Welcome to the Total Joint Replacement class. As you prepare to have your knee or hip replaced, there may be questions and concerns that you may have. Our goal is that this class will help answer these questions and ensure that you come ready and prepared for your surgery. As you view the presentation, please pay extra attention to the pages in the book that are referred to. These pages will aid you in your preparation for your surgery and recovery time following. Having a joint replacement is a big decision and we want to make sure that your experience at MidMichigan Health is an excellent one. Thank you for choosing us. What should you do to prepare for surgery? Start with these homework assignments prior to your surgery date. First, please identify a support person who will be available to help you at home after your surgery. Many people will need assistance during the recovery period for mobility or activities in the home. It is important to have someone available if these needs arise. If you have a pet, consider some options ahead of time in case you are unable to provide care for them. Another step to take is to safety-proof your home. Remove all throat rugs, any electrical cords and walkways, and all other objects that may increase your risk of falls at home. Make sure you have pathways in your home to the areas that you will need to access in those first days and weeks after surgery. Work on getting ready for your surgery by completing any recommended pre-operative exercises. You may also be referred to some physical therapy ahead of time to strengthen for your upcoming surgery. Exercises will be demonstrated for you by the physical therapist or occupational therapist later in the presentation and are also listed on pages 5 and 6 in your joint replacement book. Gather items for your hospital stay. It is a good idea to bring your guide to total joint replacement. This is a good resource with references you can use during your stay. If you have advanced medical directives such as a durable power of attorney, bring this in so that we may make a copy and add it to your mid-Michigan electronic medical record. Bring your updated prescription medications list with you. Our pharmacy will provide your medications during your stay for your nurse to dispense per your surgeon's order. This will prevent any discrepancies and ensure that all medications are appropriate to be taken after surgery. Your surgeon will be prescribing medications such as antibiotics and pain medications and pharmacy will verify that all medications are appropriate to be taken together. It is important to pack comfortable, loose-fitting clothing for your stay. You will attend therapy sessions so you'll want to wear something that you will feel comfortable moving about in. Loose-fitting clothing such as sweats, athletic shorts, or lounge pants work the best. For shoewear, avoid backless shoes or slippers as these can pose a tripping hazard when walking. Shoes should be supportive and evenly worn. Keep in mind when choosing footwear that you may have some swelling in your feet due to surgery. If you have a front-wheeled walker, please bring this in with you to the hospital stay on your surgery day. Bring along any personal hygiene items you wish to have with you during your stay and discharge home will occur the same day of surgery or the day after. Consider having stool softeners such as Seneca or Meralax available as major side effects of your pain meds will be constipation. Consider options of medical equipment to make your recovery easier. Please make sure that you have transportation arranged for discharge as needed in the days and weeks ahead. Call the hospital as noted on page 3 in your workbook for your arrival time. On page 9 in your booklet, you will find detailed instructions on skin preparation. You must wash with an antibacterial soap called Clorexidine Gluconate or CHG which may be obtained from your surgeon's office for your short wash daily three days prior to surgery. Do not shave the surgical area within 72 hours of surgery as this can increase infection risk. What should you do the night before your surgery? Please do not drink alcohol for 24 hours prior to surgery and after midnight. Don't eat anything including gum or throat lozenges. Do brush your teeth but be sure not to swallow any water and once again use the antibacterial wash. When you arrive for your surgery, you will arrive at the main hospital entrance. A greeter will direct you to the surgical services area. Nurses will complete your check-in at this time and anesthesia will meet with you and discuss your plan for anesthesia. Most patients will have spinal anesthesia for their procedures but sometimes general anesthesia is used for total joint replacements. Due to HIPAA privacy laws, we are unable to give any of your health information over the phone to family or friends during your stay unless they provide your PIN number. You will be provided this four-digit number at the beginning of your hospital experience, so please share this number with a few close people you know and trust to check in on you. It is not advised to share this number publicly. After surgery, you will be able to order food after arriving to your room. For most people, there will be approximately an hour of recovery time before you're brought to your room. You will be up and moving as soon as possible after your surgery. For most patients, this will be within the first four to six hours after surgery is completed. For your safety, you will always ambulate with a gate belt and hospital staff. This means you may not move around your room without assistance from staff at any point during your stay. Please call before you get up for any reason. It is helpful to know some of the equipment you may encounter during your stay. Expect to have intravenous or IV access throughout your stay. This will likely be in one of your arms and provide fluids and antibiotics as needed as well as pain or nausea medication. You will likely be disconnected from these fluids at some point during your hospital stay, but the IV itself will remain in place until discharge in case any of these medications is needed. Ted Hose are tight white stockings that help keep compression to the legs to reduce swelling and risk of blood clots after surgery. These come in knee-high or thigh-high versions and will be in place throughout most of your stay. You will be asked to wear these at home as well per your physician's guidelines. A Foley catheter is a urinary catheter that helps drain urine from the bladder. This is physician-specific and not all patients will have a Foley catheter. If you do, it will likely be for the first part of your stay only and will be removed to get you urinating on your own. Compression boots or sleeves are another form of blood clot prevention. These are a device with velcro straps that go around the legs or feet that are hooked to a machine that fills them with air that massages the leg to promote blood flow. A drain may be placed during your surgery depending on your provider. These, if placed, are only in place for one or two days and are removed before you go home. They help with the healing process to help drain extra swelling and bleeding from the surgical site. Most patients will require some oxygen in the recovery period as your body wakes from anesthesia. This is typically given via a small nasal cannula and you will be weaned off this as soon as possible. An incentive spirometer is simply a device we use to help you achieve good deep breathing post-operatively to reduce risks such as pneumonia. It ensures air gets to the base of your lungs. An abduction pillow is a foam wedge placed between the legs and is used for some, but not all total hip replacements depending on your restrictions. It is a pillow with velcro straps which keeps your legs in an abducted position, preventing movements that may cause damage or injury to your new surgical joint and will be removed when up. The day after surgery you can expect to start your day early. Joint cat mornings start early because all patients need to be ready for the day before 7 a.m. when PT, OT, and physicians come through. This means all patients need to be moved from their bed to the chair, get washed up and dressed, have drains, catheters discontinued, and have medications given, which means we need to start early. We apologize for this as we know not everyone is a morning person. The hospital is the place where you need sleep the most and you will find it is the hardest place to get sleep. You will be up and walking with a physical and occupational therapist during the day. Your coach and or care partner should attend the family training with you. These times and dates will be posted on the communication board in your room. I3 doses of IV antibiotics are generally given after surgery and often times patients will need anti-nausea medications. There are many cases of nausea, medications, empty stomach, and pain itself can cause nausea. Your nurses are on the lookout for nausea and other side effects of medications, but please be on the lookout as well. If any medication is not working or not tolerated, please let your nurse know. We are in the line of communication to the physician and can try to change medications if needed. Many of your medications, such as pain and nausea medications, are considered PRN meds or by request. So always let us know if you need something for pain or nausea. Using a notepad to keep track of your medication, times, and pain level may help. What medications will you need when you are in the hospital? Everyone will receive some type of blood thinner to reduce risk of postoperative complication of blood clots. Aspirin is the most commonly used. Other blood clot prevention medications may be used as directed by your surgeon. Pain is an expected part of the postoperative process following total hip or knee replacement. So do expect pain, but our goal will be to keep you at a tolerable pain level during your stay. This means a target of 3 or 4 or less out of 10. Zero pain would be a wonderful goal to have. Unfortunately for many or most patients, this is not a realistic expectation. Sometimes a narcotic or opioid will be necessary to control your pain. Sometimes Tylenol or other non-narcotic can control your pain enough. And if that is the case, we will try that route. Some other non-opioid pain options are ice and elevation, turning the lights down, and using distraction such as TV, visitors, or listening to music. If you have an ice man machine from a previous surgery or have one that you can borrow from a friend, please feel free to bring this in and we will use it at the hospital. Our goal will be for you to be discharged home by the day after surgery. Some may go home the same day. Some of the criteria we look for are that you are walking greater than 50 feet, you are sitting and standing with minimal assistance, and that your pain is controlled with oral medication. You will also need to be able to tolerate food and urinate. At home, remember that movement is the key. You should be able to get up and move around often, do your exercises, and take short naps. Constipation is very common after surgery. This can happen as a result of taking pain medications, less activity, and being outside your normal routine. The following are some tips on how to manage constipation after surgery but should not take the place of advice from your physician. Make sure to include plenty of fiber in your diet. The goal is 25 to 35 grams daily. Eating fruits, vegetables, legumes, and whole grains can increase your fiber intake. Fiber supplements are also available over the counter. 6 to 8 glasses of non-carbonated fluids per day is recommended to help maintain healthy bowel habits. Caffeine should be avoided due to that it is a mild dyretic and it can cause fluid to shift from the bowels to the kidneys, which can cause drier, harder stools. Don't skip breakfast. It is one of the most important meals of the day to promote normal bowel function. If you feel the urge to have a bowel movement, don't wait. Waiting can lead to constipation. Make sure when the time comes that you are positioned comfortably on the toilet or commode. Try to relax. This will make it easier to have a bowel movement. Relax your throat and open your mouth. This allows for the pelvic floor muscles to relax, making it easier to have a bowel movement. Do not strain to try to have a bowel movement.  If needed, you may also take a laxative or stool softener. It is best to take what you have used in the past for constipation or ask your physician for a recommendation. Now that we've covered your hospital stay, let's discuss briefly what to expect in your recovery time at home. Having a total knee or hip replacement is a big decision. It can be a challenging experience, but it can also be a very worthwhile experience. Mid-Michigan Medical Center has a lot of repeat customers who are glad that they had their joint replaced and say that it was the right decision. Remember, each day gets a little easier, so keep your chin up and keep working hard. Fatigue will occur at home during exercise, so rest as necessary and take short naps. Expect that especially for knees, but occasionally for hips, outpatient physical therapy may be even necessary and your provider will let you know if they recommend this for you and your case. Some patients will experience post-surgery blues, so do your best to plan activities and have visitors. Regarding your dressing incision, most patients currently go home with a dressing called mepilex, which stays in place until the physician or assistant removes it at your follow-up appointment. These are water-resistant but not waterproof, so avoid soaking or swimming, but you may shower with the dressing on. Gently dab dry when you are done. Reinforce the dressing if necessary with paper tape and notify your surgeon's office if the bandage comes off. Please take your time to read through the following and final screen to familiarize yourself with what is normal and expected, what are reasons to call your physician and what is an emergency situation necessitating a call to 911 or a trip to the emergency room. Hi, my name is Alyssa and I'm an occupational therapist here at MidMichigan Health. And my name is Kim and I'm one of the physical therapists assistant here at MidMichigan Health. Physical therapy will educate and address your bed mobility, walking, strengthening, range of motion, and any equipment needs that you may have at home, including a two-wheeled walker. If you have hip precautions, you will not be allowed to bend past 90 degrees, no twisting on that hip joint, and no crossing your legs. Knees, no twisting at the knee joint. Pre-op and post-op exercises. The following exercises can be completed while lying in bed or in a chair. Ankle pumps. Bend the ankles going up and down 10 times. Then make circles going in clockwise direction 10 times and counterclockwise 10 times. Glute sets. Squeeze both buttock muscles together as tightly as possible and hold for five seconds. Do 20 times. Quad sets.  With toes up, straighten the knee on your surgical leg as much as possible. Hold it for five seconds. Do 20 times. Short arc quads. Place towel roll or coffee can under the knee on your surgical leg. Keep your knee on the roll. Point toes up and try to straighten it by lifting your foot towards the ceiling and hold it for five seconds. Then slowly return to starting position. Do 20 times. Heel slides. Gently bend knee on surgical leg by sliding the heel up towards your buttocks, keeping the heel on the bed. Don't let your knee fall in or out. Keep it straight. Make sure you do not bend your hip more than 90 degrees if you have hip precautions. Hold this exercise for 20 to 30 seconds and then slowly return down to straighten out the knee. Do 20 times. Abduction. Hips only. Keeping your surgical leg straight, slowly move it out to the side. Carefully return it to the starting position, being careful not to cross the midline. Do not turn toes in or out. Keep up and straight. Do 20 times. Do not do this exercise if you have anterior lateral precautions following surgery. Straight leg raises. Knees only. Slightly bend your non-surgical knee and place that foot flat on the bed. Lift the surgical leg up towards the ceiling approximately 8 to 10 inches, holding for 3 to 5 seconds and keeping the knee as straight as possible and slowly return it down to a flat position. Do 10 times. Seated knee flexion. Knees only. While sitting in a straight back chair, bend your surgical knee underneath the chair as far as possible. Hold the stretch for 30 to 60 seconds, remembering not to force the knee. Slowly return to starting position. Do 10 times. Long arc quad. Hips and knees.  Hold for 3 to 5 seconds and slowly lower back down towards starting position. Do 20 times each leg. Using your two-wheeled walker. Move the walker forward. With all four walker legs firmly on the ground, step forward with the surgical leg. Place the foot in the middle area of the walker. Do not move it past the front feet of the walker. Step forward with the non-surgical leg. Take small steps. Your doctor and physical therapist will instruct you in your proper weight-bearing status. Do not carry items in your hands while using your walker. Your hands must be directly on the walker handles. Getting into bed. Back up to the bed until you feel it on the back of your legs. You need to be midway between the foot and the head of the bed. Reaching back with both hands, sit down on the edge of the bed extending your surgical leg. And then scoot as far back towards the center of the mattress as you can. Move your walker out of the way, but keep it within reach. Scoot your hips around so that you are facing the foot of the bed. Lift your leg onto the bed while scooting. Keep scooting and lift your other leg onto the bed. Scoot your hips towards the center of the bed. Getting out of bed. Sit up, scoot your hips to the edge of the bed. While lowering, your surgical leg to the floor and then the other leg onto the floor. Scoot to the edge of the bed.  Balance yourself before grabbing the walker. Going up and down the stairs. Is recommended that you have at least one handrail installed prior to your surgery date. To go up the stairs, lead with your non-surgical leg followed by your surgical leg. Non-surgical leg, surgical leg. To go down the stairs, lead with your surgical leg followed by your non-surgical leg, surgical leg, non-surgical leg. Occupational therapy will address your ability to perform self-care tasks following surgery, including equipment needs for your bathroom and dressing, dressing, bathing, and toileting, transferring in and out of your vehicle, shower, and toilet. Some things to keep in mind and prepare for at home prior to your surgery includes adequate lighting, especially nightlights within your bathroom, bedroom, and kitchen. It is also very important to make items accessible. This includes keeping frequently used items within easy reach, especially in the kitchen, bathroom, and bedroom. And finally, laundry and cleaning. Make sure you have a few weeks of clean clothing available as you will not be able to carry a laundry basket while using your walker. Equipment that the occupational therapist will address with you includes in the bathroom, a shower chair, a toilet riser, or commode. The occupational therapist will also address your ability to get dressed. If you are a patient with hip precautions, you will be given the following equipment, saccade, shoehorn, reacher, and long-handled sponge. The occupational therapist will go over this equipment with you in regards to the proper use, and you will have the ability to practice using this equipment prior to going home. The following slide is a visual of all the equipment that you may need for home, including the shower chair, a tub transfer bench, a toilet safety frame, toilet riser, bedside commode, and finally the dressing equipment. Getting into the tub. Shower chairs, grab bars, and hand-held shower heads make bathing easier and safer. Use a rubber mat or non-skid adhesive on the bottom of the shower or tub. First, place the shower chair in the tub facing the faucets. Back up to the tub until you can feel it at the back of your knees.  Reach back with one hand for the shower chair. Keep the other hand gently on the walker. Slowly lower yourself onto the shower chair, keeping the surgical leg out in front. Move the walker out of the way, but keep it within reach. Turn and lift your legs into the tub. Do not cross your legs while doing this. Getting out of the tub. Turn and lift your legs over the outside of the tub without crossing legs. Scoot to the edge of the shower chair. Push up with one hand on the back of the shower chair while holding the walker gently with the other hand. Balance yourself before grabbing the walker. You will use the same technique for getting into and out of the vehicle using the front passenger seat. Getting onto the toilet. You will need a raised toilet seat or a 3-in-1 bedside commode over your toilet following surgery. Your occupational therapist will assist with this information. First, take small steps and turn until your back is to the toilet. Never pivot. Back up to the toilet until you feel it touch the back of your legs. Keep one hand on the walker while reaching back for the toilet seat with the other hand.   Balance yourself before grabbing the walker. Again, we are so glad that you have chosen MidMichigan Medical Center for your total joint replacement. We will work with you to best ensure that you have an excellent experience. Please let us know how we can best help to achieve that. Thank you for attending this virtual class. We look forward to seeing you on the day of your surgery.


A culture-centered approach to prevention, care and support is increasingly recognized as a critical strategy. PEN-3 is a model developed to centralize culture in health promotion interventions. The behavior of the individual in relation to family and community is one major cultural factor that has implications for sexual behavior and HIV, AIDS prevention and control efforts. This article was authored by Collins Ohehehenbua and J. DeWitt Webster.


Feeling down about the wild-priced wins in the crypto markets, don't. Do yourself a favor and take a look at the PAP Talk Coinbase CEO Brian Armstrong gave to his stuff and then shared on Twitter. Now, all should feel right in the world, I'm Catherine Ross from CoinTelegraph and this is your weekly Hobbler's Digest. BigHum temporary suspended all deposits and payments, moving all assets to a call wallet and will compensate victims of the hack. The Korean Ministry has since launched the probe into the causes of the BigHum hack. There was a brief market deep, but Charlie Lee said that that was to be expected. Whenever there is a hack, people get scared and the price drops. Whenever there is some bad news like an exchange hack, the prices drop like 5%. 5% is a lot in the stock market world, but it's nothing new in the crypto space. Bitcoin bounced back from $6,500 to over $6,700. CNBC's Brian Kelly and Charlie Lee laid out three main reasons for their recovery. First, BigHum reacted straight away. As soon as the news hit, they acted. Second, they immediately promised to pay back the victims of the hack. Third, the fundamentals are not affected. After a bank robbery where gold is stolen, it is not the price of gold that is affected. The same is true of Bitcoin. Going forward, quick action in response to a hack seems to be the key for exchanges. Have you ever heard about this word blockchain? I'm sure you did. At the height of the Bitcoin frenzy, blockchain became a buzzword, and companies tried to use it to boost their market value. Entertainment companies bragged about ties to blockchain while tobacco businesses got into crypto mining. Every kind of business, it seems, now has tulip grown facilities. Cut and paste in the term blockchain is cheap. The result is a brief uptick in the market value and then a deep when the market realizes the company has added nothing of substance to their profile. Using buzzwords to benefit your stock price is nothing new. During the tech bubble, companies saw their value skyrocket then crash after adding .com to their names. It became so common that companies actually rallied after dropping the suffix. In many ways, blockchain is like a young Matthew McConaughey, too sexy to be taken seriously. Older Matthew McConaughey is slightly less sexy, but he is taken more seriously as an actor. Think true detective or Dallas Buyer's club. Okay, interstellar sucked, but you get the point. Blockchain needs to be the older Matthew. People need to be bored with it because it works so well. It needs to become part of the everyday infrastructure, not a digital gold rush. Blockchain is a revolution that won't be televised because immutable ledgers are McConaughey with his shirt on. Boring. 2018 has been a busy year for a shoe-learned chief, John McAfee. He announced the 2020 presidential run, his own fiat currency backed by crypto, and he revealed that he charges $105,000 per tweet to promote ICOs. But alas no more, John fought the law and the law won. John McAfee tweeted that he will no longer work with ICOs or promote them due to alleged threats from the SEC. If you doubt his claims, it might not be advisable to show up at his house for several reasons. The SEC did not comment on the McAfee case, but has increased regulatory scrutiny in the crypto space. The SEC commissioner criticized ICOs, saying that the crypto space has been full of troubling developments that we've seen at the SEC and especially the ICO space. Will you vote for McAfee in 2020? Leave your comments below. Big institutions are warming up to crypto. Sorry. Goldman Sachs CEO Lloyd Blankfein says Bitcoin is not for him, but that's okay. I've learned over the years that there is a lot of things that work out pretty well that I don't love. Blankfein linked the evolution of paper money with the rise of crypto. Paper money, like Bitcoin, doesn't have intrinsic value, yet it somehow became the main form of money. Blankfein poses the question, why couldn't you have a consensus currency? According to Goldman's CEO, it is too arrogant to argue that crypto won't be adopted on a large scale just because people are uncomfortable or unfamiliar. Goldman Sachs has been skeptical about crypto. In 2014, they argued Bitcoin was an occurrence. In 2017, it backed down and was rumored to be opening its own cryptocurrency trading desk. In 2018, the Goldman Back Circle app launched a new feature that makes it easier for newbies to enter the crypto market. Crypto, it seems, is making progress. In the past, big institutions like Goldman shook their heads in incomprehension. Now they nod their heads in incomprehension. Meet Ladislav Messer, aka Bitcoin Grandpa. A 57-year-old computer programmer from the Czech Republic is the single most prolific contributor to Bitcoin's Wikipedia page. He spends two hours a day editing and maintaining crypto articles on the site. He's providing a valuable service. The Czech Republic loves Bitcoin. It is home to the first Bitcoin mining pool and ALSA, aka the Czech Amazon, which accepts Bitcoin. Having lived through the Soviet Union, Ladislav is no stranger to misinformation and censorship. So it's important for him that people have access to good info. I don't want any censorship.  Messer fights a daily battle with anti-Bitcoiners who vandalize the page and think crypto is a scam. He has even been accused of being Satoshi himself. Despite being deleted several times, Messer has contributed over 1,000 edits to the article. He has no regrets about not investing in Bitcoin at $2 back in 2012. He is risk averse and just wants to pay off his mortgage. So guys, don't get down or out of the market. For every marketing, there is a Ladislav. Like to go for a walk with Bitcoin Grandpa. Like, subscribe and hodl and he'll get you some pie as well.


Have you ever wondered why people act the way they do? Do you want to know why we get angry, sad, happy? Psychology can offer answers and insights into how we act and why we feel how we do. Do you want to learn some really exciting and surprising psychological findings? If you do, watch on for nine very interesting psychological facts that you may not know about. Number 1. People who speak two or more languages may change their personalities between languages without even knowing it, so someone may become more introverted when speaking French or more agreeable when speaking German. Number 2. People are more likely to follow orders in unfamiliar settings. This is because we're more likely to be obedient when we're unsure or when we feel others have more knowledge than us.  Number 3. Even those who are concerned with equality hold implicit bias about things such as race. This is due to something known as the out-group bias, where we implicitly trust those who aren't a part of our in-group class. It is important to remember that this is implicit, meaning it is not consciously controlled. Number 4. Eye contact makes us more resistant to persuasion. This seems to be because eye contact is related to dominance, something we resent when someone is trying to persuade us to change our minds. So when you're trying to convince someone to buy something or to go to the cinema with you, eye contact might not be good. Number 5. The actor-observer bias is a tendency for us to blame our behavior on situational factors but blame other people's behaviors on internal factors. For example, we may blame our own bad mood on getting stuck in traffic while we blame others' bad mood on the personality. It's important we don't just make exceptions for ourselves, so try to be open-minded towards others when working out why they haven't acted a certain way. Number 6. Women who give birth to boys are more likely to develop postnatal depression. Myers and Johns' finding could be helpful in identifying those at risk of postnatal depression and giving them extra support. Number 7. Social media usage increases depression and loneliness. Hunt Eau found that this was especially true of people who were already depressed. It seems this is the case due to social comparison, comparing your lives to others' lives as seen on social media. So if you find yourself feeling lonely or depressed, spending a bit less time on social media might be a good idea. Number 8. Daughters who have close ties with their fathers can overcome loneliness easier. This was only true with daughters. With sons, the closeness of their relationships with their parents didn't affect how well they overcame loneliness. Yanayale suggested this is because boys aren't socialized to have close bonds and relationships in the same way girls are. Did you enjoy our first series on interesting psychology facts? If so, comment some interesting facts you know that you would like us to share in our next video. You might even get featured! Be sure to like this video and subscribe to our channel for more psychological content.


In Pakistan, chronic kidney disease, CKD, has been increasing rapidly over the past two decades. This has resulted in a large number of people suffering from this condition, leading to a high level of psychological and financial stress. Hemo-dialysis is one of the most common treatments available, but it comes with its own set of drawbacks such as the need for large amounts of water and solid waste production. On the other hand, peritoneal dialysis is a more eco-friendly and cost-effective option, making it a better choice for those suffering from CKD. This article was authored by Salman Imtiyaz and Ashara Lam.


Thank you very much youngsters. Thank you very much Elders. Thank you all. Merci See you scoff It is an honor to be with you here today on traditional treaty 7 territory I'd like to thank you to National Chief Perry Belgard for being here with me today and for his leadership I want to thank Elder Starlight for The prayers he's going to share with us later to the Elders and to the dignitaries from across Canada And especially to Chief Whitney one spot on the Tsutina nation for your incredibly warm welcome. I am truly grateful. I am Profoundly touched to be receiving this great honor today I can say without a doubt that I will remember this ceremony and cherish this experience Always and I will remember the responsibility that comes with the great honor. You bestow on me today It is a distinct privilege to become an or an an honorary Tsutina and member of the chieftainship You can be confident that I will wear both the title and the Tutsina feather hat with the utmost pride and respect The Tsutina nation is a strong proud and independent people with a rich and vibrant cultural heritage The site on which we gather today and the ground you continue to break for important new initiatives Are only a few examples of the many recent successes of the Tsutina people. I also have deep admiration for your incredible efforts and Important efforts to preserve your language Thanks in no small part. I know to elder starlight and to youth initiatives health and wellness programs and so many other successful projects you have put forward The traditional symbols on display today reflect a value. We both share peace with all people and in that spirit today We find our relationship on a new path Guided by that value and by the common principles of recognition rights respect cooperation and partnership In these early days as prime minister, I have been so grateful for opportunities like I have today To signal the profound Importance I place on renewing Canada's nation-to-nation relationship with indigenous peoples Sincerely committed to this renewed relationship and we will honor our promises Just like we have done in moving forward with an inquiry into missing and murdered indigenous women and girls As I have said on many occasions There is no relationship more important to me and to Canada And the one with First Nations the Métis nation and the Inuit a relationship built on the recognition that the constitutionally guaranteed rights of First Nations in Canada are a sacred obligation a Relic a Relationship that is guided by the spirit and intent of the original treaty relationship Respectful of inherent rights treaties and of jurisdictions and a relationship Committed to making progress on the essential work of rebuilding a partnership based on cooperation respect and trust Now this Is something that we will work on together And we will make significant achievements In the coming days and months But this is a work that will go on for years and decades and generations But I commit to you that the government of Canada Will walk with you on a path of true reconciliation in partnership and in friendship And we will work together to make sure we succeed For your children and grandchildren and for future generations as an honorary Tutsina as Prime Minister and as a father And as a Canadian I Will not lose sight of that goal Thank you again for this great honor, which I will accept and value With the utmost appreciation and gratitude and understanding Of the responsibilities that come with it Thank you. Merci See you guys


This suggests that GLP-1 may play a role in helping these individuals better manage their blood sugar levels.  This suggests that the increase in GLP-1 production may help these animals better control their blood sugar levels. Our findings also indicate that this effect is likely due to an increase in the number of GLP-1 producing cells rather than an increase in the amount of GLP-1 produced by each cell. Finally, we discovered that the increase in GLP-1 producing cells in the small intestines and colons of mice fed a high fat diet was caused by an increase in the number of cells expressing the gene NGN3 which is necessary for the development of GLP-1 producing cells. Taken together, our results suggest that the increase in GLP-1 producing cells in the small intestines and colons of up. This article was authored by Thomas Arranias, Alexandra Grossfeld, Christine Poitoux, and others.


162173 Regus soluble organic matter analysis reveals an extremely high molecular diversity on the C-type asteroid, indicating a water-rich environment with low temperatures on the parent body and involving generic processes such as earlier carbonisation and serpentinisation with successive low-temperature aqueous alteration. This article was authored by Philippe Schmitt-Coplin, Norbert Hurtkorn, Morod Heria, and others.


What's happening guys? It's Shane here. So there are a few key things that I focus on in this channel in terms of what you should be looking at when you're deciding which degree that you should go for. Talk a lot about salary of course. I talk a lot about job satisfaction, future growth, and then how many jobs are available now. And I think that the most important of all of those might actually be the future growth. And the reason for this is because it really tells you which degrees and which careers and the skills that you need to have in order to do those degrees and careers are ones that are extremely valuable right now. And this is going to affect a ton of other things. It's going to affect the salary of course because if a ton of people want to hire people that have this degree or this skill, then there's going to be a lot of competition and they're going to have to increase salaries. It's also going to affect your quality of life, your job satisfaction because they're going to want to keep you. If you have the set of skills that they need, they're definitely going to do whatever it takes to keep you. They'll give you really good benefits. They'll pay you more. They'll treat you really well. I mean just picture, you know, Google employees, how well they get treated. It'll be something along those lines. So this is going to be a super quick video. I'm going to jump right into it and we're going to be talking about the fastest growing occupations in the next 10 years. And of course I found this on BLS.gov. And you know, it's a great resource. You should definitely look into it. Let me know if you want me to make a video on how to, you know, how to use it to do research on careers. But let's start. Let's get right into this. Let's start with number one on the list. Number one, growing at an expected about 27.3% is going to be speech language pathologists. And basically they're experts in sort of the mechanics of communication, if that makes any sense. So if you've ever seen the movie The King's Speech where, you know, a king needed to give a speech in the early 1900s to kind of rally the country because World War II was about to happen. And he had a stuttering problem and he worked with a speech language pathologist. And they were able to fix his stuttering issue and he was able to give a very good eloquent speech. This is kind of what they do. You know, they work with people who have, you know, issues swallowing as well. So just anything that has to do with that area, the mechanics of it is something that they are experts at. They get paid really well for this. They get paid around $77,500 a year. That's really solid. Wow, look at this. Do you know what this means? So this is a really good one to get into to look into growing extremely fast. And you're going to notice that there are a lot of health related professions on this list. There's a reason that I put health related degrees up on a high level. And that's because there's just so much demand and, you know, you're pretty much always going to have a job with like 95% of them. Next on the list is going to be another health related degree. That's nurse practitioner and they come in at about 28.2% growth, which is just insane over the next 10 years. That's just crazy. Now this one is more of like a six year degree.  It's basically a master's level degree. But it's kind of like a nurse sort of, I think everybody knows what nurses do, but they have a lot more, you know, range and scope of what they can do. So for instance, nurse practitioners can generally write prescriptions. They can generally diagnose people or help to diagnose doctors and take a lot of the workload off of doctors as well. They have really good quality of life as well. That's a great thing about being a nurse practitioner versus being a doctor. For instance, you'll work generally about 40 hours a week and then you get to go home. It's a lot nicer than being a doctor where you have to work like 60 to 80 hours a week and sure you get paid more, but quality of life is not that good. They make about $107,000 a year median annual income, which you know, that's pretty solid. But again, this is a six year degree, not a four year degree. So just keep that in mind. Next one on the list is going to be statisticians and they are growing at about 30.7% in the next 10 years. That is crazy.  It's my least favorite type of math. I'm very bad at it as well. But you know, hey, if you like statistics, if you like math, $87,700 a year and it's growing like crazy. This is one of the best careers to look into.  The next one on the list is growing at about 31.1% of the per year. And that's going to be physicians assistants. So physician assistant is a little bit similar to nurse practitioner. There are some key differences. Of course, it's another degree that takes around six years or so to get. So it's kind of like a master's level degree. But it's growing extremely fast. You know, I'll probably make a video where I go over the differences between nurse practitioner and PA. They can both prescribe, they can both diagnose. Nurse practitioners generally can go to other countries, for instance, and they still have all of the or most of the range and scope of what they can do in those other countries. Whereas PAs, it's kind of only an American thing at this point. And there's a lot of other like little subtle differences. But you know, PA is amazing. They were basically designed to take a lot of the workload off of doctors. And yeah, this is a super, super good one to get into. They make about 108,600 a year. And they're growing really fast. So definitely another one to look into. Three out of the top four so far that we've gone over have been health related careers. Are you noticing a trend here? Information security analysts is next. They're growing at about 31.6% over a 10 year period. And what these guys do basically is they plan and implement different security measures to protect, you know, an organization's information. They'll design the different computer networks and systems so that they're safe, you know, no hackers can get into them. And there's not going to be any information leaks or anything like that. And as you can imagine, with all the information leaks with like the target credit card and all that sort of thing, all these huge scandals, I think it was like Equifax or something like that also happened to them. This is a huge, huge deal these days. I mean, this is very important that companies have their information on lockdown. It's extremely important, especially if you look in places like the healthcare field where you have HIPAA laws, and you've got like different health related laws where if any of that information gets leaked, it's even more serious. So as you can imagine, these guys are getting paid very well, an average of about 98,500 a year, you know, it's growing super, super fast. Another great one to look into, very, very important, kind of like an anti-hacker sort of thing going on there. Next one on the list is going to be occupational therapy assistance. And it's growing at about 33.1% per decade. And basically, what they do is they're kind of like a physician's assistant a little bit, but they're going to help people who are trying to recover from injuries or maybe people who are a little bit older, and they're not able to function normally. So they kind of help those people and they help the occupational therapist to either, you know, improve their ability to help themselves or just take care of them in general. And it looks like they're making about 60,220 per year, so that's very, very good. They're growing at about 33.1% per decade, like I said, which is also excellent. So again, this is another health related one. So I'm, you know, I can't say that I'm surprised, very good one to get into. Next one is going to be a much lower paying one, but there's a huge amount of demand. And in my opinion, like I said before, where you see a lot of demand, you're going to see the pay going up, right? And this is going to be personal care aids. Now, it's growing at about 36.4% in the next decade, just an insane growth because they're expected to have 881,000 of these jobs open up in the next decade, which is just that that's crazy. That's like an entire country and just one job in the next decade. That's insane. But it only pays about $24,000 a year. Now, this is one of those where you don't need too much education or anything to get into it. So, you know, you can't really compare this to a six year degree or a four year degree, but still 24,000 is quite low. It's not what I'd like to see. But at the same time, you're still growing really fast. You have a lot of job security, a lot of opportunity because there's so many jobs open. So this is a good one to look into. And the next one's very similar. It's home health aids and it's like a personal care aid, but they actually go to people's houses and they take care of them at those houses. Pretty self-explanatory, I think, but this one's growing even faster, 36.6%. Again, it pays around the same about 24,200, which isn't very good. But like I said, when you have a lot of growth like that, I see this going up in the future. I think they are going to be paid better in the future. And because of the fact that there's so much demand, you know, they don't have to go through too much in terms of training. So this is one that you can kind of get into very, very easily. So if you're somebody who doesn't want to go to college or anything like that, but you want to make a decent living, this is one to look into. The next one on the list jumps up to an absolutely insane 56.9% expected growth in the next decade. That is just, that's totally nuts. This one is going to be the wind turbine service technician. And I think it's pretty self-explanatory. You know, those big turbines that you see when you're driving through Kansas without stopping because Kansas is really flat and boring. And I can say that because I lived there for a long time. Yeah, these are the guys. These are the people who take care of those big spinning turbines and they get paid pretty dang well for it. They get paid about 54,370 a year and there's tons of demand for this one. So this is a really good one to look into. Next one on the list, this is actually number one. It's going to be solar photovoltaic installers. And that's kind of a big mouthful, but basically they install solar panels and that sort of thing onto different houses or they repair them or they maintain them. They just take care of those sorts of things in general. Now this one is growing at an absolutely crazy 63.3% in the next 10 years. That is just that's nuts. And you know, you make about 42,680. That's not too bad, especially since you probably don't have to do too much training to get into this sort of thing where you don't have to go to a lot of schooling. So that's actually pretty good. But I just wanted to say one thing about this list. If you noticed six out of the top 10 were in the healthcare field. And one thing I always say on this channel and some people will argue with me is that when you go into the healthcare field, you have a pretty good chance of having a stable job. It's not like that for every job out there. You know, there's some jobs that are getting a little oversaturated right now. I'm definitely going to be making videos about that in the future. But overall, you have a very, very safe and stable job when you're in the healthcare field. You don't really have to worry too much about getting fired or that sort of thing. Because there's literally all the time there's shortages in the healthcare field. I mean, if you work with a nurse or anybody in a pharmacy or anything like that, you'll probably have heard them talking about how, you know, they're short staffed. Or the last time you went into a pharmacy or anywhere else, they were probably short staffed. And that's because there's just not enough people to fill these jobs. And that's really good. That gives you a lot of leverage when you're an employee. It's definitely something to think about and just chew over for a little bit. But overall, make sure you check out these videos right here. Smash the like button, hit the subscribe button, ring the notification bell and comment down below any ideas that you have about the video. Thank you for watching and bye for now.


I'm a skateboarder. Hey everybody, my name's Eli Morgan-Gessner and I'm the style editor here at Uproxx. And today I'm doing an interview with Giovanni Reda who just made a documentary about the legendary Nora Vasconcelos. Wow. Yes. I like that. And we're gonna be talking to them about Giovanni's new documentary he's done about this legendary little tank of a woman. You're kind of in the, in the cut, right? You live in the country in Massachusetts. You get into skating. Like when I was starting off around that time my dad would take me to Skaters Edge which was this indoor like gritty in like an old mill building in Taunton. But I would go there and I would go on Tuesdays cause it was girl skate free and I would show up there and I was pretty intimidated and I would just go skate the ball with myself. And then eventually- Is that how it happened? Yeah. And then- Cause your bowl skills are phenomenal. Oh, thank you. But that's I think why I skate transition. I called her, I was like, hey, so this is what we're doing. She was like, okay, let's do it. Yeah, okay cool. Like I don't know why you guys want to do this. And this is one of those things I wouldn't have done it with anybody else. You would only do it with Rada. Pretty much. Especially based on like what he's done in the past. The Brian Doc, that was kind of like a big turning point for the skateboard industry and then for Brian himself. 100% seminal. I don't mean this as a diss towards any other female skaters. There's always a certain like feminine body mechanic. Yeah.  You know, which- That's so sick. That's so sick. People always tag me while I always, I've seen photos of guys that's like, is that me? It's kind of hard to translate it to people that don't skate. Like how important style is. And especially Nora has this like unbelievably amazing style like we were talking about. There was this weird thing that sort of happened in the early 2000s where I would talk to kids who skate for me and they would be really excited on someone's style. Are you talking about this fashion style? And they were like, yeah. And I was like, that's not what skate style is. Every other day I get hit up right now. That's like, where do you get your pants? Specifically the purple ones. Like where do you get your pants? Where do you get your pants? Like I make them. Really? Well, I don't sew them but they're white dickies that I just dye.  You know, every skateboarder that I've looked up to from when I was a kid and the ones that are like the most influential. I'm just saying like Nora has that like the style, she has the personality, she has the tricks. She's an artist. One of the things that was I found shocking in Red's Doc is your slams. And I love that sort of thing. There's definitely more too. There is way more. You just need to be totally comfortable with the fact that. You're going to get hurt. Yeah, well in the film she says when I came to skateboarding she's like, yeah I'll bleed for this. That's kind of like. Oh, I'm Giovanni Reda and you're watching Uproxx. Thanks, all right. See you at the end. Okay, thanks. Bye.


NGC 454 is a galaxy pair with a large red elliptical galaxy and an irregular gas-rich blue galaxy. The system is in the early stages of an interaction that has severely distorted both components. Below the dust lanes that stretch all the way to the center of the elliptical galaxy suggests the gas has penetrated that far, no signs of star formation are visible.


What's going on guys got Kyle here with Layton sports cards, and we are ripping one box of 2023 Bowman jumbo This is gonna be for Michael S. Good luck Michael. Let's see what we got in this jumbo See some nice little numbers here See some red yes, yes, I am in I'm in for a red I'm read in for a super I'll take a true gold Come on Michael. Good luck Had a pretty nice box of hobby for you earlier. There's a size on September Volpe first insert Now we got Cromes Braille and Bishop the louder De Jesus and Colton Couser top 100. There's a rookie Tristan Casas spotlight Prospects of Sammy Munoz. There's a Fraley And this is Randy De Jesus on the Lunar Glow not numbered new parallel this year top 100 of a Royal paper base Got inserts McLean Brady house roams Lawler green and gray rod there Gray rod top 100 number two. Here's our first auto. It is gonna be base Prospect auto here Manuel Beltre For the Blue Jays Manuel Beltre on the base auto. Let's see some color on the next two There's a Jacob Barry chrome Noel V Marte and do a little switch here. I believe the next two are gonna be Save the last two autos for last I think Think I'm doing that that way There's a Josh young rookie spotlight Prospects of Jordan Lawler. There's a chrome Gabe Garcia Gabe Gonzalez. There's a camp Collier base first base Brady house Probably the the Palo probably the Palo Luke Palo sells very well. There's the 299. That's gonna be JD Martinez It's on the Dodgers there Forest favorite version of JD on the fuchsia to 299 Dodgers JT JD Martinez. There's chromes. That is Lazaro Montez chrome base Julian Mauricio paper paper. We've got a rookie Brett Beatty sky blue paper. This is the 499 for the Mets gonna be Simon Juan Nice Mets prospect there Got a Blake chrome Ronnie Simon Ramirez top 100 paper paper got von Grissom rookie Machia insert chromes Arias. There's a Spencer Jones chrome top 100 Coleman Aris Looking for two autos here Michael good luck, sir. We got one nice one here to 250 We got a true purple of Nicao Puaca Grego out of New Zealand there For the Phillies prospect of 250 very nice one there on the true purple Puaca Grego out of New Zealand and we've got a Gunner Henderson rookie favorites Sanchez and Sanchez Benny Montgomery Few packs left Come on. See some nice color There's inserts Vargas and Bayez Chrome Garcia Corona Montecino and a James Wood top 100 and our last auto is gonna be for Boston It is a speckle auto to 299 Fraley in Carnasio Nice one there on these speckle auto first. I think he's the only one who separates his auto like that. He does that a lot One side of the logo and then the other side Nice one there though Fraley speckled the 299 nice box for the first autos there Jordan Walker Chrome Luis Matos and last pack here Michael good luck Paper we've got insert Jackson shurio Raffella Chrome Sweeney And on the back we have purple Kumar Rocker to 250 that'll be your last hit there For the Rangers on the true purple on home Martinez and that will do it Michael For one box of 2023 Bowman jumbo. Thank you so much my friend. We'll get it right out to you


Hi and welcome to the session. I am Asha and I am going to help you with the following question which says find the intersection of each pair of sets. So first let us learn what is the intersection of two sets. Suppose we have any two sets A and B, then intersection of A and B is equal to all those x such that x belongs to A and x belongs to B also. So with the help of this definition we are going to solve the above problems. So this is our key idea. First part x is equal to a set having elements 1, 3 and 5 and y is a set having elements 1, 2 and 3. Now the common elements in x and y are 1 which is both inside x and y and 3. So x intersection y is equal to a set having elements 1 and 3. So our answer is the intersection of x and y is equal to a set having elements 1 and 3. So this completes the first part. Now proceeding on to the second part where A is a set having elements A, E, I, O, U and B is a set having elements A, B and C. Now let us find the common elements which are both in A and B. So A is the only common element. So the common element in both as we have A intersection B is equal to singleton set having only one element that is which is A. So answer of second part is A intersection B is equal to singleton set A. Now proceeding on to the third part where we have A set having all those x such that x is a natural number and as we know natural numbers begin from 1 and goes on and a multiple of 3. So A will be a set having natural numbers start from 1 and the first multiple of 3 will be 3 then we have 6, 9 and so on and set B contains all those x such that x is a natural number which is less than 6. Thus B will be a set having elements 1, 2, 3, 4 and 5. Now the common elements in A and B, A intersection B will have only one element and that is 3. So the answer of third part is A intersection B which is 3. This completes the third part and now proceeding on to the fourth part where A is a set having all those x such that x is a natural number 1 is less than x is less than or equal to 6. And B is a set having all those natural numbers 8 such that x is a natural number 6 is less than x is less than 10. So A will have the elements greater than 1 and the natural numbers so we first number is 2 and 3, 4, 5 and less than or equal to 6 and by 6 is also included in the set. Now let us write the set B which have all those x such that x is a natural number and x lies between 6 and 10. So the first number is 7 then 8 and then 9. Now observing these two sets we find that there is no common element in A and B there is no element which is both A and B. We must have A intersection B as an empty set 5. The answer of fourth part is an empty set which is 5. Now proceeding on to the last part where A is a set having elements 1, 2 and 3 and B is a set having no element that is B is an empty set. Now the intersection of any set with the empty set is always empty since there is no element in set B this implies there is no common element which is both in A and B this implies that A intersection B is an empty set which is 5 and thus answer of fifth part is A intersection B is equal to 5. So this completes the last part and ends the session. Hope you enjoyed it. Take care. Have a good day.


Today we're opening the last Ghost Rare set. What's up guys, we're back with another video. Today we're opening Dimension of Chaos Booster Box. We've never opened this as a booster box, one of my favorite sets, but we have opened it in a lot of loose packs, and we did really well. Before that, we do have a giveaway. I'll be giving away these two cards from Maximum Gold Eldorado, Blue Eyes, and Dark Magician. All you guys have to do is like this video, be subscribed, let me know what you think about Dimension of Chaos, and let me know your favorite set. Let's get this thing open. So we opened a few hundred of these packs before and got two Ghost Rays. That was like a year and a half, two years ago. So let's be really careful here. We don't want to destroy this thing, but this was the last Ghost Rare set in Yu-Gi-Oh! That's why we opened it so much, until they finally returned Ghost Rays with Rage of Rock, but it also has Ultimate Rare. So this is the last Ultimate Rare set, I guess, and it also has, besides OTSs, and it has Ghost. So to have both, it is the last one. These first edition boxes are actually really hard to find, because I had never heard of this set a couple of years ago. I found it, I was like, this set looks really cool to us. Some pretty good stuff in it. I really wanted to open it. I could not find a booster box. They were like $200, two years ago. I couldn't find anything. And then I found a ton of them for $250 a piece. We ended up pulling those four Ghost Rays. So let's see if we can bring it back and pull something crazy. 24 packs of Docks, Dimension of Chaos. The Fluffle Wings, oh, don't spoil it. The Fluffle Wings have returned. There are a Rare and a foil in, not every time, but you can get both. Ignite Cavalier, we got the Cosmo, Light Sworn, Dark Contract with the Witch. Raid Raptor, Field Eagle, yep. Oh, there's the Super Rare. DDD, Wave, Oblivion, King Caesar, Ragnarok. We're gonna have a mouthful trying to read that one. Ignite Veteran and Pot of the Forbidden. I think Pot of the Forbidden was actually worth a little bit. So we're gonna pull out the Fluffle Wings, which I don't know if it's worth anything anymore. But for a while it was. Next up, so we have 24 packs here. We haven't done a booster box of this. So this is actually pretty fun. I've been considering doing this and we have Grand Horn of Heaven. We got the Yatta, cool. Great illegal. Yeah, I just can't believe there's a Yatta like retrain. DDD Burfomet, cool. Oh, and the Black Glosser Soldier, Super Soldier. It took us so many packs. This was the original goal of the opening was to pull this. Not even an Ultimate Rare and we cannot pull it. It took so long. The Black Glosser Soldier, Super Soldier. It's like a throwback to those openings. That is so awesome. But that's a good start. And yeah, it's not guaranteed super. So is it? It's not guaranteed supers? I don't think. So we're just pulling crazy so far. We've got a super and an Ultra. And Ultis are very difficult to pull in here. So it's gonna be tough. If we get one, we gotta go crazy. They're not guaranteed per box. We got a Tempest. Radiant, all that's a good Kaiju. Yeah, this card was like $10 when we were opening those. I think it did get a reprint. So it's not like that crazy anymore, but it's still worth quite a bit. All right. All right, Kaiju's. Yeah, there was a ton of valuable cards that finally did get reprinted between since we opened them. And now Cosmo Lightsworn, we got the Fright for March Ignite Cavalier, DDD Wave King Caesar, and the Dark Contract with Swamp King. Lots of DDD stuff in here, which back then I had no idea about DDDs. Then they came out in dual links. I actually have some familiarity with some of them. Yeah, so I'm a new man since then. DDD Necro Slime, another one that we wanted. Fluffle Wings, they're always together. Plush Fire, another decent one. I didn't realize that was banned when we were opening those. Samurai Cavalier of Reptier. And Contract Lundering, very cool Super Soldier Soul. Next pack of Docks. Man, these are very like wimpy packs. Like they don't have a lot of integrity to them. So they just rip right down the middle. Plush Fire, we got the Human Resources. Deskbot Jet, that's cool.  This comes in Ultimate Rare as well. That is, ooh, that's a nice card. Odd Eyes, Vortex Dragon, very beautiful. You love to see it, very, very nice. Okay, our pulls have been crazy so far. We've already got a Secret Rare, Ultra, and a Super. Wow, okay. Odd Eyes, Vortex, I don't think is a very good one. We would rather probably have the Scarlight, I think. It comes in Secret Rare, Ultimate Rare, and Ghost Rare, as you guys know. DDD Savant Galilele, Galilele, Galilele. Soulhorns, struggling. The Oblivion King, Abyss Ragnarok, this one's pretty good, I think. And then the Rebel Leonidus, very cool Super Rare. And Super Every Samurai, so they're Samurai, Super Every Samurai's in here. I don't think they ever took off. Oh my goodness, why won't these exit the packs correctly, Tempest? Grado Impact, Super Every Samurai Soulhorns. Dark Contract with the Errors. Performa Pals, Second Donkey, and Death Spot, 006. Cool, Super Rush Headlong is in here. I totally forgot about that. That is the most dual links of dual links. That card was big for like two years.  Like at the time, I didn't realize how banned this card was. That's pretty cool, Shuffle Reborn, Samurai Drum, Veteran, and a DD Swirl Slime. It doesn't seem that long ago that we opened these, but it really was. It was forever ago. It was so long. Okay, let's see if we can pull something crazy there. Dark Contract with the Witch. Grado Alligator, Necro Slime. I don't even know what these boxes are worth, but they're worth way too much, I think. Kunai, the Drizzle, and Samurai Thief, the Cosmo Wicked Witch. Shuffle Reborn. Next Docks. Let's keep going. Frightfur, March, the Frightfurs. Ignite Cavalier, Grand Horn of Heaven. Maddyspector, Crow Yatta, Grado Slime, and. Ooh, DDD Duo Dawn King Kaleuga, Kaleuga. Not Kaleuga. There we go. Super Rare Kaleuga. Man, DD stuff. We are getting a lot of it. Maddyspectors and Super Soldier Soul. This is the last pack on the right side. We actually, it's been, we just don't know the lot of booster boxes anymore. Unless, like, new sets, I guess, is basically it. Grado Eagle. Fluffle Wings, good. Raid Raptor's Ultimate Mace. Skull Eagle. Sphere Caribo, another epic, Dual Wings slash, just, yeah, Speed Dual Card. There we go. Oh, Black Luster Soldier, Super Soldier. The card that we could not pull for, like, 200 packs or something. We open it and get it twice in the same box. Wow. I think it's only, like, 40, 30 bucks, something like that, but that is one of my favorite cards. The reason we originally opened this was because it's nostalgic, you know, retrained, basically, not because there are any other good cards, and we get it again. Oh my goodness. That's an incredible happen. Yeah, Ultimate Rear's are, like, one of every three boxes in this era, something like that. So that is actually insane, not only to get one, but to get the one we actually want. We got these Soul Horns. Greatest Slime. DDD Contract Change, cool, and Super Heavy Samurai Thief. Wow, that's nuts. If we get, like, a Ghost Ray, this is literally the best box, and I could have picked the other box, but I just picked this because they had the $80 prize tag on it. Necro Slime, we got the Fright for March. Raid Raptor Fiend Eagle. And the Fright for Sabertooth. This is another one that had not been reprinted when I was opening this. It was a $20 card. I think it got reprinted, so it's probably more, like, $4 or $5 now. But wow, this is a great box. Like, if we had opened this back then, this would have been incredible because I think the Super Soldier actually went way up at one point for some reason. I don't think it was because of our openings, but it could have been partially because of that Galilea, the Witch, Alligator. Toon Barrel Dragon, this is another decent one. And Super Soldier Rebirth. There were so many rares that were worth, like, $2, which is why I wanted to open this set because I would usually make a lot of my money back. I would make either from Toon Barrel Dragon or from Radiant, would make, like, five packs back because I bought them for $2 each. We got the Transporter, Great Old Alligator. Skilled Red is very cool. The Legendary Fisherman 3, that's another cool one. Okay, wow, there's so many supers in here. They're not in every pack, but it feels like they're almost in every other pack you get a foil. Wow, what an amazing box.  Let's go. Dark Contract with Airs, Great Olegal. Fluffle, Wings, Ultimate. Raptor's Ultimate, Mace Windu. Diddy Burfomet, and Great Old Cobra. All right, felt psychic blade. Like, I don't even know what else.  Like, there's gotta be nothing left, right? I mean, unless there's a Gosher, which is possible, Fluffle Wings, Cavalier, Pendulum Area, Ignite Vetter. I mean, this is the set we have crazy luck with. So if it's ever gonna happen, it would be now. So I'm just banking on that. By the way, I think this set came out around late 2015. So it's a pretty old set at this point. It's like almost seven years ago, guys. Dark Contract with the Gate, Performapal Help Princess, and the Mirror Conductor Cosmo Wicked Witch, and the Diddy Swirl Slime. We're about three quarters of the way through this opening. Okay, Plush Fire. Raptor's Ultimate, Mace. Plush Fire is a cute card. Well, I just checked this out. I mean, just look at that card. It's a cute little Fire Ice Cream cone. Got the Fire Eye of the First Aid Squad. There we go, Performapal Second Donkey. Diddy Contract, change, very nice, and super heavy drum. A few more packs at the ghost area. Chances to pull something legendary. The Scarlight Red Dragon Archfiend. We have Diddy, Necro, Slime, Fry for March. Plush Fire again, and we've gotten a lot of those. Yada, Performapal Splash, Memmoth, and a Gateway to Chaos. This is such a cool card. Throwback to, like, Duel Links, KC Cup Number One. I think the one where, what's his name? Duel Links, Meta, whatever his actual name is. I can't remember. Didn't he win with that, I'm pretty sure? Yeah, yeah, playing like Gaia and stuff like that. Yeah, that was the throwback. That was, like, 2017. Skull Eagle, we got Soul Horns. Diddy, Necro, Slime, Fluffle Wings. Gamma Seals in here. Man, there's so many good Kaijuus. That's crazy, and a Contract of Laundering. Wow, wow, that's amazing. Two more packs. This has been a great opening, guys. Great opening. Docks. This has been worth, I mean, not really worth, because I think the box is really expensive, but we've done pretty good. Great old eagle, Grand Horn of Heaven. Super Soldier Ritual had some value. I don't know if it still does, but here we go. Magispector Cubie, okay. And a Raid Raptor, cool. And the final pack of the opening, Dimension of Chaos. Let's do this. Hit that like button, guys, for luck. We gotta pull that ghoster. We gotta yalla. We got a dark contract with the gate. Savant Galaday, Rank Up Magical Raid Force, and DD Swirl Swarm Slime, okay. That was an amazing opening, guys. I hope you guys enjoyed it. If you did, make sure to subscribe to the channel because we will be doing more epic openings like this in the future, even more epic. Some was epic. Some of the same, who knows? Shout-outs to TCGTrust, the trust cards home for a show, Tomato Juice, Noa J, Stanley, Mike Nance, Mehmet Gekko, Duel's King of Cards, Bankipa, Frontland, G-Raider, and Daxter. Thank you guys for supporting the channel, and I'll see you guys next time. Peace.


Hello, my name is Andrew Goodall, I'm the NHS Wales Chief Executive and I hope that I had the opportunity to see some of you at previous staff events. I just wanted to give you an update on where we stand on health education and improvement Wales and look I've worked in the NHS for many years, too many years to remember, but actually this organisation, its creation is probably one of the most important structural changes that we have been looking to introduce on behalf of the NHS Wales system. As a national organisation it places education and skills of our workforce into one single organisation and the benefit for me is to ensure that we take the best of these three very successful organisations and have an advantage in bringing together their skills and experience into one place. Whilst being one of the most important changes that we are taking forward this means that it is an environment which has many challenges, there are lots of risks for us to understand but we need a clear way forward on the advice of the programme board and I would want to reassure all of you that at a level of detail we are working through as a programme board a whole range of issues ranging from finance, from ICT, the structures that we need in place, location and of course some of the detailed arrangements that need to be in place for the transfer of staff but we are clear that we will be looking to establish this organisation on safe and proper grounds and we will be looking to give some advice on the clear timetable for this as we go into the new year. There remains much to do in a short time scale but I do want to give you some assurance about progress that we are making so I know you will be aware about the arrangements in place for an interim chair which is through Dr Chris Jones. I am also pleased to report that we have now been able through a national process been able to appoint the chief executive of the organisation Alex Howells and Alex will be giving you some personal reflections as part of this video message but we have also had to put in some practical mechanisms to support the work of the programme board so there is now a transition management team in place that includes representatives of the different organisations making up this new organisation and I will again have expectations at a level of detail that they give us good advice on the actions necessary but have a really important role in liaising and linking with you as staff in terms of your expectations for this organisation and as part of that will be to continue to communicate to you. Moving into the new year we will be looking to make an announcement about the intended location for HEIW. I know that is an important issue for staff and it is important that we ensure that you are aware of our proposals very quickly and also we will be able to let you know about other appointments that have been made to the board and also our process in place to make sure that executive appointments are made as well. So I would just like to finish by once again acknowledging the patients that you have demonstrated in this process. It is a large task to set up a new organisation and we need to maintain the existing tasks and duties in the interim period of time. Thank you for your professionalism. I do have confidence that we are going to be able to establish this organisation to meet the expectations that we have for a better workforce for the health and social care system and finally I would just like to wish you the best. I hope you have some time for a break over the Christmas and New Year period and we will be coming back and letting you know about the progress in the New Year. Thank you very much for listening. Hi, my name is Alex Howells and I've just recently been appointed as the first chief executive for health education and improvement Wales and I'm really excited and looking forward to starting the new role in the New Year. I've got 28 years experience in the NHS and I see this new organisation as a massive opportunity to really help create and develop the workforce for today and the future so I'm really looking forward to the challenges ahead and to working with all of you. I'll be taking up the new role on 1 February and one of my first priorities will be to meet as many staff in the existing organisations as I can. This is really important to me because I think that staff engagement involvement will be a critical part of the success of the new organisation and it's really important that we start in the way that we mean to go on. I've been really encouraged by the number of people who've contacted me already to tell me about their ideas for the new organisation, whether they be staff within the existing organisations or people from stakeholder and partner organisations and I'd encourage anybody to do that. Just drop me a line or give me a call at any time. I'm obviously going to be attending the staff event on 11 January and the stakeholder event on 12 January so I hope to meet a lot of you at those events and in the meantime I hope you have a great Christmas and I look forward to working with you in 2018.


And out of Africa now, Afghan security forces and armed citizens engaged with Taliban fighters on the outskirts of Kunduz on Saturday in a bid to drive them out of the city. Reports say that the Taliban had suffered heavy casualties and the offensive faced resistance from Afghan forces. Talks between the Afghan government and Taliban negotiators in Qatar have failed to make substantive progress, though the war insides have been holding meetings in recent days.


So, let's do something simple to start off with on these, you know, factoring higher degree polynomials than just degree 2, right? So let's say we want to factor the following polynomial. So the question would be, they would be asking you to factor this polynomial, x cubed minus 1. Now, there are formulas for this, just like there are formulas for factoring quadratic functions, the quadratic formula, but we're not going to use the formula to factor this, right? Because it's going to work on all possible, all polynomials that have, you know, have factors that exist in the real number set, right? Or at least as part of the rational numbers, integers that we have, right? Things that factor out simply. So what we're going to do to factor this guy is we're going to look at the last term and the coefficient from the highest power, right? The last term, the possible factors of 1 is just plus or minus 1. The possible factors of negative 3, or the 1 here is just plus or minus 1. So possible factors of this is just going to be plus or minus 1 that we're going to try out. Now if those didn't work out, then you're going to have to use a calculator or go to the formula and try to figure this out. But you know, we came up with this question and we already know, I already know one of these is going to work. So let's try possible factors that's just going to be plus or minus 1. And this is x cubed going down to a constant. And we have to put everything in descending order, right? But we're missing the x squared term and we're missing the x term. So what we've got to do is put place markers for the x squared term and the x term. So let's lay out the division statement here, or the synthetic division statement here, right? Or the synthetic division form here, that way you can see how it all lays out. And then we're going to go ahead and do the synthetic division. So the possible factors of this polynomial are going to be plus or minus 1 divided by plus or minus 1, which is just really plus or minus 1. So what we're going to do, we're going to try out x is equal to 1, which means x minus 1. We're going to see if x minus 1 is a possible factor of this, right? And what we did when we laid it out in the synthetic division form, we put in place markers for x to the power of 2 and x to the power of 1, right? Because we're missing those terms. So that's 1 and then 0x squared plus 0x minus 1, right? And what we're going to do is just go through the synthetic division part. So the 1 comes down here, 1 multiplies 1, comes up here. You add those guys, whatever the result is, comes here, multiplied by 1 again, comes up here. So we're just doing this exact thing, thing, thing, thing, thing. So again, what we did was brought the 1, multiply 1 times 1, 1. Add these guys together, 1, multiply 1 times 1, 1. Add these guys together, you get 1, multiply 1 times 1, 1. Negative 1 plus 1, 0, right? That way, we know that x, x minus 1 is a factor of this top guy. So right away, we know that x minus 1 is a factor of this guy because our remainder is equal to 0. What we have as the end result here, we just took an x cubed and divided an x from it, right? So our end result here is that's 1x squared plus 1x plus 1. If any of these terms were 0, it would just be a place marker for the missing x term, right? So if this guy was 0, your factor here would have been x squared plus 1, right? Because this guy would be missing, but it's not. So we're going to fill in the x terms so you know what it looks like. That's the polynomial that we get, the quotient that we get when we take x minus 1 divided into that if we're thinking about a division, right? What we're looking for here, the question for this guy would have been factor this. So what we have right now, this guy factored, right now, we've taken it down to x minus 1 times this whole thing, x squared plus x minus 1. Now we're going to have to try to factor this further, right? We can't use simple, simple, what's it called, simple trinomial factoring because we don't know two numbers that multiply to give you negative 1 and add to give you 1, right? And we can't use complex trinomial factoring because that's just a 1 there, right? We don't need it. So what we're going to have to use for this guy is to use the quadratic formula, right? Because, you know, top of my head, I can't think of two numbers that multiply to give you negative 1 and add to give you 1. So we're going to use the quadratic formula, but before we use the quadratic formula, we're going to look at the discriminant to see if it even has any factors and the discriminant, if you remember from the quadratic formula section, is b squared minus 4ac, b squared minus 4ac, right? So if it's equal to 0, it's got one real root or two identical roots, right? If it's greater than 0, it's got two real roots and if it's less than 0, it's got no real roots, right? So let's take a look at the discriminant before we go ahead and do the whole, you know, layout of the quadratic formula. So the discriminant for this is going to be b squared minus 4ac, right? Just did a correction here because that shouldn't have been negative one. It should have been positive one, right? That's x squared plus x plus 1, right? So our a is equal to 1, our b is equal to 1, our c is equal to 1. If we subbed it in into the discriminant, this is what we're going to end up getting. So we sub in a, b, and c into the discriminant.  So it's going to be 1 minus 4, which is negative 3. Now that means the discriminant is less than 0. So this guy has no real roots. So we're stuck. So possible factors of this guy is just going to be x minus 1 times this. And we've factored as far as we can in the real number realm, right? If we go to complex numbers, imaginary numbers, we can factor this further. But we're not there yet. We're just functioning right now in the real number realm. So this is where we would end up if they said factored this guy. And we can write that down here. So if you're factoring this guy, right? This is as far as you can go. That's it. Because this guy you can't factor in your real number realm, right? So we just factored something that's higher degree than power of 2 using synthetic division. And that's where we're really going with this, because we want to be able to factor large polynomials that way we can get their x-intercepts, right? And once we get their x-intercepts, we can begin to graph them, right? And what this is here is when x is equal to 1, again, what we're talking about here is this is your x-intercept for this function. When x is equal to 1, y is equal to 0, that's where this function crosses the x-axis, right? So if we have your Cartesian coordinate system, if you graph this guy at x equals 1, the function crosses the x-intercept, okay? Let's go do one that's a little bit more complicated than this guy.


The one thing the narcissist fears you will realize. When a narcissist comes around a person who is powerful and dynamic, a person who is positive in attitude and full of energy and new ideas, a person who displays power and strength, there is one thing the narcissist must do. They are attracted to you because of your good qualities. They admire that and they want to be around it. But they want to get you to hand your qualities over to them. They want you to give them your power and love. If you give it to them, it greatly benefits them because they're getting it from a powerful, dynamic person. So it's a very potent source of supply for them. But they know that a powerful, dynamic person is not just going to hand it over to someone. They have to trick you. They groom you. They prepare and train you for the purpose of misuse where they mistreat you and exploit you. It's abuse. And the abuse strips away your powers until you become trapped or confined with the narcissist.  They will constantly be in disagreement with you about anything relating to your skills or talents, anything that makes you a good, righteous person. They will become oppositional to all of that because that's what gives them the ability to break you down. When a person becomes oppositional to everything that you are representing, to your skills and talents, to your confidence in yourself, when a person becomes oppositional to that, it makes you doubt yourself. It makes you lose trust and certainty in who you are, in everything that you have worked so hard to establish. It makes you insecure. The narcissist does this so that they can gain control over you because they know that a person who is insecure lacks control over themselves, which means that naturally, they will be seeking that security and stability from another source outside of themselves.  They will make you feel insecure about things that you are currently going through or even things that you have overcome from past situations. They attack things that you are confident in, things that you are passionate about. Whatever you are most confident and passionate about is where they have to strike first because that is going to be the greatest opposition to them being able to control you. A confident person who knows who they are is a difficult target for the narcissist to break down. It's difficult for the narcissist to contain someone like that. So they have to put an extra effort to damage your reputation, which is why you will see them always trying to make you doubt something, always going against whatever you believe in, whatever you think is right or true, even if it's just something where you support a sports team. They have to support the opposing side. They always have to be in opposition to you. They can never be in agreement with you. They can never share your views or opinions. But then when it's something you have no desire or interest for, they will treat those things in a way that is kind of helpful, but in a way that betrays a feeling of superiority. They will support things that you don't really care for. They will not promote anything that is usual, expected or logical so that it gradually creates a person who is dysfunctional. It gradually creates a person who doesn't have the confidence in what they've worked so hard to build and establish to make them who they are in the first place. But this is the one thing that the narcissist fears you will realize because if they hate all these things about you, why did they target you? Why did they choose to remain around you? They're trying to manipulate you. They're trying to brainwash you into being their source of supply by keeping you in a state where you can still supply them with all of the things that they need while making you doubt yourself, while making you feel like you're not good enough so that it keeps you looking at yourself.  They don't like it when you display intelligence. They don't like it when you display a positive attitude when you're full of energy and new ideas because it overpowers them. It makes them feel like they're losing control because they're very weak people. The more powerful, intelligent and dynamic of a person you are to them, it intimidates them. It makes them feel inadequate. It makes them feel like they're insufficient for a purpose. It makes them feel like they're unable to deal with a situation or with life. They want to receive all of the qualities, abilities, skills, talents and resources that you possess without consistently giving you the compliments and praise of who you are and of what you are doing for them because after some time, you would realize that they have nothing to offer you. They're not benefiting you in any way. If anything, they're a hindrance to your progress.  They're holding you back from being the powerful, dynamic person that you were meant to be because they're weak, but you're making them appear strong. You're giving your power away to them. When narcissists come around people who are powerful and dynamic, they have to downplay everything that you're doing.  They hate it.  They have to tame you. They have to domesticate you. They have to contain you so that they can bring you under their control and secure a more predictable supply of resources from you and then they have to keep you in that condition where you cannot exist in that powerful nature of who you really are and what you've worked so hard to achieve. They don't want you to do that because you would naturally have power over them and they want to have power over you. They have to keep you under their control to secure you as their source of supply.  They don't want you to display logical reasoning. They hate anything that has influence or authority over them. When you fight back at the narcissist, they will experience fear and anxiety. Many of them will disappear. You won't hear from them after that because they realize that you have realized your own power over them, the power that they try to strip from you to use you as a tool. They realize that you're waking up. You're realizing that they don't have any power. You're realizing that they tricked you.   Instead of focusing on what they're trying to get you to believe, remind yourself of who you are. Remind yourself the work you put in to get to this point.  They know what you had to do but they cannot acknowledge it. They cannot give you the praise and compliments that you deserve because if they were to do that, they would be allowing you to take the chair. They would be allowing you to preside over them with your influence and authority with the power that you possess. But how would that benefit them in any way? If they don't have anything, if they're weak, why would you even keep them around? If you knew their true nature, if you knew that they don't have anything to offer you anyway, if you knew that they're not about anything, which is why they have to break you down. They have to pull you down to their level to make you think that you're equal to them. But you're not equal to them. You're greater than them. And they are fully aware of this. That is why they always have to go against you. That is why they always have to put you down. That is why they're always so oppositional to you because the one thing that they fear is you waking up and realizing your own power. Thank you for watching. I hope this video has an end with you. Please like, comment, share and subscribe. If you'd like to donate, my pay-bar link is in the video description. Coach Linkwise, you can email me at coaching.narc-survivor.uk Thank you for watching and I'll talk to you soon.


So now we've got the rise of the entertainment industry and information industry outside of religion, what happens when religion tries to compete in the public square? What happens when clergy and rabbis and priests and ministers go on TV? That affects their image, right? The rabbi is always going on TV. That reduces his prestige. He's now competing in an alien outlet. So when you go on TV, you are reduced to the status of that medium, right? The rabbi is always getting quoted in the newspapers. He's not usually known as the rabbi's rabbi. He's like selling out. He's like a court shoe. So when you use mass media to try to communicate religiously, it alters your image and the image of your religion. So religion effectively in a secular society has to accept a marginal position in the various communication agencies, which is completely in defiance of its own self-assessment that it is the preeminent source of truth.  So religion claims transcendent truth, but then when you're going on grubby mediums like much of radio, TV, press, cinema, it kind of marginalizes your claims to transcendent truth, right?