Robert Fischell – TED Prize wish: Finding new cures for migraine, depression, malpractice (2005) |Fischell||||||||Migräne||Fehlverhalten |||||||||migraine|depression|malpractice |Fischell||Premio TED||||tratamientos|||| Robert Fischell - TED-Preis-Wunsch: Neue Heilmittel für Migräne, Depression, Kunstfehler (2005) Robert Fischell - Deseo del Premio TED: Encontrar nuevas curas para la migraña, la depresión y la mala praxis (2005) ロバート・フィッシェル - TED賞受賞記念：片頭痛、うつ病、不治の病の新しい治療法を見つけること (2005) Robert Fischell - Życzenie nagrody TED: Znalezienie nowych leków na migrenę, depresję, błędy w sztuce (2005) Robert Fischell - Desejo do Prémio TED: Encontrar novas curas para a enxaqueca, a depressão e a negligência médica (2005) Роберт Фишелл - Желание получить премию TED: Поиск новых лекарств от мигрени, депрессии, халатности (2005) Robert Fischell - TED Ödülü dileği: Migren, depresyon ve malpraktis için yeni tedaviler bulmak (2005) 罗伯特-菲舍尔--希望获得 TED 奖：寻找偏头痛、抑郁症和渎职的新疗法（2005年） 羅伯特費雪 (Robert Fischell) – TED 獎願望：尋找偏頭痛、憂鬱症、醫療事故的新療法 (2005)

I’m going to discuss with you three of my inventions that can have an effect on tens to a hundred million people, which we will hope to see happen. |||||||||Erfindungen|||||||Zehntausende|||||||||||| Ich werde mit Ihnen über drei meiner Erfindungen sprechen, die sich auf Dutzende bis Hunderte von Millionen Menschen auswirken können, was wir hoffentlich erleben werden. Vou discutir com vocês três de minhas invenções que podem afetar dezenas a cem milhões de pessoas, o que esperamos ver acontecer. Sizinle, gerçekleşmesini umut edeceğimiz, onlarca ila yüz milyon insan üzerinde etki yaratabilecek üç icadımdan bahsedeceğim. We discussed, in the prior film, some of the old things that we did, like stents and insulin pumps for the diabetic. ||||vorherigen|||||||||||||Insulin||||diabetischen |||||||||||||||stents|||bombas de insulina||| Wir haben im vorherigen Film einige der alten Dinge besprochen, die wir gemacht haben, wie Stents und Insulinpumpen für Diabetiker. Önceki filmde şeker hastaları için stentler ve insülin pompaları gibi yaptığımız eski şeylerden bazılarını tartışmıştık. And I’d like to talk very briefly about three new inventions that will change the lives of many people. ||||||kurz|||||||||||| ||||||brevemente||||||||||||

At the present time, it takes an average of three hours after the first symptoms of a heart attack are recognized by the patient, before that patient arrives at an emergency room. Derzeit dauert es durchschnittlich drei Stunden, nachdem der Patient die ersten Symptome eines Herzinfarkts bemerkt hat, bis er in die Notaufnahme kommt. Şu anda, bir kalp krizinin ilk semptomlarının hasta tarafından fark edilmesinden sonra, hastanın acil servise gelmesi ortalama üç saat sürüyor. And people with silent ischemia -- which, translated into English, means they don’t have any symptoms -- it takes even longer for them to get to the hospital. ||||Ischämie||||||||||||||||||||| ||||ischemia||||||||||||||||||||| ||||isquemia||||||||||||||||||||| Und bei Menschen mit stummer Ischämie - was übersetzt bedeutet, dass sie keine Symptome haben - dauert es sogar noch länger, bis sie ins Krankenhaus kommen. Ve sessiz iskemisi olan kişilerin -- ki bu, İngilizce'ye çevrilirse herhangi bir semptomu olmadığı anlamına gelir -- hastaneye gitmeleri daha da uzun sürer. The AMI, acute myocardial infarction, which is a doctor’s big word so they can charge you more money -- (Laughter) -- means a heart attack. |||myokardial|Infarkt||||Arzt|||||||||||||| O IAM, infarto agudo do miocárdio, que é a grande palavra de um médico para que eles possam cobrar mais dinheiro -- (Risos) -- significa um ataque cardíaco. AMI, akut miyokard enfarktüsü, ki bu bir doktorun sizden daha fazla para isteyebilmesi için söylediği büyük sözler -- (Gülüşmeler) -- kalp krizi anlamına gelir. Annual incidence: 1.2 million Americans. |Inzidenz|| Jährliche Inzidenz: 1,2 Millionen Amerikaner. Yıllık insidans: 1,2 milyon Amerikalı. Mortality: 300,000 people dying each year. About half of them, 600,000, have permanent damage to their heart that will cause them to have very bad problems later on. Bunların yaklaşık yarısı, 600.000 kişinin kalplerinde sonradan çok kötü sorunlar yaşamalarına neden olacak kalıcı hasarlar var. Thus 900,000 people either have died or have significant damage to their heart muscle. Assim, 900.000 pessoas morreram ou sofreram danos significativos no músculo cardíaco. Böylece 900.000 kişi ya öldü ya da kalp kaslarında ciddi hasar oluştu. Symptoms are often denied by the patient, particularly us men, because we are very brave. Os sintomas muitas vezes são negados pelo paciente, principalmente nós homens, porque somos muito corajosos. Semptomlar genellikle hasta tarafından reddedilir, özellikle biz erkekler, çünkü biz çok cesuruz. We are very brave, and we don’t want to admit that I’m having a hell of a chest pain. Çok cesuruz ve göğüs ağrım olduğunu kabul etmek istemiyoruz. Then, approximately 25 percent of all patients never have any symptoms. Daha sonra, tüm hastaların yaklaşık yüzde 25'inde hiçbir semptom görülmez. What are we going to do about them? was||||||| Onlar hakkında ne yapacağız? How can we save their lives? It’s particularly true of diabetics and elderly women. ||||Diabetiker|||

Well, what is needed for the earliest possible warning of a heart attack? A means to determine if there’s a complete blockage of a coronary artery? A||||||||Verschluss|||Kranzgefäß| |||||||||||heart-related|blood vessel ||||||||bloqueo completo|||| Um meio de determinar se há um bloqueio completo de uma artéria coronária? That, ladies and gentlemen, is a heart attack. The means consist of noting something a little technical, ST segment elevation of the electrogram. |||||||||||Elevation|||Elektrogram ||||||||||||||electrogram ||||||||||||||electrograma Translated into English, that means that if there’s an electrical signal in the heart, and one part of the ECG -- which we call the ST segment -- elevates, that is a sure sign of a heart attack. |||||||||||||||||||EKG|||||||||||||||| |||||||||||||||||||electrocardiogram|||||||||||||||| İngilizce'ye çevrilirse, kalpte bir elektrik sinyali varsa ve EKG'nin ST segmenti dediğimiz bir kısmı yükselirse, bu kesin bir kalp krizi belirtisidir. And if we had a computer put into the body of a person who’s at risk, we could know, before they even have symptoms, that they’re having a heart attack, to save their life. Ve eğer risk altındaki bir kişinin vücuduna bir bilgisayar yerleştirseydik, hayatlarını kurtarmak için kalp krizi geçirdiklerini daha semptomlar bile göstermeden anlayabilirdik. Well, the doctor can program a level of this ST elevation voltage that will trigger an emergency alarm, vibration like your cell phone, but right by your clavicle bone. |||||||||||Spannung||||||||||||||||Schlüsselbein| |||||||||||voltage|||||||vibration|||||||||clavicle| |||||||||||||||||||||||||||clavícula| Pekala, doktor bu ST yükselme voltajının bir seviyesini programlayarak acil durum alarmını, cep telefonunuz gibi titreşimi tetikleyecek, ancak doğrudan köprücük kemiğinizin yanında. And when it goes beep, beep, beep, you better do something about it, because if you want to live you have to get to some medical treatment. Ve bip, bip, bip sesi verdiğinde, bu konuda bir şeyler yapsan iyi olur, çünkü yaşamak istiyorsan tıbbi bir tedavi görmelisin.

So we have to try these devices out because the FDA won’t just let us use them on people unless we try it out first, and the best model for this happens to be pigs. ||||||||||FDA|wird||||||||es sei denn||||||||||||ist||| Wir müssen diese Geräte also ausprobieren, denn die FDA wird uns nicht erlauben, sie an Menschen zu verwenden, wenn wir sie nicht vorher ausprobieren, und das beste Modell dafür sind zufällig Schweine. Bu yüzden bu cihazları denemek zorundayız çünkü FDA, biz denemeden önce onları insanlar üzerinde kullanmamıza izin vermiyor ve bunun için en iyi model domuzlar oluyor. And what we tried with the pig was external electrodes on the skin, like you see in an emergency room, and I’m going to show you why they don’t work very well. ||||||||äußere|Elektroden|||||||||||||||||||||| |||||||||electrodes|||||||||||||||||||||| Ve domuzla denediğimiz şey, acil serviste gördüğünüz gibi, deri üzerindeki dış elektrotlardı ve size bunların neden çok iyi çalışmadığını göstereceğim. And then we put a lead, which is a wire, in the right ventricle inside the heart, which does the electrogram, which is the signal voltage from inside the heart. |||||||||||||Ventrikel|||||||||||||||| |||||||||||||ventrículo|||||||||||||||| E então colocamos um eletrodo, que é um fio, no ventrículo direito dentro do coração, que faz o eletrograma, que é a voltagem do sinal de dentro do coração. Ve sonra kalbin içindeki sağ ventriküle bir tel olan bir elektrot yerleştiriyoruz, bu da kalbin içinden gelen sinyal voltajı olan elektrogramı yapıyor. Well, with the pig, at the baseline, before we blocked the pig’s artery to simulate a heart attack, that was the signal. ||||an||Basislinie|||blockierten||des Schweins|||simulieren||||||| Bem, com o porco, na linha de base, antes de bloquearmos a artéria do porco para simular um ataque cardíaco, esse era o sinal. Domuzla, başlangıçta, kalp krizini simüle etmek için domuzun arterini bloke etmeden önce, sinyal buydu. After 43 seconds, even an expert couldn’t tell the difference, and after three minutes -- well, if you really studied it, you’d see a difference. Nach 43 Sekunden konnte selbst ein Experte keinen Unterschied feststellen, und nach drei Minuten - nun ja, wenn man sich wirklich damit beschäftigt hätte, würde man einen Unterschied erkennen. 43 saniye sonra, bir uzman bile farkı anlayamadı ve üç dakika sonra -- gerçekten incelerseniz, bir fark görürsünüz. But what happened when we looked inside the pig’s heart, to the electrogram? Ama domuzun kalbinin içine, elektrograma baktığımızda ne oldu?

There was the baseline -- first of all, a much bigger and more reliable signal. Temel vardı -- her şeyden önce, çok daha büyük ve daha güvenilir bir sinyal. Second of all, I’ll bet even you people who are untrained can see the difference, and we see here an ST segment elevation right after this sharp line. ||||||||||untrainiert||||||||||||||||| ||||||||||no entrenados||||||||||||||||| Zweitens, ich wette, dass sogar Sie als Ungeübte den Unterschied erkennen können, und wir sehen hier eine ST-Segmentanhebung direkt nach dieser scharfen Linie. İkincisi, bahse girerim siz eğitimsiz insanlar bile farkı görebilir ve burada bu keskin çizginin hemen ardından bir ST segment yükselmesi görüyoruz. Look at the difference there -- it doesn’t take much, every lay person could see that difference, and computers can be programmed to easily detect it. ||||||||||lächerliche||||||||||programmiert|||| Sehen Sie sich den Unterschied an - es braucht nicht viel, jeder Laie kann diesen Unterschied erkennen, und Computer können so programmiert werden, dass sie ihn leicht erkennen. Then, look at that after three minutes. We see that the signal that’s actually in the heart, we can use it to tell people that they’re having a heart attack even before they have symptoms so we can save their life. Aslında kalpte olan sinyali görüyoruz, bunu insanlara semptomlar göstermeden kalp krizi geçirdiklerini söylemek için kullanabiliriz, böylece hayatlarını kurtarabiliriz.

Then we tried it with my son, Dr. Tim Fischell, we tried it on some human patients who had to have a stent put in. ||||||||Tim||||||||||||||Stent|| ||||||||||||||||||||||stent|| Sonra oğlum Dr. Tim Fischell ile denedik, stent takılması gereken bazı insan hastalarda denedik. Well, he kept the balloon filled to block the artery, to simulate a blockage, which is what a heart attack is. ||||Ballon|||||||||||||||| Atardamarın tıkanması için balonu dolu tuttu, bir tıkanıklığı simüle etmek için, yani kalp krizi budur. And it’s not hard to see that the baseline is the first picture on the upper left. Und es ist nicht schwer zu erkennen, dass die Grundlinie das erste Bild oben links ist. Next to it, at 30 seconds, you see this rise here, then this rise -- that’s the ST elevation. ||||||||||||||||ST-Hebung Daneben, bei 30 Sekunden, sehen Sie diesen Anstieg hier, dann diesen Anstieg - das ist die ST-Höhe. And if we had a computer that could detect it, we could tell you you’re having a heart attack so early it could save your life and prevent congestive heart failure. ||||||||||||||||||||||||||||stauende Herzins||Versagen ||||||||||||||||||||||||||||heart failure|| Und wenn wir einen Computer hätten, der das erkennen könnte, könnten wir Ihnen so früh sagen, dass Sie einen Herzinfarkt haben, was Ihr Leben retten und eine Herzinsuffizienz verhindern könnte. And then he did it again. We filled the balloon again a few minutes later and here you see, even after 10 seconds, a great rise in this piece, which we can have computers inside, under your chest like a pacemaker, with a wire into your heart like a pacemaker. |||||||||||||||||||||||||||||||||Herzschrittmacher|||||||||Herzschrittm |||||||||||||||||||||||||||||||||marcapasos||||||||| And computers don’t go to sleep. Ve bilgisayarlar uykuya dalmaz. We have a little battery and on this little battery that computer will run for five years without needing replacement. |||||||||Batterie||||||||||

What does the system look like? Well, on the left is the IMD, which is implantable medical device, and tonight in the tent you can see it -- they’ve exhibited it. ||||||IMD(1)|||implantierbar|||||||||||||| |||||||||implantable|||||||||||||displayed| ||||||IMD|||implantable|||||||||||||| Nun, links ist das IMD, ein implantierbares medizinisches Gerät, das heute Abend im Zelt zu sehen ist - sie haben es ausgestellt. It’s about this big, the size of a pacemaker. Yaklaşık şu büyüklükte, bir kalp pili büyüklüğünde. It’s implanted with very conventional techniques. |implantiert|||konventionellen| And the EXD is an external device that you can have on your night table. ||EXD(1)|||||||||||| ||external device|||||||||||| ||EXD|||||||||||| It’ll wake you up and tell you to get your tail to the emergency room when the thing goes off because, if you don’t, you’re in deep doo-doo. |||||sagen|||bring(1)||Hintern|||||wenn|das|Ding|||||||du bist|||doo|Sch |||||||||||||||||||||||||||caca|miedo Es wird dich aufwecken und dir sagen, dass du deinen Schwanz in die Notaufnahme bringen sollst, wenn das Ding losgeht, denn wenn du das nicht tust, steckst du tief in der Scheiße. Ele vai acordá-lo e dizer-lhe para levar o rabo para a sala de emergência quando a coisa disparar, porque, se você não fizer isso, você estará em uma grande merda. And then, finally, a programmer that will set the level of the stimulation, which is the level which says you are having a heart attack. und|||||der|||||||Stimulation||||||||||||

The FDA says, okay, test this final device after it’s built in some animal, which we said is a pig, so we had to get this pig to have a heart attack. Die FDA sagt: "Okay, testen Sie das endgültige Gerät, nachdem es gebaut wurde, an einem Tier, und wir sagten, es sei ein Schwein, also mussten wir dieses Schwein dazu bringen, einen Herzinfarkt zu bekommen. And when you go to the farmyard, you can’t easily get pigs to have heart attacks, so we said, well, we’re experts in stents. ||||||Hof||||||||||||||||| ||||||farmyard||||||||||||||||| ||||||granja||||||||||||||||| Tonight you’ll see some of our invented stents. Heute Abend werden Sie einige von uns erfundene Stents sehen. We said, so we’ll put in a stent, but we’re not going to put in a stent that we’d put in people. Wir haben gesagt, wir setzen einen Stent ein, aber wir werden keinen Stent einsetzen, den wir auch bei Menschen einsetzen würden. We’re putting in a copper stent, and this copper stent erodes the artery and causes heart attacks. ||||||||||löst sich auf|||||| |inserting||||||||||||||| ||||||||||erode|||||| Wir setzen einen Kupferstent ein, und dieser Kupferstent erodiert die Arterie und verursacht Herzanfälle. That’s not very nice, but, after all, we had to find out what the answer is. Bu pek hoş değil ama sonuçta cevabın ne olduğunu bulmamız gerekiyordu. So we took two copper stents and we put it in the artery of this pig, and let me show you the result that’s very gratifying as far as people who have heart disease are concerned. |||||||||||||||||||||||||befriedigend|||||||||| |||||||||||||||||||||||||satisfying|||||||||| Wir haben also zwei Kupferstents in die Arterie dieses Schweins eingesetzt, und ich möchte Ihnen das Ergebnis zeigen, das für Menschen mit Herzkrankheiten sehr erfreulich ist.

There it was, Thursday morning we stopped the pig’s medication and there is his electrogram, the signal from inside the pig’s heart coming out by radio telemetry. ||||||||||||||||||||||||||Telemetrie Then, on Friday at 6:43, he began to get certain signs, which later we had the pig run around -- I’m not going to go into this early stage. ||||||||bestimmte|||||||||||||||||| Dann, am Freitag um 6:43 Uhr, fing er an, bestimmte Anzeichen zu bekommen, die wir später das Schwein herumlaufen ließen - ich werde nicht auf dieses frühe Stadium eingehen. Sonra, Cuma günü saat 6:43'te, daha sonra domuzu koşturduğumuz bazı işaretler almaya başladı -- Bu erken aşamaya girmeyeceğim. But look what happened at 10:06 after we removed this pig’s medication that kept him from having a heart attack. ||||||||||||verhindert hat|||||| Ama bu domuzun kalp krizi geçirmesini engelleyen ilacını çıkardıktan sonra saat 10:06'da bakın ne oldu. Any one of you now is an expert on ST elevation. Artık herhangi biriniz ST elevasyonu konusunda uzmansınız. Can you see it there? Can you see it in the picture after the big rise of the QRS you see ST elevation? |||||||||||||QRS(1)|||| |||||||||||||QRS|||| This pig at 10:06 was having a heart attack. What happens after you have the heart attack, this blockage? Your rhythm becomes irregular, and that’s what happened 45 minutes later. Then, ventricular fibrillation, the heart quivers instead of beats, this is just before death of the pig, and then the pig died, it went flat-line. ||Ventrikelflim|||zittert|||||||||||||||||||| |ventricular|quivering heart||||||||||||||||||||||| |ventricular|fibrilación|||tiembla|||||||||||||||||||| But we had a little bit over an hour where we could’ve saved this pig’s life. Aber wir hatten etwas mehr als eine Stunde, in der wir das Leben dieses Schweins hätten retten können. Well, because of the FDA, we didn’t save the pig’s life, because we need to do this type of animal research for humans. ||||FDA|||||||||||||||||| Nun, wegen der FDA haben wir das Leben des Schweins nicht gerettet, weil wir diese Art von Tierversuchen für den Menschen durchführen müssen. But when it comes to the sake of a human, we can save their life. ||||||Wohl des Menschen|||||||| We can save the lives of people who are at high risk for a heart attack.

What is the response to acute myocardial infarction, a heart attack, today? ||||||myokardialen|Herzinfarkt|||| ||||||heart muscle|heart attack|||| Wie wird heute auf einen akuten Myokardinfarkt, einen Herzinfarkt, reagiert? Well, you feel some chest pain or indigestion. |||||||Verdauungsstörungen |||||||stomach discomfort It’s not all that bad; you decide not to do anything. Several hours pass and it gets worse, and even the man won’t ignore it. Finally, you go to the emergency room. You wait as burns and other critical patients are treated, because 75 percent of the patients who go to an emergency room with chest pains, don’t have AMI, so you’re not taken very seriously. |||||||||||||||||||||||Brustschmerzen||||||||| |||||||patients|||||||||||||||||||acute myocardial infarction|||||| Man wartet, während Verbrennungen und andere kritische Patienten behandelt werden, denn 75 Prozent der Patienten, die mit Brustschmerzen in die Notaufnahme kommen, haben keinen Herzinfarkt, so dass man nicht sehr ernst genommen wird. They finally see you. It takes more time to get your electrocardiogram on your skin and diagnose it, and it’s hard to do because they don’t have the baseline data, which the computer we put in you gets. |||||||Elektrokardiogram|||||||||||||||||||||||||| Es dauert länger, ein Elektrokardiogramm auf der Haut zu erstellen und eine Diagnose zu stellen, und es ist schwierig, weil man keine Basisdaten hat, die der Computer, den wir Ihnen einpflanzen, erhält. Finally, if you’re lucky, you are treated in three or four hours after the incident, but the heart muscle has died. Und wenn man Glück hat, wird man drei oder vier Stunden nach dem Vorfall behandelt, aber der Herzmuskel ist abgestorben. And that is the typical treatment. In the advanced world. In der fortgeschrittenen Welt. Not Africa -- that’s the typical treatment in the advanced world today.

So we developed the AngelMed Guardian System and we have a device inside this patient, called the Implanted AngelMed Guardian. ||||||||||||||||||Implantierte AngelMed| ||||AngelMed||||||||||||||| And when you have a blockage, the alarm goes off and it sends the alarm and the electrogram to an external device, which gets your baseline electrogram from 24 hours ago and the one that caused the alarm, so you can take it to the emergency room and show them, and say, take care of me right away. Und wenn Sie eine Verstopfung haben, geht der Alarm los, und er sendet den Alarm und das Elektrogramm an ein externes Gerät, das Ihr Basiselektrogramm von vor 24 Stunden und dasjenige, das den Alarm ausgelöst hat, abruft, so dass Sie es in die Notaufnahme mitnehmen und dort vorzeigen können und sagen können: Kümmert euch sofort um mich. Then it goes to a network operations center, where they get your data from your patient database that’s been put in at some central location, say, in the United States. Then it goes to a diagnostic center, and within one minute of your heart attack, your signal appears on the screen of a computer and the computer analyzes what your problem is. |||||Diagnosezentrum||||||||||||||||||||||analysiert|||| |||||diagnostic|||||||||||||||||||||||||| |||||||||||||||||||||||||||analiza|||| And the person who’s there, the medical practitioner, calls you -- this is also a cell phone -- and says, "Mr. Smith, you’re in deep doo-doo, you have a problem. |||||||Arzt||||||||||||||||||||| We’ve called the ambulance. |||Krankenwagen The ambulance is on the way. It’ll pick you up, and then we’re going to call your doctor tell him about it. We’re going to send him the signal, that we have, that says you have a heart attack, and we’re going to send the signal to the hospital and we’re going to have it analyzed there, and there you’re going to be with your doctor and you’ll be taken care of so you won’t die of a heart attack." That’s the first invention that I wanted to describe. (Applause)

And now I want to talk about something entirely different. At first I didn’t think migraine headaches were a big problem because I’d never had a migraine headache, but then I spoke to some people who have three or four every week of their life, and their lives are being totally ruined by it. ||||||Migräne kopfschmerzen||||||||||||||||||||||||||||||||||||| |||||migraine headaches|||||||||||||||||||||||||||||||||||||| We have a mission statement for our company doing migraine, which is, "Prevent or ameliorate migraine headaches by the application of a safe, controlled magnetic pulse applied, as needed, by the patient." ||||||||||||Vorbeugen oder lind||verbessern||Kopfschmerzen|||Anwendung|||||||angewendet||||| ||||||||||||||reduce severity||||||||||||||||| Temos uma declaração de missão para nossa empresa que faz enxaqueca, que é: "Prevenir ou melhorar as dores de cabeça da enxaqueca pela aplicação de um pulso magnético seguro e controlado aplicado, conforme necessário, pelo paciente". Now, you’re probably very few physicists here. |||||physicists| If you’re a physicist you’d know there’s a certain Faraday’s Law, which says if I apply a magnetic pulse on salt water -- that’s your brains by the way -- it’ll generate electric currents, and the electric current in the brain can erase a migraine headache. |||||||||Faradaysches Gesetz|||||||||||||||||||||||||||||||lindern||| |||||||||de Faraday|||||||||||||||||||||||||||||||||| That’s what we have discovered.

So here’s a picture of what we’re doing. The patients who have a migraine preceded by an aura have a band of excited neurons -- that’s shown in red -- that moves at three to five millimeters a minute towards the mid-brain. ||||||vorangegangen|||Aura|||||||||||||||||Millimeter pro|||||| |||||||||aura||||||||||||||||||||||| Bei Patienten mit einer Migräne, der eine Aura vorausgeht, bewegt sich ein Band erregter Neuronen - in rot dargestellt - mit drei bis fünf Millimetern pro Minute in Richtung Mittelhirn. And when it hits the mid-brain, that’s when the headache begins. There’s this migraine that is preceded by a visual aura, and this visual aura, by the way -- and I’ll show you a picture -- but it sort of begins little, with little dancing lights, gets bigger and bigger until it fills your whole visual field. |||||vorangeht|||||||||||||||||||||||||||||||||||||| Es gibt diese Migräne, der eine visuelle Aura vorausgeht, und diese visuelle Aura beginnt übrigens - ich zeige Ihnen ein Bild - ganz klein, mit kleinen tanzenden Lichtern, und wird immer größer, bis sie Ihr ganzes Gesichtsfeld ausfüllt. And what we tried was this, here is a device called the Cadwell Model MES10. ||||||||||||||Cadwell Modell MES( ||||||||||||Cadwell||MES Weighs about 70 pounds, has a wire about an inch in diameter. Wiegt|||||||||| Er wiegt etwa 70 Pfund und hat einen Draht mit einem Durchmesser von etwa einem Zoll. And here’s one of the patients who has an aura and always has a headache, bad one, after the aura. |||||||||visual disturbance|||||||||| E aqui está um dos pacientes que tem uma aura e sempre tem uma dor de cabeça, ruim, depois da aura. What do we do?

This is what an aura looks like. ||||Aura|| It’s sort of funny dancing lights, shown there on the left and right side. Es ist eine Art lustiger tanzender Lichter, die dort auf der linken und rechten Seite zu sehen sind. And that’s a fully developed visual aura, as we see on top. In the middle, our experimentalist, the neurologist, who said, "I’m going to move this down a little and I’m going to erase half your aura." ||||Experimentator||Neurologe|||||||||||||||||| ||||experimentalist|||||||||||||||||||| ||||experimentalista|||||||||||||||||||| And, by God, the neurologist did erase it, and that’s the middle picture, half of the aura erased by a short magnetic pulse. ||||||||||||||||Aura|||||| ||||||||||||||||||by|||| What does that mean? That means that the magnetic pulse is generating an electric current that’s interfering with the erroneous electrical activity in the brain. ||||||||||||stört|||||||| Das bedeutet, dass der magnetische Impuls einen elektrischen Strom erzeugt, der die fehlerhafte elektrische Aktivität im Gehirn stört. And finally he says, "okay, now I’m going to -- " all of the aura get erased with an appropriately placed magnetic pulse. |||||||||||||||||angemessen||| |||||||||||||||||appropriately||| Und schließlich sagt er: "Okay, jetzt werde ich..." Die gesamte Aura wird mit einem entsprechend platzierten magnetischen Impuls gelöscht. What is the result? We designed a magnetic depolarizer, that looks like this, that you could have -- a lady, in her pocket book, and when you get an aura you can try it and see how it works. ||||Entmagnetisierer||||||||||||||||||||||||||||| ||||magnetic depolarizer|||||||might|||||||||||||||||||||| ||||depolarizador||||||||||||||||||||||||||||| Well, the next thing they have to show is what was on ABC News, Channel 7, last week in New York City, in the 11 o’clock news. ||||||||||||ABC(1) Nachrichten||||||||||||

Anchor: For anyone who suffers from migraine headaches -- and there are 30 million Americans who do -- tonight a possible answer. Anker(1)||||unter leidet|||||||||||||| ||||||migraine headaches|||||||||||| Eyewitness news reporter Stacy Sager tonight, with a small and portable machine that literally zaps your migraines away. |||Stacy Sager|Sager||||||||||wegzaubert||| |||Stacy|Sager||||||||||elimina||| Christina Sidebottom: Well, my first reaction was that it was -- looked awfully gun-like, and it was very strange. |Sidebottom||||||||||||||||| |Sidebottom||||||||||||||||| Christina Sidebottom: Nun, meine erste Reaktion war, dass es furchtbar nach einer Waffe aussah, und es war sehr seltsam. Stacy Sager: But for Christina Sidebottom, almost anything was worth trying if it could stop a migraine. Stacy Sager: Aber für Christina Sidebottom war fast alles einen Versuch wert, wenn es eine Migräne stoppen konnte. It may look silly or even frightening as you walk around with it in your purse, but researchers here in Ohio organizing clinical trials for this migraine zapper, say it is scientifically sound. |||lächerlich||||||||||||Tasche|||||Ohio|||Studien||||Zapper||||| |||||||||||||||||||||||||||zapper||||| That, in fact, when the average person gets a migraine, it’s caused by something similar to an electrical impulse. ||||||||||||||||||impulse The zapper creates a magnetic field to counteract that. Yousef Mohammed: In other words, we’re treating electricity with electricity, rather than treating electricity with the chemicals that we’re using nowadays. |Mohammed|||||behandeln||||||||||||||heutzutage Yousef|||||||||||||||||||| Yousef Mohammed: Mit anderen Worten, wir behandeln Elektrizität mit Elektrizität, anstatt Elektrizität mit den Chemikalien zu behandeln, die wir heute verwenden. SS: But is it safe to use every day? Experts say the research has actually been around for more than a decade, and more long-term studies need to be done. Christina now swears by it. ||schwört darauf|| ||jura|| CS: It’s been the most wonderful thing for my migraine. SS: Researchers are hoping to present their studies to the FDA this summer.

Robert Fischell: And that is the invention to treat migraines. (Applause) You see, the problem is, 30 million Americans have migraine headaches, and we need a means to treat it, and I think that we now have it. |||||||||||||||Mittel||||||||||| |||||||||||e||||||||||||||| And this is the first device that we did, and I’m going to talk about my second wish, which has something to do with this. Our conclusions from our studies so far, at three research centers, is there is a marked improvement in pain levels after using it just once. |Schlussfolgerungen|||||||||Forschungszentren||||||Verbesserung|||||||| Unsere bisherigen Studien an drei Forschungszentren haben ergeben, dass bereits nach einmaliger Anwendung eine deutliche Verbesserung der Schmerzwerte zu verzeichnen ist. Nossas conclusões de nossos estudos até agora, em três centros de pesquisa, é que há uma melhora acentuada nos níveis de dor após o uso apenas uma vez. The most severe headaches responded better after we did it several times, and the unexpected finding indicates that even established headaches, not only those with aura, get treated and get diminished. ||||reagierten||||||||||||weist darauf hin||||||||||||||verringert werden |||||||||||||||||||||||||with aura|||||reduced in intensity Die stärksten Kopfschmerzen sprachen besser an, nachdem wir es mehrere Male gemacht hatten, und das unerwartete Ergebnis deutet darauf hin, dass auch etablierte Kopfschmerzen, nicht nur die mit Aura, behandelt werden und abklingen. As dores de cabeça mais severas responderam melhor depois que fizemos isso várias vezes, e a descoberta inesperada indica que mesmo dores de cabeça estabelecidas, não apenas aquelas com aura, são tratadas e diminuídas. And auras can be erased and the migraine, then, does not occur. |Auren||||||||||auftreten And that is the migraine invention that we are talking about and that we are working on. (Applause)

The third and last invention began with an idea. Epilepsy can best be treated by responsive electrical stimulation. Epilepsie||||||reaktiver|| Epilepsy|||||||| Now, why do we use -- add on, nearly, an epileptic focus? |||||||||epileptischer| |||||||||epiléptico| Now, unfortunately, us technical people, unlike Mr. Bono, have to get into all these technical words. |leider|||||||||||||| Leider müssen wir Techniker, im Gegensatz zu Herrn Bono, uns mit all diesen Fachbegriffen beschäftigen. Well, responsive electrical stimulation means that we sense, at a place in your brain which is called an epileptic focus, which is where epilepsy -- where the epileptic seizure begins. |||||||||||||||||||||||||||Anfall| |||||||||||||||||||||||||||epileptic seizure| |responsiva||||||||||||||||||||||||||crisis| We sense there, that it’s going to happen, and then we respond by applying an electrical energy at that spot, which erases the errant signal so that you don’t get the clinical manifestations of the migraine headache. |fühlen||||||||||||anlegen||||||||löscht||fehlerhaften|||||||||Manifestationen|||| ||||||||||||||||||||||||||||||||manifestations|||| |||||||||||||||||||||borra||errante||||||||||||| Wir spüren, dass es passieren wird, und dann reagieren wir, indem wir an dieser Stelle eine elektrische Energie anlegen, die das fehlgeleitete Signal auslöscht, so dass es nicht zu den klinischen Manifestationen des Migränekopfschmerzes kommt. We use current pacemaker defibrillator technology that’s used for the heart. ||||Defibrillator-Technologie|||||| ||||defibrillator technology|||||| ||||desfibrilador|||||| We thought we could adapt it for the brain. The device could be implanted under the scalp to be totally hidden and avoid wire breakage, which occurs if you put it in the chest and you try to move your neck around. |||||||Haut des Schäd||||||||||auftritt||||||||||||||| Das Gerät könnte unter der Kopfhaut eingepflanzt werden, um völlig unsichtbar zu sein und Drahtbrüche zu vermeiden, die auftreten, wenn man es in die Brust steckt und versucht, den Hals zu bewegen. Form a company to produce a neuro-pacemaker for epilepsy, as well as other diseases of the brain, because all diseases of the brain are a result of some electrical malfunction in it, that causes many, if not all, of brain disorders. ||||||neuro(1)-||||||||Krankheiten||||||Krankheiten||||||||||||||verursacht|viele|||||| ein Unternehmen zu gründen, das einen Neuroschrittmacher für Epilepsie und andere Erkrankungen des Gehirns herstellt, denn alle Erkrankungen des Gehirns sind auf eine elektrische Fehlfunktion zurückzuführen, die viele, wenn nicht sogar alle, Hirnstörungen verursacht.

We formed a company called NeuroPace and we started work on responsive neuro-stimulation, and this is a picture of what the device looked like, that’s placed into the cranial bone. |||||NeuroPace||||||||||||||||||||||||Schädel-| |||||||||||||||||||||||||||||skull| |||||NeuroPace||||||||||||||||||||||||| This is probably a better picture. Here we have our device in which we put in a frame. Hier haben wir unser Gerät, in das wir einen Rahmen einbauen. There’s a cut made in the scalp, it’s opened, the neurosurgeon has a template, he marks it around, and uses a dental burr to remove a piece of the cranial bone exactly the size of our device. |||||||||||||||||||||Zahn-|Bohrer|||||||Schädel-||||||| ||||||||||neurosurgeon|||||||||||||||||||||||||| ||||||||||neurocirujano|||||||||||||||||||||||||| Es wird ein Schnitt in die Kopfhaut gemacht, sie wird geöffnet, der Neurochirurg hat eine Schablone, die er anzeichnet, und er benutzt eine Zahnfräse, um ein Stück des Schädelknochens zu entfernen, das genau die Größe unseres Geräts hat. And tonight, you’ll be able to see the device in the tent. Und heute Abend werden Sie das Gerät im Zelt sehen können. And then we’ve -- with four screws, we put in a frame, then we snap in the device and we run with wires -- the one shown in green will go to the surface of the brain with electrodes, to the epileptic focus, the origin of the epilepsy, where we can sense the electrical signal and have computer analysis that tells us when to hit it with some electrical current to prevent the clinical manifestation of the seizure. |||||Schrauben||||||||||||||||Drähten|||||||||||||||||||||Ursprung||||||||||||||||||||||||||||||Manifestation||| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||seizura Und dann haben wir - mit vier Schrauben, setzen wir in einem Rahmen, dann schnappen wir in das Gerät und wir führen mit Drähten - die in grün gezeigt wird, um die Oberfläche des Gehirns mit Elektroden gehen, um die epileptischen Fokus, der Ursprung der Epilepsie, wo wir das elektrische Signal und haben Computer-Analyse, die uns sagt, wenn es mit einigen elektrischen Strom zu treffen, um die klinische Manifestation des Anfalls zu verhindern. In the blue wire, we see what’s called a deep brain electrode. |||||||||||Elektrode If that’s the source of the epilepsy, we can attack that as well.

The comprehensive solution: this is the device, it’s about one inches by two inches and, oddly enough, just the thickness of most cranial bones. |||||||||||||||seltsamerweise||||Dicke|||| Die umfassende Lösung: Das ist das Gerät, es ist etwa ein Zoll mal zwei Zoll groß und seltsamerweise gerade so dick wie die meisten Schädelknochen. The advantages of responsive neurostimulation: It can detect and terminate seizures before the clinical symptoms occur, provide stimulation only when needed, can be turned off if seizures disappear, it has minimal side effects -- as a matter of fact, in all our clinical trials to date, we’ve seen no side effects in the 40 or so patients in whom it’s been implanted -- and it’s an invisible, cosmetically hidden, so, if you have epilepsy and you have the device, no one will know it because you can’t tell that it’s there. |||reaktive|neurostimulation|||||beenden|||||||stimuliert nur bei||||||||||||||||||||||||||Studien||||||||||||||||||||||kosmetisch versteckt||||||||||||||||||||||| |||||||||terminate|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||| ||||neuroestimulación||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||cosméticamente||||||||||||||||||||||| And this shows what an electroencephalogram is, and on the left is the signal of a spontaneous seizure of one of the patients. |||||Elektroenzephal||||||||||||||||| |||||electroencephalogram||||||||||||||||| |||||||||||||||||crisis||||| Then we stimulated, and you see how that heavy black line and then you see the electroencephalogram signal going to normal, which means they did not get the epileptic seizure. ||stimulierten||||||||||||||||||||||||||| ||||||||||||||||electroencefalograma||||||||||||| That concludes my discussion of epilepsy and -- which is the third invention that I want to discuss here this afternoon. (Applause)

I have three wishes. Ich habe drei Wünsche. Well, I can’t do much about Africa. Nun, ich kann nicht viel für Afrika tun. I’m a tech, I’m into medical gadgetry, which is mostly high-tech stuff like Mr. Bono talked about. ||||||Geräte||||||||||| ||||||medical devices||||||||||| ||||||aparatos||||||||||| the first wish is to use the epilepsy responsive neurostimulator, called RNS, for responsive neurostimulator -- that’s a brilliant acronym -- for the treatment of other brain disorders. |||||||||||RNS(1)||reaktiven|Neurostimulator||||||||||| |||||||||neuroestimulador||RNS(1)||responsivo|||||||||||| Der erste Wunsch ist es, den Epilepsie-Response-Neurostimulator (RNS) - das ist ein geniales Akronym - für die Behandlung anderer Hirnkrankheiten einzusetzen. Well, if we’re going to do it for epilepsy, why the hell not try it for something else? Then you saw what that device looked like, that the woman was using to fix her migraines? I tell you this: that’s something which some research engineer like me would concoct, not a real designer of good equipment. |||||||||||||ausdenken||||||| |||||||||||||create or devise||||||| |||||||||||||elaboraría||||||| Ich sage Ihnen: Das ist etwas, was sich ein Forschungsingenieur wie ich ausdenken würde, nicht ein echter Konstrukteur von guten Geräten. (Laughter) we want to have some people, who really know how to do this, perform human engineering studies to develop the optimum design for the portable device for treating migraine headaches. |||||||||||||||||||||optimale||||||||| And some of the sponsors of this TED meeting are such organizations. ||||Sponsoren||||||| Then we’re going to challenge the TED attendees to come up with a way to improve health care in the USA, where we have problems that Africa doesn’t have. |||||||TED-Teilnehmer||||||||||||||||||||| |||||||asistentes||||||||||||||||||||| And by reducing malpractice litigation -- malpractice litigation is not an African problem, it’s an American problem. |||||litigation|||||||||| (Applause)

So, to get quickly to my first wish -- the brain operates by electrical signals. ||||||||||arbeitet||| If the electrical signals create a brain disorder, electrical stimulation can overcome that disorder by acting on the brain’s neurons. In other words if you’ve screwed up electrical signals, maybe, by putting other electrical signals from a computer in the brain, we can counteract that. |||||estropeado||||||||||||||||||| A signal in the brain that triggers brain dysfunction might be sensed as a trigger for electrostimulation like we’re doing with epilepsy. ||||||||Dysfunktion|||wahrgenommen|||||Elektrostimulation||||| ||||||||||||||||electrostimulation||||| ||||||||||||||||electroestimulación||||| But even if there is no signal, electrostimulation of an appropriate part of the brain can turn off a brain disorder. ||||||||||angemessenen|||||||||| And consider treating psychotic disorders -- and I want this involved with the TED group -- such as obsessive-compulsive disorder that, presently, is not well treated with drugs, and includes five million Americans. |||psychotische||||||||||||||zwanghaft|||||||||||||| Und erwägen Sie die Behandlung von psychotischen Störungen - und ich möchte, dass dies mit der TED-Gruppe besprochen wird - wie z. B. Zwangsstörungen, die derzeit nicht gut mit Medikamenten behandelt werden und von denen fünf Millionen Amerikaner betroffen sind. And Mr. Fischer, and his group at NeuroPace, and myself believe that we can have a dramatic effect in improving OCD in America and in the world. |||||||NeuroPace|||||||||||||OCD(1)|||||| ||Fischer|||||||||||||||||||||||| That is the first wish. (Applause)

The second wish is, at the present time, the clinical trials of transcranial magnetic stimulators -- that’s what TMS means, device to treat migraine headaches -- appears to be quite successful. ||||||||||Studien||||Stimulatoren|||TMS (Transkranielle Magnetstimulation)||||||||||| ||||||||||||transcraneales||estimuladores|||TMS||||||||||| Well, that’s the good news. The present portable device is far from optimally designed, both as to human factors as appearance. |||||||optimal|||||||| |||||||ideal|||||||| I think she said it looks like a gun. A lot of people don’t like guns. (Laughter) Engage a company having prior successes for human factors engineering and industrial design to optimize the design of the first portable TMS device that will be sold to the patients who have migraine headaches. |Engagieren Sie||||vorherige Erfolge||||||||||||||||||||||||||||| (Gelächter) Beauftragen Sie ein Unternehmen, das bereits erfolgreich in den Bereichen Human Factors Engineering und Industriedesign tätig war, mit der Optimierung des Designs des ersten tragbaren TMS-Geräts, das an Patienten mit Migränekopfschmerzen verkauft werden soll. And that is the second wish. (Applause)

And, of the 100,000 dollar prize money, that TED was so generous to give me, I am donating 50,000 dollars to the NeuroPace people to get on with the treatment of OCD, obsessive-compulsive disorder, and I’m making another 50,000 available for a company to optimize the design of the device for migraines. ||||||||||großzügig||||||spende|||||||||||Behandlung|||||||||||||||||||||| ||||||||||||||||donando||||||||||||||||||||||||||||||||| And that’s how I’ll use my 100,000-dollar prize money. (Applause)

Well, the third and final wish is somewhat -- unfortunately, it’s much more complicated because it involves lawyers. ||||||||leider||||||||Anwälte (Laughter) Well, medical malpractice litigation in the US has escalated the cost of malpractice insurance, so that competent physicians are leaving their practice. ||||Rechtsstreitigkeiten|||||gestiegen|||||||||Ärzte|||| ||||lawsuit|||||||||||||||||| (Gelächter) Nun, die Rechtsstreitigkeiten über ärztliche Kunstfehler in den USA haben die Kosten für die Kunstfehlerversicherung in die Höhe getrieben, so dass kompetente Ärzte ihre Praxis verlassen. (Risos) Bem, o litígio de negligência médica nos EUA aumentou o custo do seguro de negligência, de modo que médicos competentes estão deixando sua prática. Lawyers take cases on contingency with the hope of a big share of a big settlement by a sympathetic jury, because this patient really ended up badly. Anwälte||||Erfolgshonorar|||||||||||||||||||||| ||||contingency fee|||||||||||||||||||||| Anwälte nehmen Fälle auf Erfolgsbasis an, in der Hoffnung auf einen großen Anteil an einer hohen Entschädigung durch eine wohlwollende Jury, denn diesem Patienten ging es wirklich schlecht. Os advogados aceitam casos de contingência com a esperança de uma grande parte de um grande acordo por um júri simpático, porque esse paciente realmente acabou mal. The high cost of health care in the US is partly due to litigation and insurance costs. |||||||||||||Rechtsstreitigkeiten||| Die hohen Kosten der Gesundheitsversorgung in den USA sind zum Teil auf Rechtsstreitigkeiten und Versicherungskosten zurückzuführen. I’ve seen pictures, graphs, in today’s USA Today showing it skyrocketing out of control, and this is one factor. ||||||||||in die Höhe schießen|||||||| ||||||||||disparándose|||||||| Eu vi fotos, gráficos, no USA Today de hoje mostrando que ele disparou fora de controle, e este é um fator. Well, how can the TED community help with this situation?

I have a couple of ideas to begin with. Tenho algumas ideias para começar. As a starting point for discussion with the TED group, a major part of the problem is the nature of the written extent of informed consent that the patient or spouse must read and sign. ||||||||||||||||||||||Umfang|||Einwilligungserklärung|||||Ehepartner|||| Als Ausgangspunkt für die Diskussion mit der TED-Gruppe ist ein wesentlicher Teil des Problems die Art der schriftlichen Einverständniserklärung, die der Patient oder Ehepartner lesen und unterschreiben muss. For example, I asked the epilepsy people what are they using for informed consent. Ich habe zum Beispiel die Epilepsie-Patienten gefragt, was sie für die informierte Zustimmung verwenden. Would you believe, 12 pages, single space, the patient has to read before they’re in our trial to cure their epilepsy? Können Sie sich vorstellen, dass der Patient 12 Seiten lesen muss, bevor er an unserer Studie zur Heilung seiner Epilepsie teilnimmt? What do you think someone has at the end of reading 12 single space pages? They don’t understand what the hell it’s about. (Laughter) That’s the present system. How about making a video? We have entertainment people here, we have people who know how to do videos, with visual presentation of the anatomy and procedure done with animation. |||||||||||||||||||Anatomie|||||Animation |||||||||||||||||||body structure||||| Wir haben hier Leute aus der Unterhaltungsbranche, die wissen, wie man Videos macht, mit visueller Darstellung der Anatomie und des Verfahrens durch Animation. Everybody knows that we can do better with a visual thing that can be interactive with the patient, where they see the video and they’re being videoed and they press, do you understand this? ||||||||||||||||||||||||||aufgenommen||||||| No, I don’t. Well, then let’s go to a simpler explanation. ||||||einfacheren| Then there’s a simpler one and, oh yes, I understand that. Well, press the button and you’re on record, you understand. And that is one of the ideas.

Now, also a video is done of the patient or spouse and medical presenter, with the patient agreeing that he understands the procedure to be done, including all the possible failure modes. |||||||dem|||Ehepartner(in)|||||||||||||||||||||Fehlermodi The patient or spouse agree not to file a lawsuit if one of the known procedure failures occurs. |||||||||lawsuit|||||||| Now, in America, in fact, you cannot give up your right to trial by jury. However, if the video is there that everything was explained to you, and you have it all in the video file, it’ll be much less likely that some hotshot lawyer will take this case on contingency, because it won’t be nearly as good a case. ||||||||||||||||||||||||||||Schnösel|||||||||||||||| ||||||||||||||||||||||||||||abogado destacado|||||||||||||||| ||||||||||||||||||||||||||||advogado esperto|||||||||||||||| Wenn es jedoch ein Video gibt, auf dem Ihnen alles erklärt wurde, und Sie alles in der Videoakte haben, ist es viel unwahrscheinlicher, dass ein angesagter Anwalt den Fall auf Erfolgsbasis übernimmt, weil er nicht annähernd so gut sein wird. No entanto, se o vídeo está lá que tudo foi explicado para você, e você tem tudo no arquivo de vídeo, será muito menos provável que algum advogado figurão leve este caso em contingência, porque não será tão bom caso. If a medical error occurs, the patient or spouse agree to a settlement for fair compensation by arbitration instead of going to court. |||||||||||||||Entschädigung||Schiedsverfahren||||| |||||||||||||||compensation||arbitration||||| |||||||||||||||||arbitraje||||| |||||||||||||||indenização justa||arbitragem||||| Wenn ein medizinischer Fehler auftritt, vereinbaren der Patient oder der Ehepartner eine faire Entschädigung durch ein Schiedsverfahren, anstatt vor Gericht zu gehen. Se ocorrer um erro médico, o paciente ou cônjuge concorda com um acordo de compensação justa por arbitragem em vez de ir ao tribunal. That would save hundreds of millions of dollars in legal costs in the United States and would decrease the cost of medicine for everyone.

These are just some starting points. And, so there, that’s the end of all my wishes. I wish I had more wishes but three is what I’ve got and there they are. (Applause)

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