clean running water 42.5 percent of Liberians have no access to protected wells and 23 percent of rural households rely totally on unprotected water. Poor nutrition has resulted in 35 and a half percent of children whose growth is stunted while malaria is a major killer of young children. 33 percent of females and 13 percent of males have never attended any school and gender inequality is widespread.  There's a lack of safe roads and of transportation and that makes it really difficult for pregnant women especially those who live in rural areas to access safe healthcare before, during and after labor. In the two years since HLMT was set up we've raised more than 60,000 pounds towards our initial target of 100,000 pounds through donations from individual friends, fundraising events including sponsored walks, concerts and making and selling cards and gifts using like traditional Liberian lapper fabric. Ultimately we aim to fund ongoing midwifery training from the interest earned from investments and in this way build a sustainable financial model. However because of the current uncertainty around investment due to COVID we've had to draw on the money we've raised in order to fund the cost of training students. Our priority since 2019 has always been that we should build relationships with appropriate Liberian agencies and to evaluate the quality of midwifery training provision in Liberia so that we would be able to select the most suitable training institute as a partner for the trust. With this objective one of our trustees Carol McCormick who is an experienced consultant midwife from Nottingham together with a friend who's a senior lecturer in midwifery from De Montfort University in Leicester traveled to Liberia on a fact-finding visit in January 2020 they got there just in time before the pandemic. Abdul Rahman Bah a former Liberian colleague and a very close friend of Helen who has a master's degree in public health from Nottingham Trent University organized meetings for them with the Ministry of Health, the British Ambassador, the Liberian Board for Nursing and Midwifery and also the representatives of several training institutes. This resulted in an agreement being made between HLMT and the Esther Bacon School of Nursing and Midwifery in Zorzor which is a remote rural area in the northeast of Liberia. Following due diligence by HLMT a memorandum of understanding was later signed between HLMT and the Esther Bacon School of Nursing and Midwifery. The memorandum of understanding commits HLMT to supporting two midwifery students through their three-year course starting in the current academic year and Esther Bacon School to providing regular monitoring reports about the progress being made by these students who have been funded by HLMT. The cost for each student is 3,084 US dollars and that includes the cost of essential equipment and uniform, their accommodation and their final registration fees. In December 2020 after long delays due to COVID-19 a very thorough entrance exam and interview process took place at the Esther Bacon School. The interview panel included Esther Bacon School teachers and Abdul Rahman Bah acting on behalf of HLMT to ensure that the chosen candidates matched HLMT criteria in addition to the criteria set by the Esther Bacon School. We were absolutely delighted that two students Aminata Suimani and Sua Valai were selected. Both Aminata age 29 and Sua age 19 impressed the interviewing panel with their high academic grades and their passion to become midwives. Aminata and Sua also met the HLMT criteria. They had the appropriate academic qualifications and they needed sponsorship in order to enroll on the three-year diploma in midwifery training course. Both these students have indicated desire once they qualify to pursue their careers in the rural areas where they grew up and where their families live. Ever since its inception HLMT trustees have sought to avoid a neocolonial approach and the imposition of unnecessary conditions or demands on its partners in Liberia. The trustees only need to be satisfied that the funds we provide are used genuinely to benefit additional individual students who meet HLMT criteria rather than being absorbed into the general funds of an institution and we also need to know that the institution provides qualifications recognised by the Liberian midwifery accrediting body the Liberian Board for Nursing and Midwifery. And as long as these conditions are satisfied HLMT doesn't want to influence the curriculum or the selection or assessment processes of the institution. Aminata and Sua, our two sponsored students, began their three-year studies in January this year and we've already received reports from the Esther Bacon School of Nursing and Midwifery indicating that they're both doing really well with their studies and that their midterm reports were really impressive. We'll receive further reports when the semester ends and then we'll receive feedback on their progress in the future on a regular basis. In addition to the agreement with the Esther Bacon School of Nursing and Midwifery HLMT has established positive working relationships with other key stakeholders in Liberia and these include the Liberian Ministry of Health, the Liberian Board for Nursing and Midwifery and the Liberian Midwifery Association. Looking to the future HLMT is exploring funding support from other UK charitable trusts as a way to increase our impact by enabling at least two more students to begin their training courses each year. On a personal note together with Helen's dad Pete we're hoping to make a personal visit to Liberia later this year. This is a trip that we had to delay in 2019 for medical reasons and then the trip was made impossible in 2020 due to the COVID pandemic. With Abdul Rahman Bar as our guide we hope to explore the country and meet Helen's friends there and hopefully we'll also meet the direct dress of the Esther Bacon School of Nursing and Midwifery and if the two students we've sponsored would like to meet us we'll be delighted to meet them too. This brings me to the end of my presentation today. Thank you for joining me and for listening and I'll be really happy to answer any of your questions about HLMT and about my presentation. Thanks very much. Thank you everybody so are there any questions in the paper? They're in the private public chat and thank you so much Stella That was a truly amazing and really powerful presentation and thank you so much for sharing that with us. Yeah I'm just looking to see if we do have any questions in the... I think we have some questions received in advance as well so I can deal with those if that's helpful. If you have any I'm sorry I'm just I think Elita is muted and I'm struggling to unmute her. I didn't want to put it back but yes I do have a question I will post it in chat as well. And the question is the mortality rates in Liberia are shocking is there anything we can do to help promote your work and increase the number of midwives being trained? The most obvious way to help us to increase the number of midwives being trained is to probably have a look at our website which is here on this slide hlmt.org.uk If you're in the UK then there are lots of ways there that immediately that you can help to support our work and that could include fundraising events. Lots of people have done various different fundraising events on our behalf they could be concerts they can be stalls where you sell things they can be selling food they can be a sponsored walk or a sponsored run or a sponsored bike ride or a sponsored anything. Silence would be a good one I remember Helen wants Helen herself once did a sponsored silence for 24 hours in order to raise money to go to Zambia to do a place a midwifery placement in Zambia one of the hardest things she ever did anybody that knows Helen would know that. So lots of ways that you can help to raise money and perhaps publicize the work that we do which would be great thank you. Thank you and okay Pipa says will the newly trained midwives be tempted to emigrate better salaries in the USA or Europe? I think that kind of thing is always a worry but in the case of these two midwives they one of the questions that they were asked was specifically whether they wanted to continue to live and work in Liberia. One of them actually has I think three children and her mum and they all live in that in that rural area close to where the Esther Bacon school is but they have both got families in that area and they're both very committed to working in particularly in a rural area rather than actually in the city. As I said earlier there are very few midwives in rural areas and they during their interviews they show tremendous commitment to trying to change that and make the kind of situation for women who are pregnant in those areas a much better and safer one. Are there any more? Sorry. Yes one more since we have time. Are there jobs in Liberia for midwives once you are trained? Aha there's a very interesting question you could ask that in this country actually because regularly our government successive governments have talked about increasing the number of midwives that are trained only to find that what they didn't do was increase the number of jobs that are available at the end of the training so it's you know it's not something that just applies to Liberia. In Liberia there is a new Bachelor of Science midwifery program and that is due to graduate 50 to 75 registered midwives each year and that ought to be helping to staff more than 700 different health facilities across the country. I'm assured by Abdul Rahman Bah who's our our main contact in Liberia that there are many many jobs in Liberia for midwives but one of the difficulties is that because and this applies to a lot of other very poor countries really in a lot of these countries midwifery and nursing is seen as a job which is something that you really care about and therefore it's not a proper job in a sense and very often people don't get paid the full amount for the work that they've done and that often applies in Liberia where many midwives who at the end of each month don't actually get in their pay packets what they're what they do so that's an ongoing problem. There are many NGOs that work in Liberia and some of those are also undertaking midwifery work so they actually have midwives what trained midwives working for them and and also some other charities who are they're not doing training but they're supporting traditional birth attendance in their work. One of the challenges there is that if the NGOs leave the country then those jobs will disappear as well but Abdul assures me that you know the plan is very much to increase the number of midwives particularly in the rural areas but of course all of us are having to face up to the consequences of the of the COVID pandemic and how that leaves any country across the world in terms of what they're able to do in recovery. Any more? Yeah actually yes it is actually related to this one then why is training more midwives going to have such a huge impact? Oh where do you start? Most maternal deaths are actually preventable and you only have to look at the statistics in in countries where their health services their infrastructure is well funded and where midwives are well trained so the healthcare solutions to prevent or manage complications are actually very well known but they're known often only to those midwives who are fully trained and I think at some point in my presentation I mentioned to you the fact that in one of the first workshops that Helen delivered she discovered that not one participant knew how to resuscitate a newly born baby. Now bearing in mind these were not trainee midwives these were practicing midwives and birth attendants and they really should have known how to do that and that's a fundamental skill that all midwives and birth attendants need to have. So if we train more midwives then obviously we're increasing the number of women who can have access to high quality care during their pregnancy, during their labour and following childbirth that also obviously will have a huge impact in the number of babies that die at birth or very soon after birth a well you know well managed birth pregnancy and labour and delivery will lead to you know women not dying in childbirth and their babies not dying in childbirth and women who are well informed well educated in the run-up to the birth of their children are also educated in things like basic hygiene and if good hygiene is practiced then that eliminates early infection and makes sure that the circumstances in which the babies are being brought up in those early months are clean and hygienic and safe anymore. And last one for me. Okay, why did you assess the bacon school to train your sponsor student midwives? Well I have to say that for that I have to give credit to our trustee Karen McCormick and her friend Maureen who went to Liberia on a fact finding visit at the beginning of last year because that was the bit that we were finding really really difficult you know for us to be here in Nottingham in England trying to make those contacts and really talk to people was very very difficult you send emails they get lost in you know they don't necessarily end up with the person that you needed to talk to that you needed to correspond with and so that visit to Liberia and the fact that Abdul Rahman Bah was there and he's familiar with the health service he worked as a pharmacist in the Ministry of Health himself and has also supported life for African mothers training in service training for midwives so he knows the system really really well and he was able to enable Carol McCormick to visit key people in the Ministry of Health key people in the Liberian Board for Nursing and Midwifery and the Liberian Midwives Association and talk to those people about which training facilities provided the best training and were actually registered with the Liberian Board of Midwifery and Nursing so that the qualifications that that the students would achieve at the end were the best possible ones and Esther Bacon was identified as one such place and I have to say that our dealings with them our negotiations with them have been absolutely brilliant and they totally understood the concept of additionality that we didn't want to just give them a sum of money to do whatever they wanted to do with we wanted to give them the money to pay for two additional students to become midwives via their training program so that's why we chose them


Good morning to everyone. My paper presentation is combined mammographic and sonographic evaluation of palpable breast masses. And my co-authors are Dr. Pradeep Kumar, M.D.R.D. Krukset and Dr. Panil Kumar, M.D.R.D. Krukset. Coming to introduction, breast cancer is the leading cause of non-preventable cancer death among the women, and the palpable mass in the women breast represents a potentially serious lesion and requires evaluation by history-taking, physical examination and mammography. Mammography is a well-defined and widely accepted technique to evaluate the clinically suspected breast regions and screening for breast cancer. In these patients, sonography is a useful adjuvant modality and helps in characterizing a mammographically detected palpable abnormality, especially in patients with dense breast. And the sensitivity and specificity of sonography and mammography is higher if sonography and mammography are combined. The aims and objectives are to evaluate the role of combined mammographic and sonographic imaging in patients with palpable abnormalities of breast and to provide the systematic and practical approach to imaging evaluation of palpable breast masses and then evaluate its image characteristics which helps in decision-making by clinician as to go for biopsy or lesion follow-up. The source of data is collected from the Department of Radiology-Sandhra Medical College, Nizal. Over a period of 18 months, 50 patients aged 30 or above with palpable abnormalities of breast underwent combined mammographic and sonographic evaluation. The inclusion criteria includes women with more than or equal to 30 years referred to the center with palpable abnormalities of breast and the exclusion criteria is women less than 30 years of age with palpable abnormalities of breast and the women with fungating mass per breast and mass adherent to chest wall where performing mammography was difficult. Mammography is performed with GE Sonograph 800 equipment and the sonography is performed with 70 megahertz transducer of senile strain. Coming to the results and analysis, there were 50 patients with palpable abnormalities of breast who underwent combined mammographic and sonographic evaluation. The palpable abnormalities were reported in 29 patients in right breast and 19 patients in left breast and two patients on both sides. This is a table one showing the age distribution of patients in the study group. Since the persons with palpable abnormalities were in the age group of 30 to 39 and 15 were 40 to 49 and 6 were 50 to 59 and 4 patients more than 60. The 33 palpable abnormalities are the palpable lungs and 6 show palpable thickening and 6 nodulity and 5 are non-stress life. And table 3 is the mammographic tissue density in the patient's study. 25% of the patients with palpable abnormalities show scattered fibrogramma density. 50 patients predominantly fatty paranormal density and the 3 palpable abnormalities were heterogeneously dense and the 2 were dense. This is a final assessment of a combined mammographic and sonographic evaluation of palpable abnormalities. The emerging findings were negative in 23 palpable abnormalities and benign in 20 palpable abnormalities and suspicious in 7 palpable abnormalities. Out of the 20 palpable abnormalities, 2 were well benesist, 4 were fibroadnomar, 2 were well deductive tissue and 1 fat microcosm and 1 fibrocystic disease. Table 6 is showing the sensitivity, the specificity caused to a negative predictive value. The sensitivity is 100%. Specificity is 84.3% and positive predictive value is 28.5% and negative is 100%. Out of the 20 palpable abnormalities were benign assessment and 12 benign lesions were visible on both mammography and sonography. 7 of the 20 benign lesions were mammographically occult and agenfitted sonographic evaluation. One lesion was sonographically occult and visualized on mammography. In 7 of the 50 cases the imaging evaluation resulted in suspicious assessment and all of this underwent biopsy and 2 were diagnosed having malignancy. 23 of the 50 palpable abnormalities have negative imaging assessment findings. Of these 9 patients underwent biopsy and have benign findings, the sensitivity and negative predictive value for combined mammographic and sonographic assessment is 100% and the specificity was 80.1%. This is a case showing a calcified non-lil consistent with fibroadnomar on mammography and this is the overall solid lesion with the posterior acoustic enhancement which is the case of fibroadnomar. This is a well-defined homogenous mass lesion on mammogram which is confirmed with sonography as benign cysts. Here we can see the speculated dense mass lesion in the retro-areolar region which is the malignant mass. Here we can see multiple well-defined mass lesions on mammography and now there is one of the same patients showing multiple cystic lesion which is consistent with fibrocystic disease. Here we can see the speculated mass lesion characterized as high probability of malignancy confirmed with biopsy as malignant mass. Here we can see the gene fibroadnomar. Discussion, breast carcinoma has been reported in 4% of the patients with breast symptoms and even among the palpable lesions undergoing biopsy. A large number of lesions turned out to be benign. The role of mammography in patients with palpable breast lumps is of benign cause of palpable abnormality and to avoid the further intervention to support the earlier intervention for a mass with malignant features screen the reminder of the ipsilateral and contralateral breast for original lesions and to assess the extent of malignancy when cancer is diagnosed. In this study, 20 of the 50 lesions were characterized as benign after a combined mammographic and sonographic evaluation clearly showing the value of imaging in helping avoid unnecessary biopsies. Sonography is complementary to mammography in patients with palpable abnormality. Its superiority over mammography in being able to show lesions substituted by dense breast tissue and characterizing the palpable lesions that were sonographically visible or affected. Mammography is complementary to sonography because of its ability to screen the reminder of the ipsilateral and contralateral breast for clinically occult lesions. It has been reported that accuracy of sonography is comparable with that of mammography as a spinning modality for breast cancer. However, the role of sonographic screening for additional lesions in symptomatic patients has been has not been recorded. Conclusion, the combined use of mammography and sonography plays an important role in management of palpable breast regions. The application sought characterizes palpable mass lesion, avoid unnecessary interventions in which imaging findings were unecohocally benign. The negative findings on combined mammographic and sonographic imaging have very high specificity and they are reassuring to the patient. And these are my following references. Thank you.


Hi, good morning and welcome to today's products and focus most global equity markets are substantially higher today Led by the American markets that reached an all-time high yesterday So many other markets are taking a little bit of solace from that and they moved that a little bit higher as well even though there's been a little bit of disappointing macroeconomic data at the US last night PMI again disappointed only just but still still a miss as we head into this week with the ECB meeting on the press conference on Thursday talk about their stimulus measures and of course non-farm payrolls on Friday We're a big figure. We'd obviously add a lot of weight to an early rate hike But nevertheless US market a great session yesterday and hit an all-time high as well So looking at the previous levels there that were broken if I just get my SR line right there You could be looking at a new potential Springboard in about 18 to 4 0 We already are seeing a slight little bit of drift this morning Germany market looking particularly strong on the back of Record highs in the US and obviously the rate cut we had in China over the weekend moving on to the UK 100 Resource-style stock given a bit of a late burst the UK 100 still ending and negative territory last night But looks to be that we're going to be re-challenging in 69 64 at some point today very volatile the UK 100 has been the last couple days drops in them and West Texas and Brent impacting BP and shell I haven't actually had an update yesterday, but that only happened later on in the session So we'll see how the UK market starts things off when we start taking So looking in Japan to do five we saw a bit of a resurgence in the Japanese yen last night That's caused a little bit of a move down by Japan to do five But you're looking at 186 48 is being that was a broken resistance now expected to act as a potential support level The other technicals are of course slightly overbought because the Japan to do five has been in a Two-month long rally going away from 16,000 above 18,000 so it's been a decent move to the upside right there So a little bit of pressure removed wouldn't be necessarily a bad thing for Japan to do five And as I said the yen has wrestled a little bit control off the US dollar after that disappointing PMI data yesterday So actually let's have a look at dollar yen right now Just look like it was going to break out a little bit higher Feel which break across 120 spot 46 any drift well one 19 has been something we've been talking about for quite some time I wouldn't be a massively surprised if we saw dollar yen move back into that area But obviously depends on a lot of the macro data not a huge amount today You've got domestic auto industry sales in the US fast forward on to Wednesday You've got a Chinese PMI German PMI your own PMI UK PMI retail sales ADP public payrolls and of course course cruel inventory So Wednesday you've got a whole raft of US and European focus data and now obviously Thursday the ECB press conference So a lot of fundamentals still to come so looking at West Texas crew just not really doing a huge amount pretty volatile Yes, they look at this doji formation right here. It's flattening out just now We could just begin to see moves around about this $50 level for quite some time Moving quickly on to gold gold very volatile again already this morning. It came off that a little bit more yesterday kind of I guess a lot of surprising on the back of the PMI the weakening PMI data some traders is really feeling that the Interest rate hike in the US is going to come sooner rather than later Obviously that initial spike that we had yesterday was in the back of the potential Chinese demand such a volatile start to the morning, but 1186 is the next potential support. So Depending on traders views as to interest rates in the US. That's gonna have a big impact on gold going forward. So moving on to your dollar Your dollars next potential support is one spot 11 effectively It's tried to push higher the last last two sessions yesterday in particular We're trying to move higher only to get pushed that little bit more as well So it looks at your dollars and really struggle That's even in the back of that kind of disappointing PMI figure from America. So finishing up with GBP USD Broken below one spot before 24 hugging 21 pure FMA This could be a trend line break, which would be very negative for cable actually that would open up one spot 51 85 That's a case you got a crossover in the MACD A crossover in the slow to cast it so from a technical perspective if we break below those moving averages Then that's that's that's not looking that tasty for GBP USD But we've not done it yet and those moving averages have got a history of providing some relative support and resistance So do bear that in mind So as ever keep your eye on the chart for make insights probably be late going forward and join me again tomorrow to find out What happened next?


alright welcome to today's stream give me a second I need to open the chat so I can see what you guys are guys and gals are saying let me put it up pop it out pop it pop lock it alright now it's on the screen let me prepare my cookie little Annie cookie it's called you got a good one today alright now yesterday hello fellow here is today's cookie perfect super good good stuff okay now let's start with today's problem what's it about you reach another volcanically active part of the cage let me just do a little bit alright it would be nice if you could do some kind of thermal imaging so you could tell ahead of time which case are too hot to save the enter fortunately the submarine seems to be equipped with thermal camera it's a very high-tech submarine when you activate you're greeted with congratulations on your purchase to activate the infrared thermal I want to know okay this is a classic okay apparently the elves never use this feature to use the price you manage to find the manual as you go through to open in the page one falls out it's a large sheet of transparent paper okay the transparent paper is marked with random dots and includes instructions on how to fold it your puzzle import for example okay this is gonna be some crazy stuff okay so 17 dots are visible okay also notes that some dots can end up overlapping this cost a dice okay so we have to fold did it do okay let's do this do okay new file example is our input okay so to parse the input I think we're gonna say read input file path to it's gonna be a pair of points data point type point x comma y no it's gonna be to end point eight comma in so okay we're gonna say a list of points let's just have it list of integers IO this of int comma int and then we get a fold along y equals and x equals let's actually look at the input let's just see what we can get for the puzzle we get a bunch of points and then fold along and then it's y x or y okay so we say okay let's do this data so okay data fold in stir equals a x int or y int now a parse import text dot parse x read p instance a read fold in stir where reads Prec read p to Prec parse where ours is going to be a read p fold in stir parse equals undefined okay so this is gonna be a list of points points and then a list of fold in stir okay so and so how do I parse a fold in stir well let me do read p to Prec what does this function do okay I don't care read p to s parse and we don't care about the first one and now this one is gonna be do we don't care about a string fold along okay and then we say so then we get the we have to try two of them so it's either gonna be y equals or x equals there's gonna be choice of the first one are gonna be do a string x equals and then a p so x over read s to p of read okay otherwise we do this one right off we're gonna be just like this so I will read a x and then it's an x or it's a string y equals and then y over read s to p read and that's how we parse a full instruction okay so now we want to so we just say data input and it's gonna be a list of points and it's gonna be a full list of fold instructions instance read input where parse reads correct we don't care about equal p to s parse where parse equals f type read p input now parse equals do so we are going to we are going to read the we're gonna say do many one so the points are gonna be many one of so how do we read a point well we we read an int right so many read p okay and let's say skip spaces read point is gonna be a right this is gonna be read int okay so read point just do a x read p char comma y read p return x come away so you say here read point and then we say let's just say input f map over this one combined with many one a read p read p to s and what doesn't it like this all right so this one has to be like this right all right it's the same here it's a read p all right this one is the wrong way around this is read s to p let's just do it like this read s to p a read there's some read under brackets here okay i think this should work uh might fail though let's see this one becomes um read input input becomes read input over f map read a file read file read input for example into a print let's try it probably gonna get the ambiguous parts no parts yeah as a gti day 30.hs so uh read well let's see uh read fold along x equals one x equals one and now this is how we did it let's see um what do we do then let's see fold along x equals one return x one two look at this one works this one works okay then we say um i'm cutting cooking my fault okay and then um why doesn't it want to read the next one why doesn't it want to read the hint am i doing wrong here we're still in the folding while we're still on the task one we're still on the parsing of the input it's not gonna be good today i think sorry guys let's at least do here let's see if we can work make this one the arriving show now let's see as a point what is going on today i just know i'm not it's just my some something that goes wrong here k munch true let's just do that i just want to see what what's left at this point okay so it's taking the uh string let's take the rest of the string now what do we do before we have a previous days right so read input we have that for all the days read p to ace reads preck delete this we just say it's the choice between these two what is the read end read as to p cd day 13 now read and why is the read ain't not working all right it's before right can this i don't understand anything here google it read as to p read that ain't oh my god i think it's reads okay that was a bit much okay and let's call this just parsing okay because it's the same here okay and at least we know we knew how to read the view so let's see here now let's sort back up here and just say call this parse point okay now this one's going to be a parse point okay so we say uh day 13.hs okay now uh bars point one comma two read p to s parse point apply this to the function one comma two okay and it parses let's say many one parse point we have this uh star bracket right something like this so how do i parse the input that's going to be do no points there's going to be many one a x comma y okay and now it's going to say many one parse point skip spaces a folds many one a fold insta s to p return input folds okay so what does it say now all right so it's fold instruction let's do it like this okay so we got the full instructions we just had to skip the spaces at the end okay great we're 30 minutes in and we've just managed to parse the input amazing anyway let's copy the input here okay so uh now there's a list of fold instructions okay so we have the top is a thousand transparent papers zero zero risk percentage top left coordinate first value x increases to the right so i'm going to increase each hour so coordinate three window okay where stars it out okay then there's a list of fold instructions these instructions in case i line will transfer you all the folder paper up for the left fold along y equals seven lines five vial positions where y is seven okay so so the x coordinates remain the same but i'm guessing it's like modulo seven okay so um apply insta fold insta just the points just the points apply insta so if it's it's if it's y and then we map a mod n it's not not okay all right we map it over the second so we do f map now let's see and let's do it do a input ps fs now print ps print fs now apply insta and then let's just do here the pattern let k okay f fs is equal to fs um that is fs prime so apply instructions f ps and we print this so we apply the first one and then uh so the six x so six ten it becomes so you want to see what zero so zero fourteen became zero zero yeah that was correct okay uh but so nine three which one is nine three one two three four five six seven eight nine three oh nine ten okay so nine those are fourteen nine ten okay that's this one i think one two three four five six seven eight nine zero one two three four five six seven eight nine ten so that's this one that one goes two nine three let's uh print the points or let's just see okay so for now only 17 points are visible okay so we do um well what if we do uh so we do set dot from list dollar set dot two no set dot two list set dot size of set dot from list now we have to report data dot set apply to this set dot from list set dot size we get 18 now only 17 dots are visible we should be getting 17 but we're getting 18 which ones uh disappear let's print print points to string okay now print points equals where uh equals map a maximum map s and d uh ps ps okay uh x max equals maximum map map fsd ps okay um and we do psp set equals set dot from list ps now we say uh so i would just map over the list um i think we do nothing x comma y and x from zero to five y from zero to five we zero zero one zero zero zero okay yep so we want to go map over x comma y so we're gonna have a string with the strings okay so we're gonna say for the uh y's in zero to y max this is gonna be the list uh x to x from zero to x max and the case here is going to be uh if x comma y set dot uh member p set then uh there should be a list of strings or it's actually a list of strings and then we just say let me say uh unlines okay let's print the first points uh print ps uh put stir ellen print points ps okay this is the first one let's print this one let's see how it can pass okay hashtag the first line is correct oh we're missing this one where are we missing this one that should be so this one which is a zero comma 13 where is it so uh let's sort the points okay zero comma 13 here becomes a what's a 13 mod what's 13 mod seven what's seven mod 13 though yes okay so uh okay we can't just take the modulus so you want a zero comma 30 so you want 13 to go to one how do you do that is it like minus 13 mod seven no that's minus six 13 mod minus seven how do we do the phone do you want zero 13 to go to zero one zero 14 to go to zero zero i mean zero six zero eight should go to zero six we want to find like the closest mode okay so okay let's just do it like this and apply instructions y and map f map moment okay so y and uh is this map f where uh f uh x comma y equals x comma and then uh f prime y f prime uh y equals so if if uh y so if it's less than n we want to if it's less than n then y else i think it's we do a so for seven we do let's do um n times two minus y then it's uh correct i think uh set dot size a f no links we get 17 okay let's do this no we're not gonna print the points it works for the example and uh we just do um so now we just care about the uh first fold and we're gonna say here uh fs f f underscore add and we say print set dot size apply in stir f ps now it's set dot from this to run this for the input non exhaustive patterns in apply in stir okay it's probably because the input has a x so for x it's the same right map f except we do f prime to x and then x if x less than equal to n then x else then minus two minus x we get 837 all right we got the first one whoop whoop now let's look at the second one page folding a paper according to the instructions the manual says the code is always eight capital letters okay um so yes nice so now we use the folder to apply all the fold instructions okay so we say uh fold r and uh no it's it's fold l right i think let's see yeah fold l fold left fold l um now it's fold r apply in stir fs ps right print points so fold r is a stir and then and now fold r takes an a and a b and a b oh yeah and we have to it's the points that we say fs i think it's because we keep saying that these are not functional things so he made the one that's literally a fold okay what does it do if you want an early example we get the zero now what do we get for the i think maybe our um wait so let's go over the input oh we get a lot of minuses that's not good why do they become minus and we've got the right amount of points but they all ended up being negative right like this okay we apply instruction ps all right i think it's because we didn't so for each of these we have to say set that to a list um set not for our list same as here it's not the a b s i think it's just we never we didn't remove the unique so we had some points left print p okay so when does this happen when does it become negative it becomes negative when um about nine times two mod then no there's nothing either it's uh it's just hard right because it works for the example i think i want the i don't want the um i think i want the distance of the point to the line i think that's the one that i want i think i want so minus n i think i just want the a b s of y minus n so okay so zero zero it's always good zero zero okay so i think it's the difference i think yeah this one is correct a b s y minus n why is this this shouldn't be so hard actually uh that's wrong okay so okay so if it's if it's uh less than n it should go to n that's for sure okay uh else it's the yeah it's the difference minus y i think so otherwise it's the difference from like twice of a b s n times two minus x everyone works what i don't get is that it says that it should be eight capital letters it's saying let's open out what do they mean by eight capital letters finish folding the transparent papers according to the instructions the manual says the code is always eight capital letters maybe if i change this to less than n maybe i just off by one or something that's still just random it's like it's not that we're getting the wrong i like i i don't even know what we're doing wrong maybe we're printing it out wrong it doesn't look like that has anyone done this do you know like we're supposed to read from the paper right that's like the final result here right okay so um so i i know what i what i'll do so for y of n i need to i need to figure out the max y okay that's going to be maximum of the second there's going to be ps maximum of the second of the ps now f is going to be a function we're going to say set to list set from list map f to the ps what's wrong with this one expected type okay max y maximum this is a list of points and max y is uh okay and then this one is comma y so if y is less than equal to n then we just return x comma y otherwise we do the uh otherwise it's the max y minus y the distance to the top modulus n x comma maximum map second right so max y is going to be on ps yes i think this is how we do it then we exchange y for x and then this one is going to be f x y then if x is less than equal to n and then x y otherwise it's a max x minus y minus x modulus n i'm just amazed that it kind of it's still it worked for the the previous one worked for the example okay now at least it's uh turning a lot fewer points applied to the example uh it's wrong on the example right so the so yeah okay so the sheet okay so we have so the sheet is marked with random dots and includes instructions how to fold it up your possible input first this is just in a transform point but that's your first value increases the right so i'm going to increase it on the corner three yeah corners in this example form of all our partner where x is a dot and paper and dot is an empty unmarked position then there's a list of fold instructions usually instructed okay i think i need to kind of compute the initial fold so apply instructions there's gonna be um you see what i mean like right because we might fold you know we might fall like not not at the edge right and then we might get something like this right so where the where the minimum one becomes the new maximum so we also have to fold the ones that are below okay so it's not okay for us to do and we can't do that we can't rely on max y either let's just focus on this one first okay so let's say we are folding like this so where does where does 0 0 end up if you know don't fold in the middle this case is not correct right but then we should have the negative amount right okay so i think it was correct before let's keep it like this i think it was correct when it was i think our first implementation of the fold was correct it's just that our printer doesn't know what to do so the printer has to find the x-men we go from x-men to then we print these points are we still doing it still correct here let's try changing the y's no like 0 0 will become 0 0 and then if we fold it like this whatever is here will become 0 0 right and then this one will become minus y something so it is i think it is correct to do it like this just that there's a lot of a lot of points like y for instance right so here but why don't we have any we don't have any star on this part right why is it showing up in the let's say normalize this point to list of points normalize ps equals so we do x-men we do y-men equals to minimum map s and d ps and we do uh right to x plus x-men y plus y-men i don't think this should matter at all but what's happening now min e me xm equals is if x-men less than equal to 0 then 0 else a b s x-men i am prime if y-men less than 0 then 0 xm let's see this doesn't make there's something something very weird that i'm missing here so here okay xm if x-men less than equal to 0 then 0 oh if this should be larger than equal to 0 then 0 let me look at the out okay now these are all positive points right like missing i'm just not getting it this is the first time i'm just not getting it and now it's no longer given 17 for the example that's because we did it twice right print because like i'm saying it because it it works for the example right so we do put strln apply in str fps right and then maybe i'm kind of losing the empty part of the sheet of course like at the end none none of them okay so this is a instance of like how to mirror yeah i mean that's the thing right if i fold the paper like this and i fold it like not at the half some of them will end up on the other side right so they will be negative right so i think it's they should end it and negative are you have you done this to me because like uh we're just we're stuck okay so all of the positions where y is 7 this is an instance of reflection mirror line measure from point to the mirror line measure the same distance against on the other side and place a dot then connect the new dot so when the mirror line is the x-axis when there was a y-axis yeah i think that's also what we should be getting okay um well let's see here um this is it's going to be one f okay and it's going to take an int to let's take some int and int to an int f so mirror mirror n x equals undefined okay so if it's for the axis then we say where axis we do unsip a ps unsip ps so x is a comma ys so if it's the axis then we map mirror n over the axis sip wise same for the ys except then it's the axis sip with map mirror n ys now how do we mirror across a a point across a line what's happening nothing happening let me sec so how do we mirror uh across a line just type it up now i have to write some things okay and okay now we just have a unit interval your coordinate is defined by mirroring over the unit interval okay so i have um x and i have how am i supposed to mirror it okay so first of all we only mirror those that are on the other side of the line right i think that we have to do that case x less than equal to n equals x so if it's on the line or if it's um if it's if it's not on the line yeah this is what i have but it it is wrong it gives me the wrong result let's do the back then minus x i mean what i do is i run it it works for the example and then i run for the input and it just returns a lot of garbage output and it doesn't work at all and i'm getting a lot of negatives right so like what is it saying like okay if i so i think maybe it's just the instructions that are unclear okay so if i fold it like this does this become the new zero and does that mean that the new fold instruction is relative to this new zero and not to the old zero maybe that's just it okay then i just do um let's see no it works for the example let me see that's what tim thinks it is i'm implying it in the wrong order okay whoo fold along y equals seven and then fold along x equals five okay and then the input says fold along x and fold along where okay maybe if i okay yeah so it's not the wrong order it's uh yeah i was using the wrong fold right so it says fold left and then it works okay cool so it says e p said g k c h u e p said g k e p e p said g said g k c h u okay we have to wait 36 seconds okay yeah it's very annoying that they have the wrong order in the example and it just works right at least we don't have to normalize we don't have to find the x min and y min yeah i think it's yeah so initially we were like oh we should use the fold l because it says fold left but i didn't think of uh that it could be the yeah we'd but obviously yeah that's how it does it if you fold in the wrong direction they are uh the operations get applied in the opposite order okay we learned our lesson but it was getting very frustrating right for a while there all right but yeah because i thought the mirror was wrong somehow and i kept focusing on that all right let's say git status git at day 13.hs input example okay that was very frustrating and i didn't think of all let's try the different order so thank you to me again for saving us a lot of frustration again yeah i don't know this is also like one of those i don't know like last year i felt it was more um kind of you had to you had to do it get the computation correct like the data structures and stuff but now it's just like here you know it's just you don't do anything right i mean there's no okay i mean we we parsed right but like this was the solution okay there's no kind of awe we have to be very careful with how we compute things so it it's fast right it's just now it's all about figure out what to do so we're not really being we're not able to show off you know what what what we're good at and whatnot but okay thank you for coming today i'm gonna relax i've been working all day see you again tomorrow seven o'clock and enjoy


During an Instagram live stream representative Alexandria Ocasio-Cortez Powerfully tore into the Republican lawmakers who have basically enabled this president Who are abdicating their responsibility to invoke the 25th amendment and remove him and Everything that she says here. She just she puts it perfectly. It's concise. It's eloquent and This is what someone in power has been needing to say and the way that she says this It really is that just perfect. So this is relatively long It's a five-minute clip, but it's worth every single second and I want everyone to hear this because what she says I Think this is this is really really crucial and I truly believe that we're gonna look back at this moment as a Turning point in US history. Take a look. We know that Donald Trump cannot be president We know that we cannot wait until January 19th We cannot wait until January 20th. We cannot wait until inauguration day. He cannot be president Right now He should not have been president yesterday. He should not have been president the night of the attack Because Republicans and the people around him are cowards They will not do it the president's cabinet You have secretary Elaine Chao who is the wife of Mitch McConnell by the way seems Does that seem a little conflict of interest inappropriate?   Yes, then you were a part of it You don't get to allow for an attack that kills five people and Then afterwards you say I wasn't a part of it.  You were a part of it. Those five people's blood is on your hands What are you going to do and they think that?  It is always on them They are forever stained with the deaths of five people Especially when they did not invoke the 25th amendment to remove this president when they had the power to do so cowards cowards Couldn't even stand up in the memory of these officers that they pretend to care about That they pretend to care about I don't want to hear or see the Republican Party Talk about blue lives ever again. This was never about safety for them.    They lust for power more than they care about democracy That's what those people did when they voted to Overturn the results of our free and fair elections and you can barely call them that with the amount of voter suppression That they have engaged in across the country. It is generous to say the least to call them that and So with all of the rules rigged in their favor The Electoral College is built on a compromise with slavers The Senate is rigged in their favor Jerry Mander districts are rigged in the Republicans fever This presidency and the law breaking and the pardons of people who have betrayed our country all of it Rigged in their favor and they can't even win with the whole deck stacked with them They can't even win with the deck stacked in their favor And so what they were willing to do is set a match and light our entire democracy on fire So that they can so that they can uphold the social order of white supremacy. That's what this is about straight up This is about thinking That if an election doesn't reinforce your power Then you believe it is fundamentally illegitimate and why do you think it's illegitimate? And how do you try to delegitimize our elections by saying black people shouldn't vote? by saying Latino people shouldn't be full u.s. Citizens By saying by trying to take away the take away strip citizenship away from people who already have it Not even we're not even getting to the denial of Citizenship a full civic personhood that this party engages in we're talking about them tying trying to strip the citizenship away from non anybody who isn't them anybody and That's what this is about. That was incredible. I don't have much to say like I don't think that my commentary Supplementing what she said is even meaningful at this point everything. She said was absolutely on point You know the Trump era is coming to an end and it may be coming to an end sooner than I thought like I had previously Believed that even if Trump is out of office, you know Trump in politics is still gonna be a thing He's still gonna have influence within the Republican Party, but I think that this this event The January 6th coup attempt, you know, it may have accelerated the demise of the Trump era in American politics And what's gonna happen after we leave the Trump era is there's gonna be a lot of Republican politicians Who are going to do in about faith? They're gonna try to pretend as if they didn't have any role. I mean, they're already Scattering like cockroaches Betsy Divas Elaine Chao Chad Wolf They were there, you know all along As she said when kids were getting locked in cages Chad Wolf was allowing Donald Trump To be an authoritarian he enabled it to very directly. He was complicit while Trump was sending, you know unmarked vehicles to abduct people in Portland, Oregon all of the things that Trump did they enabled and now they think that because they're resigning because they're jumping ship at the very last moment Well, you know, they'll they'll be okay And they may not necessarily be wrong because what we've seen is that whenever you come from the Trump administration No matter how egregious your actions were in enabling Donald Trump and the damage that you caused directly so long as you speak out Against Donald Trump. You get welcomed to the resistance with open arms. I mean we see John Bolton who Constantly agitated in Trump's administration tried to go Trump into war with Iran and immediately like he gets welcomed He publishes a book profits off of his time in the Trump administration when folks like that should be marginalized Folks like Anthony scaramushi should not be brought on MSNBC and CNN. You wanted to work for this fascist So all the things that you're saying about Donald Trump now that's so terrible Well, it wasn't terrible enough for you to Not want to take a job Seems like you're an opportunist seems like these folks are grifters and we shouldn't actually take them seriously and anyone who worked for Donald Trump and enabled Donald Trump should be permanently marginalized Not be welcomed in politics in political discussions because these folks are traders Especially now like if you sat by while the president literally lied about this election and Got his cult following to believe that the election was stolen stolen if you like stood by During those times to the very end. I mean what is a matter? You're jumping ship at the last minute. Come on. Come on So, you know, I can expect folks like Betsy DeVos and Chad Wolf to have their own little autobiographies about my time working for Donald Trump and they're gonna have some tea and You know mainstream media is gonna eat it up for clicks it's gonna be sensationalist stories and Everyone is going to forget the role that these folks played in aiding and abetting a fascist But I want you to be smarter than that what AOC is doing here is letting them know that they're never going to escape culpability the blood is Directly on their hands and not just the blood of the five folks who died on the day of the siege on the Capitol But all of the blood that Trump has caused His drone strikes that he ramped up in Afghanistan The children in cages the families that were separated everything that Donald Trump has done It should be a stain on their legacy forever and you know Even though mainstream media is going to forget and Rehabilitate these goals we should never ever let these folks live it down and constantly remind everyone that these are not Allies these are not American patriots.


6 things narcissists do when you go no contact.     You have to preserve everything that makes you who you are but when you do this there are certain things that the narcissists will do. One, they will go back to the love bombing phase. When the narcissists first targeted you, they love bombed you because that's what pulls you in, that's what secures you so they go back to that again because they're assuming that it's going to keep you around since that's what got you with them in the first place. So they will try to rekindle the relationship. They will try to make you have feelings that you had in the past. They will try to charm you again. They will do whatever worked for them before.   If the love bombing doesn't work, they will become very obsessive. The messages and phone calls will become more persistent and they will become more pervasive.  Three, they will start a smear campaign. They will talk about you to other people. They will smear your name. They will assassinate your character. They will say horrible things about you. They will make false accusations. They will spread rumors. They will discredit you because they want to prevent your occurrence. They want to remove you from consideration. They want to deny you access to a place, group or privilege. They want to isolate you. They want to punish you for going no contact with them.  So you're the one who has to pay the price for your decision because now everyone is going to be against you. Everyone is going to think you're crazy. Everyone is going to think you're bad or you're the narcissist. It's divide and conquer. They make people disagree with you so that you will not join together against them. It's how they maintain their control over you. Narcissistic rage. When you go no contact with a narcissist, it will cause a narcissistic injury which will be followed by narcissistic rage. They will be very angry. They will try to force you to do what they want. They will make excessive demands. They will try to control you because they're trying to intimidate you. They're trying to punish you. They're stunted at the emotional development of a two-year-old child.   They know they're losing control of you. So this is how you know that they're losing their grip and this is when things will start to get better for you because narcissists are at their worst just before they give up. 5. They give up. Eventually the narcissist will give up. They won't know what to do. They won't know what to think about the situation. They will no longer be able to uphold their grandiose covenant image. So they will withdraw because they have a very fragile ego. They see the world as a place where they have to survive. So they're constantly in survival mode. But sometimes they just give up. They stop trying. And when that happens, you won't hear from them because they don't want you to know about it. They don't want you to see it. They don't want you to have the last laugh. So they stay ghost. They stay hidden. 6. New supply. At some point they're going to look for new supply. They can't live without it. It sustains them. But it won't always be a relationship partner. It could be a friend or family member. Someone they're using as their emotional tampon. Someone that they can vent to. Because they have all of this emotional baggage. And it's too much for them to carry. And you're not willing to hear about it anymore. So they have no choice but to find someone else. Someone who is going to listen to all of their problems. Someone who is going to believe all of their lies. That's the only way that they can feel sane. They need people to validate the illusions of their false self. Thank you for watching. I hope this video resonated with you. Please like, comment, share and subscribe. If you would like to donate, my PayPal link is in the video description. You can email me at coaching.artfivert.uk Thank you for watching and I'll talk to you soon.


Hello everybody, Andrew Maeski here with Dental Tutoring. So are you a new dental hygienist or a new dental assistant? You might be thinking, oh, I am so new. I don't know how to get started, but how can I act with patients so they don't necessarily know that I'm brand new and I'm nervous. So how to appear confident when you might not be? And honestly, you guys, this is a normal, you know, nervous thinking to have. Okay, we have all been there. We have all done that. When I became a dental assistant, I started working right away, actually. I was very nervous because I had never been in a dental office before, like on the back end. And when you're in school and you go through internships, well, you do learn it hopefully a lot there too. And that did help me a ton, but I still was not very confident at all because how can I be? But how can you act confident? Okay, there's a couple of things that just simply helps. Okay, keep in mind, people understand, not patients, but you know, dentists, staff understand you are new. They are assuming you will be nervous, but it's worse to act nervous. It is worse to just keep on saying, I'm new, I'm new, I'm new, I'm nervous. Don't say things like that, okay? Act confident because you should be. You know, I mean, maybe not confident because that can take time, right? But you have been through so much. Either dental assisting, dental hygiene, it doesn't matter, you have been through so much. You have seen patients. Now it's time to do what you're made to do. It took me probably two weeks to feel comfortable, I must say, but it can take me longer to feel comfortable if I'm doing something for the first time because I personally don't like change. But it took me two weeks, even for assisting too, to just feel comfortable that, okay, patients don't necessarily know that I'm new. I am acting as if I've been here forever. That's what they want to do. So rule number one is don't say I'm so nervous. Don't say I'm new. Don't say this is my first day. Don't say anything like that.  How long have you been here? And you don't want to lie and say, oh, I've been here for like 10 years. Kind of change the subject. That's what I would do. And say, oh, I don't think I've seen you here either. I'm typically here Mondays, Tuesdays, and Thursdays. So that's probably why I haven't seen you before. If for some reason they're like, oh, well, are you new here? Say yes, I'm new here, but I have two years of dental experience, depending on how long it took you to go through school. That's true, right? When I took dental assisting, it took me a year. Well, actually it took me 11 months, but I would just tell people a year for dental hygiene in total since I took the program twice. Yes, I took the dental hygiene program twice because the first time I took the program, my school shut down. We were three weeks away from graduating, but that's another video for another day, but that took me about four years. So even if I've been to an office for the first time and even thinking, okay, what would I say if I was brand new? I would say, but I have two years dental experience. I have four years dental experience, but yes, I am new here. It is so nice to meet you. I hope to see you again, something like that, right? I still get that a lot when I still work in a dental office because I'm Tuesdays and Thursdays in one place and Friday's another place. Oh, are you new here? And I go, oh, wow, well, thank you. Well, I have 14 years experience, almost 15, but I don't know, I don't think I've seen you before because just so you know, some patients can be quite rude if I can say that. Not a lot of them, like maybe 2% of them, so that's not a lot, but some patients can be quite rude, like, oh, I don't want somebody new that has happened to me probably once or twice. But usually patients just want to know, like, oh, have you been here before? I haven't seen you. Oh, are you the dental assistant? Are you the dental hygienist? You know, because people just don't know. But that's one way to act confident. Don't hesitate to ask questions ever to the staff, but don't ask so many questions where you're annoying. I was with the dental assistant ones where she was assisting the dentist and she would literally ask questions about everything, like, oh, why are you using that instrument? In school, we use this one.  I've never seen this material before. Can you talk about it a little bit? That's too many questions. There's no harm asking questions like, oh, I'm not sure where that is. Let me go get somebody to help me. Or do you know where that is? Or if you don't, just get somebody to help. You know, that's okay. Or after the patient has left, don't hesitate to ask. Like, oh, was there anything that I could have done better? Or, well, you know, even then, I don't like saying that because it kind of implies you did something wrong, which maybe you didn't.  Hope that was okay with you. Thank you for your patience. Would you like another assistant to kind of help me for the next procedure so I don't slow you down too much? I'm still learning. Something like that.  If you're a dental hygienist, it's a little bit different because you're typically on your own, which is awesome. But if you have questions, you might not have anybody to ask. If you go ask up at the front desk, they'll probably have no idea because they're never in the back. If you try to look for an assistant, depending on how many assistants there are, you might not be able to, you know, speak to one. Because if you have a dental assistant who's working with a patient, don't go in there and say, I have a question. Can you help me with one thing? Don't do that. You just kind of have to roll with the punches. But hopefully that day, if it's your first day, whoever's showing you around will let you know who you can go to to ask questions because you will have questions. When I used to temp as a dental hygienist, I would always have questions because you don't know where things are. You don't know a little bit of everything, right? Like, oh, where's your medium-sized gloves? Because I see extra small here, but the dentist says that he needs medium, you know? Like who's, you need to know who you can go to for questions. Charting's the tricky one. For dental assistants and dental hygienists. For dental assistants, hopefully the dentist is doing the charting for you, but you might be in charge of doing the charting for them. So always check those previous entries and see sort of similar procedures to know how they want you to write things down. That's the best thing to do. Like let's say you're assisting with a 3-6 MO composite. Look previously in that chart to see when was the last time they did a composite. Look to see sort of how they wrote things down and then if you can copy and paste into the computer, do that. If it's on paper, just keep kind of going back and seeing how they wrote things down. And in this case, if you don't know Ask, because if you're writing in a chart, you have to be precise, right? It's okay to get something wrong because you can always add it later, but it's still if you're not sure Ask. For dental hygienists, kind of the same thing. Look in previous charts to see sort of how they wrote things down because every office is different. I would say for dental hygienists, booking the next appointment or knowing what to book is the hardest thing if you haven't seen the patient before. Because even if you're coming every three months, well, that's a pretty good indication. You will want them back in three months, but the patient might try to confuse you and say things like, oh, I'm pretty sure I come every nine months. And then you're thinking, okay, the chart says three months. The computer says nine months. Well, what is it? Is it three or nine months? You can't ask the patient. So when you wanna come in, you should know at that point. But I kind of have another video for knowing the appointment intervals too because that was the hardest thing for me to learn as a dental hygienist just because you don't learn that in school per se. You kind of learn it as you go along. But honestly, you guys, it takes time. Don't expect to be perfect because you won't be perfect, but it does help to act confident because you want patients to see you are confident. Staff will think you're pretty amazing if you're new and you act confident. Even if you make two mistakes, three mistakes, eight mistakes, it will happen because you are new, but always act confident. Learn from things you are doing wrong if you don't know ask. Don't ask too many questions, but if you don't ask anything when you should, that's not a good thing either. So just kind of think about things like that. But if you guys need help with something, comment below if you're kind of worried about something and then I can tell you guys how to work through it so you don't have to worry because people know you are new. They will totally understand. It's nice to bring somebody new into the office because then they can kind of train you how they want. It would be hard for me to go into an office and have them train me how they want because I'm set in my ways. After 14, 15 years, we are set in our ways. If they kind of tell us to do something differently, we would do it, but we won't like it. So it's just so much nicer to bring in somebody new. So this is awesome, you guys. Let me know though, comment if you need help with something else. Thank you guys for watching and good luck. You will do amazing.


So we're here with Libralato, and who are you? I'm Dan Harris, I'm the Managing Director. The engine was invented by Regera Libralato, it's an Italian, it's a UK company. This is a next generation rotary engine. It solves the problems of the vanquil rotary engine because it has long escape path, non-contact sealing surfaces. It has a very high compression ratio and it has an even higher expansion ratio on this side. It makes it about as efficient as a diesel engine using gasoline, but it's half the size and weight with very low emissions. It's an enabling technology for plugging hybrid electric vehicles, which can drive pure electric in the city with zero emissions and use the engine for high speed, long distance on the motorway. It means we can make electrified vehicles cost competitive without subsidy, reducing fuel consumption by about 70%. But this is for gasoline. It's a gasoline engine, but it's about as efficient as a diesel engine, but without the emissions. But it's still gasoline, right? It is using gasoline, but if you have a vehicle that drives 50% electric and 50% on the engine, when the engine is operating at high efficiency and with regenerative braking, you still reduce the fuel consumption by 70%. And that's cost competitive with conventional vehicles, actually cheaper than diesel vehicles. So what are you showing here on the wall? The background is showing you how you can use the engine as a plug-in hybrid electric vehicle. This is the testing that we've done previously that shows that the engine is about as efficient as a diesel engine using gasoline. And over here, we show how you can use a 48-volt system, which is a relatively low-power system, but it's very low-cost to drive the vehicle in congested urban traffic in a very low-cost way, which is cost competitive with conventional vehicles. Is this on the market? No, we're working with the UK Proving Factory and some other partners to get the engine into production. We think it will take about five years, hopefully a bit less. We've got some demonstration vehicles in the meantime, and hopefully we will connect with larger car companies to get the engine into mass production. So how many percent of cars should be using this? Well, we think that all cars should be able to drive electric in the town, in the city, and use a high-efficiency, low-emission engine for the motorway. An engine like this, hopefully it could be maybe five percent of all cars. So basically every hybrid should be getting your system in there? Well, our big vision about the future of mobility is that the most cost-effective way is for the average car to be able to drive electric in the town, in the urban cycle, and use the engine for higher speed and longer distance, and that makes electrified vehicles cost competitive without subsidy.