– WELCOME TO A LESSON ON VENN DIAGRAMS AND SET OPERATIONS. THE GOALS OF THE VIDEO ARE TO DEFINE A VENN DIAGRAM, USE VENN DIAGRAMS TO SHOW RELATIONSHIPS AMONG SETS, AND …
– WELCOME TO A LESSON ON VENN
DIAGRAMS AND SET OPERATIONS. THE GOALS OF THE VIDEO
ARE TO DEFINE A VENN DIAGRAM, USE VENN DIAGRAMS TO SHOW
RELATIONSHIPS AMONG SETS, AND ALSO TO DEFINE SET
OPERATIONS. A VENN DIAGRAM
IS A VISUAL DIAGRAM THAT SHOWS THE RELATIONSHIP
OF SETS WITH ONE ANOTHER. THE SET OF ALL ELEMENTS
BEING CONSIDERED IS CALLED THE UNIVERSAL SET, AS REPRESENTED BY A RECTANGLE
AS WE SEE HERE. THE COMPLEMENT OF “A” IS THE SET OF ALL ELEMENTS IN U,
NOT IN “A.” OR USING SET BUILDER NOTATION, THE COMPLEMENT OF “A”
IS THE SET OF ELEMENTS, X, SUCH THAT X IS AN ELEMENT
OF U, AND X IS NOT AN ELEMENT OF “A.” SO IF WE LET THE UNIVERSAL SET
BE THE INTEGERS ONE, TWO, THREE, FOUR, AND FIVE, AND “A” WAS THE SET CONTAINING
ELEMENTS ONE, TWO, AND THREE, THEN THE COMPLEMENT OF “A”
WOULD BE THE ELEMENTS IN U THAT ARE NOT IN “A,”
SO IT WOULD CONTAIN THE ELEMENTS FOUR AND FIVE. SO THE ELEMENTS ONE, TWO, AND
THREE WOULD BE INSIDE SET “A,” AND THE ELEMENTS FOUR AND FIVE
WOULD BE OUTSIDE CIRCLE “A.” SET “A” AND B ARE DISJOINT IF THEY DO NOT SHARE ANY COMMON
ELEMENTS. SO USING A VENN DIAGRAM, SET
“A” AND SET B WOULD NOT OVERLAP. SO HERE IF THE UNIVERSAL SET WAS A SET CONTAINING ONE, TWO,
THREE, FOUR, FIVE, SIX, AND SET “A” CONTAINED THE
ELEMENTS ONE, TWO, THREE, SET B WOULD NOT BE ABLE TO
CONTAIN ONE, TWO, OR THREE, BUT IT WOULD HAVE TO CONTAIN
ELEMENTS WITHIN THE UNIVERSAL SET. SO MAYBE B WOULD CONTAIN
FOUR AND FIVE. SO FOR THE VENN DIAGRAM,
ONE, TWO, AND THREE WOULD BE INSIDE SET “A,” FOUR
AND FIVE WOULD BE INSIDE SET B, AND SIX WOULD BE OUTSIDE
BOTH CIRCLES. IN THIS DIAGRAM, B IS A PROPER
SUBSET OF “A.” THIS MEANS THAT B IS A SUBSET
OF “A,” BUT B DOES NOT=”A.” USING THE SYMBOLS DISCUSSED
IN THE PREVIOUS VIDEO, WE CAN SAY THAT B IS A SUBSET
OF “A,” AND B DOES NOT=”A,” THEREFORE B
IS A PROPER SET OF “A.” AND INSTEAD OF USING THIS SYMBOL
FOR A PROPER SUBSET, SOMETIMES YOU’LL SEE
THIS SYMBOL HERE USED. SO IF WE LET THE UNIVERSAL SET
CONTAIN THE ELEMENTS ONE, TWO, THREE, FOUR, FIVE
SIX– AND LET’S SAY SET “A” CONTAINS
ONE, TWO, THREE, AND FOUR SET B WOULD HAVE TO CONTAIN SOME
OF THE ELEMENTS SET “A,” BUT NOT ALL OF THEM BECAUSE
THEY’RE NOT EQUAL. SO MAYBE SET B
WOULD CONTAIN ONE AND TWO. SO WE’D HAVE THE ELEMENTS
ONE AND TWO INSIDE — THAT ARE ALSO INSIDE SET “A.” THREE AND FOUR WOULD BE OUTSIDE
SET B BUT INSIDE SET “A.” AND THEN FIVE AND SIX WOULD
STILL BE IN THE UNIVERSAL SET. AND IF WE HAVE EQUAL SUBSETS, THAT MEANS B IS A SUBSET OF
“A,” AND BE IS ALSO=A. SO ALL THE ELEMENTS IN “A” AND B
ARE IN THE SAME CIRCLE. SO THE UNIVERSAL SET WAS ONE,
TWO, THREE, FOUR, FIVE. IF SET “A” CONTAINS ONE, TWO,
AND THREE, THEN IN THIS CASE B
ALSO CONTAINS THE ELEMENTS ONE, TWO,
AND THREE. SO WE’D HAVE ONE, TWO,
AND THREE HERE; AND THEN OUTSIDE “A” AND BE
WOULD BE FOUR, FIVE, AND SIX. SO IF “A”=B, WE CAN SAY THAT
“A” IS A SUBSET OF B, AND B IS ALSO A SUBSET OF “A.” THE INTERSECTION OF “A” AND B IS THE SET OF ELEMENTS IN BOTH
SET “A” AND SET B. USING SYMBOLS WE HAVE “A” INTERSECTION B=ALL THE
ELEMENTS X, SUCH THAT X IS CONTAINED WITHIN
“A” AND CONTAINED WITHIN B. SO IF THE UNIVERSAL SET=ONE,
TWO, THREE, FOUR, FIVE, SIX, AND WE HAVE SET “A”=TWO,
THREE, AND FOUR, AND SET B=THREE, FOUR, FIVE, WE CAN SEE THAT SETS “A” SHARE
THE ELEMENTS OF THREE AND FOUR, SO THAT WOULD BE IN THIS REGION
HERE. SO THREE AND FOUR WOULD BE
IN THIS REGION HERE. AND SET “A” ALSO CONTAINS
THE ELEMENT TWO, SO THERE’D BE A TWO HERE. AND THEN SET B ALSO CONTAINS
THE ELEMENT FIVE, SO WE’D HAVE A FIVE OUT HERE. AND THAT LEAVES THE ELEMENTS ONE
AND SIX IN THE UNIVERSAL SET. SO THE INTERSECTION OF “A” AND B CONTAIN THE ELEMENTS
THREE AND FOUR. AND NOW LET’S TALK ABOUT
THE UNION OF SETS. THE UNION OF “A” AND B
IS THE SET OF ALL ELEMENTS IN SET “A” OR SET B. SO “A” UNION B=ALL THE
ELEMENTS X, SUCH THAT X IS CONTAINED WITHIN
“A” OR X IS CONTAINED WITHIN B. SO THE BIG DIFFERENCE BETWEEN
INTERSECTION AND UNION IS INTERSECTION WE HAVE AN AND, UNION WE HAVE
AN OR. USING THE SAME SETS AS WE DID
FOR THE INTERSECTION EXAMPLE, IT WOULD LOOK THE SAME EXCEPT NOW THE UNION WOULD BE ALL THE
ELEMENTS THAT ARE IN “A” OR B. SO WE’D BE TALKING
ABOUT THIS ENTIRE REGION HERE, BECAUSE AN ELEMENT ONLY
HAS TO BE IN ONE OF THEM IN ORDER TO BE IN THE UNION. SO “A” UNION B IN THIS CASE
WOULD BE ALL THE ELEMENTS IN THE UNIVERSAL SET EXCEPT ONE
AND SIX. SO WE’D HAVE TWO, THREE, FOUR,
AND FIVE. AND A COUPLE THINGS TO MENTION
ABOUT THE EMPTY SET– ANY SET “A” INTERSECTED WITH THE
EMPTY SET=THE EMPTY SET. AND THE UNION OF ANY SET “A” AND THE EMPTY SET WILL ALWAYS BE
THE SET “A.” I THINK WE’LL STOP HERE
FOR PART ONE AND TAKE A LOOK AT SOME
ADDITIONAL EXAMPLES IN PART TWO.
(uplifting music) – I’m Ellis Christian, I’m an interventional cardiologist and I practice at Heart & Family Health Institute. Women are usually taking care of everybody in the family, whether it …
(uplifting music) – I’m Ellis Christian, I’m an interventional cardiologist and I practice at Heart &
Family Health Institute. Women are usually taking care
of everybody in the family, whether it be the kids,
the husband, the grandkids, and unfortunately, sometimes, they forget to take care of themselves. And it’s our job to make sure that we take care of them. I think it’s incredibly
important to screen women. I think women, in general, have just been viewed as
people that are overlooked from a health perspective, unfortunately, you know, just the way our society is. You do any study, and you compare how women are
being treated or screened, and it’s always not optimal. You know, especially
post-menopausal women, their risk of heart disease
goes up astronomically. So it’s very important that we
pay more attention to women, that we’re screening
women for heart disease and we’re treating them to the level of standard of care that they deserve. (uplifting music)
CareVoyant for long-term care is the solution your clinical and financial staff can agree on! Streamline your organization by integrating intake, census, receivables and clinical notes with user-friendly bedside charting. CareVoyant …
CareVoyant for long-term care is the
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– ‘Cause can I just take a little comb to your beard? Wow Dave, Amelia Earhart could be in this tuft of hair, honestly. – Mm-hmm (affirmative) (buzzing) Ow, Jesus! – …
– ‘Cause can I just take a
little comb to your beard? Wow Dave, Amelia Earhart
could be in this tuft of hair, honestly.
– Mm-hmm (affirmative) (buzzing)
Ow, Jesus! – He’s lying. Are you okay?
– I’m fine. – You’re literally combing
my face really hard, my face skin.
(laughing) That is someone who
looks like they’re ready to sign a treaty at Fort Sumter honey. (laughing) Cute. (funky drum music) – In here? Hi everybody. – How are you?
– Hi, nice to see you. – So nice to meet you. – Yeah it’s a pleasure to meet you. – How are you? – You know, I’m well. – Dave, you are looking
fit as a fiddle these days. – God bless you. – Your beard looks great Dave, I love your post-retirement beard. (laughing)
I do! It’s very mysterious, it’s like
“What’s going on with him?” – Yeah, let me just ask you a question about beard care generally.
– Yes, yes. – I just use a bar of soap on my head– – Yes.
– And on the beard. – While I do like that
you’re disinfecting you face, (giggling)
and your beard, and your head. However, gray hair is a little bit drier which is why I would encourage you– – Oh yeah. – To impart a little bit
of a beard oil on this. Because it’s just gonna give
you a little bit of shine, it’s gonna make it a bit more malleable. Doesn’t that feel nice? – Yeah. – All of these little guys
want to follow the rules, but then this one is like “Go fff, nya.” Know what else we could trim that would also look really nice? – We’re not trimming anything. – You have this triangle of
hair that’s living up here. – Right.
– It’s Bermuda’s Triangle. Shouldn’t we just get that hair? – If you touch that with anything sharp– – You’ll die.
– With a blade– – You’ll punch me.
– No, I’m gone. (funky music) – ‘Cause you were born in… – Indiana. – And have you ever
heard of Crawfordsville? My great grandfather was the
mayor of Crawfordsville once. You like history? This is the Teresa May of
your hairs right here– – But, but. (laughing)
– She’s all herself. And no one wants to listen to her. You know who I literally just interviewed? Erin Brockovich. Didn’t you love that movie? – Has anyone, in conversation, ever just fainted from talking to you? – No. – Let me ask you a question, have you experimented with this? – Oh the mustache wax, yeah
that’d be great on you. – Well I don’t know if I
have enough mustache to do. – Oh you totally do, oh
you have plenty of ‘tache. Take some on your thingies. On your finger.
(laughing) – Jesus. Okay.
– Speak homosexual for you. – Okay.
– Okay, No! No!
– Not that bad. – I’m gonna work it right on up. – Ouch. – I just, okay, shh.
– I feel like a trout. – It is a little stuck. – What about super glue, would that help? Almost as unpleasant as
a trip to the dentist. Is it working?
– Look at that. I feel like that part in Mrs. Doubtfire when we’re gonna fit you for your new look and we’re like “Boop boop
boop boop boop boop.” Remember?
– Yeah, of course I do. – Honestly I love you with a
little curly mustache so much and look at how cute it is. You are so disarmingly handsome Dave. – Well I–
– Look at you. – I can’t argue, you’re right. – Could you be any cuter? And then you–
– No. – Know what you could do with your extra balm on your thingies? You could take it and
then you could just ask these little guys–
– Okay, okay. – To calm down a little bit. – Okay, and I’m just
gonna ask you to stop– – Pat ’em down.
– Saying thingies. (funky music) – Let use some cuticle and nail oil. – No. – Just a little bit, come here. What’s some self care that you do? – You know what I have
done now is meditating, do you ever meditate?
– Ooh. Love mindfulness, love meditation. – What kind do you do? – I’ve just done the kind
that you learn about, like you go to yoga, just like
a gorgeous, like Shavasana. Like listen to the sound of your breath, like close your eyes, see your thoughts, like coming and going, but you’re like “I’m inhaling, I’m exhaling.” – Mm-hm. (affirmative) – What do you do? – I pay the guy, who came to my office and taught me transcendental meditation. – Yeah ’cause I– – So I am kinda snobby about that. So what you’re describing I consider mm, yeah call me when you’ve
had a guy come and train you. – Totally well, one of the tenets of mindfulness and meditation is ruthless judgment of other people. So I would love take from
your teacher, he sounds great. (laughing) (funky music) When it comes to the art of interviewing, what do I need to work on? – Listening.
– Mm-hm. (affirmative) You know that’s not the
first time I’ve hear that? – Is that a fact?
– Yeah. – What I want is a
conversation, not an interview. You and I are having a conversation. It may be wandering and out of control. Nonetheless, it’s a conversation. – What about, like Late
Night becoming more, she’s like more political now, thoughts? – Do with it as you want, is my feeling. If that’s what is driving you as a person, that’s what your show should be. – Love. That.
– Yeah. Let’s talk about the
history of the neighborhood. This is the neighborhood
where Stonewall is. And this is the route I used to take home every night from work, and we would drive right by the place. And now it’s the 50th anniversary
of what happened there. – It’s such a different experience of how we would have Pride now. Now it’s like a gorgeous parade,
it’s like a gorgeous party. And while it is celebratory
and it can be really fun, it was born out of this like, literal riot that happened aa Stonewall 50 years ago. I didn’t even understand
until this Pride month, the amount of oppression and violence that the LGBTQ community faced
at the hands of the police. It would have been a
crime for me to wear this, on the way to do your hair. If you are born male you cannot wear more than two articles of
clothing of the opposite sex. The charge would have
been Female Impersonation. – To me that is stunning,
that what was illegal was illegal only 50 years ago. It seems primitive. – It was totes primitive. I mean just the way that there is like, you know seven billion
people in the world. – Right.
– That all experience life in a different, unique way.
– Mm hm. (affirmative) – There is that many
different unique ways– – Yes.
– That sexuality and gender can be expressed too. I identify as non-binary, so it means that I don’t identify with my gender that I
was assigned at birth. I just, I don’t feel that I
identify in the binary period, like I don’t feel that I’m
representative of binary. – And binary in this case
represents male, female? – Yes.
– Okay. – That’s The Binary
that we’re referring to. But you know what I think is interesting? It’s okay to not know all the definitions. – Mm hm. (affirmative)
– And all the answers. – Yeah. (mellow music) In my family, and I think
in everyone’s family the acceptability or
understanding if not acceptability has come a little more easily as it gains momentum of awareness. Is that a smart assessment of this? – I do think that like socially
in America we have made, you know some progress. Even though I do think that
there is a concerted effort as we speak right now, to
roll back those efforts. ‘Cause the struggle has like
really been going on forever. Like marriage equality in America, even though like we weren’t
putting a name to it. There was advocates and fierce
trailblazers in the 20s, 30s, 40s, that we will
never know their names. So I don’t think that
it happened that quick. And I think that people
are really too quick to congratulate themselves
on, on where we are. On women’s issues and on gay issues. – I would agree with that. I’m coming out of my
position of ignorance, with the rest of the country, because of my son and his school. And they are so far ahead of this, I take that as a bell
whether that in fact things, perhaps glacially, but through
his generation and earlier will make this acceptability easier. So that the bullying will
stop and beatings will stop and the violence will stop. – There are really
awful things that happen that don’t make the news to
LGBTQ people all over the place, and like no one would hear about it. Especially if it’s like
not actually in Pride month or like the time to talk about it. And so I think that,
what’s really important for you that has the platform
on the gorgeous TV show that we’re on and making, that you feature people like
me so that other young people and other non young people,
important decision making people can see that people that
don’t look like them and don’t talk like them
and don’t act like that, or can be you know seen
as people and not as like something to be scared of. And it’s a very good place to start. – Yeah, yeah. That’s right, yes, a place to
start, yeah I agree with that. – Yeah. (funky music) Now just close those eyes. Soften your face, soften your brow, soften your jaw, soften
your eyes, let ’em close. – Oh man I feel… Whoa I feel great.
– Close those eyes! – Whoa.
– Close, shush shush. – That was great, how long was I out? – Shush shush shush.
– That was fantastic, whoo. – Dave, we didn’t even get there. – Look at the time, well– – Your transcendental meditation
coach needs to be fired. – Come on, make the noise.
(humming) Okay keep making the noise. – That’s really pretty. – Go ahead. – Okay.
– Just have a seat. – No watch the ‘stache David.
– Okay. No, don’t you, no, we’re done combing. – Here.
– No. – Here, that smells nice. (cheerful music) – I, this has been a
good experience for me. – It has?
– Yeah. Thank you very much for your time thank you very much for–
– Thank you. – Your interest in me. Nothing right ever
happens without a fight. – That is correct and I
couldn’t think of something to rhyme that quickly. (laughing) Look at that smile, you’re so handsome. Wanna hug you. – Yes, give me a hug. – Okay. (music drowns out speech)
This lecture is on glucocorticoids. You know steroids are simply an organic compound with a specific structure. When discussing steroids many people think that we’re talking about anabolic steroids, you know …
This lecture is on glucocorticoids. You know steroids are simply an organic compound with a specific structure. When discussing steroids many people think that we’re talking about anabolic steroids, you know those synthetic versions of testosterone that athletes you to build muscle. But corticosteroids are quite different. They’re a group of steroid hormone, which are made by the adrenal glands of the kidneys. Corticosteroids are actually classified as glucocorticoids and mineral corticoids. We’ll talk about glucocorticoids in depth in the following slides because they’re used so commonly in pharmacology and they have a tremendous impact on the immune systems inflammatory response. That’s why they’re used! Mineralocorticoids include aldosterone. This steroid regulates the balance of water and salt in the body. Corticosteroid medications are synthetic drugs that closely resemble cortisol. That’s our stress hormone! that’s made by the adrenal glands. Corticoidsteroid drugs are very powerful and they’re used to prevent or limit inflammation by suppressing the immune system. As you can see, they’re used by every route and they’re used for everything from brain tumors to skin conditions. We’ill see these drugs throughout the study of pharmacology and they’re used PO and IM, and IV. They’re used for arthritis or colitis. They may be used to prevent organ rejection and individuals that have organ transplants. They may be used topically for skin conditions or otic or opthalmic for eye or ear inflammation. Some nasal sprays may contain cortisone to decrease the swelling in the nasal passages and make it easier to breathe. Corticosteroids may be given by inhalation for inflammation that’s happening in the airway. They may also be given rectally for hemorrhoids or they may be injected directly into a joint to treat or help stop an inflammatory process in a joint. I think of these glucocorticoids as the number one drug for inflammation because the common generic ending of these medications is O-N- E,one. Examples are prednisone, dexamethasone, cortisone, and triamcinolone. I would like to paint you a picture of the effects cortisol has on the body so that you can understand and remember the side-effects and adverse effects the corticosteroid drugs. First off, know that cortisol is our stress hormone. It’s released by the adrenals in time of stress. So think about the side effects in terms of fight-or-flight. The body is not concerned with maintaining optimal function. It’s about survival so processes that are not critical for survival; these processes are shut down. Cortisol prevents the release of substances in the body that cause inflammation. When you’re under stress the body’s not seeing supporting the immune system as a priority when it’s in survival mode. So when the immune system is suppressed, inflammation is decreased. That’s the reason these drugs are prescribed is to decrease or prevent inflammation. Now under stress cortisol increases blood sugar as a survival method so we can escape the threat. Putting energy into digesting lunch, preparing for sex, optimizing the immune system, these are unimportant. These aren’t the priority when you’re under stress. So, cortisol suppresses immunity and decreases libido. Serotonin is one of our feel-good neurotransmitters. This level is decreased by high cortisol levels. Cortisol also helps with bone density. When cortisol is increased, calcium absorption is decreased. Cortisol, regulates metabolism of carbohydrates and proteins and fats. Lastly cortisol will increase sodium retention and potassium excretion. So remember that when glucocorticoid medications are used they do not have a big systemic effect when they’re used topically so always remember that. Also consider what cortisol does, now the side effects hopefully will make sense and be easier to remember. I use the letter S to think about the side-effects and adverse effects of corticosteroids. I think of sugar, salt, sex, sadness, sick, stop, and shrink bone. Prednisone is probably one of the most frequently used oral corticosteroids So hyperglycemia. Remember cortisol controls blood sugar. So remember sugar hyperglycemia. With retention of salt, patients may have edema. They can also have weight gain and appetite increased and hypertension. Libido is decreased because of these sex hormones. Serotonin is another S so think of sadness. Depression may be seen patient in patients that take these drugs. Because cortisol revs the body some may have even have anxiety or nervousness or insomnia as the brain kind of gets revved up. The next S is for sick. Because cortisol suppresses our immunity, patients on glucocorticoids can get sick easier. You know, that’s also why people who are always stressed and they’ve got high levels of cortisol, why they’re frequently sick. The cortisol also when it’s kicked in the immune system is suppressed, you may see poor wound healing. That wound healing is going to be prolonged. Inflammation begins wound healing so if we suppress it again, we may mess up the body’s ability to heal wounds, okay. Let me see what else. These have to be stopped gradually, because what happens is when we give the body artificial cortisol it quits making cortisol and actually the adrenals; they can even kind of shrink. So if they’re on patients are on these medications for any prolonged period of time, they want to gradually stop these. The docs will probably order a gradual dose. They’ll have them take you know, five for five days, and then take four, and then take three. So that’s how it’ll be ordered. The last S is for those spongy bones. Remember again, because of cortisol’s role in bone health and calcium patients who take corticosteroids long-term may have a higher risk of osteoporosis. Many individuals on long-term steroids are recommended to take vitamin D and calcium. For patient teaching for glucocorticoids, you should always include the direction to take as directed. You never want to stop these medications immediately if you’re taking them for any length of time. Again, watch for the side effects and the adverse effects that we just discussed. You want to monitor the patient’s white blood count and look for signs of infection. Again, the patient may have poor wound healing and be more susceptible to getting sick. You also should monitor vital signs, blood pressure, you know may go up and weight gain. Because of the multiple effects corticosteroids have on the body, these medications can cause serious problems if they’re not managed properly. Prolonged use of corticosteroids can cause problems with adrenal gland suppression and reduced immunity. A cushionoid appearance are signs and symptoms of excess cortisol. So think of Cushing’s as being crushed by cortisol, too much cortisol! Cushingoid appearance refers to the signs and symptoms associated with excess cortisol in the body regardless of the cause. Because of the fat redistribution that happens these patients may have moonface and acne. They may have a buffalo hump that happens. There’s also trunk obesity and stretch marks. You know, there is a Cushing’s disease and this is caused by a pituitary gland tumor which is usually benign but it causes an overstimulation of the adrenal glands and cortisol production. These patients will also have a cushioned appearance. Remember, cortisol is needed to maintain life. When individuals take corticosteroids the body senses higher than normal amounts of cortisol and the adrenal glands atrophy and stop making cortisol. So corticosteroid medication cannot be stopped suddenly or acute adrenal insufficiency can happen. When oral corticosteroids are prescribed the patient is usually directed to gradually again gradually decrease the dose. Addison’s disease, now this is a rare condition where your adrenal glands produce too little cortisol and often too little aldosterone. People with Addison’s disease can lead normal lives as long as they take their medication to replace these important hormones. Think of Addison’s as they need to add some cortisol. Well, that concludes the review of corticosteroids. I hope that makes it clearer and easier for you to understand and know those side effects. Let me know if you have any questions.
I’m going to give Gambit some medicine. So to demonstrate how we’re going to put the syringe in his mouth… right now this is a syringe filled with Royal Canin recovery …
I’m going to give Gambit some
medicine. So to demonstrate how we’re going to put the syringe in his mouth…
right now this is a syringe filled with Royal Canin recovery diet and warm
water so you see he likes it so this is gonna be an easier thing just to show
how we are going to get it in his mouth so you see he’s just willingly eating it
they’re not going to do this with the medication so most likely what you’ll
have to do is when you scruff them, you want to kind of put it in the side by there
like a back part of their teeth and you squirt it in there aiming towards the roof of
their mouth (Sorry Gambit) So with him… so literally just eat it so I like to keep a syringe of whatever
he’s eating handy to help wash down the meds with so we’re going to give them
his first medication first thing we’re gonna give him right now is
metronidazole so that’s a really nasty tasting one it’s a very small dose but
as soon as he smells it he’s going to clench up so he is pretty well scruffed
right now but a lot of ferrets even when they’re scruffed when it’s something
that they really don’t like it’s going to happen they’re still going to react
to it so as soon as they smell it you know something bad is coming in so he’s still
gonna twisting his body and he’s pushing away so I want to make sure I have a
really firm grip on him I’m gonna get a good scruff. he’s gonna be kicking
his back leg so I’m gonna tuck him under now I have him so that way it’s harder for
him to move and what I’m going to do is I’m going to take the medication I’m
going to put it right back here where his lower jaw meets his upper jaw and I’m
going to try to get in the back of his throat (Thank you, Gambit) (laughs) there we go and I
want to keep his mouth shut and make sure he swallows you want to make sure
when you’re putting it in the back of their throats like that so you’re not
jamming it down their throat. You don’t want to end up in their lungs that can cause
pneumonia then I’m going to follow up once I know that he kind of swallowed
it sometimes they have more of a reaction to
the medication and will foam a lot at the mouth so you don’t want to start giving
the food to wash it down until after you know if they’re not going to be foaming
and spitting it all back up Just washing it all down
Introducing Manchester Local Care Organisation Leading local care Improving lives in Manchester With you In April 2018, we launched a new public-sector organisation in Manchester, which will transform community-based health and …
Introducing Manchester Local Care Organisation
Leading local care Improving lives in Manchester
With you In April 2018, we launched a new public-sector
organisation in Manchester, which will transform community-based health and care.
For the first time, the organisations that provide community health, primary care, mental
health, and social care services in Manchester, are working together in partnership, to join-up
community-based health and care. This means that we’re bringing teams together,
from different organisations, to work with each other collaboratively. We’re integrating
our services, and building new and better ways to deliver care.
We’re changing the way that community-based health and social care in Manchester is designed
and delivered. We’re bringing services closer to people’s
homes, creating local teams, in each neighbourhood. We’re working together with local people,
and communities, and with local groups, charities and organisations, to help to design the right
services, for each neighbourhood. We’re supporting people to keep well, to
be independent, and to be connected to local support and communities.
We’re putting people at the heart of everything we do.
So, the Manchester Local Care Organisation is a partnership between organisations that
you will recognise. In Manchester, the GP surgeries, the mental
health trust, the council, and the hospitals, have all come together in a partnership for
the good of patients. Making it easier
Providing the support and systems for us all to work together, collaboratively, across
different organisations Reducing duplication and silo working
Making more of the buildings we use Sharing data and improving IT
So, instead of having different bits of information in different parts of the system, we’ll
be able to collect it all together and plan, and organise, new services, in a different
way. So that we don’t have to think about what happens in a GP surgery separately to
what happens in a hospital, separately to what a social worker might do, and separately
to what mental health workers might do. Instead, we can get all of those people together,
in one room, and come up with one plan, for what’s best for the people and patients
of Manchester. To achieve what we want to and to create an
organisation that is able to put people at the heart of their care, 4 big organisations
that already work in Manchester have given us some responsibility in order to be able
to do that. And those organisations are: the local authority, so Manchester City Council,
Manchester Foundation Trust, which is the big hospital trust in the city, the GP federations,
which represent all of the GPs and practices across Manchester, and the mental health trust.
And they have all agreed that they will give us some power to change what is on offer to
people across the city, in collaboration with the voluntary, charity and other sectors,
to create something quite different, that has the power to change some of the way in
which we’ve done things for a long time. The way I’d describe it is, a real strong
partnership between health and social care, primary care, mental health, in its purest
form. But, beyond that, it’s more than that, it’s about working with the voluntary and
community sector, it’s about working with communities, working in peoples’ homes,
being really close in the neighbourhood. But, with the philosophy that it’s a very
much integrated, multi-professional way of working.
Manchester’s got thousands of dedicated health and care workers so we’re building
on a strong platform of people who are committed to the people of Manchester to making a difference
in their lives. We’ve got very strong plans to make a difference,
we’ve seen the biggest ambition for hospitals in the single hospital system. We’ve seen
social care commissioning come together and we’re really the 3rd element of that plan,
developing all of the community and neighbourhood services to be integrated, both to deliver
better care, but also better population health, prevention, and to improve the health outcomes
in Manchester. This is about developing our relationships,
understanding each other’s roles and transforming our care models, with people at the heart
of everything we do, to make sure we’re supporting them to lead better lives, have
more independence and, more importantly, that we’re involving them in all of our plans
going forward. And asking them, what’s important to them.
Simplifying the journey through our health and social care services
working with local people and supporting carers involving people in their care
As a person who uses services in Manchester, it can be very difficult at times.
Things like going to different hospitals, with multiple health conditions, you end up
carrying a filing cabinet around – literally – of your notes.
I want to have a say in what matters to me, and what doesn’t. I want 2-way conversation.
I want to see some better integration; Person-centred care is starting with, what’s
important to the person. So, rather than starting with diseases and problems, and trying to
fix things, it’s starting with: what’s important to you, what are you goals, what
are you trying to achieve – what would being healthy, or having a better quality of life,
look like to you? Locally designed care, delivered in neighbourhoods
Reducing inequalities in experiences, So we know that, a lot of the services that
we provide, people would prefer to have them closer to where they live and accessed in
a way that suits their lives, better. So it doesn’t mean that everything, necessarily
has to be in a hospital and that people have to travel to a big building and park and work
out complex systems, just to see a doctor, or a nurse or another healthcare professional
– it might be that we can bring those people either to your home, or to your GP surgery,
or to your local community venue. I’m really excited because no one agency
and can do this on their own and, really importantly, we have a duty to collaborate,
We have a duty to work together and really, further develop those relationships with people
at the heart of everything we’re doing. And if we do that, we stand a really good
chance of delivering better outcomes for the people of Manchester. Better experiences and
really importantly, we’ll get rid of some of the duplication and we’ll make much better
use of the services across the system. So, I think in my experience for the first
time, working across hospitals and community services, this is the first time we’ve had
the opportunity to work in a much more integrated way, connecting teams in a much more integrated
way and make sure that conversations and support for families and carers and people and patients
are all much more joined-up in the system. And it’s for us to use that knowledge and
information to set out how we can improve services over the next 2-3 years.
Over the next 10 years, that plan has to take account of the requirement to improve public
health outcomes in Manchester, to improve daily living, to improve access to good advice
on health, nutrition, sport, exercise and things that we all know ultimately
enable better public health outcomes for the people of Manchester.
We are going to lead and challenge some of the ways in which services are delivered,
to improve them for the population of Manchester, working together and we have plans to do those
very much at a neighbourhood level. We have 12 identified neighbourhoods in Manchester.
We’ve developed neighbourhoods that will encompass around 9 or 10 GP practices across
the city, those neighbourhoods will come together and will support patients and individuals
with the greatest level of need, will improve the way in which they get access to care.
So mostly, individual people, patients, will access services in the way in which they do
now. Sitting behind that though, is a much more joined-up approach to how we plan your
care and how we deliver that care across the city.
The LCO in Manchester is seeking to support hospitals by speeding up the processes around
which patients leave hospital. We can look at patients’ requirements who
might not need hospital and can access directly care in the community, so we need to have
those interventions in place So we very much rely on the teams that already
exist, so one of the things we don’t want to do with this new way of working is to duplicate
anything that’s already there. We recognise we’ve got some very good teams and very
good services that work very well at the moment – it’s more around how that communication
is shared, so we very much link up with those teams in the hospital
a patient will tell me about the difficulty they’ve had getting a hospital appointment,
or a letter from the mental health trust, or accessing some piece of social care that
they need for themselves or it might be for their elderly relatives , or for someone else
in their family. And joining all these bits of the jigsaw takes a lot of time for GPs;
those areas where communication falls down or people don’t work together with one collective
aim – they’ll be improved by the local care organisation.
In my experience working as a physiotherapist, in both community and the hospital, you see
a lot of breakdown in communication from different services and it always affects the person
and they always end up being the one coming out worse from it, so improving communication
and improving that continuity of care from hospital to home is absolutely vital and to
see it happening makes me really proud. Helping people stay independent, in their
own homes, and be connected to local support and community groups
Shifting the focus of care away from hospitals and into our communities
I think we’re on a journey in Manchester, about changing the way we think about public
services. We know that for peoples’ health and wellbeing, staying at home, close to family
and friends, when they need care or support, is the best thing for them, and that really
people should only be going in to hospital, or residential came or nursing care, if that
is the only option. So what we’re trying to build at neighbourhood
level are a range of different options that people can choose from and we want to support
that by giving people some personalised budgets, so some money they can use, to buy that for
themselves, and to have the power to change their own lives, as opposed to a service model
that just looks at the difficulties that people are having.
coming to a door near you soon, will be a neighbourhood partnership that you can get
involved in, either by being involved in an annual planning event for your neighbourhood,
or working with people who do provide services in that area, by having a new kind of conversation
about what’s important to you, about what will make a real difference in your life,
about what’s working well in your community that you think there should be some more of,
or where you think there’s something that you really need that isn’t there and how
you might be able to work with other people to make it happen.
There’s absolutely a clear model developing with our colleagues in the voluntary, community
services sector around how we connect people who live in neighbourhoods to help and support.
At the moment it can be really difficult, even for professionals in the health and social
care system to navigate, for relatives for example, we aim to make that much simpler
in the City of Manchester. Through access to public buildings, information,
websites… a better description of how we’ve joined up our services across the whole.
The things that influence people’s health and keep them healthy – a big part of that
is about having really good health and care services and medicines and nurses and doctors,
and they’re really important – but what has even more of an influence are eating healthily,
having family, friends and being connected in your community, having green spaces that
you can enjoy being active in and going for walks and running.
Having a safe, warm house that’s secure – those are the kind of things that really
keep us healthy and well. But for health and social care organisations to have an influence
on those things, we need to work with housing associations, and the people that run the
transport and the voluntary and community groups in our neighbourhoods that run all
sorts of different activities and things that can help people make friends and keep well
in their communities. Where the LCO can really make a difference
is facilitating those connections and those relationships and especially, within those
neighbourhoods, providing the spaces for people to get together and build relationships and
have conversations. and once we start bringing people together
in a neighbourhood with a focus on what’s going to keep us healthy, lots of creative
solutions are going to emerge, that we wouldn’t have thought about if the LCO hadn’t been
there. We believe that, by working together, we can
help the people of Manchester to: Have equal access to health and social care
services Receive safe effective and compassionate care,
closer to their homes Live healthy, independent, fulfilling lives
Be part of dynamic, thriving and supportive communities
Have the same opportunities and life chances – no matter where they’re born or live.
What I believe is that, through enabling lots of people to talk about what they need; through
capturing a real diversity of voice and of people’s preferences and experiences, we
can really build something that is really incredible.
Leading local care, improving lives in Manchester, with you
DR CRINER: COPD is a common and morbid problem for people throughout the world as well as the United States. There’s no cure for COPD. For some patients with a sub-type …
DR CRINER: COPD is a common
and morbid problem for people throughout the world
as well as the United States. There’s no cure for COPD. For some patients with a sub-type
of COPD called emphysema, they may benefit from procedures that
could decrease the volume of air that’s trapped in the chest
because of the emphysema, using either lung volume reduction
surgery or lung transplantation. In some patients, however,
they may be candidates for a less invasive option called
bronchoscopic lung volume reduction. It provides the benefits of lung
volume reduction surgery but avoids the increased morbidity and mortality
related to an open surgical procedure. Bronchoscopic lung volume
reduction is actually a breakthrough. Temple has played a central role
in helping to design the pivotal trials that led to FDA approval. We did the first commercial cases
and have served in a leadership role in teaching physicians how to apply these
bronchoscopic techniques for lung reduction in many centers across the United States. This is just the beginning.
Our goal is to improve patients’ outcome and minimize their risk and bring
a therapy like bronchoscopic lung reduction more into the mainstream that others
can safely do this and treat a larger group of patients across the world.
Mission Objectives: Find and secure the orange suitcase. I was lucky! I wouldn’t do that. Medic! Hit! Calling HQ. We need support! I repeat, we need support. No! You have no …
Mission Objectives: Find and secure the orange suitcase. I was lucky! I wouldn’t do that. Medic! Hit! Calling HQ. We need support! I repeat, we need support. No! You have no support. Just hold your position! Where was I? Commander… …Sir… you have… What? …a BB… There are BBs everywhere. I can’t concentrate! So, where is the suitcase? It should be somewhere here! Any news? We crashed their left flank. I did! Excellent! But they pushed us back on the right. And in the middle. Where is my coffee? It should be somewhere here. I can’t work here. Move! Sir! They broke our lines! Yes, I know. Did you find the suitcase? Sir… commander… …your face… Shut up! Did you find the suitcase? No. Not yet. They are everywhere. So shoot everywhere! Change your position! You’ve been there for ages. That’s the strategy! They think we are everywhere. Did they find the suitcase? Not yet. Move! Hi guys! It’s time. Your respawn is over. You and you. – Yes, it’s time. – No, no. Yes. It’s time to go. Please no. I don’t wanna go. I want to stay on the Respawn. Sir… …sir our Respawn is… What? What’s wrong with the Respawn? It’s overcrowded. Built a bigger Respawn. Anything else? Yes. There is a kid who wants to tell you something. What do you want? I want to kick some ass! That’s the spirit! Come closer. Look! See that trench? Clear it and you can play with us. Grenade! He has got the suitcase! The orange suitcase! They will kill him! Take him down! Wait. Move! What are they doing? What are you waiting for? Cover him! I am coming… … to crush you. Hit! Hit! Who the hell is she? Hit! And where is the suitcase? You won. Good job. Let’s go to HQ. I need my coffee.
[MUSIC PLAYING] Hey Ghosts, Year 2 has been a blast so far. We’ve released three special operation updates and brought very unique guests to the wild lands. It is now time …
[MUSIC PLAYING] Hey Ghosts, Year 2 has
been a blast so far. We’ve released three
special operation updates and brought very unique
guests to the wild lands. It is now time to
reveal more information about Special
Operation 4 Special. Operation 4 will
release on February 27 and will include a new PVE
experience, a new Ghost War update, as well as
special features requested by the community. Guerrilla is a new PVE
mode designed for Ghosts who like evolving challenges
that grow deadlier each round. It is playable in
solo with AI teammates or up to four players in co-op. In this brand new
mode, you’ll need to defend key locations
against enemy waves. Before each wave
starts, your team will need to
strategically choose their weapons and attachments. Once the preparation
phase has ended, your goal is to defeat all
of the incoming enemies and prevent them from
entering the objective area. The more waves you complete,
the more challenging your opponents will be. The last wave at each
set will challenge even the most
experienced Ghosts, if you make it that far. At any time between waves,
you have the opportunity to visit the shopkeeper
to trade gear parts looted on enemy bodies for new weapons,
attachments, and skills. As you complete waves, you’ll
be granted prestige credits, XP, resources, and an
exclusive reward. We are very excited to see which
strategies you will come up with to survive Guerrilla mode. We are also very happy to
introduce two new PVE features requested by the community. First, you will now be
able to set the time of day when playing solo. Second, the compass
from Ghost War is now available for all in
the main campaign of the game. Finally, new exclusive
items have been added to our battle crates. A new pack with
military equipment has been added to
the in-game store. All new weapons from
Special Operation 4 will be available for
individual purchase. Year 2 pass owners will
get exclusive access to the Active Duty Pack,
which contains a new weapon and customization items. As a thank you for your support
during our second year of Ghost Recon Wild Lands, everyone
who played during Year 2 will be able to redeem a
special reward in the Ubisoft Club starting March 7th. In Ghost War, players
will have access to two new maps
and one new class. The Sapper can deploy
a specialized drone that shoots concussion mines. These mines drain
stamina from players and suppresses them,
slowing down their rush. Ghost War now features
a custom match browser that allows players to see
other active custom matches and join on the fly. Players can filter matches
based on several criteria, such as HUD selection,
map rotation, and so on. We’re looking forward
to your reactions to the last Special
Operation update from Ghost Recon
Wild Lands Year 2. We’ll see you soon
for more, Ghosts. [MUSIC PLAYING]
