bedevil our setup. Now, just for three practical points. First, it is very important that we work assiduously on expanding legal pathways. This is the most effective form of protection we think you can have. However, just because you have a job does not mean you are immune from abuse. So therefore, it is necessary to ensure that there are no firewalls and that the workers or whatever their status have access to the necessary legal health and labor services. This is very important to ensure all the objectives we have discussed. Secondly, we would like to strongly endorse, nonetheless, government to government cooperation. We have government to government cooperation with Germany for nurses and with Canada for certain skills. They are working very well and we think that there are models that could be scaled up depending upon the needs. In the case of Canada, this is depending on the province. So our government negotiates with individual provinces. And the final aspect is, we cannot ignore the role of the private sector. This has already been pointed out. But a very potent actor in the private sector are the recruitment agencies. And in our view, they need to be disciplined and they have to be given access to the information that was all discussed here. So frameworks have to be elaborated that would allow a greater degree of compliance, if you want, and discipline of the recruitment agencies so that they understand what their responsibilities are. Oh, and the last point, I forgot. Upscaling is critical in this fast-moving global economy of ours. The world is coming out of the pandemic, we hope. This is not going to, in any way, diminish the demand for skills and semi-skills all over the world. And it's important that we do this both in the destination country and in the home country. The dividends can be enormous in terms of preparation and foreseeing market trends. And we think that's something that we could all invest in. So I'm sorry for having been the last, for having been signing up so late but I just came from another meeting at the ILO. So forgive me, Amy. Thank you. No forgiveness is necessary. We always welcome your contribution. So thank you and very, very good points indeed. I'd like to give our panelists the opportunity to respond to the interventions that have been made and to provide any final statements that they'd like to make at this point. If I could start with the Assistant Deputy Minister Jarvis from Canada, the floor is yours. Thank you so much. This has been a terrific discussion on inclusion and empowerment and really looking at that labor economic migration nexus. I think, you know, really reinforces the importance of safe orderly managed migration across that continuum from development in the source countries through to destination countries where settlement services, language, skill development continues to be important. I think it's important to really leverage all pathways and optimize all of those pathways, both temporary and permanent, to support that managed mobility. And in terms of skills development, just want to underscore the importance of that transferrable nature of skills development. So thank you. This has been a really, really interesting discussion. Thank you. Really useful interventions, which I hope our other member states and stakeholders will be able to take into their own practices moving forward. Dr. Kaur, if I could just turn it over to you for any closing remarks or response to the interventions made. So thank you so much, Amy. And I echo the sentiments that have been expressed by these people who have spoken before me, particularly from the Philippines and Sri Lanka, because I do identify with all of us being the countries of origin. And all these issues of disciplining the recruitment agents of upskilling, of investing in skills development, except for extremely critical. And at National Skill Development Corporation and at the Ministry of Skills, there's a ministry that was instituted in India in 2015, which really focused on this particular aspect of skill development as the word suggests itself. So as a country of origin, I think as supply destination, we have a huge capacity that has been built over the past decade for skilling. We have a huge stock of skilled and certified workers, both men and women. And of course, we have the demographic advantage in India as well. So as a supply destination, I think we are really well positioned, but there are challenges and there are issues that need to be overcome, starting with access to information as basic as that. And then ensuring that we work closely together with the countries of destination, we invest in this together, not only for the sake of our country, but also where these people will be working. And then it's all cyclical in nature, it all comes back. The global mobility is truly global today. And therefore, if you invest here, it's all coming back to your country one day or the other. So I think we are all in it together and very happy to hear about the various initiatives and activities that are being undertaken. So thank you so much. We definitely are all in it together. Thank you for that. Final word, Ms. Dempster is yours. Go ahead. That's a lot of pressure, but thank you very much. And I do think it's important to keep what our end goal is in mind here, which personally, I would say, is building the skills of people, especially if they're operating in sectors that have a global shortage and helping them have access to a range of different labor markets and the ability to migrate in a safe, legal and orderly way. So there are many different elements to consider and trying to reach that end goal. And I think we've heard about most of them in the session today, but I would like to emphasize one of the pieces that Ms. Bardak mentioned. It definitely requires additional and expanded coalitions, people, partners, countries to come together and explore whether there is potential to better link migration and skills for mutual benefit. And so I really hope that this session has sparked an interest in doing so among some of these partners. And we at CGD are definitely here to help in any way we can. And I know IOM is too. So thank you very much for the invitation. I'm really looking forward to engaging with all of you in the future. Thank you. Thank you for being part of it. And thank you to our other panelists and our participants. It's clear that this is from many, many different angles, many different sides. The idea of skills-based mobility is gaining traction. And that's because it has real benefit. And I think we haven't fully tapped the opportunities that it offers. And to do so in a way that is humane to make sure that migrants' rights are protected, to make sure that we're not contributing to brain drain, but rather brain circulation, to lead to the development of countries and persons, et cetera, and economies, all come into this category. Moving forward in terms of the global compact on migration, objectives 5 and 18 are really, we're living it here. We're seeing it in practice. And it will remain a priority. Because we want to make sure that migrants of all categories, no matter who they are, no matter where they come from, are benefiting from the skills development and being recognized for what they are bringing to communities who host them. And that we're really promoting safe, regular, and orderly migration opportunities around the world. So with that, I thank all of you. I will end this panel. I'll turn it over to my colleague, the head of our governing bodies division, Dejan. Thank you, everyone, for attending. Thank you, deputy director general. Thank you, all panelists and all participants, for an excellent last panel of the first IDM session for this year. Now we are going towards the closing session. In the closing session, we'll have three distinctive and distinguished representatives. The first one is Amy Pope, deputy director down for management forum, who just moderated excellently the last panel. Then we have Johannes Luciner, deputy director general of the director of the general for the immigration and home affairs from European commission. And we have Alicia Lelwick, social economic integration lead at the United Nations major group for the children and youth. I would like to invite all three for the closing session. Thank you. Wonderful. Thank you so much to everyone. I'd like to first invite Alicia Lelwick to offer her closing remarks for this panel of the session. Actually, the IDM is a whole. It's yours. Thank you very much, Amy. Thank you, and thank you to IOM for the opportunity to represent youth priorities here today. My name is Alicia Lelwick. I'm the social and economic integration lead at the migration youth and children platform, my CP for short. We are the migration constituency of the major group for children youth. For the past three years, the my CP has enabled youth participation in migration spaces at the regional and global fora, such as at the GCM regional reviews and the global forum for migration and development. Recently, we have also co-hosted IMRF preparatory run table three on access to services together with WHO and UCLG. During the last three days of the IDM, we've heard a number of best practices and innovative approaches to protecting migrants in vulnerable situations, to advancing their socioeconomic inclusion and to facilitating regular migration. The demographic boom across much of the developing world has made these areas particularly important for youth. Young people face higher rates of under unemployment, lack opportunities to make their voices heard and often experience a feeling of exclusion from society. Given that youth also tend to have higher immigration rates than the rest of the population, making over 30% of international migrants, the issues discussed at this IDM are crucial going forward. However, at this point, we must move beyond recognizing the vulnerabilities of migrant youth to maximizing the roles in spurring development and broader prosperity. Children and youth have quite unique migratory experiences that's probably due to their adaptability, the ability to quickly absorb a new language or culture. Their recommendations hold a sense of positivity about the future. You tend to face the future with optimistic and fixed attitudes, which we hope further intergovernmental organizations and government can draw from. We should be listening to the recommendations of young people and include migrant youth in all stages of policy and program design, implementation and review, rather than make broad assumptions on their behalf. Young people must be part of the solution to make migration safe for everyone. Member states and partners should ask themselves whether youth and other marginalized groups have been sufficiently engaged in developing solutions to opening legal migration avenues or migrant inclusion. Could the level of the engagement be a factor in the success or failure of a given solution? Young people must be meaningfully involved in the development of bilateral and multilateral migration policies and instruments such as skills partnerships. As we found during our consultations, youth have repeatedly called for access to decent jobs, the elimination of barriers to access the labor market and more legal migration pathways. After three global youth forums bringing together hundreds of youth and consultations gathering the perspectives of 10 of thousands of young people, it is clear that young people care about migrant issues. As such, youth want and should be involved in the development of policies that are of key interest to them. Young people must also be meaningful involved in international policy debates with meaningful being the key word here. Unlike the diplomatic community, young people do not have extensive experience in navigating spaces like the GCM. This is why they need to get prepared. The youth forums organized by MyCP are an example of a space for children that facilitate their engagement in policy processes. It's a platform that prepares young people before their participation, allows them to articulate their thoughts and learn how to advocate effectively. To maximize the role of youth in migration policy processes, member states and organizations need to support and scale this type of tools and platforms provided by youth for youth. As part of the MyCP, I'm privileged to work with youth making a difference from building incomes for vulnerable and displaced migrants through hospitality and tech training in Malaysia and Turkey and so much more. Let me just finish by saying that we, as MyCP, are ready to work with member states, international organizations, local authorities, private sector to help engage children and youth in the implementation of the global complex measures at local, regional and global levels. Thank you very much for the opportunity to share my remarks here today. In presence of such inspiring and admirable colleagues, I am very honored to be here and I look forward to seeing effective actions and outcomes from the AMRF process. Thank you very, very much. Deputy Director General Johann Lucneri. Thank you very much. I'll pick up where the previous speaker left off, the admirable speakers and the learning that was also in for us for these last three days. Special thanks to you at IOM for dedicating this session of the International Dialogue on Migration to the implementation of the global compact. Thanks also to the UN Migration Network for all the work going into the preparation of this forum. And of course, a big welcome from our side to the report of the Secretary General on the implementation of the global compact. I would just like to reiterate the key objectives that the European Union has and that show our commitment to the implementation of the global compact. The global migration challenges require effective and comprehensive multilateral approaches and they require strong international partnerships based on a shared understanding and a shared narrative as well as joint policy priorities. The global compact provides these common principles and narratives that all countries can refer to, even on issues that are difficult to handle for all partners in this conversation such as return and reintegration or for countries as destination as we just heard in the last panel on labor migration. These policies are fully in line with the European Union's approach to migration including the 2020 pact on migration and asylum that has a very significant external dimension. They are also fully coherent with EU development cooperation policy and the consensus on development. What we believe is that migration and migration management require international cooperation in migration governments across the globe. Our aim is to build strong partnerships with countries of origin, transit and destination. We need a balanced and comprehensive framework for engagement. Just by way of example, our partnership with African countries has been further strengthened during the recent European Union African Union Summit where migration was also one of the subjects of discussion. The need for a comprehensive framework for migration was further underlined by the COVID pandemic which was mentioned also and dealt with over the last days and which has in particular affected migrants and unfortunately further deepened inequalities, vulnerabilities and human suffering as the discussions over the last days have demonstrated. At the same time, they highlighted the reliance of many states including many of the European Union's member states on migrants in their workforce and the contribution, the invaluable, invaluable contribution that they bring to our societies. The EU aims to mitigate the impact of COVID-19 on migration including on migrants themselves. Our global response amounts to 46 billion euros. We are committed to playing the role in achieving global vaccination which is key in order to restore mobility. During the recent European Union Africa Union Summit, we reaffirmed our commitment to provide at least 450 million vaccine doses to Africa and we are painfully aware that the effort must not stop there. We actually must also make sure that people get vaccinated. We share the recommendation of the Secretary-General's report that we need to build inclusive societies and include migrants in the COVID response and recovery plans. As I said, without migrants, we could not fight the pandemic and our economies could not recover without them. We have launched a new action plan on integration and inclusion for the years 2021 to 2027 proposing targeted and tailored support for integration and inclusion. The events of the last days and hundreds of thousands and very soon millions of people moving west towards the European Union have reminded us that saving lives is actually the number one priority of the European Union. The continued high number of deaths on migratory routes towards the European Union calls for continuous and further action in which cross-border operational cooperation and timely information sharing are crucial. We have stepped up our efforts inside the European Union to better coordinate search and rescue, disembarkation and relocation efforts as well as efforts outside in cooperation with partner countries. For example, under the EU UN Africa Union Task Force on Libya, the EU IOM joint initiative for migrant protection and reintegration and more recently with the support package for the Afghan people and neighboring countries. Allow me to emphasize that the right to seek asylum and the principle of Nora Fulmont are enshrined in EU law and we are taking allegations of pushbacks seriously. Any such allegations must be investigated and followed up upon by the competent national authorities. Expanding pathways for legal migration, including labor migration and better matching of skills as just discussed in the last panel are important elements of our comprehensive approach to migration. We will not be able to manage irregular migration if we don't focus more on regular migration. Around three million migrants come every year to the EU legally and we are constantly working to improve European Union rules in full respect of the national competencies of our member states to make things easier for migrants wishing to come to the European Union legally. We will soon present a so-called skills and talents package that will include proposals for simplified procedures for applying to work and for residing inside the European Union while providing protection and ensuring fair treatment and to improve the rights of non-EU nationals already integrated in the European Union. In June 2021, we launched the so-called talent partnerships as a new tool to provide comprehensive policy and funding to better match skills and needs between the European Union, its member states and the number of partner countries. We also recognize that universal access to legal identity is a cross-cutting issue for migration management and support international efforts to achieve this goal. We are very committed to strengthen efforts to tackle migrant smuggling and trafficking in human beings and have adopted new European strategies and action plans for that purpose. Those include enhanced rules on sanctioning smugglers and employers, non-criminalization of victims and unconditional access to protection and justice for victims. We recognize the need to consider the complexity of climate change and address its adverse effects and look forward to assuming the EU chairmanship of the Geneva-based platform on disaster displacement as of 1st July, 2022, which will allow us to put the issue of disaster and climate-related displacement high on our agenda and strengthen our efforts. As you will know, the number one priority of the European Commission is actually to manage climate change. Concerning capacity building, which is another significant recommendation of the Secretary General's report, we also believe it is key and the EU support includes the EU-UN partnership for Migration Capacity Building Project, through which we join forces with IOM as the chair of the UN Migration Network Secretariat. Looking at the future and in conclusion in our development cooperation funding instrument for the period 2021 to 2027, we have earmarked 10% of the funding to actions that are related to migration and forced displacement, including the fight against the root causes of migration. This will support our sustained cooperation with partners towards achieving the sustainable development goals, including through comprehensive migration partnerships. Continuing our work towards the International Migration Review Forum and the Progress Declaration, I would like to thank very warmly the International Organization for Migration and DGV Torino for their leadership, for your leadership. We look forward to the discussions on the Progress Declaration and hope for a balanced outcome with best practices and recommendations encompassing a 360-degree approach. Let me, in conclusion, assure you that you can count on the EU institution's support in implementing the objectives of the Global Compact on Migration, and we look forward to a successful IOM-IRF that gives new impetus to the implementation of the GCM. Thank you very much. Thank you very much, Deputy Director General. So we've now reached the end of three days of very rich discussion and exchanges of good practices, experiences of successes and challenges in implementing the objectives of the Global Compact on Migration. I want to thank all of you for your valuable time. We know this IDM session responded to the Member State's call in the resolution adopting the Global Compact on Migration to contribute to the International Migration Review Forum by providing relevant data, evidence, best practices, innovative approaches and recommendations. And that is what you have done over the last three days. So thank you. This is a very timely IDM. Many of you highlighted the relevance of the dialogue for your preparations for the IOM-IRF. And we are very pleased to see the IDM's inclusivity and transparency. And we're very, very grateful to the multitude of stakeholders who have provided their views, their knowledge and their experience. As Ambassador Fatima of Bangladesh, a co-facilitator of the IOM-IRF mentioned, the discussions at this session of the IDM will input the zero draft of the Progress Declaration together with the Secretary General's report. The regional reviews undertaken, the migration dialogues by the network on migration, and the broad consultations with our Member States and stakeholders. Please allow me to underline just a few of the key messages that have emerged from discussions in these last three days. And I promise I won't hit all of them, but these are the three that a few of them that really just resonated. First, over and over, we heard of the need to strengthen and improve cooperation on saving lives and on the rights of migrants and on reducing the risks and the vulnerabilities of migrants. Significant progress has been made on achieving the GCM objectives in the past three years, despite the challenges of COVID-19. Nevertheless, as His Excellency Abdullah Shahid, President of the 76th General Assembly underlined, our successes remained fragile. We have to therefore build on these efforts through continued international cooperation and concerted action. And we heard the consensus on the need to improve cooperation, to expand legal pathways, to offer alternatives to the current dangerous migration routes and thereby to undercut criminal networks who seek to exploit vulnerable people. There was also a call to protect data. The migratory context is highly, highly sensitive. The exclusive use of data for humanitarian search purposes must be assured so that all can have confidence in the data that's being collected and how it's being used. Second, there was very rich discussion on the need to address irregular migration, build inclusive societies and expand social protections to cover migrants, including, and this is very important and timely, by providing them access to healthcare and vaccinations. It also emerged very, very clearly the right to be recognized as a person before the law, to enjoy one's human rights without discrimination and the right to legal identity is absolutely fundamental for safe migration. The good practices we learned about yesterday, they're really crucial to guide the road ahead for implementation of a global compact on migration and to ensure that mobility during and after COVID-19 is accessible to all. There are a couple of key points here. First, we need to standardize identity documents across countries, below the level of passports and identity cards. We need to digitalize access to legal identity while we are safeguarding the protection of data and the individuals. And speakers also highlighted the very important issue of a parallel shadow society and the environment this creates for exploitation crimes and a whole range of human rights abuses. How can these issues be addressed, if not by creating opportunities for safe and regular access to labor markets and access to basic health services, including universal access to vaccines in times of pandemics. We've heard of efforts to reach migrants and refugees in conflict and fragile states through the COVAX facility, which donated more than a billion doses to more than 144 countries. And finally, we discuss the critical importance of migration and climate change. We know the urgency upon us. We know that adaptation must be complimented by implementation and financing with a just transition approach. Let us take the opportunity of COP 27 to advocate for and ensure that mobility is a key feature on the agenda of the COP. Ladies and gentlemen, so many actors over the last three days have generously shared their views, governments, United Nations agencies and bodies, organizations like the ICRC, civil society organizations. And if you'd allow me, I'd like to have a special word for the call made by our youth representative. Young people are our future. They must be given a voice. They must be meaningfully involved in the development of bilateral and multilateral migration policies and instruments. Let me thank you again for your participation in this very timely and important discussion ahead of the first International Migration Review Forum. It is truly impressive how much knowledge and experience was shared in this forum and how many similarities we find among various actors if we allow ourselves an open and frank discussion. We appreciate your time and we know that some of you joined us in the middle of the night. We will ensure that the good practices and recommendations shared at the dialogue over the last three days are included in our report that we will have ready in time for the IMRF. We hope this will serve you as a resource and will allow you to input the review forum as requested in the resolution adopting the GCM. Thank you for your participation. Thank you very much. Thank you. Dejan, I think that's your cue. I can just say thank you all and see you in October on our next IDM that will help here in Geneva, hopefully in person. Thank you all.


The Biosys State Government has been advised to encourage businesses in the state to grow by providing adequate security and good road infrastructure. The government is told to understand that nobody will site any business in an unsecured environment. One constant song on the lips of business owners in the state is that of over taxation, harassment by government officials and insecurity, though this is always greeted with deniers from government squatters. Gospel Obolo is an entrepreneur whose era of business is also an entertainment, a platform he has been using to engage young persons, especially in Biosys State. He has also tasted the unfriendly business environment. We should try to understand that Biosys have gotten three opportunities that they did not use very well. We have the mind to develop Biosys, but the problem is the freedom of development is not there yet. The over taxation is not helping the state. It's even making the state more poor because many people are afraid to come into Biosys. Most of those that don't have the connections are afraid to go into farming because of the instilling rate in Biosys as well. People that have acres that want to go, but if there is, it will end, a lot of people are going into farming. Now, farming will have a gain to push back many of our communities. People should start going back to their rural areas because now I was into farming too before and because of too much of theft, I have to stop. Kibolo is also the vice president of the Nigerian Kidbossing Federation, he speaks on the journey so far. Nothing comes easy. I was not the best in my family.  So his artwork, entertainment, has a lot of power of showcasing you. I have a fabrication company called Gene Engineering in Biosys, but it was not well known. I don't even know that I'm a very good mechanical engineer. But when I enter into entertainment, now the whole world knows me. I have an academy in Turkey, I have a football academy, I have a football club in Turkey.  So if Biosys can tap into entertainment and tourism, we have a lot of places that we have now and next. He urges parents to be more dedicated to parenting and grooming their children as he attributes the growing crime rate to poor upbringing. Just see, you see. Plus, TV News.


I'm going for longevity. I realize that this life thing, although it can be very short, it's also a marathon. And you know what makes running a marathon easier? A good attitude. Today, I'm going to give you one massive key to changing so many aspects of your life. And the first thing I want to talk about before we dive into it is let me explain to you how most people try to change. I'll give it, and I'll give you a real quick example before we dive into it.  Right? And they become disgusted with the body. They look at it and they're like, oh man, like I used to be in better shape when I was younger. You know, now I've got these love handles and they look at themselves and they look at their body with a form of hate. They hate their body. So what do they do? You know, they decide they're going to change it.  I'm going to start working out. So they decided to work out to change this thing that they hate. Right? Then they decided, you know what? It's not just working out.    They try to change it as much as they possibly can, because why? Because they hate it and they want it to not be the way that it is. And don't get me wrong. This can work. Many people have changed their bodies for the better by hating their bodies and by having negative feelings towards their bodies. It can work, but it's so negative that it doesn't feel as good. It doesn't feel good to change your body by doing this, by waking up, by feeling like you're disgusting, by looking at yourself in the mirror and wishing that you were someone else that causes, you know, anxiety. It causes anger. It causes sadness, all kinds of different emotions that are completely unnecessary. Now, let's take that exact same example, but let's try to move it and see if we can still change somebody's body, right? So somebody wakes up and they look at themselves and they don't enjoy the way that they look. They look at themselves and they're like, like, I didn't used to look like this. I used to be in shape. Now I've got these love handles and then they think about what got them there. You know, the lack of working out. Oh man, I've known for years I should work out more, but I just haven't been doing it. So the lack of working out. Then they think about, yeah, I mean, there has been quite a few times where I've eaten things I know I wasn't supposed to eat just because I simply wanted to see what it was like, want to just have, as Joe Rogan calls it, mouth pleasure, just the pleasure of having that thing in my mouth. Even knowing it wasn't that good for me, it was just the flavor that did it, right? There are some times that I've overindulged in alcohol. There are some drugs that I've done in my past and you start thinking about all of the things, all of the actions, all of the decisions or lack of decisions that got you to where you are, which is the way your body currently looks. It's not your body's fault, right? Whose fault is it? It's your fault, obviously, the person who's in this situation. And then you think about it, you think, wow, all of the lack of working out, all of the food I shouldn't have been eating, all of the alcohol that I've had, all the different drugs that I've had in my body still running. That's pretty damn amazing. It's running pretty damn well for all of the things that I've put it through. And then you go, wow, I haven't really been on my body side, but my body's been on my side. And then you look and you go, man, maybe instead of heating this body, maybe I should be grateful for all of the things that it's done for me. And then you have gratitude and love towards your body versus negativity, hate and anger towards your body. And with this gratitude and this love towards your body and all of the showing up that it's done for you, even when we weren't showing up for it, you go, you know what, I actually want to take care of my body better. So you know what I'm going to do? I'm going to decide to work out more often. I'm going to work out because my body deserves it.  I'm going to take my body outside. I'm going to get more sun. You know what I'm also going to do? I'm also going to drink a lot more water and a lot less alcohol. OK, maybe what I decide to do as well is I'm actually going to eat healthier and give my body the nutrients that it deserves because it's been taking care of me for sodium lung. Maybe it's about time that I start taking care of it.  Change the body. Both of them involve working out. Both of them involve eating healthier. Both of them involve doing the things that you need to do in order to make your body be in a better situation than it currently is.  Do you think that it's easier? Or let me actually rephrase the question, which do you think is easier to keep long term? Do you think it's easier to keep that hate and that anger? Or do you think it's easier to keep the gratitude and love up? You know, I would say from what I've seen and people that I know that have been in really good shape and still are really in good shape long term, the love and the gratitude towards your body tends to be easier to hold on to long term.  There's a lot of people that change your body and they go really hardcore for three months, six months a year.  What do they do? They go back to their old ways. Why? Because it's easier and it doesn't feel so negative. Both of them can work, but one is way easier and one feels a whole lot better. OK, let me give you another example.  I've been in situations where I've looked around at my circumstances, everything that I have and I've hated my circumstances. And I'll be honest with you, that's how I got into personal development was that I looked at my current circumstances and I hated them. I hated where I was. I hated where I lived. I hated my body. I hated my bank account. I hated the, you know, all of these aspects of my life that once again, I built that life. I was the one. There was no one else building my life for me. Every part of my life were all decisions that I had made. And that's what got me in a personal vomit. And you can hate where you are so much right now that you want to change. And I see so many people do this. You can hate it. You can hate your current life circumstances. You can hate where you live. You can hate the car that you drive. You can hate the money or lack of money that's in your bank account. You can hate the people that you surround yourself. You can hate the area that you live in. You can hate the lack of opportunities. You can hate all of those things. And you can force yourself to change through it. And it can 100% happen. No doubt about it. You can change through that. Or you can go, you know what? Are my current circumstances what I want? No, probably not. But you know what? I can at least be grateful for where I am.  So you're either watching this on YouTube, Facebook, Instagram or you're listening to it on a podcasting app. So you either have a computer or you have a phone to be able to access the internet. Well, that's a beautiful thing. There's a lot of people that don't have access to this information. You can hate your current life circumstance. You can hate where you live, but you can look around also. And you can say, you know what, I have a place to live. There's a lot of people that don't have that. There's a lot of people that are homeless right now. I've, you know, I can look around and say, OK, I have food every day. I have water every single day. I have shelter. I have clothing. I have a few people that love me around me. And you can look at it and you can say, OK, even though my current life circumstances are not exactly what I want them to be in the future, I wish that I had something more. I can still look at it and realize there's a lot to be grateful for. I was listening to a story the other day of a lady who was inside of the hospital and there was a spiritual leader that went in and she went and went to go talk with her and she was just so depressed and so pissed off about being in the hospital, which rightfully so, you can understand that. And she was just, she's like, this is the worst thing that's ever happened to me. And this is terrible. And she's like, listen, I completely understand. She's like, hey, I've got I've got a couple of questions for you. She goes, yeah, and she goes, I'm curious. Are there are other people that come in here and check on you every once while and she said, yeah, there's people who come in here and check on me just to make sure that everything's good. OK, cool. She goes, I'm also curious. Do you do you do they feed you in here? They do. OK, cool. I'm curious, how's the temperature of the room? Is it pretty decent? And she starts to realize she starts asking her these questions where she could focus on the fact that she's in the hospital or could she she also could focus on the fact that she has food, she has water, she has shelter, she have people that are taking care of her. It's probably not the circumstance she wants to be in at this moment. But she can look at those tiny things that are around her and build gratitude around those tiny things first before taking any action.  I know people that have Lamborghinis and hate their Lamborghinis. The car is not what's going to change. It's your attitude around what you have that needs to change. There's a difference. There's there's forcing, which is the hate side of it. And then there's allowing and there's love and there's gratitude. There's the hate side of it. And then there's a gratitude and the love side of it. And if you're going for longevity to be able to do this long term. This life thing, you probably have a good amount left. Hopefully you've still got time, right? I'm 35. Hopefully I get another 35, 40, 50, 60 years. That'd be really nice if I could. That would be really great. I've got a long way to go if I do live another 60 years. I've got another 60 years. I'm going for longevity. I realize that this life thing, although it can be very short, it's also a marathon. And you know what makes running a marathon easier? A good attitude. Loving the marathon instead of hating it, instead of pushing myself through instead of forcing myself to go through instead of hating it and having anger and being pissed off the entire time. I'm going for this long term, long jevy thing. And you know what makes it easier? Loving your current circumstances. It's about having positive dissatisfaction. In this moment, you are positive, but the dissatisfaction isn't a negative. The dissatisfaction goes, I love where I am, but I'm still going to change it. I love the people around me, but I'm still going to change that. I love the fact that my body is the way that it is. That it's taking care of me as much as it has, but I'm still going to change it. It's about realizing that no matter where you are right now, you're blessed. You have amazing opportunities in front of you. You have a long road ahead of you of this life. And if you're looking for long-term growth, if you're looking for long-term change, if you're looking for long-term success, it starts from a place of love and gratitude, not a place of hate. I know a lot of people that have built multi-multi-billion-dollar businesses, million-dollar businesses, billion-dollars, hundreds of millions of dollars. I have friends that have sold businesses for hundreds of millions of dollars, all of that. And I know people who have massive amounts of success, but they hate where they are and they don't know why. They can't, they don't know how to change it. It's because their entire life, they've learned. It's just a routine, the same way that you wake up on the same side of the bed. They've learned to just wake up and hate where they are.   And they thought that once they finally get all of that money, they're finally going to be happy. But no, the same way that they wake up on the exact same side of the bed is the exact same way that they've woken up and they've learned to hate their life.  The money doesn't change that. It's the mindset around what somebody has that changes that. So many people think they're going to get rich. They're going to make all the money. They're going to have all the success they want. And then they'll finally be OK to just take a step back and chill. Doesn't work that way. It all starts now. I always tell people an easy example of this. People are like, oh, I can't wait till I have $10 million so I can donate a million to charity. I'm like, that's not going to happen. Because if you have $10 right now and you're not donating $1 of your $10, you're not going to donate $1 million of your $10 million. It's not going to happen. It's a routine. It's a habit. It's a way of life that you start now. So that once you get to that point, it's a routine. It's a habit. It's a way of life. And if you're working towards the long term, it's a lot easier to work long term and love where you currently are because you're not going to get to a certain point in your life and go, oh, I've made it. Now I have everything that I want.  It's not to hate the way that it currently is. It's to take a step back from your hate, from your anger, from your emotions, and to say what can I appreciate about these circumstances? Okay, I found a couple things. Now instead of focusing on all of the stuff that I hate, what I'm going to do is I'm going to focus on a few of the things that I love. Even if you look at your body and you're like, I'm super overweight.   I don't want to be this way anymore. You can still find a couple things to love. A few things to have gratitude for. The fact that it's still working is a pretty damn good place to start. You're still breathing. I hope so. If you listen to this, you're still breathing. Your heart's still beating. Your organs are still working. Why don't you start there? Your body breathes in oxygen and breathes out carbon dioxide. There's trees around you that take your carbon dioxide and then make oxygen so that you can breathe it again. You have this beautiful symbiotic relationship between you and the trees. You can start there. There's so many different things that you could find gratitude for. If you just take a moment and take a step back and look for the gratitude, because I promise you this, gratitude is not just a state of being. Gratitude and happiness are habits. But you don't build that habit once you finally have what you want. You build that habit now and then that will give you the starting point to start working towards what it is that you want. So that once you have what you want, you realize, oh my goodness, I love this. I'm satisfied the same way that you loved it and you were satisfied before. You don't wake up and your life changes and your mindset changes. You have to work every single day to find what you love.  Because ultimately that's what's going to help you now and that's what's going to help you long term. Hey, thanks so much for watching this video. If you want to learn even more about Master Your Mind, click right here and watch this video as well. You are your abuser. Let me say that again for everyone in the back. You are your abuser. If you talk down to yourself, you're your abuser.


Everybody forced here being twenty one twenty two leave pearl multi sport one box number six random hit style 11 hits 11 spots will type minutes we go random off at the end. Good luck everybody again get a cut auto in every single box of pearl Last one we pulled a buzz Aldrin. Yeah, so sick. It was redemption, but probably numerous reasons that that's a redemption Here we go. I think that's the cut. It's not it's there. It should be it might not be though Well, the other night we open one of the colors right here. I Think you do about showing the cut first over there I think this is it actually. Yeah, this is it Let me see this one No, they're just misplaced that's the cut we're saving that for the end. That's the cut Wow, that's sick though to Cristiano Ronaldo auto eight of eight Cristiano Ronaldo auto eight of eight Very good start like the design on that to quite a bit actually Seven of ten the Hulkster auto Hulk Hogan auto seven to ten do this stuff is so much fun to rip. Oh, yeah, I Don't know of any other product on earth or you could pull a Ronaldo and then a Hulk auto back to back Next up other auto here Jersey auto Jeff Bagwell to a four Basically Matthew. I didn't know it's gonna be a Ronaldo to be fair. It's one of the make sure you end with the cut Jersey auto Jeff Bagwell one of four two of four. That is a Randy Johnson Four color patch auto three of three or two of three. Yeah, Randy Johnson patch auto two of three It's a sweet big unit right there Four color debacks patch autos here. It's all auto so far. Yeah, whoops all autos like whoops all punch berries Do a lot of Aikman and Marino five of seven with the jerseys Do a jersey auto Aikman and Marino to seven and we'll send the bags with the hits guys Not not that not know if you want them, but it came like that. So you like the store like that other auto here multi-auto Which way this way? One of one dual auto Magic Johnson Joe Montana That's pretty fire Magic Johnson Joe Montana dual auto one of one. This is a crazy good case or box I should say magic in Montana Dual button relic is Tony Gwynn and a Fernando Tatis Jr. I have not seen one of these yet pearls of history Dual game use buttons of Gwynn and Tatis That's a pretty sick one This case is crazy this or this box you say cases. It's like a case, but this box is crazy Which one did you buy Shane the the Randy Johnson? I would guess it's yours That's pretty wild relic here satchel page very cool six-way jersey relic and that will be to want to make sure that it is Game used satchel page six-way relic Wizard Celtics Clippers are in trade talks on a three-team trade That would send Chris Haps was against of the Celtics Marcus Morris and draft compensation of the Wizards and something else. That's interesting What what I just read Got pearl a green pearl Maria Sharapova five of eight Maria Sharapova pearl five of eight Next is jumbo patch. That is an insanely chunky patch is Shaq four out of six Perlescent patch Shaq four of six put part of the awesome, man Alright, let's see what that cut auto is four of seven Hap day day cut auto four of seven Maple Leafs Maple Leaf Gardens limited hockey club four of seven half day I'll be honest. I have not heard that name before. Hey, that's an old cut signature right there Leafs legend always holding the cup. So that's how you know it's old for the Leafs Good stuff Half day cut auto four of seven. All right, let's go ahead and random Very old but very good hockey player. That's who half day was Yeah, sorry always got a first shade of the Maple Leafs. What do you have to the photo was in black and white and he had the cup in his hand That's that's old What do you want me to I? Took the low hanging fruit. I'm sorry guys All right names and hits randomized same amount of time put them side-by-side is you guess what? Three and six nine times. All right names first nine times one two three four five six seven eight and nine Zonghan L down to June Z and nine times on the hits one two three four five six seven eight and nine Ronaldo auto down to Hulk Hogan auto all right Zonghan with the CR seven Philip R. Randy Johnson patch auto Shane W With the Akeman and Marino dual jersey auto to seven Edward E the Shaq patch Corey S. Titus and Gwynn dual button one of one Gwansu the sheriff hope of Pearl John M. Magic Johnson and Joe Montana dual auto one of one Pete M. Satchel page six-way Jersey Dale C. Jeff Bagwell Jersey auto Brian G the half day cut auto and June Z with the Hulk Hogan auto That's a really good box. Thanks again everybody moving on to select


Hello everyone, I'm Dr. Shoba. I'm an aftarmologist at Manipal Hospital. I'm a glaucoma consultant over here. I did my M.B.B.F. from Adhichinchengiri Institute of Ballur and I did my dorms from M.S. Ramayana, D.N.B. from Mysore Race Club by hospital and I did my glaucoma fellowship from Minto Eye Hospital, Bangalore and I have total of eight years of experience in this branch. So I want to tell few things related to glaucoma. See, it is a blinding condition all over the India and all over the country also and it can be preventable also. So I request all the people who are above 40 years, please go and meet your eye doctor that is an aftarmologist just for screening purpose of glaucoma. So since glaucoma is a blinding condition once we are patients as glaucoma condition means it's very very difficult to stop or halt the condition. So I'm advising all the people who are above 40 years, please go and go to your eye doctor for screening of glaucoma. And here I'm very happy. So this Manipal Hospital is giving and providing each and every service to the patient even for poor patients to reach people. So I kindly request that patients who can offer or who can want to see or experience the better doctors you can reach to Manipal Hospital. Thank you.


This is St. Cloud State in a minute. Our university has had many famous visitors to educate, inform, and entertain the campus community, ranging from athletes to authors and performers to politicians. The earliest documented politician was then presidential candidate Dwight D. Eisenhower, who made an appearance on the steps of the Stearns County Courthouse during the 1952 homecoming. The late 70s made room for musical acts like Hollen Oates, Cheap Trick, and Elton John at Hollenbeck Hall. Pulitzer Prize-winning reporter Carl Bernstein was on campus in May 1973 to discuss the Watergate break-in the year prior. That was St. Cloud State in a minute.


the European aviation industry needs to take drastic measures to reduce its climate impacts in order to achieve net zero goals. While focusing solely on flight CO2 emissions may seem like a good idea, it does not account for the majority of the industry's climate impacts. To address this issue, researchers have developed a methodology based on rigorous lifecycle assessments and time-dependent quantifications of non-CO2 climate impacts. They found that electricity-based synthetic jet fuels and direct air carbon capture and storage, DACCS, could potentially allow for climate neutral aviation. However, these methods are only viable if air traffic is reduced significantly or if the industry switches to renewable energy sources. If neither of those options are taken, then the industry will continue to rely heavily on fossil fuels and their associated climate impacts. This article was authored by Roman Sakkai, Viola Beccatini, Paolo Gobrieli and others.


What's up everybody? Ricky Grooth here. Welcome back to my channel. Good to have you. Today I want to talk about an extra avenue that you could have in your business that's right under your nose that you've never even thought about.  This is real. Relationships are universal. And if you're new here, I want to welcome you to the family. If you haven't picked up my book list to last, I'm going to put a link in the description below. Everyone should pick up that book. It's been life changing for so many people. I'm just grateful to be able to share some of my experiences. It's actually called list to last, how to survive every real estate market crash. And it's basically my story of going through the crash, losing everything and everything I learned from losing everything through the crash and how you can prepare for the next crash and build a recession proof business. You see, I want every agent out there to have a business that doesn't go away when the market crashes like mine did. I want you to have a business in place that's going to withstand any market conditions and thus reduce the failure rate in the industry because of the philosophies I'm sharing will help agents not have to get out of the business when the market crashes on top of the fact that out of the 87% of agents who fail less are failing. So pick up the book and leave me an Amazon review. It really helped me out. I'm also writing a third book I'm really excited about. So be on the lookout for that as well. So today I want to talk about this extra spoke in your business, this, this avenue of business that I've been doing for a really long time. And I haven't really shared it. But I think it's something that all of you can start doing. You can benefit from and it helps you in so many different ways. So let's get into it. This avenue I'm talking about is networking with other agents. Okay, so so many positive things comes out of this. I talked about it in another video. I'll link below about three ways, three easy ways to get more listings. And the way that I talked about it in that video was by spotting the agents that represent a lot of buyers in your market, networking with those agents about what buyers they have on the sidelines or on the fence, that's looking for particular properties they just can't find. With low inventory in the market right now, there's a lot of buyers out there that can't quite find what they're looking for. And so if you will step in and now work with these agents and say, Hey, how can I help you? What buyers do you have that you quit can't quite find exactly what they're looking for? Do they want something in this neighborhood and that neighborhood? You know, they're looking for this size house or that size condo. And then you can start picking out certain subdivisions and complexes that fit the criteria and start circle prospecting for that buyer, looking for a property to try to link that buyer up with. I do this with several agents in my market and I have capitalized on so many deals that I wouldn't have had a chance to even know about if I didn't network with these agents and try to find out what buyers they have that I can help with. Now I said that there's so many positive things that comes out of this. So here's a couple of them here. As your circle prospecting for that buyer, let's say that you don't find a listing that that buyer wants, but you still created 10 more relationships with property owners that day that will do business with you in the future. So everything should have dual purpose. With everything you do, you should have more than one reason why you are doing it. Dual purpose. Everything should have dual purpose. So when your circle prospecting, you're looking for a property for that buyer, that's one purpose, but another purpose might be that you're just trying to create more relationships and build your database bigger, right? Your object as an agent is to create relationships and build your database full of people who love you and want to do business with you. So you can network with the other agent about what buyers they have. Use that as an excuse to call more owners to create more relationships. And who knows, you might actually find an owner that wants to sell for a price that buyers will want to pay and then you have a deal out of nowhere. It's happened to me countless times. And I'm still doing it today. I actually have a listing right now. As we speak, I have a listing that I found from circle prospecting, looking for it for a buyer that one of an agent, another agent in my office, had the buyer said I'm looking for this and I went and found that but the buyer ended up not buying it. They changed their mind or was wishy-washy or whatever the case may be. Well, I listed the property. Now I have it listed. But there's been so many times where the buyer did step up and actually buy the property that I found. I can't even count. I don't even know how many of these properties I found and did this whole transaction with. So this is a really good strategy. It also deepens your relationships with the agents around town, right? And I don't think you should necessarily just go after the ones that represent a lot of buyers. Listen to that work with as many agents as we can about how we can help them. What clients do they have? Because it can go both ways, right? You can say, hey, what kind of pocket listings? What kind of sellers do you have? Right?  You may have a buyer for something they have that's off the market, but they know the seller will sell. They just don't really want it to be listed. And you have a buyer looking for that specific thing vice versa. So there's a lot to be said about networking with agents, trying to put deals together off market, deepening your relationships with the agents in your local market is always good. Agents in your market are could be debatably even worth more to you than your clients. They're they're they're at least on the same level. Okay, they're very important. They're selling your listings. You're selling their listings. You're working together all the time. Those relationships need to be taken seriously. This is something you can do as a new agent as well. Network with other agents. See what kind of buyers they have. Use that information to go, you know, as an excuse to go talk to owners. So how do we find owner's phone numbers? Red X. Red X has the best data that I found. They're geo leads you put an address on the address bar finds all the owners in the subdivision with one click of a mouse used to take me 10 hours. So you can save $150 in the link in the description the red X discount. There's also a video below that goes through step by step that I made that tells you exactly how to find how to go through the process of finding those numbers. And I would also suggest getting their on X expired leads and their storm dialer so you can just use their dialer to just blow right through the numbers. You know, you can call a couple hundred numbers in a couple hours. It's literally the best tool out there for real estate agents because voice to voice is the reason why technology will not replace real estate agents and voice to voice is the reason why I sell so much property because I understand that voice to voice is where it's at. Technology is great. Use technology to get to the voice to voice.  What's more efficient than that talking to property owners who already own the type of property you want to sell or that own the type of property that you know a buyer is waiting for is the most efficient most effective way that you can spend your time. So I hope this video really helped you a lot. Please hit that like button and shoot me a comment. Let me know what you think. I hope it adds another layer and another dimension to your business and just helps you grow stronger and have better roots and a better foundation moving forward as you go deeper with some of these relationships with other agents. It's huge and I want to say I really appreciate your time watching these videos. I know that you're getting a lot of value out of it or you wouldn't keep watching video after video after video but I just want to let you know how much I appreciate it. When I say at the end of my videos is there anything in the world I could do for you. I'm being dead serious. I answer every single deal on Instagram. I answer every question. I talk about whatever and love hearing about your small successes along the way. So keep them coming and until the next video let's go.


It's the Corbin. I'm Rick. You can follow us on Instagram, Twitter, Fondue, juicy content, text on Patreon, follow us, show the accounts, subscribe to us, hit the like button Down below. Today we got a video. It's a The world's most dangerous road. Ah, so oh we Know a top five, but I don't believe because I looked through our top the top five one and because this is called say this one Bungy via Kishtwar. I didn't see that in our the top five one Really like the top five most dangerous road in India that was crazy ones that we saw and this is more This is just one road and it kind of felt you it's these people that take a trip and they kind of it's gonna be around the edge of a cliff thing one lane ridiculous But it's a I think in The Jamu division of Jamu Kashmir, okay, but here The usual route via such pass was closed for the season So we had to take them more longer and more dangerous round via Kishtwar, Jamu and Kashmir There is a six kilometer patch near Tiare It is so dangerous and rough You can't take a small car on it It is so narrow that no buses and trucks drive on this road The road after Tiare is so rough And it took us four hours to cover the last 30 kilometers. What's 30 kilometers in? And it's like 15 miles, I think How many miles is 30 kilometers 18 miles, okay. Oh, yeah, that's a long time for four hours for 18 miles But on these you can't go more than a mile an hour Or you risked death. Yeah, I Don't know why it makes me so I'm not scared of heights But driving on something like this because obviously that there's a whole different element obviously Yeah on stuff like that. No, there's a lot of things. I see people doing in the back of my mind My thoughts like why Why would you do that? Yeah, here we go. I'm probably gonna feel that way watching this. That doesn't look that dangerous. Oh Okay It's very pretty I would I would be so concerned about rock slides and overhangs collapse Oh My god Feel uncomfortable walking that Forget driving in a car. I'd feel uncomfortable walking. I could probably walk it but driving. I still feel uncomfortable. Oh My god, and the thing is if you're if you're driving If you're driving you're on the right side where the edge is He doesn't seem to care at all, but he's hanging on The passenger seat was hanging on Oh, that's just all you could go to a waterfall. That's cool. Oh Turn oh Now it's getting dark great. They're gonna do this at night. Oh What you should have showed us you passing I want to see that seriously He can't show you cuz he ran him off the road. Oh my god.  Hope you don't have any mechanical failure while you're out there flat tires Blow a gasket that's gorgeous though. Oh my god.  Oh Who put those rocks in the middle of the rock? That's a point It's really now. It's gonna get icy. That's just great. Oh, that's great Let's just add ice and slush on top of that. Well, if you have a G you're good. Oh He's good. I don't know what he's saying. Is he clearing the road for him? Well, that's nice. Got an escort And what do you do if you're in there and a blizzard comes through That's your fault for not looking at the weather And I've gone I like cuz I have a Jeep and so I I've gone off-roading and and like stuff We have mountains here and so we'll go and do like through the mountains and all the kind of stuff Cuz that's what you do with jeeps and it's the point of having a Jeep mudding. Yeah, yeah, but yeah, I don't know man Interested How much longer can the way around there's I mean this there's one way you'd get me to do that That's where we have to go film Seriously I'm in a movie and that's where we have you know, you're doing a take out of life insurance Yeah, you're doing a film like it you name it I could name I could rattle off a hundred names of people who I want to work with and if they said this is the film We're doing and we're doing it here and this is the road we have to take to get there No question asked. I'm doing it other than that you'd never get me up. I Would like to go up there for a hike cuz I think it's gorgeous. I think it's absolutely hike. Yeah. Yeah to drive that road Yeah, driving is different. Yeah, that's a little thing Because I gotta be careful for the draft because I do love hiking I don't too a hiking is one of my favorite things for me and my wife. That's what we've always enjoyed doing but man because you have a massive car that's a whole nother element of weight and and You can't fully see where it's where the tires are and Whoo, is anybody drove that road?   I just know What's the thinnest road you've ever gone on? Have you ever you've never been in Maui, right? No, but there is There's a road to Hanai when you leave Cape Town and go to the tip of the penis there is yes there is a Road Right as you get past there's this really pretty little area that apparently Oprah Winfrey and Will Smith and a couple of people have homes in there and There's a there's a segment you can barely fit two cars past each other when you go by and it's rock on the left and Cliff on the right, but it's pay it's in the Santa Monica Mountains. No, no, no, no, no, no This is in in South Africa. Oh, but that's place like that here in Santa Monica. Oh, yeah, there are and like Canaan Road Decker Canyon here. Have you ever been down Decker Canyon Decker Canyon is pretty thin Yeah, they when I used to deliver for Amazon yeah, we That was like the worst route I ever had and any time that I ever saw that route again I was like I'm never doing that again because there's no cell service So you can't even right scan what you need to scan and then you don't know where these houses are and the roads are Incredibly thin. There's some parts of the Santa Monica Mountains that are like that. Yeah Oh boy, and there's a stretch when you're going up to a big bear There's a stretch that gets pretty uncomfortable, but it's nothing like oh nothing like nothing like that I wonder what the most dangerous road in America is I think someone's got to have it Wouldn't have you see now it probably be somewhere over here the scariest road I ever drove Maybe Alaska scariest road I ever drove was when I was driving from LA to Omaha, Nebraska I was 18 And the day before I had fallen asleep at the wheel in Arizona and had tweaked my Alignment so the wheel was pulling hard to the left And I was taking there's a couple ways you can go I took the route that takes you through the Rocky Mountains and I went through the Rocky Mountains at night It was snowing There's no lights on the road And with the snow you start to get that bedazzled hypnotized thing and your headlights are just going And you don't know if the edge of the road is a sheer cliff down to the left or maybe it's some forest So you can't tell and you're driving that way for a good two to three hours in the dark With your car if you let go of the wheel is doing this I was fully adrenaline I was Yeah, but actually it's probably the uh the roads up in like Alaska Because they're iced over absolutely full on iced over because like you got the ice road trucker Well, yeah, they got the ice truckers that do those things and the ice can give way underneath them and you're gone Um, so yeah, let us know if you've driven you're braver than us No, anyone who didn't didn't make it I bet I wonder how many people die on this road. I bet it's a lot I wouldn't surprise me actually indians here.  That's a terrible. There's so there's how did your grandfather die? He was hit by a boulder on the road up there.


First speakers today, and I will introduce both of them. And that is Dr. Andreas Stzakis, who leads the transplant program at Cleveland Clinic, Florida. Dr. Stzakis is a renowned transplant surgeon. And then Dr. Rick Kodish, who's the chair of the Department of Bioethics at Cleveland Clinic Foundation and Professor of Pediatrics, Lerner College of Medicine at Case Western University. And Dr. Stzakis and Kodish will be speaking on the provocative topic of ethical issues in uterine transplantation. I think Dr. Stzakis is speaking first. Thank you very much. And I want to thank Dr. Siegler for the kind invitation and the McLean's for having made this possible. So the subject is uterus transplants. Why should we talk about uterus transplants? Uterus transplants is intended to be as an option for uterine infertility, which is due to either absence of the uterus congenital, as in the Rokotansky syndrome, or surgical. Usually, hysterectomy is done for bleeding or for cancer, for tumors, or it can be due to dysfunction from infection short abortions. It's a common problem. There are about 50,000 women in the United States alone who have uterine infertility. Now, if they want to have children, at the moment they have two options, adoption and surrogacy. And these have been great options for thousands of women. There are thousands of happy families as a result. But these options are not possible for others. The adoption saves lives. It saves lives because there are more than 20 million children in the world that are orphaned and they need their home.  It also saves a sick mother from the risk of a pregnancy that could be dangerous for her life. On the downside, there is no genetic relationship of the parents to the child, a fact which is prohibitive for some families. There is a relative shortage of available children. The process of adoption is lengthy and expensive. And families resort to adopting children from other countries. At times, international adoption is subject to diplomatic games between governments. Surrogacy provides parents with a child that's genetically related to one of both parents.  It is an ancient practice. From the Bible, Sarah could not conceive. So she offered her Egyptian slave, Hagar, to Abraham to bear his children. There was a problem, though. As soon as Hagar became pregnant, she became very difficult to live with. So they asked her to leave the house. Indeed, she left. But then the angel told her that her son Ishmael will be a leader of the Jews. And she had to go back. So she went back. But then Sarah miraculously became pregnant. And after Isaac was born, Hagar was sent away for good to the land of Paran. So there were some problems with surrogacy, even in antiquity. Now, in modern times, there are no national policies. Several states expressly prohibit surrogacy. So agreements signed are unenforceable and void simply by crossing state lines. The cost is significant, more than $100,000, today's money. Most insurance policies do not provide coverage for surrogates. So who is responsible for maternity benefits? Who is responsible for complications? What about postpartum depression? Then there is a risk of exploitation of poor women by attracting them to a career in commercial surrogacy. This danger is present and clear. If you have any doubt, just Google career in surrogacy. So although adoption and surrogacy have been great solutions for many women and families, they are not acceptable for others. Utterine transplantation is intended as an option for these situations. So what is so different about this transplant? First, it is not a life-saving procedure. In this way, it is not different than phase or extremity transplants. As a matter of fact, kidney transplants till recently were not thought to be life-saving, just improving quality of life. We now know that they also save lives, prolong lives. But this is the first ephemeral transplant to ever be attempted. A transplant, which is not intended to last for the duration of the patient's life, but only till the goal of successful pregnancies is accomplished. Indeed, support for with immunosuppression will be discontinued, and the uterine graft will be removed or left to atrophy. In uterine transplantation, there are three lives at risk. The mothers, the donors, and the offsprings. And the risks cannot be overemphasized. The risks to the mother are surgical, obstetrical, and the risks of immunosuppression. The surgical risk of the transplant itself is probably equivalent to that of a kidney transplant. Indeed, it has been done safely in many experimental models. The immunosuppression is similar to what we use in other solid organ transplants, like kidney transplants, but it will not be lifelong. It is expected to last no longer than three or four years. The pregnancy will be a high-risk pregnancy, and will have to be followed very carefully by a qualified obstetrical team integrated to the multidisciplinary transplant team. Experienced with well over 1,000 recipients of solid organs who became pregnant and deliver babies have shown that there is a high risk of preeclampsia and eclampsia. They are frequently related to preexisting comorbidities of this patient as diabetes or hypertension. Uterine transplant recipients are expected to be healthy without comorbidities. So this risk should be minimized. The risk to the donor in case of a live donor is equivalent to that of a radical hysterectomy. And then last but not least is the risk to the offspring. The effects of the immunosuppression on the offspring are well known. There has been no teratogenesis with a commonly used immunosuppressants, cyclosporine, entachrolimus, and steroids, and anti-linfocytes globulins. The use of mycophenolate morphetil is associated with teratogenesis as it discontinued during pregnancies. Babies born from transplant recipients are normal, although frequently small forage. Cyclosporine entachrolimus cross the placenta so attention is paid to renal dysfunction and hyperkalemia, which are temporary and resolve within a day or so after delivery. Gestation and delivery are species-specific, although extensive studies have already been performed in small and large animals and demonstrated successful outcomes. The effect of growing in a transplanted uterus in humans is a process we all anticipate in all. In closing, we propose that uterine transplant is a project worth pursuing, because if successful, it'd be a valuable option for women with uterine infertility. Thank you. Again, to talk about the ethics a little bit by referring to something called the Montreal criteria, which were specified about a year or two ago. It's for the ethical feasibility of uterine transplantation and the authors from Montreal talk about recipient criteria, donor criteria and the healthcare team as the three areas to look at. And I'm not gonna go through the whole thing, but I wanna point out that they require that the recipient be a genetic female of reproductive age with no medical contraindications to transplantation. The fact that the first sort of order of business is to specify that the recipient should be a genetic female I think signals to us something that we should be thinking about because part of our job as ethicists is to think about future problems and anticipate them. And certainly the possibility of uterine transplant into a male is something that is proscribed by the Montreal criteria right now. I'm not gonna go into that today, but I think a few years from now we may be talking about that. What I also wanna say is that criteria one C is that the person has either a personal or legal contraindication to surrogacy and adoption measures and desires to have a child or two, the person seeks a uterine transplant solely as a measure to experience gestation with an understanding of the limitations provided by uterine transplant in this respect. They go on to talk about donor in the healthcare team which I'm gonna skip over and would point out that the Montreal criteria don't talk about the fetus or child at all which I think is a gap. As a pediatrician I wanna also acknowledge that this is a little bit out of my comfort zone but I've been studying informed consent for many years and that is a place I'd like to begin. For a uterine transplant to be ethically permissible I think we would all agree that there are important informed consent considerations and there would be four involved parties in my mind. There would be the recipient, there would be the donor, there would be the fetus slash infant and then there would be the father of the fetus slash infant. When it comes to consent for the recipient there would be a number of challenges. I think helping her to understand the very experimental nature of the procedure. The risks, benefits and alternatives which Dr. Tzak is outlined. Consent for the donor would be very different depending on whether the route chosen was a living donor or a cadaveric donor. If it's the former I think the consent process would be a lot like that which we've developed for living kidney donors and living liver donors. A key component of that would be to rule out coercion or financial compensation for the uterus. If the organ is a dead donor I think the consent process needs to go beyond the routine discussion with survivors because of the experimental nature of the transplant. What about the fetus or infant who is gestated as a result of a uterine transplant experiment? We've talked about a separate advocacy team for the fetus infant consisting of a pediatrician, a clinical ethicist, and a pediatric nurse or social worker. A team that would monitor the progress of the pregnancy and follow the infant in the first several years. And we feel this is important because the stakes of a pregnancy in a uterine transplant situation would be very high and the parental decision making could be constrained in a number of ways. And that's a piece to the Montreal criteria that we would add is important I think. And finally, as I said in many cases there will be a father involved in giving the novelty of the procedure and the likely focus on the recipient and the fetus slash infant. I think there's considerable risk that his perspective would be ignored or minimized and I think that would be problematic and should be avoided. So those are some informed consent considerations. Beyond informed consent, I think there are several other important ethical considerations. One is the role of cultural sensitivity and the variety of religious and cultural perspectives that impact attitudes toward the acceptability of this procedure. And I'm gonna do on one hand and on the other hand here. On the one hand, our initial research suggested for many Muslim families, neither surrogacy nor adoption is a viable option if uterine factor infertility is the diagnosis. And we think that that may increase the relative interest in this procedure among the Muslim community. By contrast, the Catholic faith tradition has a prohibition on many forms of reproductive technology and that might be a problem among Catholics for uterine transplant. My purpose here is not to provide an in-depth analysis of these considerations. I have neither the expertise nor enough time to go into it, but only to signal that I think these religious and cultural considerations are really, really important as we tackle this ethical challenge of uterine transplant. Another area of critical importance that was mentioned this morning is moral imagination. And by this, I mean to say that an excellent clinical ethicist must have the ability to think both with a creative and empathic approach. As it relates to uterine transplant, my first reaction was of admittedly narrow moral imagination. I could not imagine why someone would go through something like this to have the experience of pregnancy. Assuming that there were other ways that is adoption of surrogacy to get to that end goal of having a child. I tried my best to use my moral imagination to understand how this could be meaningful and important enough for someone to accept the accompanying risks and uncertainties. As my friend who's a physician in Portland said when I mentioned this whole idea to he said, that's crazy, why would someone want to do that? And I have to admit that was my initial reaction as well. But I remember that God gave us two years in one mouth for a reason, and we should always listen twice as much as we talk. And that helps us to develop our moral imagination. So I talked to my wife first, having never been pregnant. It was the closest I could do. She was pregnant three times and she stated conclusively that the experience of pregnancy, nausea, back pain, labor delivery were difficulties she could have easily done without. It was the pot of gold at the end of the rainbow. It was the three wonderful children we have that are a blessing that made it worth it for her. I spoke to other women who had experienced pregnancy. I think the vast majority, as I listened, felt the same way about this issue as my wife. But several women that I talked to took the opposing view and said the experience of pregnancy itself was wonderful and meaningful. I got the sense from some of them that it was holistic and helpful as a conduit to positive maternal bonding experience. And that this might be lost if an adoption or surrogacy option was taken. So this informal survey is decidedly not rigorous, not scientific, but it allowed me to change my thinking a little bit and hopefully allowed me to cultivate the moral imagination that I think a good ethicist needs to have. Finally, I want to do a little transplant ethics casuistry with you. As some of you know, I had the privilege of being involved with the first North American face transplant. And as we come up on the five-year anniversary of that, I think it's important to reflect on that experience and try to do some comparison in the ethical analysis of uterine transplant, vis-a-vis face transplant. So let's start with the question that Dr. Tsakis mentioned about what's a vital organ. Without going into in-depth, I think we would all agree that the heart and the liver are vital organs. There was some controversy about whether the face counts as a vital organ or not. But I think almost everyone would agree that the uterus is not a vital organ. So we can put that aside. I don't think it counts as a vital organ. It's not to say that we shouldn't transplant non-vital organs. So that's an important difference. An important similarity, I think, relates to progress in surgical innovation, something I know that's of great interest to many of you in this audience. And when it comes to progress in surgical innovation, I think the face and uterine transplant cases both have extensive pre-clinical science and animal experiments that lay the foundation for this first in-human operation. And looking back more generally at surgical progress, we find that this is truly one of the enduring questions in surgical ethics. When is the right time to cross the threshold and try something for the first time in a human being? Dr. Tsakis didn't mention this, but his colleagues in Sweden have answered this question by conducting a series of uterus transplants in the past year. I think they've done eight or nine. And we at the Cleveland Clinic, I think, feel compelled to learn from that experience before we go forward with our first uterus transplant. Finally, I think there's the issue of candidate selection. And we learned something in the face transplant process about that as well. We worked with a remarkable woman named Connie Kulp who was both courageous and generous. She was a victim of facial trauma. And as we spoke with her before she was listed, it became clear that she was motivated both to help herself and to allow us to learn something to help other victims of facial trauma. So she was committed to the scientific project, if you will. With any novel surgical procedure, this is the ideal, I think, because going first with the wrong candidate runs the risk of torpedoing the whole project. And as more cases are done and experience is gained, the issues of generalizability, which are standard for good clinical research, become more important and paradoxically, I think, case selection becomes less tightly controlled. So one final important lesson in this casuistry has to do with a very careful patient selection when it comes to the first North American uterus transplant. In conclusion, I'd like to say that uterus transplant may ultimately offer an approach to uterine factor infertility that is ethically superior to surrogacy. And I'm making a big normative judgment here, I realized, but I feel safe with this crowd. Ethically superior to surrogacy. I think the latter is plagued by concerns about commercialization, potential exploitation, legal uncertainty, psychological challenges, and my gravest concern, the risk of commodification of children. If the surgical technique in immunosuppressive science and the gestational questions of uterine transplant can be safely and effectively mastered, it may one day replace surrogacy and come to be seen as another landmark of improving the lives of people through surgical progress. So with that, we conclude, we look forward to your concerns and your questions and comments. Thanks.


Good morning and welcome to the chart of the week video with me David madden today's date is Thursday the 20th of August 2020 and the time has just gone 952 British summertime and this week's chart of the week is Euro dollar As we can see here the wider trend for the last few weeks and months has been in a solid upper trend It's been quite positive It wasn't too long ago only on Tuesday Euro dollar in its highest level in over two years So it's been on a very much kind of positive upward run But where do we go from here? If you take a look at yesterday's price action this candle here the big red one That has the potential to be a bearish daily a daily bearish engulfing Which if that is the case Could suggest that we could see and move to the downside Now for those of you don't know What a bearish engulfing is let's just take a look at a textbook example This is this is the price pattern here where you have several days in Rome of an upward move all these green candles And then what you have here is a large downward day We could see here The body of this candle here did the big red red rectangle completely engulfs The body of the previous days candle this green body here, which is this is where the engulfing Part comes in and then what we can see is after that The the engulfing itself is that followed by and followed by a negative down day If you look at that the price action in the past, you know a couple of days We have the large We have the large negative body here engulfing the previous days But positive state body, but we could also see that we were also in the red today So it is possible that we could be this this could be a bearish engulfing on a Euro dollar And should that be the case? We could see you know further losses We could potentially head back towards this area in one spot 1781 a move below that could take us down towards this zone here just north of kind of in around the kind of 117 area that the lows of early August are in around one spot 1696 If you have a break below that we could potentially see his head towards the kind of 116 one spot 16 zone That area saw a bit of consolidation In late July and it's only if you really have a very significant Pullback move to the downside Could he head back down towards this blue line here the fifth to the movie average and that comes in the play in at one spot 1511 and notice how in the kind of latter half of May The fifth to the movie average acted both as resistance and also as support and if the metric has been important in the past It makes it more likely it'll be important in the future although there are no guarantees But let's not let's not forget what the wider trend is so the wider trend is very much to the upside So if a broader trend does continue We can if you take out the recent highs that we saw only only a couple of days ago We could then be looking up towards the kind of psychology born to 120 level and if you go beyond that We could also be could be looking heading back up to them this level here in at once this level up here In at one spot 2140 because like I said Only a couple of days ago euro dollar had its highest level since May 2018 so it's highest level in over two years So every does depend on what kind of time frame you're looking at some traders are very much short short You know a short time. Where is it going to be in the next couple of hours? So it is or some traders look where is it going to be in a few days or weeks? So it is possible we could see a this could be this could not to be a bearish engulfing whereby we have We have a pullback and move to the downside But the pens some people might take I've been taking a longer term view And because that let's face it buying on the dip has been a popular strategy the last number of months So if we do the move at the downside that could we could see some fresh buyers enter the fold although some traders would have very much a short term time span could be looking to could could be looking to Could be looking to to to these downside targets as potential areas Actually to close up potential short positions rather than as enter as long positions If you are going to be trading euro dollar, it is worth keeping an eye on what's going on with the dollar index This is the dollar index here. It's been in a very much a negative trend The dollar index is basically the US dollar basically against the basket of other currencies and The euro dollar the euro makes up over half that at some of the region around 55 57% of the dollar index And we talked about what appears to be a bearish engulfing on euro dollar Well, conversely, we seem to be seeing a bullish daily engulfing on The US dollar index and so we're seeing a push higher in the dollar Which could suggest we might see further gains from here If you do put to the upside on on the and the dollar index keep an eye on for this zone here They can at 94 area. It's been area where that which is the dollar index has kind of really struggled to break above But if you do see a break above it That could be quite significant and that could and if you do see a break above 94 on the dollar index That could suggest we could be in for further losses on euro dollar Conversely, if the dollar index fails to break above 94 and holds above that That could be assigned at the kind of wider upper trend a euro dollar is going to continue Now if you are trading euro dollar or any dollar crosses today Please keep in mind that at 1330 British summer time We have US jobs data out we have the all the jobless claims and also the continued claims reading as well That's all from this video. Thank you for listening. Have a good trading week and good luck