Welcome to the this week's edition of our noon interdisciplinary conference, and it is an honor for me to introduce our speaker today who is well known to many of us here at the University of Chicago. Dr Monica peak is the LNH block professor of health justice at the University of Chicago and also an associate director of the McLean Center. Dr peak is a graduate of Johns Hopkins medical school and completed residency at Stanford has been on the faculty now for how many years Monica I've lost track a while, a while. So, Dr peaks research pursues health equity and social justice with a focus on promoting equitable doctor patient relationships among racial minorities integrating the medical and social needs of patients and addressing health care discrimination and structural racism that impact health outcomes, specifically for example diabetes and COVID-19. Dr peak has authored over 150 here reviewed papers has served as principal investigator for multiple grants from institutions such as NID DK NHL BI PCORI AHR Q and the Robert Wood Johnson Foundation along with Greenwall Foundation, the Merck Foundation, among others. In addition to being the associate director of the McLean Center, Dr peak is associate director of the Chicago Center for diabetes translational research, the executive medical director of community health innovation. And she is a senior associate editor for the journal health services research and a member of the National Academy of Medicine. So today by Dr peak will speak on clinical medical ethics and human rights. Welcome Monica. Super excited to be here. Thank you all for coming out with it being like three degrees. So, so yeah today I'm hoping that we can have a bit of a discussion if possible so I'm going to talk, but I'm I've thrown a couple of slides with some questions that hopefully we can either address in real time and then I have them sort of again at the end and I'm technically challenged so we'll see how this goes. I'm supposed to lean into the microphone also already getting challenged. So simple. Okay, um, so just always like to start by giving a thank you to all the places I sit on campus. But today I am also representing physicians for human rights. So that's an organization for the past year. I've been on the board of directors and previous to that I was on the physician advisory council. And so I say that because for all for lots of reasons, one of which many of the slides have come from Michelle Heisler, who is the current medical director Michelle is like one of us.  And like myself a lot of her work had previously been in diabetes but she'd always had a passion for human rights particularly international human rights and so she still works at the University of Michigan, but spends a lot of her time in New York City. I'm being the medical director for physicians for human rights. And so she's brought some of her friends to be on the board, which even though it's a physicians for human rights organization because a lot of our work has to do with legal issues. Many of our board members are lawyers and our current chair is a lawyer and also has a PhD. And I also just wanted to give a shout out to Dr. Robert Lawrence, who is one of the founding members is currently a board member emeritus and a past board chair and I met him. I think in like night before 2000, many years ago. And he's just been so generous with his time such a dedicated servant to social justice, and it's really been an honor to work with him. Again. All right, let's see here. So today is my roadmap. I'm going to talk briefly about clinical medical ethics, because you guys are here so I have to elaborate on that health and human rights physicians and human rights, and then sort of walk through for sort of case studies about some of the work that was done. And then have us think together about the implications for what we as clinical medical ethicists might do what our role might be, etc. So you'll sort of see what I'm talking about. All right, so I always have these slides of my talks just to reorient myself and everyone else who might be watching or listening, which hopefully is all of you. So clinical medical ethics is a medical field that helps patients, families and health professionals reach good clinical decisions by taking into account the medical details of the situation, the patient's personal preferences, values, socio economic considerations and ethical concerns. It examines practical ethical concerns that arise routinely and encounters among patients, families, healthcare professionals and healthcare institutions. There are four key ethical principles that have beneficence. So, you know, doing good, maximizing a patient's well well being in health, non maleficence. Do no harm, reducing or avoiding patient harm autonomy respecting our respect for patients ability to make decisions for themselves, and then justice. And we sort of define that in ethics as ensuring fairness. And so we'll talk a bit about what that might look like. So then thinking about human rights.   And there's a range of fundamental protections, the right to life, the right to be free from torture and ill treatment. Some of these are positive rights, so the right to necessary that are necessary for a dignified life like health, housing education. And some of them have been sort of codified into laws or covenants or treaties conventions etc. So then they can become can become enforceable or there's some accountable agency or body. And there are connections between health and human rights. And so this is sort of a been diagram, because some human rights may have a direct implication for your health. I'd say almost all of them do, but some may have less of a direct impact on your health. So what is unique in our role as physicians, because a lot of people who think about human rights aren't physicians. Many of them are lawyers are social scientists are, you know, case workers. Just many people come to the field of human rights who aren't physicians. So what do we have that is unique to offer. And so a lot of times we have a different kind of moral high ground or ethical high ground that we can sit upon which is why I'm talking about it here in this context. But we also are trained as clinicians and so we actually have skills and tools that can be applied to patients in need whose health has been harmed. So we have the clinical expertise and the use of scientific evidence to document violations of human rights and their health effects. And so many of you may think of physicians for human rights and like, oh, that's the group that does like physician asylum cases a lot. And I actually spent a good bit of my time consider my life as many of you might sort of pre children and post children so much. Or when I had free time and when I no longer have free time. And so pre kids, I did a lot of human rights asylum cases for pH are before I sort of joined officially as the organization and leadership. We have the perception of having objectivity rigor and credibility. Our profession is guided by professional ethical obligations. We have specific training to assess and a seek to assess and seek methods to alleviate pain and suffering. We're often at the front lines where we can witness health harms from violations, particularly free are working in urgent or emergent care situations. And if we have chosen to volunteer to travel abroad and work, particularly in areas of conflict or war, or just in areas that are in natural disasters areas just need because of structural violence. You know, an absence of a lot of infrastructure. And, you know, some of the things that I was just mentioning the right to water, you know, clean water housing, etc, where there may be less of that. And we actually don't even have to leave the country to experience those things we have those conditions in this country. But every country has a tendency to not really have the ability to look internally to look fully at itself and see our own limitations. We like to go abroad and see other people's limitations. And so, so many of the challenges that we can more clearly see in other countries we have right here at home that we could be addressing. What do you have as physicians the influence and reputation of being the good doctor. And the internet we have the international language of, you know, Dr. speak, which is its own language and communication, and then we have an international community that can be mobilized we're using the same skills and tools and actually just last week or two weeks I had an email from our Dean Vinnie Aurora, someone had reached out to her from Stanford, and someone had reached out to him from an area of conflict in the world. And so they were friends, he knew Vinnie, and he said I'm assuming you know Monica peak, because she's on the board of phr. I'm trying to get a message from this person around the world. And so we're an international small community, and that's uniquely connected. So physicians for human rights, we work at the intersection of medicine, science. That's blocked over there to and justice as a secure human rights and justice for all. So we were founded in 1986 by a group of physicians. And this guy here is Bob Lawrence, the one over here to my point my ability. I'm geographically challenges guy in the corner. So he was I wanted again the founding member. So health professionals with their specialized skills their ethical duties and credible voices, who have been uniquely positioned to stop human rights violations. And it really, really has been an honor this past year to move to the board of directors and see firsthand the reports as they're about to be launched, the amount of work that has gone into them, and to sometimes be involved in them before and just the magnitude, the dedication. It's really it's been crazy. It's incredible, the amount of work that we're doing and how effective we've been able to be in lots of spaces and places. So we work to investigate and document the health effects of human rights violations to amplify the voices of survivors and witnesses, and to provide evidence to ensure that perpetrators are held accountable. We collaborate with hundreds of partners around the world, we could not do the work without lots of places on the ground, people whose lives are literally at stake. And we have had multiple times when there were people who were conferencing in. And I'm just going to just say this upfront anyone who see me talk. There's a 75% chance you've seen me start crying. It's like my feelings are just like always right here. So that probably what I'm realizing I'm about to have that happen right now and I'm just like getting started. So just a heads up warning. But many times we've had people who have conferenced in, and they have been in secret locations where they could not even tell us where they were, because their life would be harmed in harm's way. But they were doing such important work that it was critical that they still be involved in documenting the things that were happening. And so we are privileged to be sort of a large national and international banner. But there's absolutely no way that we could do our work without people who have literally sacrificed their lives to make sure that the work is done. So we have lots of sort of key issue areas. And the methods that we use to defend and document human rights and I list them here because these are things that are skills that you may think I have these skills. Medical assessments. I can read x rays and I can review medical records. I know how to do cross sectional population based surveys and do systematic reviews. These are not things that are unfamiliar to anyone in this audience. They're the bread and butter of clinicians of clinician investigators. You know, they're, they're what we do. It's why Michelle who is basically my clone, as far as her skill set is the medical director of PHR. And so I say this to encourage all of us, you know, who are ethicists. So that's an extra level of training to consider expanding how you see yourself as an ethicist in the world into the world of human rights. So this is again, sort of our, our, the categories of work that we that we do a role of documenting torture and ill treatment. I'm supporting claims for political asylum, a role in providing medical care for all without discrimination and the role in documenting attacks on health care workers and health systems and a role for health professionals and documenting finding what's what we call dual loyalty. And so that maybe obviously may not we're going to have two of our case studies going to be in that space. These are obviously not mutually exclusive categories. And so some of our cases are, are in two categories and we'll talk about those. So we're going to jump right in. So, I bring this up because many people. And that's how I had always thought about it is that think about human rights violations as things that primarily happen in international countries, other places. And certainly that changed with Guantanamo. So generally we think about all of these horrors is not really happening here in the US. So we had a report that came out within the past year about not within the past year, obviously because Trump's president. So, like my sense of time is all fluid. But I said the past year because I want them the board of directors of past year within the past several years. And we were still under the Trump administration. So I was on an advisory board then about people who are being separated at the border. And so, HR analyzed 31 medical legal affidavits of parents and children up to a year after experiencing their separation. And all continue to show symptoms of PTSD, depression and or anxiety, stemming from that single traumatic episode of the forcible separation. In all of the cases, the governments, our government's actions met the legal standards for torture. So discriminatory actions that cost severe pain and suffering with the intent to punish, coerce and intimidate asylum seekers to give up their claims to and to defer future asylum seekers. So one person said every night I would go to bed alone, I was sad, and I would cry to myself. And this was a six year old girl from Guatemala who said she felt abandoned after being separated from her mother. So this is just a picture of a shelter for migrants in Tijuana, Mexico. And so in this case, all of the asylum seekers interviewed described gratuitously cruel, gratuitously cruel and inhumane treatment at the hands of the US government, including physical and verbal abuse by US officials in humane detention conditions, active deception about their expulsion and whereabouts of their family members and whereabouts of their family members active deception and unsafe returns that put people at heightened risk of harm. So putting purposely returning people into harm's way when they know when they have just divulged where harm's way is. And so this was a report in July of 2021, neither safety nor health. So how the title 42 expulsions harm health and violate rights. The use of clinical and health knowledge to document and denounce poor health conditions in US immigration detention centers so praying for hand soap and masks. So just how few there were in the detention centers and how that contributed to the spread of COVID during the pandemic. And so this was just a panel.  Just about lots of different things, COVID sparrows, etc. And this is one of the panels that they had about COVID in detention conditions. And we know that congregate living is a huge risk factor for the spread of COVID. And in our country, we tended to prioritize the elderly who were also at high risk. But the elderly living in nursing homes or other kinds of congregate living. And we had a really difficult time thinking about people who were in jails or prisons or detention centers because of our country's inability to put public health and public risk ahead of our social commitment to thinking about worthiness and punishment. And so many, despite recommendations, many people who are in congregate living and who should have gotten vaccinated did not. Many people who are in congregate living did not receive appropriate masking and the rates of death within prisons and jails was exorbitantly high. And there, I'm not sure if anybody saw pictures of their signs that people had on the outside of their jail cells like we're dying in here, please let us live, you know, etc. And then there was a study by a former medical student here about the impact of jail cycling on COVID in our communities here in Chicago where people were the over policing in our community was leading to people getting arrested, but not on things that would lead them to be arrested and kept in jail for a long period of time or in prison just temporarily for like things like protesting Black Lives Matter. So they would be arrested, their masks were taken away, they would be exposed to COVID, they'd be released into the neighborhood, COVID would spread. And so the magnitude of the effect size of that jail recycling was a larger contributor to COVID disparities than almost any of the other disparities that were being measured here in our city in Cook County jail. Immigration detention, these kinds of things. So what is our role as clinicians? Do we provide substandard medical care and be complicit within these systems? Do we just refuse to participate unless the standards are improved? And this is this kind of question are ones that have been analogous throughout history for physicians.   Or do we say no, we're not going to participate at all until there's no system? You know, you can't do this because you clearly don't know what you're doing unless you're doing, you know, things differently. And so that's that's a question I want to throw out to the group. What is our role as clinical medical ethicists? And so when I say that I sort of think institutionally because, you know, seeing patients, how do our roles change from just merely a provider of care? And how do we interpret beneficence and non-maleficence for patients in this situation where you're trying to do no harm or maximize patient benefit for people who are in detention centers? And that sort of is getting back to that same question I was just asking. And does patient autonomy even exist for people who are living in these conditions? And then what is our role as global ethicists? And meaning that is clinical medical ethics something that we even do outside of our institution? Is that something only for patients for whom we have direct clinical care? I would say obviously not, but it's something that I want us to challenge ourselves to think about. So next I'm going to talk about attacks on the role in documenting attacks on health care workers and systems. And I'm going to use Ukraine because we published a study on that report on that about almost exactly a year ago. And that was looking at the attacks that had happened over a period of a year. And so it was about the start of the war for a year. And this was research that was done in collaboration with a number of other organizations. And these were some of the people that were in hiding when they were coming to meetings or would be on TV, but from undisclosed locations, etc. They were just incredibly, incredibly brave people. And so for that first year, well, up until like the end of December of 2022, these were the number of healthcare facilities and attacks that were taking place in that country. And so it's the attacks on healthcare were a daily feature during the first weeks of the full scale Russian invasion of Ukraine. And for 35 days, healthcare was attacked every single day between February 24th and the end of December, which is where I showed you that map. There was an average of more than two attacks on healthcare each day. So they were really trying to cripple the healthcare system. And so that was one of the strategies of war, the active strategies of war. And so these are just some scenes that some of the hospital workers and medical personnel took. And so obviously the tax diminished diminished access to care reduced vaccinations rate back and vaccination rates were in the middle of the pandemic when this was occurring, diminished the ability to monitor to manage chronic disease and increased financial barriers. As of December of 2022. So right before the report came out almost one fifth of Ukraine's population reported insufficient access to healthcare services and medication. Obviously the war is still ongoing. These numbers have only worsened. And so one of the things that PHR with has been trying to do, and particularly with the report was to try and make the case at the Hague for accountability for war crimes and crimes against humanity. Using the international criminal court, Ukrainian criminal law, universal jurisdiction, and the UN independent international commission of inquiry. So using multiple different legal mechanisms around the world, but to try and make this case. And so in addition to the report to being, you know, on multiple, multiple media venues. Michelle as an clinician investigator has also been really instrumental in tapping into the medical literature. And so this is an editorial in the BMJ. So things in JAMA, the Lancet and the Lancet has always been much more progressive and sort of thinking about sociopolitical factors that impact health. And so it's been great partners. I will say that there has been a lot of controversy about what's happening in Gaza. And so I'll just note that on October 13th, PHR made a statement about the attacks by Hamas. And in October 17th, it made a statement about the impact of what was happening on the devastating hospital strikes. And so while I'm not allowed to sort of comment on current ongoing things that we're doing until they're, you know, published, I will say that we believe that war and victims of war, that war is a public health issue, and that victims of war are our people that deserve medical attention. So war and conflict, what is our role as clinicians, when and how do we decide to provide humanitarian medical aid to victims of international war. What is our role as clinical medical ethics, as ethicists institutionally, do we have one for war that's outside of our US borders. And then what are our role as global ethicists. What are the opportunities to use our skills as ethicists health services researchers and thought leaders to impact the global narrative that's that happens and, you know, there's war raging the time across the globe. All the time. So then I'm going to talk about two cases of dual loyalty, and I use these because they're ones where we have been doing work here at home, which is really important for lots of reasons, but also to highlight that mirror for our ability to take a deeper look at ourselves. Right. And to see what is happening here at home, and not just always be the warrior abroad. So, what is dual loyalty. It's when health professionals find their obligations to their patients, or what we owe to our patients and direct conflict with their obligations to a third party that holds authority over them. So your boss. So, here, even though I didn't talk about it in that way, because I said, you know, that their multis are not mutually exclusive categories, but the challenges of providing for health professionals and providing care to immigration detainees. So the first case or situation involves dual loyalty, and also the provision of medical care for all without discrimination. I'm going to let you guys ponder what I'm getting ready to talk about. So it's the excited delirium and police deaths or deaths in police custody. Raise your hand if you've heard of the term excited delirium. Okay, so you held your hand the longest. I know you're like me, what. Why did your eyebrows go up in shock and horror. Do you want to, and you don't have to, because I just appreciate you volunteering to like, yeah. But if you feel comfortable. Do you want to share what excited delirium means or what you've heard about it. And you can, you can check your head now. So I'm going to say what I thought I heard you say, and you nod your head if that was correct, that there's sort of an autonomic hyper reactivity, sort of delirium that can lead to death in circumstances that might otherwise not. And that there's some controversy around it. And maybe something else. Okay, that is exactly right. And it sounds kind of nutty because it is nutty. But it's the I so.  So these are people who were claimed to have died from excited delirium. And the ultimate finding from our report was that it's not a valid independent medical or psychiatric diagnosis and should be not should not be used as a cause of death. So, what methods did pHR use in sort of making this determination. Ones that we all have, we reviewed the literature, we read, you know, documents and we interviewed people. Right. These are not things that you all are unfamiliar with. So the origins of excited delirium just sound too ridiculous to be true but they are. They started in 1990, where the Miami Herald had whether there's some deaths of black women. And when we think about the intersectionality, which is people who have multiple marginalized social identities, the more that you have the higher your risk of poor health and you know being pushed to the, you know, the most extreme margins where society cares the least about you and is willing to come up with all these reasons why somehow you're to blame for these bad things happening to you, rather than structural things being in play.  So rather than saying maybe they're being murdered. Like, no, that can't be happening.  And so they're saying for some reason the male of the species, as though black people are different species, become psychotic, some reason. The female species dies in relation to sex. So the autopsy so these are forensic pathologists have conclusively shown that these women were not murdered 70% of people dying of coke induced delirium are black males, even though most users are white says the deputy chief medical examiner, why it may be genetic. So the, the hypothesis was that people were taking cocaine and getting so delirious that they would just spontaneously die. And that the women, when they had sex, while they were having cocaine with spontaneously die for genetic reasons, of course. So, so this was like okay this theory was was starting to make its way around. Then there was a book published called the excited delirium syndrome, and then taser bought 1000 copies of that book and start distributing it to forensic pathologists. And then scoring the ethical harms of the mismatch of getting into bed with industry, and in what that can possibly mean. And then as a sort of takes off. And in 2009, there's a white paper that was published by the American College of emergency physicians. And it's the consensus of the task force that excited delirium is the unique syndrome, which may be identified by the presence of a distinctive group of clinical and behavioral characteristics that can be recognized in the pre mortem state. Excited delirium while potentially fatal may be amenable to early therapeutic intervention in some cases. So then it becomes medicalized. It's used and diagnosed almost exclusively by police in the pre mortem state. That means during police custody. And they'll say that this man has excited delirium. What he's doing is fighting for his life. But because he's resisting. He's delirious. And we have to apply more force to suppress him. And that happened to many black men and police custody. It happened to George Floyd. And it happened to others. But during that time of 2020 was a time of racial reckoning around state based violence. And a lot of publicity around that. And people like what exactly is this excited delirium business. What's what's going on with that. People start asking questions. And so this delirium is frequently asserted as a as a defense by police officers who kill people during the course of restraint. But it can't be disentangled from its racist and unscientific origins. Yes, state medical examiners have listed this as a cause of death. And police have been exonerated on this diagnosis. In June of 2021, the American Medical Association, which just has this horrible history as we all know, but they have been like coming into, you know, the real world, right. So they've had a lot of good people join their team. They have been trying to do right for a while now, you know, I've joined the AMA again. So they officially announced a policy that opposed excited delirium as a diagnosis, the ACEP in 2021, put out a white paper. And then in case you missed it in 2023 said just to say again, retracting that statement from 2009. And our report, you know, came out. And this was just in October. When I was in DC, we found out that the governor and California banned excited delirium as a cause of death. And you all can say this, this makes no sense at all. It is now against the law in the state of California for people to use excited delirium. And they attribute or that they comment about the American Medical Association and the first person they quote is Dr. Heisler, our medical director, who is one of us from phr. So state based violence. And that is what police killings are, or state based violence. What is our role as clinicians. And then particularly in the setting of this strange history that started in the 80s hasn't really ended but is starting to unravel. How routinely of excited delirium, how routinely do we challenge diagnosis from other specialties that we may not be fully aware of few people in the room had even heard of excited delirium. I hadn't heard of it until I helped with the report to come out.  I guess that's probably the point is these patients would have died in the ER or died in police custody I probably this why I never see that. But a bit just in general, you know, how often if, you know, if we have heard a term. It's something that has been diagnosed in another specialty. Would we say, Oh, that's, that's the realm of that specialty. I'm not quite sure I know what that is, but they're the experts. I'm going to take that, and just add it to my list of diagnoses, as opposed to saying, that sounds strange. Like, what happened here, maybe I shouldn't use my own investigation. Yeah, so that's one thing I challenge us all to do. How do we provide care for patients that are incarcerated. Thank you Megan. What is our role as clinical medical ethics, at this point say ethics, ethicists. How do we bring in and validate the historical and contextual experience of patients lives into the clinical encounter. How do we do that in a way because so often we people are telling us what has happened. But we have some official record from the ambulance driver there may be a police report as to what actually happened there may be some other something transfer document something that's the real story. We may invalidate what patients are trying to tell us. How do we learn to listen to what people are trying to tell us the state based violence that has been happening. Has been happening. For decades for hundreds of years. What is different now is that we all have cell phones. And we were able to document that. But black people have been saying this, all of this time. All of this time, and police have been saying, no, no, no, I saw a gun. He was coming at me. There's a reason that I was frightened, but he has 3000 bullets in his body, you know, there are 10 police and turns out he just had a butter knife. I was so frightened, you know, like the stories have frequently not made sense. But we've made them make sense to us. As we have not valued the lived experience and the, and the words of marginalized people who are coming in and telling us something compared to the powerful words and stories of those who have more power. How do we learn to engage in a way that's more meaningful. When we're sharing in decisions. Which parties are we sharing in. How do we bring in the ethical principle of justice. And how are we defining justice in this in this way. We think about our role as global ethicists. How have we, because everyone has been woke, although now we're like, oh, should we be both to black lives matter. After this, right.  But have we actively been involved in efforts to change the circumstances in which we have, you know, see black people getting killed every every day and it's like no, no, it's just not even noteworthy here about it on the news. Have we been involved in social justice movements that challenge state violence against the black community. And the last one is sort of an alignment between dual loyalty and attacks on health care workers and systems, although I'm not going to talk about the health care worker attacks. I don't have any slides about it, but we know this to be true. And that has to do with providers of abortion care. So, this is an issue that is here in our country that we have taken on as a human rights issue. Following the United States Supreme Court decision in Dobbs versus Jackson women's health organization in June of 22 people in the US who can become pregnant are facing an unprecedented human rights crisis. In Dobbs the Supreme Court overturned the constitutionally protected right to access abortion, leaving the question of whether and how to regulate abortion to individual states. Approximately 22 million women and girls reproductive age in the US. The number has risen now live in states where abortion access is heavily restricted and often totally accessible. And then this briefing details the intense fine human rights emergency caused by this decision discusses ways that Dobbs contravenes the US international rights human human rights obligations. There's also a study. It says embargo embargo but it's not. This was out last year called no one could say where members of phr called around in Oklahoma, which already is a desert for gyn care. And was asking, could anybody tell them what the policies were for accessing emergency obstetric care, you know what the rules were in light of Dobbs, like, you know, nobody could really say. That's why they titled it. Well, you know, they were getting referred to other people. I think it might be this but I'm not sure.  I think it's a large state had a had a firm grasp on how this decision would be impacting their providers. Yet, there are laws in place that made this illegal. What are providers and patients to do many providers in states like that pack their bags and left, which meant that patients who are not even thinking about. Obstetric care don't have the women's health care they need. And many there's that there are providers who lived in surrounding states, but would go in to provide care just because it was, you know, healthcare shortage area. And so we are, you know, creating deficits for everyone. In sort of the short side of policy to keep some people from having access to certain kinds of women's health care. So criminal, the criminalization of abortion creates a dual loyalty challenge by preventing clinicians from meeting their professional obligations. You know, this, you know, I have this for my patient that I need to treat. I have professional standards, but then the law says, I could go to jail. You know, I could lose my license. In some places, you know, neighbors, I mean, so great neighbors could file suit and start arresting. It's the nuttiest thing. And so what are we to do. So Louisiana, so I hail from the south for better or worse. If you know me, I've probably hugged you and that's good. That's because I'm from the south. But, you know, the south is just known for all for mainly bad things. So Louisiana has the highest rate of maternal mortality amongst all the states, more than 58 deaths per 100,000 live births. And black women account for 39% of the women who gave birth in 2019, but 70% of maternal deaths, four times more likely than their white counterparts to experience pregnancy related death.  So I'm 54, you know, and so. But that, you know, it used to be a horrible world for women who had to make very difficult choices and many of them died. And that we're slowly turning back so many freedoms for people who don't have power, including women and racially minoritized people and immigrants, new arrivals, and I'm frightened for her and what her future looks like. So what is our role as clinicians here in Illinois? We have this little Oasis. How do we best support patients as Illinois increasingly becomes, you know, an Oasis for reproductive rights for women. Are we going to consider providing telehealth for out of state women. We had a lot of policies in place for us to do telehealth for our patients who lived out of state during the pandemic. And some of those restrictions were tightened back up. You know, what are we going to be thinking about trying to do for this emergency. For non-gynecologist like myself, how do we best support our gynecology colleagues.  For oncologists whose patients may be undergoing chemotherapy and get pregnant, you know, oncology is not just an old person's field, as far as patients. Everyone has some stake in the abortion situation, not just the providers who have to provide the abortions. But the brunt of the burden is on those colleagues. How do we work together to support them? What is our role as clinical medical ethicists? How does this ruling change perceptions about what's best for patients? How do we do no harm for patients? Clinically, socially, you know, there are some patients in some areas that are afraid to even tell their doctors that they're trying to get pregnant. Because what if that is in the chart and something happens later, they come to the emergency room, their family's with them.  How do physicians ourselves introduce into these decision-making equation about what to do for abortion? Previously, it's been all about the patient's well-being. Now we have to think about our own well-being. Am I going to get sued? Am I going to jail? Lose my license? Never seen my kids again? Like, when did that come into play? It's in play now. What are, again, the strategies in our toolkit to help shape the national narrative, the national policy to address some of these issues? So that's all I have. The same thanks again to all of the people who make this work possible. And then I have those, these sort of four case bullets again. What time is it, Peter? Okay, so I wanted to, like, not just have these be theoretical questions, but actually have us discuss them if we, and so we have 30 minutes when we have four. Which, well, do I want to do first? Or you can be like, you know what, it's cold outside and I don't feel like talking. Can we break it one? And that answers yes all such. Megan? Yes. Right. Exactly. Exactly. So I'm just going to summarize that. I missed Grand Rounds yesterday because I was on a campus elsewhere. And so, Harold Pollock was chastised for not repeating the audience things. You know, there's a lot of dead air in there. And I was like, okay, so note to self. So Megan's comment was that to horribly try and summarize just the idea of the moral injury involved when you try to think about withholding care for the best outcome. If you're only doing it by yourself or with a group, because there's usually some sort of work around of a group of physicians that will take on that job. And particularly because it is frequently institutionalized where the healthcare institution has decided to take on that job. And so then you're not just sort of freelancing but you're reporting directly to your boss who is saying we're going to do this work. And so it brings in additional challenges. And so, Matt Winnie, who works, used to work for the AMA used to be here faculty here he's now out in Colorado, had written a piece around reproductive health and it was suggesting that we all as physicians should like band together and say, you know, we are basically going to have like a moral protest together. And we're not going to abide by these federal laws, because they can't send us all to jail.   And that's a challenge, because it is so easy to isolate us. And particularly like I said when there's one profession that is disproportionately bearing the brunt of it. Peter you had a comment. Yeah, thanks. Absolutely. Many of these slides come from a talk that Michelle gave to medical students. And I was like I was saying in my pre Children Day. I did a fair number of asylum cases that came through Chicago. And even though the cases were so black in my in my mind. What I'm doing is like, his story sounds horrible. He's got all these cars here on his body. That appears to be from, you know, like a cigarette burn just I'm just describing what this person is telling me and what I'm seeing as a doctor he's missing a leg. You know, the, the vaginal parts have been sewn together from, you know, like all this stuff, but having a physician document that, or be willing to show up in court. makes such a huge difference in whether or not that case is going to go forward or not. And I'm like, anybody can read and look and see I'm not doing it. I'm not using special advanced medical skills. You know, but the weight of just having an MD say that, say what any normal person on the street would say carries so much weight. I think this one, all of these are things everyone in the room already has skills doing, you know how to read, you know, you know how to do whatever. And so volunteering to do any of this work. You know, you don't necessarily have to ride an op ed, but so much work is needed to be done. And, you know, Michelle does a lot of her work with medical school medical student volunteers. If anyone, you know, wants to volunteer and do any of this, you know, work interviewing people like all this stuff is just work that needs to be done. You know, anybody can do it.  And so you don't have to be a human rights expert to be able to make contributions you don't have to be a world renowned ethicist to make contributions, and that's the point of this is that we already have the skills, we already have the skills. We just need to want to do it. Any other comments. Answers to any of these questions questions out there to the audience like have have you all as clinicians come across cases that weren't sort of more clearly within the clinical medical ethics box that we normally think about things that may be more like this. And it have you. And what, and what have you done with that. What do you think about that. Are you like, Oh, that's not my, you know, like, or, or do you try and squeeze it into the, what, what, I'm just curious people's experiences. The question is, can undergraduates help with some of this work. I believe so. Because, you know, medical students. They're not doctors. I mean, no offense into anybody who's listening or in the room. I mean, so, you know, and many of them don't have clinical experience. The ones who have the most time are the pre clinical students like this summer after their first year. So they're essentially kind of undergrads. So my my guess is that that would be yes. Say what. Thank you.


All right, any fuel? Yeah, just a fuel, thanks. Do you want to buy two mittens or if they're on the special? No. Do you want to buy two bodies? They're on the special as well? No. Do you want to bring a trip to Disneyland? No. Do you want to get this bag for free? Do you want to get that car? That's my own car. I'm giving it away for free. Please take it!


In this presentation, we will put together a worksheet that will then be used to create the statement of cash flows using the indirect method. To do this, we're going to use our resources, which will include a comparative balance sheet, support accounting instruction by clicking the link below, giving you a free month membership to all of the content on our website broken out by category further broken out by course, each course then organized in a logical, reasonable fashion, making it much more easy to find what you need than can be done on a YouTube page. We also include added resources such as Excel practice problems, PDF files, and more like QuickBooks backup files when applicable. So once again, click the link below for a free month membership to our website and all the content on it. An income statement and added information. Remember that in practice, we're typically going to have a comparative balance sheet, ours here being for the current year, 2000x5 and 2000x4, the prior year. So we need a comparative two time periods in order to create our worksheet. This will be the primary component that we'll use to create our worksheet. We will need the income statement when creating the statement of cash flows mainly to check up on some of the differences that we will have in our worksheet. And then in a book problem will typically be told some other things related to, for example, purchases of or sales of equipment, borrowings, if we had any cash dividends or any dividends at all, this is added information we would need. In practice, of course, we would just be checking on these things by looking at the difference and going back to the GL and just taking a look at those differences in order to determine if we have any added information that needs to be adjusted on our statement of cash flows. So now we're going to take our difference in the comparative balance sheet and create our worksheet. Now, some people will just take this comparative balance sheet and just take the difference between it. But it's easier to kind of put it into a worksheet and to put it into more of a trial balance worksheet. In other words, to put it into a post closing trial balance type worksheet. So I'm going to do the opposite of what we typically do when we create the balance sheet. And that is to take it from a plus and minus balance sheet, as we see here, to a debit and credit format trial balance. So we're going to take everything that we have here, the end result, and we're going to try to convert it into like a trial balance type result. By doing that, it'll be a lot easier for us to do the calculations on the worksheet. What we're going to do is have a plus and minus or a debit and credit type worksheet, which will make it easier for us to do the calculations. And we'll eliminate some of these subtotals. We don't need this total current assets. We don't need the subtotal for property, plants and equipment, total assets. We don't need the current liabilities or total liabilities. So we'll remove those subtitles by making the worksheet. So we're just going to go line by line. And again, we're not going to start with assets. We're not going to start with current assets. We're just going to start with the account of cash. And we're going to say, okay, 2000x5, 123, 450, and 2000x4, 61, 550. And then of course, we will subtract those two. And we'll get to the difference, the change, the change here being the 61, 900, which is going to be this number minus this number. The change is increasing, of course, because we can we can see the change. And as we go to debits and credits, we kind of got to just interpret the change and see what happened. Of course, this is the prior number here's the current number. That means it went up. This change is an increase. But we're representing these kind of in debits and credits. So we need to be careful to make that conversion. So then we're just going to go to accounts receivable, same thing. We're just going to pull these over into our worksheet, the 7, 7, 180,000, 750, 2000x4 and x5. If we subtract the two out, then we're going to add the difference here. And that's going to be 3650. In this case, of course, it went down. We decreased in this account. Then we're going to have the inventory. So the inventory is another asset, we're just pulling over these two numbers started 240,600 or started at 250,700 went down to 240,600 decrease of 10,100. And then we're going to go to prepaid expenses, we're just going to write down the line here was at 17,000. Now at 15 one decrease, 1,900. Then we're going to skip down to equipment, we're going to we're not going to add the subtotals or another subcategory, we're going to go down to equipment. It's another asset started at 200,000 went up to 262,250 change, 62,250. Then we'll go to the accumulated depreciation, a little bit tricky, because it's a credit balance accounts, a contra asset accounts. So when we convert it from a plus and minus to a debit and credit, I'm going to put brackets around it here to represent the fact that it's going to be a credit. So it started at 95,000 went up to 110,750. This 15,750 is an increase, because it's an increase in the credit direction. So you've got to be kind of careful when we look at these worksheets to set it up and make sure we understand what these signs are saying. And the only way to get good at that is just to practice keep on doing the worksheets so you can get good at knowing what's the difference between a debit and credit and a plus and minus and how can we use the two and still use math without getting the two concepts confused. And the casual statement is really good for learning that because no matter how you set it up, we got to get those differences down. And then we've got the accounts payable. So same thing. These are liabilities now. So it started at 102,000 and then it ended at 17,750. So that's a decrease. So it decreased in the debit direction, 84,250 went down in this case. Then we've got the short term payable started at 10,000 went up to 15 increase with a credit of 5,000. And then we have the long term started at 77,500 increased to 100,000 increase of 22,500 common stock. So note we're skipping the subtotals, not adding the subtotals were down to the common stock. It started at 200. It's a credit again. So we're converting these these common stock to a credit 200,000 ended at 215 increase in the credit direction 15,000. And then we've got additional paid in capital from here started at zero went up 30. So that's a change of 30 increase. And then we've got retained earnings. So here's retained earnings. It's a credit to it's in the equity section 125,500 went to 230,000 increased by 104,500. And again, we're not going to have the subtotals here. So that's going to be the entire thing. Then we can easily see if we did this correctly by if we have the in Excel, if we have the positive numbers, or if we just add these up, if we have the debits being positive and the credits being negative, we take the debits minus the credits. And if they're equal, then we'll end up with zero. And that's going to be the beauty of this worksheet, of course, because we can easily see that, well, if we're starting with something that ended up debits and credits equals zero, and we're ending with something that the debits and credits equals zero, and then we're taking the difference going the same way each time, which we can do in Excel with just a formula, or we can do it with a calculator. And then we know that the change will equal zero. Now this worksheet, if you just, if you spend some time with this worksheet, it'll give you a good understanding of where we're going to start with the creation of the statement of cash flows. So here's kind of an end result type worksheet of the statement of cash flows. We've got the cash flows from operating activities, cash flows from investing activities, cash flows from financing activities. We're going to start this process by basically just looking at each of these differences and finding a home for them in the statement of cash flows. And you can think of it just as a puzzle at this point in time. We know this, we know that the difference right here, 61.9 is going to be represented as the increase or change here. And we know that these two, obviously these two cash numbers are going to get to the difference here. So this is going to be our ending cash at the end of the time period. We're really, this is kind of like the bottom line though. This is really kind of the bottom line because that's the change that's what's happening to cash. That's going to be the change in cash. So we already knew the end result because it's on the balance sheet. The reason we want to get to it on the statement of cash flow is simply so that we can tie it out to the balance sheet. But this amount tying out to the worksheet is giving us that change. And that's really kind of what we're looking for when we're looking at a statement of cash flow. It's an activity statement. So we know that that is going to be the bottom line. And we know that this whole thing adds up to zero. If I was to add up all these changes. So that means that if this is the bottom line, then if we find a home for everything except that, then the difference is going to be this meaning if I was to say this minus this, or you know, if I was to add up this whole column to have its minus the credits or the positive numbers minus the negative numbers, then it would add up to the 61,900. We know that has to be the case because we can just see it mathematically that has to work. So all we need to do to start the statement of cash flows is to take all these changes that we have and find a home for them here and a plus and minus format. So we're just reformatting these numbers, just putting them into a different format. So that's all we really have to do. Now it is a little bit more complex from that. I would do this in a two step process. And this is what I'm going to argue to do is to first find a home for all these without getting into any more detail without looking at the added resources of the problem, just so you start with something that's in balance and then go back and look at the additional information and make changes. So I would argue to do that in a two step process and a problem like this. Let's figure this out. Let's find a home for these and then any added information that makes these more complicated will get into the detail. Why would that happen? Like for example, if the equipment here or let's say the accumulated depreciation, the change in accumulated depreciation should be depreciation expense right here. But notice it's not and if we went and if we went to the balance sheet or the income statement, we would see it's that the change is not exactly what the depreciation expense is as we would expect. And so what we would have to do is figure out what else happened. There must have been a sale of equipment or something like that that resulted in that change being different and we'll have to go back and deal with that. But I would argue that first we're just going to put this in the change for the depreciation and then go back and figure that out because when we figure out the detail what we're really doing is taking this change and we're breaking it out into multiple categories and so that's going to complicate things. So it's easier to kind of figure the thing out, make it work with just these numbers, knowing that you're going to have to give more detail to some of them. They're not completely correct and then break out the ones you need to as you recognize them as we go. That'll be the process we will use.


Zebra Mussels have been found in another area lake, this time in North Star Lake in Itasca County. The DNR officials say a North Star Lake resident contacted them after finding zebra mussels when removing a dock and boat lip. DNR staff confirmed juvenile zebra mussels along the lake shore and at the nearby public access they confirmed adult zebra mussels several hundred feet south of the location of the initial report. North Star Lake is about 20 miles northeast of Dear River near Marcel. If you've enjoyed this segment of Lakeland news please consider making a tax deductible contribution to Lakeland Public Television.


Hello and welcome to the Paul Canteveni show presented by Buffalo Wildlands. I'm Greg Royce showing my students and men's lacrosse coach Paul Canteveni. Coach, you opened up conference play last week with a couple big wins over Hood and Albright. Just talk about those wins and the importance of starting conference playoff on a strong note. It's always important to start conference playoff, you know, winning a few games and I think we did a good job of that. We got a lot of people in. I thought we played well, got a little confidence and we're able to kind of move forward and get ready for another big week for us. Yeah, talk a little bit this week. You've got you've got Christopher Newport and you've got like home in a conference game. So Christopher Newport got a chance to play a ranked team and play another quality top 20 opponent. Yeah, they're a lot like us. You know, they've had one one one win against a ranked team and got some other losses against some other ranked teams and they beat who they showed up just kind of like us. And so it'll be a pretty big game for both our teams to kind of set us up where we're going to rank regionally, hopefully. But you know, we got to continue to play well. They got a couple good attack when I think our defense is playing better. We're back to full health now. I think we're through the full flu season now. And I think we're they were kind of playing well and doing the right things. And I think we've done that a lot this year. We just got to put together 60 minutes. Yeah, talk about like we're right before conference play, obviously you played, you know, played in Salisbury, Lynchburg, York and tough straight in a row. I thought three of those four games, you know, there were stretches where you played pretty well. And obviously that fourth game tough, she alluded to it a little bit that yeah, I think we're putting together 3045 minutes, you know, just that 15 minutes that we're not all there. That's kind of really hurt us in all those games. And so we just got to continue to get better and learn from that. I think the way we've played has really helped us throughout the year playing all those tough teams for a certain level of play. I think our guys understand that and it helps us always and helps us in the second half of our season just getting better because we know the level we need to play at in order to be successful. And I don't think our plays ever dropped down in the second half of the season. I saw it got better. Yeah.  You know, he's done really well. He's getting better and he's been a real asset, especially in some of our big games, keep giving us the ball back, allowing us to go on runs. And and camp's been a starter for us all year. You know, he's done so well, but shooting the ball, facilitating the ball. But I think we have some other kids now stepping up, especially, especially Shane Ford who's playing so well now getting that second line midfield Ryan Coleman is now playing a lot more for us doing a good job. Josh Brandon's in the mix now doing a good job. So those are all kids that are pretty talented. They're going to help us down the stretch. So it's good to see them getting in the mix and getting a little confidence. Yeah, kind of now since another one stopped you. Yeah, another freshman attacking Ford is getting some play. He's played a lot, you know, in and out of the lineup, but he's done a good job. So he's another big kid that can help us and do some things. So we got a really good freshman class that we can really build on for the future. There's no question about it. Yeah, absolutely. Now he talked about the challenge to try to put that 60 minute game together. As a coaching staff, there's a team, how do you figure out how to do that moving forward as you get towards the end of the season? Well, I think a lot of us do us our mentality.  Now worry about who's scoring the goals and who's making the plays, just doing your job and getting better each time. I think at times that we haven't been able to do it for 60 minutes, but I think each game we're kind of getting better to that and understanding how we have to play. And so I think our challenge is to put our guys in the right position so they can be successful. And that's kind of what we've done with the line of change is a little bit move some people around. I think we're getting closer to what is the lineup that we need to be successful. All right, coach, we wish you the best of luck starting Wednesday right here against Chris Newport, Mustang Stadium, and we'll chat again soon. Thanks a lot, Greg. All right, for coach Paul Campimani, I'm Greg Roy since this has been the Paul Campimani Show.


Hi everyone and welcome back to my channel. I'm so glad that you're here with me today You guys know that if you've been with me for any amount of time that I am an absolute Makeup skincare beauty lover and my channel is not anything about any of the drama that goes on in you And I actually pride myself on that because I really don't want involved with any of the drama There are things going on out there that I don't agree with obviously there are people that have really put a lot of Shame on loving beauty because they have made so much monetary monetary gains from it But I wanted to do this tech not to talk about any of that because I obviously don't feel like Those people do about the beauty community I feel like the beauty community is something very dear to me and to my heart And I feel like this is a wonderful tag now little gal named Kara see and I will link her channel below She did this tag and she made it up and she has a very small small following you guys If you could go over and show her some love I know that she would be so grateful to you if you did that so make sure you show her some love I think it's a fantastic tag that she came up with because she was just saying not my beauty community Not where I live not where I interact with the folks that I interact with so I think it's just a great way To be able to show our pride in the beauty community and how much we love the people that really make a difference without showing too much Drama so there are 10 questions here about different youtubers And I'm gonna get into this because I think it's a great way to highlight some really fantastic people If you are new to my channel special welcome to you Thank you so much for stopping by and I hope that you do decide to become a part of our YouTube family And if everybody wouldn't mind please giving this video a thumbs up It does just take a second, but it does make a big difference in my videos and I really appreciate that Thank you so much. So let's get into this beauty community tag right now The first question is what is a beauty creator or a content creator that makes you laugh and that was so easy It's Mary from glitzy fritzy. I Absolutely love this woman and she has been my friend for a while But she is absolutely a deer and she really does stay away from most of the drama And she really does make you just crack up if you watch her videos all the way through you get a special treat at The end that she calls frittiness and it's just it's a hoot but Mary's personality is one that just really comes through with happiness and She just makes me smile every time that I watch her She makes me laugh every time that I watch or something comes out of her mouth And I'm just cracking up or she helps us go down memory lane She does that a lot which I think is wonderful And I've done a couple of collabs with her and you guys if you don't know who Mary is you're really missing out So definitely go take it take a peek at what she does And then the next one is a content creator who teaches you and this one was easy for me too because this is actually my introduction into YouTube was Wayne Gloss and his teachings of Makeup and his artistry is fantastic you guys and Wayne is so no nonsense a lot of his videos are Three to five minutes and you learn so much in that three to five minutes that you can't even you can't even believe it So if you haven't ever seen Wayne or if you haven't watched one of Wayne's Tutorials you have got to go over there and watch him because he just He has the most fantastic easy way of teaching and I think that Anyone that is starting out or has a really good makeup skills or whatever can learn so much from Wayne because He's just one of those people that is super down to earth super nice super kind But Wayne knows his stuff and I think that you're missing out if you're not checking him out So go over and check Wayne out Okay The next one is a content creator who lifts others up and this was super easy for me as well And that is hands-down Samantha March Samantha has been on YouTube for a long time But Samantha is such an accomplished young lady at for her age. She's a published author She runs a podcast she goes out of her way to make other people feel great And she really just kind of lays her heart out there as she's doing her videos She exceeds this confidence that is so endearing. It's not pride and it's not egotism It's just confidence and yet she has this very humble attitude And she's not afraid to show you her vulnerable side And I think that is fantastic and then she always talks about other YouTubers and she's doing collabs all the time and trying to help other people out and I just this woman to me I always call her Wonder Woman and the hardest working woman on YouTube because she at one time was putting out videos every single day Which I thought was absolutely crazy, but she was doing it and she was doing some really quality content So if you have the chance to please go and check out Samantha You will not be disappointed and she is just one of those people that endears herself to you almost immediately So yeah, definitely check out Samantha if you get a chance to alright The next one on the list is a creator that you respect that is very easy as well And that is Melissa 55 Melissa is a content creator that has been on YouTube for years and years and years you guys, but I Have so much respect for this woman because she is the most beautiful real woman She is very dainty very ladylike very sweet But she is so honest and open at the same time And I just see her as being the quintessential southern belle I think she has this beautiful quality about her that helps you relate to her very easily And I respect her more than anything because she doesn't ever get involved in any of this drama She has such great Interaction with other content creators her own audience And she keeps it very real and very down to earth and she listens to her audience as well So if her audience is saying please do a hair tutorial Melissa is going to do a hair tutorial in the next few days or if they're saying, you know We want to see a look she's usually going to do that the other thing that I respect about her She has a lot of health issues and she isn't afraid to talk about those So you know that she is just another person just like you out there that is battling her life every day But at the same time she's bringing really great joy into your life So definitely check out Melissa 55. The next one is a content creator whose collection you love This one was hard for me you guys because I really go to creators looking at Themselves not their collection But I could talk about two people here that I really do like their collections and the first one is Amanda from makeup Just for fun. This gal is all things color pop I mean she obviously reviews all other kinds of makeup But anytime color pop gets something in she is right on it to review it And you know color pop is one of my favorite brands So Amanda will review it and I can really tell from the way she feels about it whether or not it's something that I am really interested in in getting because She knows whether or not it really has been done in the past by color pop because you know Color pop does bring stuff out quite quickly But Amanda has this great recall and you know Cross-reference because she has all of their things to be able to tell you whether or not color pop has done it Whether you might have it in your collection So I really do appreciate her collection and I also Appreciate Jen Phelps collection too because Jen actually started over on Instagram. Actually both these gals did they started on over at Instagram and they did lots of comparisons lots of swatching lots of that kind of stuff So Jen has a great knowledge of makeup too as far as what's been out there for quite a while And then going ahead and compare comparing everything So she has a lot of great ideas about dupes too But I've seen her her makeup collection as well And I do appreciate that she has the ability to go in and be able to tell you if this palette is going to be like the next palette coming out and and everything in between so I really do like both of those creators for that next one is a Content creator whose create creativity inspires you creativity as far as her channel goes and her videos is Mandy Lee Mandy actually lives here in my home state of Utah and we were able to do a collab together But every single time I see Mandy put up a video I'm going oh my gosh. Why didn't I think about doing that? And I have copied a few of her videos recently just think that she's one of those creators that is so down to earth But she really is trying all the time to think about what she could do that It can be new and different for us here on YouTube And I think that's really the trick as a creator finding something that everybody is interested in But at the same time being able to relate to and not being so crazy that we wouldn't want to try it And Mandy does that for me She just makes me want to try different things and she has a lot of this thing same thought process I do about having affordable makeup She splurges on luxury like I do occasionally But she really looks at her makeup with that I too as far as being you know very Cost-effective and what we can do to make sure that we're getting our best bang for our buck So I love Mandy. I think she's great Love her personality love her beautiful hair when you guys see her So if you haven't had a chance to check out Mandy yet Make sure you go over and check out her channel and see what she's up to and I think you're gonna fall in love with her Just as fast as I did. So definitely check her out. Okay, so the next one is Who would you want? What content creator would you want to be friends with in real life? And this is Marnie from miss gold golden girl. I think Marnie is so great I can see myself totally hanging out with her and totally see how her personality could just be so easy-going and So kind and just really down to earth And I think that is what draws people in to any content creators is the fact that they are not afraid to show themselves Show a little bit of their own vulnerability and be able to really relate To you our audience and I think that Marnie does a great job of that She really does have this really great personal personality about her a little bit quirky a little bit fun And yeah, I would love to hang out with Marnie if I got the chance to so go check her out too And then the next one is who would you want to see grow and I this is hands down I know exactly who this one is and this is Kathy from Kathy beauty care chats now if you guys haven't seen Kathy She's this beautiful southern gal and she has just this bubbly loving personality and I absolutely love watching her She does so many good reviews and so she does such a good job on the reviews too She shows you why she likes things Watches them goes through them and you just can't come away without wanting something that she has because her enthusiasm for makeup shows Shows through so much and I would love to see her grow and have a bigger following Because she just really is very genuine about her love of makeup and there's just no nonsense about all the drama and the garbage That's going on with YouTube. She never gets involved in any of that Everything is just about the makeup just about what she can do to show us what's really good out there And has a really no nonsense approach about makeup, but I would really love to see her grow Her personality is very conducive for having a lot of friends and being able to relate to a lot of people And I just think that's so special about her So definitely if you haven't checked out Kathy yet, you need to check her out I just think that you'll fall in love with her and the next one is a Content creator that gives off good vibes and I would have to say that this one is Andrea Matalano, I always say her name wrong, but I always feel like Andrea. She just She is one of those people that you can go and watch her and feel so good about everything I've never gone to her video and heard her be a very negative person at all She's extremely honest about her reviews of makeup But she at the same time does it in such a nice way that you feel like, okay Well, I don't want that but it's okay.  She just gives off this really good Vibe energy as far as I'm concerned So Andrea is definitely one that I've been watching for a long time and I love her good vibes All right, and then the last one is honorable mentions And I have several that I want to mention that I could definitely not do this video if I could not talk about them The number one is graceful beauty Sherry Sherry has been my friend for several years now and you guys Sherry is one of the most down-to-earth Funny fun people and absolutely one of my best friends here on YouTube And I appreciate her more than you will ever know This was never about doing this because she wanted to get free stuff or makeup or make money or anything like that People were just encouraging Sherry to do her videos because she knew so much about skincare and makeup And she has the most beautiful face and she just looks like this doll this porcelain doll when you look at her But when you get to know this girl She is so down to earth and I'm not kidding We can talk on the telephone the first time that we talked on the telephone I think we talked for almost three hours and it was like we were long-lost girlfriends that had just picked up right where We left off and I could not believe it It was just one of these things that I was just like you're exactly like you are on your videos And I absolutely love that about her. I don't care who you are if you end up asking Sherry questions She's gonna answer it if you have something that's bugging you She's gonna help you through it and I think that is just such an amazing quality about her and you know I could have put her in every single one of these categories, but she didn't quite fit into any one for me So I'm like, okay She's my first honorable mention, but she should have been there at number one two three four Because she is that good about all of her content and about how she treats people and how much I absolutely love this girl So if you haven't seen Sherry you you definitely have to go see her Okay, the next person is Kelsey Breonna J. If you guys have not seen Kelsey She's a good friend of Mel Thompson, so we could put them both in here, but these two girls Especially Kelsey.  She did something about a tag a while back There was the very first video that I had seen of her it was something about What she doesn't like about makeup It was a bunch of questions and she got onto this rant about how she doesn't like many makeup little makeups that you get You know then the testers or the little half-sizes ones or the ones that are just trial size and she got into this I am busting it got laughing and besides that I was total in total agreement with almost everything She did there on that video but it was so funny because That video got me completely hooked on her immediately and her personality is bubbly and Exuberant and she just loves life you can tell and she's just great about what she does on her channel as far as Reviewing and if you guys haven't seen Kelsey then you have to go see her She's great Mel too, but everybody pretty much knows about Mel and Mel's this amazing makeup artist that Tries all of the new luxury palettes that come out and she knocks them all out of the park So we'll say that about Mel right here. She's wonderful. The other one I want to talk about is Lauren from the honest beauty reviews She's been here fairly new too But Lauren is just this absolute beauty and her reviews are so good and so straightforward and so spot-on That I know that I can trust her and she's a nurse that has been out there dealing with you know All the problems and yet she has little kids at home still And so she's been juggling all of this and she still kept up her content and still kept going and she She deserves so many kudos, but she has great content here on YouTube And I trust her opinion so much because she's never steered me wrong and as Lauren grows I really have seen more and more how much I appreciate her reviews But I appreciate her as a person too. Just think she's absolutely great And then I want to just quickly mention several of the people that have really inspired me penny from pensmith skin care Fantastic a statistician. You will learn everything you ever need to know about penny Also Monica from Monica's Beauty and Lifestyle a good friend of mine. She is from back east is a fantastic Older mature beauty youtuber that her heart on her sleeve to think she is just amazing You guys you need to check her out. Also if you're wanting to find Mature beauty content creators Check out Ella's for a living. She's fantastic Marlene fab and glam over 50. She is so good as well Also, Tammy's be ageless beauty. She's one of the mature gals here And then a couple others that I wanted to mention really really quickly Dana Anna if you haven't seen her She's got a huge following But she's a really fantastic reviewer as well and Kelly gooch Kelly is on her way and she's doing a really fantastic job So that is my picks you guys and yeah, I did have quite a few at the end But there I could go through so many because there's so many that I absolutely love watching and they have inspired me so much So here's our community and we are solid and we are loving and we take care of each other And I just think that there's no way we're gonna allow anybody From the outside to disrupt that peace and that harmony and that great vibe that we get from that So if you guys have seen any of the chatter about all of this Just push it to the side you guys because it doesn't make a bit of difference about whether or not We love makeup and how we like to look beautiful at anything. So thank you so much for watching this video today Please give it a thumbs up on your way out of here Hope everyone is staying happy healthy hydrated and please take care of yourselves I love you very much and I'll catch y'all in my next video. Bye you guys


You must be wondering what is all about the Elsel Stadium. The Elsel Ironic Stadium, Elsel Stadium is a football stadium in Elsel Kata. The stadium will host the final game of the 2022 FIFA World Cup Kata. The Elsel Stadium is owned by the Kata Football Association and is the biggest stadium in Kata. One of the eight stadiums being converted for the 2022 FIFA World Cup Kata. Kata max 100 days countdown to FIFA World Cup. There are just 100 days to go until Kata host the FIFA World Cup. Eight state of art stadium will stage 64 matches between 20 November and 18 December as Kata will comes the best international teams on the planet for the first FIFA World Cup in the Middle East and the Arab world. Kata will host a vast array of cultural and entertainment options for the whole family during this year's FIFA World Cup which will be held from 20 November to 18 December. The country's wild festival will include more than 90 special events set to take place on the sidelines of the tournament.


And in Class 3A, no one has slowed down the high-powered peers offense. Their lowest point total of the season, 17 against Melrose Week 4. The other 10 wins, though, 34 points or more, including 40 plus a game in these playoffs. Their semifinal matchup, Jordan winners of Section 2 with a 9-3 record, but the pioneers didn't care about that. They stuck to their bread and butter, Karsten Ohls up the middle, they're on the board first. Their peers recover the ensuing kickoff, Jalen Jansen just boys his way in the end zone for six more, just like that, 14-0 pioneers, two minutes into the game, but they didn't stop there.  This puts up a 55 spot on the afternoon, they're on the finals, here's Clayton Castle with more. Well, it's been a good two-all season and today was no different as the peers' pioneers rushed for 421 yards and we're to a 55-26 win in the Class 3A semifinals here at U.S. Bank Stadium. They felt that we could run the ball and we certainly did. I think that one series where we bogged down the other and that, we capitalized on a couple of their mistakes too. One thing that's really good about our team, we're all around. We have a great special team, great offense and a great defense and those special team things or the momentum switches and stuff, I mean that was big for us. It was a little different. I think we were all just checking out the stadium and we just kind of wanted to come to play this time, but it was still obviously really cool, the stadium we're playing in, but we just came more ready to play this time than last year I think. Reporting from U.S. Bank Stadium, Clayton Castle, Lakeland is. So 55-26, the final as Clayton said, the pioneers offense 420 yards rushing and seven touchdowns on the ground. If you've enjoyed this segment of Lakeland News, please consider making a tax-deductible contribution to Lakeland Public Television.


Welcome folks, we have the Dow Industrial trading up 51, Nasdaq is up 106, S&P is up 16, Gold contract up $3.20, trading at $2,004 an ounce, Silver up $0.24, $0.24, $0.55 an ounce, late sweet crude up $0.79, trading at $79.53 a barrel, notes and bonds, 10-year note, down $0.146, trading $1.1120, the 30-year down $0.26 at $1.2517 and $1.00, $1.00 is trading flat at $1.01348, the euro right now is at $1.10, the yen is at $1.41, the British pound is at $1.28 to $1.00 USD. So we get the Fed out here today, tomorrow, tomorrow 2 o'clock is the statement, we got Google and Microsoft after the close, let's go take a look at the markets, okay? So the spy bottom line did make a new high, the spy get up to a price point out here of 456.73, right now you're at 455.96, that was so intriguing just, you know, in general is that the futures just missed it, okay? But guess what? It's not the end of the day yet. If you take a look at the futures, you know, the high from last week was that 46.09 and the bottom line is that we just hit 46.08, now we're, we back down off of that level, but it's going to be intriguing to see how this baby shakes out coming into the close. We went to the NVX 100 and that's where this moved, well, actually the movement will be all over the place today with the aspect of Google and Microsoft coming out after the close. If we take a look at the cues, you get $26 million on the way up, now you're going at the 71, so the bottom line that should be more juiced than that, it is what it is, but there isn't any real volume behind this move right now. We go into the note and bond market, we take a look at the ten-year note and the ten-year note right now is pulling back with light volume, that says it still wants higher price, lower yield, and King Dollar really hasn't done much. Bottom line, you know, well, no, I actually did, I got up to $101.648 and couldn't hold price. Now here, here's a stat, listen to this stat, folks, this is pretty wild, man. And this is why, well here, I'll talk about it as soon as I get back. Stay right there, folks, we'll come right back. We have the Dow Industries up 51, the Aztec up 110, the S&P's up 16.5, we'll come right back.


Every good social media strategy must begin with listening, really understand the conversations that are happening online, and then understand your role, your offering, what do you bring to the table, who is your audience, who is your community. That upfront work is really the grounding of every social media strategy. As a global agency we're able to help brands scale in social media. We have hundreds of community managers, digital strategists, social strategists that are contributing to our clients' overall digital and online strategy. It is all about social video. We saw Vine, we purchased by Twitter, and Instagram video come out and really make a splash online very quickly. Pinterest is also an incredibly exciting new social network, and as they continue to open themselves up more to the developer community with making their API more available, we are going to see really exciting new technologies and emerging ways of brands interacting with customers. And of course, content marketing has become the number one talked about issue within social. How can we create better stories and tell them through interesting and social ways? Brands that are doing social right are using social as a way to make that direct connection with their customer. I interact with many brands that I use their products every single day, whether that be for an issue in customer service or just a compliment, something that really excited me about the product or service. Social media is full of buzzwords. Every year there is a hot few. This year, IRM, Influencer Relationship Management is one of my favorites. The real power that MSL Group has to offer in social is our scale, and of course the fact that social and digital are integrated into everything we do. It is not a silo. It is part of who we are and it is at the core.