Robinson Crusoe Story by Charles E. Carroll Red for Levervox by Anne Robinson Crusoe Story The night was thick and hazy when the Piccadilly days he carried down the crew and captain in the sea, and I think the water drowned them, for they never, never found them, and I know they didn't come ashore with me. Oh, it was very sad and lonely when I found myself the only population on this cultivated shore, but I've made a little tavern and a rocky-to-hook oven, and I sit and watch for people at the door. I spent no time in looking for a girl to do and be cooking, as I'm quite a clever hand at making stews, but I had that fellow Friday just to keep the tavern tidy, and to put a Sunday polish on my shoes. I have a little garden that I'm cultivating laden, as the things I eat are rather tough and dry, for I live on toasted lizards, prickly pears, and parrot's gizzards, and I'm really very fond of beetle pie. The clothes I had were furry, and it made me fret and worry when I found the moths rooting off the hair, and I had to scrape and sand them, and I bore them and I tanned them, till I got the fine Marocca suit I wear. I sometimes seek diversion in a family excursion, with a few domestic animals you see, and we take along a carrot as refreshment for the parrot, and a little can of jungle berry tea. Then we gather as we travel, bits of moths and dirty gravel, and we chip off little specimens of stone, and we carry home as prizes funny bugs of handy sizes, just to give the day a scientific tone. If the roads are wet and muddy, we remain at home and study for the gut is very clever at a sum, and the dog, instead of fighting, studies ornamental writing, while the cat is taking lessons on the drum. We retire at eleven, and we rise again at seven, and I wish to call attention as I close, to the fact that all the scholars are correct about their colours, and particular in turning out their toes. End of poem, this recording is in the public domain. The night was thick and hazy, when the Piccadilly daisy carried down the crew and captain in the sea, and I think the water drowned them, for they never, never found them, and I know they didn't come ashore with me. Oh, it was very sad and lonely when I found myself the only population on this cultivated shore, but I've made a little tavern in a rocky little cavern, and I sit and watch for people at the door. I spent no time in looking for a girl to do my cooking, as I'm quite a clever hand at making stews. But I had that fellow Friday just to keep the tavern tidy, and to put a Sunday polish on my shoes. I have a little garden that I'm cultivating lard in, as the things I eat are rather tough and dry. For I live on toasted lizards, prickly pears, and parrot-gizzards, and I'm really very fond of beetle pie. The clothes I had were furry, and it made me fret and worry when I found the moths were eating off the hair. And I had to scrape and sand them, and I boiled them, and I tanned them, till I got the fine Morocco suit I wear. I sometimes seek diversion in a family excursion with the few domestic animals you see, and we take along a carrot as refreshment for the parrot, and a little can of jungleberry tea. Then we gather as we travel bits of moss and dirty gravel, and we chip off little specimens of stone, and we carry home as prizes funny bugs of handy sizes, just to give the day a scientific tone. If the roads are wet and muddy we remain at home and study, for the goat is very clever at a sum, and the dog, instead of fighting, studies ornamental writing, while the cat is taking lessons on the drum. We retire at eleven, and we rise again at seven, and I wish to call attention as I close, to the fact that all the scholars are correct about their collars, and particular in turning out their toes. This recording is in the public domain. Robinson's Crizzle Story by Charles E. Carroll, read for LibriVox.org by Edie Berlin, Germany. Robinson's Crizzle Story The night was thick and hazy when the Piccadilly daisy carried down the crew and captain in the sea, and I think the water drowned them, for they never, never found them, and I know they didn't come ashore with me. Oh, it was very sad and lonely when I found myself the only population on this cultivated shore. But I've made a little tavern in a rocky little cavern, and I sit and watch for people at the door. I spend no time in looking for a girl to do my cooking, as I'm quite a clever hen and making stews, but I have that fellow friday just to keep the tavern tidy, and to put a sunny polish on my shoes. I have a little garden that I'm cultivating lard in, as the things I eat are rather tough and dry, for I live on toaster lizards, prickly pears and parrot gizzards, and I am rarely found of beetle pie. The clothes I had were furry, and it made me fret and worry when I found the mouth who were eating off the hair, and I had to scrap and sound them and bold them and tell them, till I got the fine Morocco suit I wear. I sometimes seek diversion in a family excursion with a few domestic animals, you see, and we take along a carrot as a refreshment for the parrot, and a little can of jungle berry tea. Then we gather as we travel, bits of moss and dirty gravel, and we chip off little specimen of stone, and we carry home as prizes, funny bugs of handy sizes, just to give the day a scientific tone. If the roads are wet and muddy, we'll remain at home and study, for the goat is a very clever at some, and the dog, instead of fighting, studies on a mental writing, while the cat is taking lessons on the drum. We retire at eleven, and we rise again at seven, and I wish to call attention, as I close, to the fact that all the scholars are correct about their colors, and particular in turning out their toes, and of poem, this recording is in the public domain. Robinson Caruso's Story by Charles E. Carroll, read for LibriVox.org by David Fetterman. The night was thick and hazy when the Piccadilly Daisy carried down the crew and captain in the sea, and I think the water drowned them, for they never, never found them, and I know they didn't come ashore with me. Oat was very sad and lonely when I found myself the only population on this cultivated shore, but I've made a little tavern in a rocky little cavern, and I sit and watch for people at the door. I spent no time in looking for a girl to do my cooking, as I'm quite a clever hand at making stews, but I had that fellow Friday just to keep the tavern tidy, and to put a little Sunday polish on my shoes. I have a little garden that I'm cultivating lard in, as the other things I eat are rather tough and dry, for I live on toasted lizards, prickly pears, and parrot-gizzards, and I'm really very fond of beetle pie. The clothes I had were furry, and it made me fret and worry when I found the moths were eating off the hair, and I had to scrape and sand them, and I boiled them and hand them till I got the fine Morocco suit I wear. I sometimes seek diversion in a family excursion, with a few domestic animals you see, and we take along a carrot as refreshment for the parrot, and a little can of jungle berry tea. Then we gather as we travel bits of moss and dirty gravel, and we chip off little specimens of stone, and we carry home as prizes funny bugs of handy sizes, just to give the day a scientific tone. If the roads are wet and muddy, we remain at home in study, for the goat is very clever at some, and the dog instead of fighting studies ornamental writing while the cat is taking lessons on the drum. We retire at eleven, and we rise again at seven, and I wish to call attention as I close to the fact that all the scholars are correct about their collars, and particular in turning out their toes. The Night was thick and hazy when the Piccadilly Daisy carried down the crew and captain in the sea, and I think the water drowned them, for they never, never found them, and I know they didn't come ashore with me. Oat was very sad and lonely when I found myself the only population on this cultivated shore, but I've made a little tavern in a rocky little cavern, and I sit and watch for people at the door. I spent no time in looking for a girl to do my cooking, as I'm quite a clever hand at making stews. But I had that fellow Friday just to keep the tavern tidy, and to put a Sunday polish on my shoes. I have a little garden that I'm cultivating lard in, as the things I eat are rather tough and dry, for I live on toasted lizards, prickly pears and parrot-gizzards, and I'm really very fond of beetle pie. The clothes I had were furry, and it made me fret and worry when I found the moths were eating off the hair, and I had to scrape and sand them, and I boiled them and tanned them, until I got the fine Morocco suit I wear. I sometimes seek diversion in a family excursion with the few domestic animals you see, and we take along a carrot as refreshment for the parrot, and a little can of jungle-berry tea. Then we gather, as we travel, bits of moss and dirty gravel, and we chip off little specimens of stone, and we carry home as prizes funny bugs of handy sizes, just to give the day a scientific tone. If the roads are wet and muddy, we remain at home and study, for the goat is very clever at a sum, and the dog, instead of fighting, studies ornamental writing, while the cat is taking lessons on the drum. We retire at eleven, and we rise again at seven, and I wish to call attention, as I close, to the fact that all the scholars are correct about their collars, and particular in turning out their toes. End of poem. This recording is in the public domain. Robinson Crusoe Story by Charles E. Carroll, read for LibriVox.org by Esther. Robinson Crusoe Story The night was thick and hazy, when the Piccadilly Daisy carried down the crew and captain in the sea, and I think the water drowned him, for they never, never found them, and I know they didn't come ashore with me. Oh, it was very sad and lonely, when I found myself the only population on this cultivated shore, but I've made a little tavern in a rocky little cavern, and I sit and watch for people at the door. I spent no time in looking for a girl to do my cooking, as I'm quite a clever hand at making stews, but I had that fellow Friday, just to keep the tavern tidy, and to put a Sunday polish on my shoes. I have a little garden that I'm cultivating lard in, as the things I eat are rather tough and dry, for I live on toasted lizards, prickly pears and parrot gizzards, and I'm really very fond of beetle-pie. The clothes I had were furry, and it made me fret and worry, when I found the maws were eating off the hair, and I had to scrape and sand them, and I boiled them and I tanned them, till I got the fine Morocco suit I wear. I sometimes seek diversion, in a family excursion, with the few domestic animals you see. And we take along a carrot, as refreshment for the parrot, and a little can of jungle-berry tea. Then we gather as we travel bits of moss and dirty gravel, and we chip off little specimens of stone, and we carry home as prizes funny bugs of handy sizes, just to give the day a scientific tone. If the roads are wet and muddy, we remain at home and study, for the goat is very clever at a sum, and the dog, instead of fighting, studies ornamental writing, while the cat is taking lessons on the drum. We retire at eleven, and we rise again at seven, and I wish to call attention, as I close, to the fact that all the scholars are correct about their collars, and particular in turning out their toes. And of poem this recording is in the public domain. Robinson Crusoe Story by Charles E. Carroll, read for LibreVox.org by Iswa, in Belgium, in September 2008. Robinson Crusoe Story. The night was thick and hazy, when the Piccadilly Daisy carried down the crew and captain in the sea. And I think the water drowned them, for they never, never found them, and I know they didn't come ashore with me. Oh, it was very sad and lonely when I found myself the only population on this cultivated shore. But I've made a little tavern in a rocky little cavern, and I sit and watch for people at the door. I spent no time in looking for a girl to do my cooking, as I'm quite a clever hand at making stews. But I had that fellow Friday just to keep the tavern tidy, and to put a Sunday polish on my shoes. I have a little garden that I'm cultivating lard in, as the things I eat are rather tough and dry, for I live on toasted lizards, prickly pears, and parrot guzzards, and I'm really very fond of beetle pie. The clothes I had were furry, and it made me fret and worry when I found the moths were eating of the hair. And I had to scrape and sand them, and I boiled them, and I tanned them, till I got the fine Morocco suit I wear. I sometimes seek diversion in a family excursion with a few domestic animals you see, and we take along a carrot as a refreshment for the parrot, and a little can of jungle bear tea. Then we gather, as we travel, bits of moss and dotty gravel, and we chip off little specimens of stone, and we carry home as prizes, funny bags of handy sizes, just to give the day a scientific turn. If the roads are wet and muddy, we remain at home and study, for the goat is very clever at the sum, and the dog, instead of fighting, studies ornamental writing, while the cat is taking lessons on the drum. We retire at eleven, and we rise again at seven, and I wish to call attention, as I close, to the fact that all the scholars are correct about their colors, and particular in turning out their toes. End of poem, this recording is in the public domain. And I know they didn't come ashore with me. Oat was very sad and lonely when I found myself the only population on this cultivated shore, but I've made a little tavern in a rocky little cavern, and I sit and watch for people at the door. I spent no time in looking for a girl to do my cooking, as I'm quite a clever hand at making stews, but I had that fellow Friday just to keep the tavern tidy, and to put a Sunday polish on my shoes. I have a little garden that I'm cultivating larden, as the things I eat are rather tough and dry, for I live on toasted lizard, prickly pears, and parrot gizzard, and I'm really very fond of beetle pie. The clothes I had were furry, and it made me fret and worry when I found the months were eating of the hair, and I had to scrape and sand them, and I boiled them and tanned them till I got the fine Morocco suit I wear. I sometimes seek diversion in a family excursion with the few domestic animals you see, and we take along a carrot as refreshment for the parrot, and a little can of jungle berry tea. Then we gather as we travel bits of moss and dirty gravel, and we chip off little specimens of stone, and we carry home as prizes funny bugs of handy sizes just to give the day a scientific tone. If the roads are wet and muddy, we remain at home and study, for the goat is very clever at his sum, and the dog instead of fighting, studies ornamental writing, while the cat is taking lessons on the drum. We retire at eleven, and we rise again at seven, and I wish to call attention as I close to the fact that all the scholars are correct about their colors, and particular in turning out their toes, and of poem. This recording is in the public domain. Robinson Crusoe Story by Charles E. Carroll, read for LibriVox.org by Christian Hughes. The night was thick and hazy when the Piccadilly Daisy carried down the crew and captain in the sea, and I think the water drowned them, for they never, never found them, and I know they didn't come ashore with me. Oat was very sad and lonely when I found myself the only population on this cultivated shore. But I've made a little tavern in a rocky little cavern, and I sit and watch for people at the door. I spent no time in looking for a girl to do my cooking, as I'm quite a clever hand at making stews. But I had that fellow Friday, just to keep the tavern tidy, and to put a Sunday polish on my shoes. I have a little garden that I'm cultivating lard in, as the things I eat are rather tough and dry, for I live on toasted lizards, prickly pears, and parrot gizzards, and I'm really very fond of beetle pie. The clothes I had were furry, and it made me fret and worry when I found the moths were eating off the hair. And I had to scrape and sand them, and I boiled them and I tanned them, till I got the fine Morocco suit I wear. I sometimes seek diversion in a family excursion, with the few domestic animals you see. And we take along a carrot as refreshment for the parrot, and a little can of jungle-berry tea. Then we gather as we travel bits of moss and dirty gravel, and we chip off little specimens of stone, and we carry home as prizes funny bugs of handy sizes, just to give the day a scientific tone. If the roads are wet and muddy we remain at home and study, for the goat is very clever at a sum, and the dog, instead of fighting, studies ornamental writing, while the cat is taking lessons on the drum. We retire at eleven, and we rise again at seven, and I wish to call attention as I close, to the fact that all the scholars are correct about their collars, and particular in turning out their toes. Robinson Crusoe Story by Charles E. Carroll Read for LibraVox.org by Liz Taylor Robinson Crusoe Story The night was thick and hazy when the Piccadilly Daisy carried down the crew and captain in the sea, and I think the water drowned them, for they never, never found them, and I know they didn't come ashore with me. Oh, twist very sad and lonely when I found myself the only population on this cultivated shore, but I've made a little tavern in a rocky little cavern, and I sit and watch for people at the door. I spent no time in looking for a girl to do my cooking, as I'm quite a clever hand at making stews, but I had that fellow Friday just to keep the tavern tidy and to put a Sunday polish on my shoes. I have a little garden that I'm cultivating lard in as the things I eat are rather tough and dry, for I live on toasted lizards, prickly pears and parrot-gizzards, and I'm really very fond of beetle pie. The clothes I had were furry, and it made me fret and worry when I found the maws were eating off the hair, and I had to scrape and sand them, and I boiled them, and I tanned them till I got the fine Morocco suit I wear. I sometimes seek diversion in a family excursion with the few domestic animals you see, and we take along a carrot as refreshment for the parrot and a little can of jungle-berry tea. Then we gather as we travel bits of moss and dirty gravel, and we chip off little specimens of stone, and we carry home as prizes funny bugs of handy sizes just to give the day a scientific tone. If the roads are wet and muddy, we remain at home and study, for the goat is very clever at a sum, and the dog, instead of fighting, studies ornamental writing, while the cat is taking lessons on the drum. We retire at eleven, and we rise again at seven, and I wish to call attention as I close. To the fact that all the scholars are correct about their collars and particular in turning out their toes. End of poem. This recording is in the public domain. The night was thick and hazy when the Piccadilly Daisy carried down the crew and captain in the sea, and I think the water drowned them, for they never, never found them, and I know they didn't come ashore with me. Oh, it was very sad and lonely when I found myself the only population on this cultivated shore, but I've made a little tavern in a rocky little cavern, and I sit and watch for people at the door. I spent no time in looking for a girl to do my cooking, as I'm quite a clever hand at making stews, but I had that fellow Friday just to keep the tavern tidy and to put a Sunday polish on my shoes. I have a little garden that I'm cultivating lard in, as the things I eat are rather tough and dry, for I live on toasted lizards, prickly pears, and parrot gizzards, and I'm really very fond of beetle pie. The clothes I had were furry, and it made me fret and worry when I found the moths were eating off the hair, and I had to scrape and sand them, and I boiled them and I tanned them, till I got the fine Morocco suit I wear. I sometimes seek diversion in a family excursion with the few domestic animals you see, and we take along a carrot as refreshment for the parrot and a little can of jungle berry tea. Then we gather as we travel bits of moss and dirty gravel, and we chip off little specimens of stone, and we carry home as prizes funny bugs of handy sizes just to give the day a scientific tone. If the roads are wet and muddy, we remain at home and study, for the goat is very clever at a sum, and the dog, instead of fighting, studies ornamental writing, while the cat is taking lessons on the drum. We retire at eleven, and we rise again at seven, and I wish to call attention as I close to the fact that all the scholars are correct about their collars in particular in turning out their toes. End of poem. This recording is in the public domain. Robinson Crusoe's Story by Charles E. Carroll Read for LibriVox.org by Ruth Golding Robinson Crusoe's Story The night was thick and easy when the Piccadilly Daisy carried down the crew and captain in the sea, and I think the water drowned them, for they never, never found them, and I know they didn't come ashore with me. Oh, it was very sad and lonely when I found myself the only population on this cult evaded shore. But I've made a little cabin in a rocky little cabin, and I sit and watch for people at the door. I spent no time in looking for a girl to do me cooking, as I'm quite a clever and at making stews, but I had that fellow Friday just to keep the tavern tidy, and to put a Sunday polish on my shoes. I have a little garden that I'm cultivating lard in, as the things I eat are rather tough and dry, for I live on toasted lizards, prickly pears, and parrot gizzards, and I'm really very fond of beet or pie. The cloves I add were furry, and it made me fret and worry when I found the moths were eating off the air, and I had to scrape and sand them, and I boiled them and I tanned them till I got the fine Morocco suit I wear. I sometimes seek diversion in a family excursion with the few domestic animals you see, and we take along a carrot as refreshment for the parrot, and a little can of jungle berry tea. Then we gather as we travel bits of moss and dirty gravel, and we chip off little specimens of stone, and we carry home as prizes, funny bugs of handy sizes, just to give the day a scientific tone. If the roads are wet and muddy, we remain at home and study, for the goat is very clever at a sum, and the dog, instead of fighting, studies ornamental writing, while the cat is taking lessons on the drum. We retire at eleven, and we rise again at seven, and I wish to call attention as I close, to the fact that all the scholars are correct about their colours, and particular in turning out their toes. End of poem. This recording is in the public domain. Robinson Crusoe's Story by Charles E. Carroll read for LibriVox.org by Secrets. Robinson Crusoe's Story The night was thick and hazy when the Piccadilly Daisy carried down the crew and captain in the sea, and I think the water drowned them, for they never never found them, and I know they didn't come ashore with me. Oh, it was very sad and lonely, when I found myself the only population on this cultivated shore, but I've made a little tavern in a rocky little cavern, and I sit and watch for people at the door. I spent no time in looking for a girl to do my cooking, as I'm quite a clever hand at making stews, but I had that fellow Friday just to keep the tavern tidy, and to put a Sunday polish on my shoes. I have a little garden that I'm cultivating lard in, as the things I eat are rather tough and dry, for I live on toasted lizards, prickly pears, and parrot gizzards, and I'm really very fond of beetle pie. The clothes I had were fairy, and it made me fret and worry, when I found the moths were eating off the hair, and I had to scrape and sand them, and I bow them and attend them, till I got the fine Morocco suit I wear. I sometimes seek diversion in a family excursion with a few domestic animals you see, and we take along a carrot as a refreshment for the parrot, and a little can of jungle berry tea. Then we gather as we travel bits of moss and dirty gravel, and we chip off little specimens of stone, and we carry home as prizes, funny bugs of handy sizes, just to give the day a scientific tone. If the roads are wet and muddy, remain at home and study, for the goat is very clever at a sum, and the dog, instead of fighting, studies ornamental writing, while the cat is taking lessons on the drum. We retire at eleven, and we rise again at seven, and I wish to call attention, as I close, to the fact that all the scholars are correct about their collars, and particular in turning out their toes. End of part


if you guys have not tried your vimates, those that know me know that they are my favorite thing ever no joke obviously not sponsored i'm nobody but uh definitely recommend them i don't do well with coffee i'm already a crazy energetic person and these hit just right so highly recommend them yeah anyways hey guys it's madison harnish back in my blue kitchen for another crazy video and today i wanted to touch on a topic that's very close to my heart if you guys didn't know i am a military spouse i guess my husband's he's in the army um and today i wanted to talk about how mlm's target military spouses and why mlm's are such a huge thing in the military spouse community those who are military spouses probably know this mlm's are rampant in military spouse communities and lots of military bases they're just everywhere and i wanted to touch on why that is and maybe what we can do to help prevent that from happening if you enjoy deep dives into businesses and unethical business practices definitely subscribe and give this video a thumbs up and if you have a story to share on a time that you've dealt with a scam or an unethical business practice definitely click my website down below and click on share your story to share your story and well let's get into the video according to data from the white house and the department of defense there are nearly 690 000 spouses of active duty military members the unemployment rate for military spouses over the past decade has hovered around 20 to 25 percent which is four times the amount of the average adult woman that means 138 000 to 175 000 military spouses are currently unemployed according to the department of defense more than half of military spouses have moved more than three times throughout their spouses military career and military bases are usually placed more than 50 miles from any major cities which means that there's usually slim pickings for jobs available in that area i currently can relate to that i'm in upstate new york right now where there is not a lot going on the closest city is a good hour and a half away and because there's so many military spouses there's a lot of job competition for jobs that normally would not be seen as that valuable or that highly sought after to read off a quote a military spouse and former pharmaceutical rep says it's really challenging to run a career when you don't know how long you're going to be in one area or you're discriminated against if you're not there long and i can totally relate to this i've definitely dealt with a challenging job market in the area that we currently live and it's this bizarre feeling of knowing that this place that you're in right now isn't really your home you're going to move pretty soon we're planning to move to colorado springs very soon here and when you go to apply to jobs since they know that your military a lot of times they'll ask do you know if you're moving soon how long are you going to be here things like that because they don't want to hire you if you're going to leave sometime soon so a lot of times it's very challenging for military spouses to find a job not only that they like but that gives them the income that they deserve luckily i was able to find a job that i really really loved working at a military surplus store and a lot of my co-workers though it was kind of a base level paid job were college graduates and they were all military spouses and i found that so odd over here they're supporting their husband in their military career but they're just not able to find a job that supports them and their education and their true abilities there's just so much job competition it can also be really challenging to make friends and form relationships because people are constantly leaving and moving around since a lot of people in the military are moving from place to place if you know that you're leaving soon it can be hard to stick your roots in somewhere knowing that you're just gonna leave and have to start over again in you know a few months on top of this if you have kids military daycare centers can get filled really quickly or you still have to pay a pretty hefty amount for daycare services so not only is it challenging to find a job that matches your qualifications but it's also very challenging to find child care so these two together makes it really really tough for military spouses especially those who have children to justify working a job and paying for child care when they're probably saving more by not having to put their child in child care in the first place all of this combined with the feeling of wanting to make new friends and new connections leads to the perfect mlm breeding ground literally every mlm has a giant foot in the military spouse community and it's upsetting to me as a military spouse and something that definitely needs to be talked about more and the awareness needs to be spread throughout military spouse communities my personal opinion too is a lot of military spouse members are younger than the average married woman i would say personally that might just be my personal opinion but something i've noticed is a lot of military spouse members are younger they're kind of just starting their lives just figuring stuff out which as we know younger people are the perfect target for mlms as well because they're a little bit more naive and well-assuming and are just more likely to get excited about the potential of an mlm without being skeptical about it i've heard so many stories of younger military spouses who look up to the older military spouses in their community as these like very wise leader type of women and a lot of those older women are in these mlms and will kind of pray on the younger military spouses who don't know any better and who want to trust them and get them into their mlm other than that since a lot of military spouses will be new to an area or wanting to make friends these mlm distributors within the military spouse community will throw parties or create these fake groups or participate in groups making these spouses feel welcome and a part of something that they wouldn't necessarily normally feel since they're in a new area and they're kind of out of their element struggling to find a job struggling to make friends and don't really know many people they promise a certain level of income and community that military spouses find it very hard to find on their own so mlms are exploiting all of the vulnerabilities in the military spouse community i personally feel like government agencies who are aware of all these issues as you saw the department of defense has clearly stated the unemployment rates of military spouses a lot of these government agencies aren't doing much to change that or help that even i when i couldn't find a job for a little while got so desperate to find a job that i ended up going to a military spouse employment center on base i personally felt like this military spouse employment center was not helpful at all they wrote down my email asked what type of jobs i'm looking for and then provided me basically indeed ads that i could find easily on my own of certain jobs that are available in the area it was not helpful at all i didn't feel like i was being supported by them and i kind of felt alone on my quest to find a job and find the right fit in this very strange place that i was still learning about the fault in those systems and the flaws in those systems have allowed mlms to flourish within military spouse communities with military spouses left out to dry with no help from their community they're made more vulnerable to these predatory mlms to highlight this i wanted to read a story sent to me by a subscriber they created their own blog post about this issue as well so i'll be linking that down below if you want to read the full story and check that out so she starts the article by saying when your spouse is in the military your abode is where the military posts you this can be a very exciting and interesting life but can also be very difficult for a spouse trying to have a non-military career when my husband was full-time in the navy most of the spouses complained about the inability to use their college education to create a career the spouses could usually find a job but moving every few years meant a career with promotions and salary increases was all that was possible i want to be very clear this article about mlm in the military is from the perspective of an officer's wife too often i hear that people fall for mlm scams are dumb and uneducated the military wives i met in officers housing all had college degrees a few even had advanced degrees these women were anything but dumb but why would they fall for an mlm where few even make a profit and many lose money and this is something that i completely can relate to because i've noticed there's so many military spouses who have college degrees who struggle to find a legitimate job on these small towns near military bases mlm and military life go hand in hand the mlm company an example would be tupperware or lula roe offer a job that moves with the spouse these companies now sell online facebook was at one time overrun with lula roe groups but also do direct sales via parties the promise of be your own boss and your success depends on how hard you work can appeal to a military spouse looking for a way to financially be successful this woman is a navy wife so she her husband is in the navy she describes her experience with tupperware which is you know the traditional experience with tupperware but the main thing that i want to touch on was when she goes into more about the connection between the different military wives and how that all works and that's something that i really want to share the navy knew without the family supporting each other keeping families in the navy was going to be more difficult and that's one thing i do have to say from my personal experience seems like the military really values family and supports it a lot and you know there's definitely a lot of great things about being involved with the military or having a spouse in the military um so i don't want to make this a complete hate video on military spouses this is just spreading awareness about mlm's within the military spouse community instead of friendships and support the navy housing became one big mlm party after party i would attend as frankly it was lonely with my husband gone for months at a time and often purchased just the smallest item it was taboo to attend a party and not purchase anything it seems like it's like a social code where if you attend a party you have to purchase something and if you're invited to a party you have to attend it it's the polite thing to do since these communities aren't like a big town it's a very small knit community where everyone kind of knows everyone so there's a lot more social pressure and combined with that oftentimes women are kind of by themselves that's something i forgot to mention earlier but when she says that her husband was gone for months at a time i've seen a lot of women who have children whose husband goes out on deployment and they're retrospectively a single mom for nine months and they have to provide for their kids which of course their husband is helping with but they also have to single parent their kids while their spouse is gone that can lead to a very lonely and isolating experience so being invited to a party if you're so lonely even if it isn't mlm party you're almost so desperate for that social interaction that you'll attend anything and that's another way that these predatory mlms prey on the vulnerabilities of military spouses when i was first married navy spouses had movie nights and going out for pizza night we had bowling parties and children's birthday parties we did fundraisers for navy relief and held each other's hands when the deployments seemed too long once mlm companies found the navy spouses it became one long party and bring your credit card or checkbook those that did not sell anything were caught with not making any money and just paying it out to simply have a social life friendships became based on hosting a party and there was a constant pressure to be recruited by people i hadn't considered close friends i truly admired these incredible intelligent women so i just assumed they knew what they were doing my own fear of trying to make anyone buy anything kept me from joining up i felt like i was a failure i just could not reconcile my moral upbringing with high pressure sales pitches which i'm exactly the same way i've always struggled with sales it's just makes me feel uncomfortable unless i just authentically believe in something i don't want to just hammer away at people to buy something so i can relate you know i talk about mean girls a lot this also it just feels like this social pressure to contribute to this mlm network and it just makes me so sad because it's like even the people who are actively participating in all of this they're not gaining anything positive from it it's not a positive aspect in one's life and so it all just feels like a waste of social worries and stresses for no reason the recruitment meetings i did attend were psychological masterpieces you were convinced you were dumb if you did not jump at this amazing opportunity there was one marike event where i was the only person that did not sign up i did not sign up as the makeup made me break out i really couldn't sell a product that i didn't use myself and she provided this like whiteboard that just looks insane it looks absolutely insane just utterly stupid and the caption says i thought i was just too dumb to understand how mlm worked which we know mlm companies make their structure purposefully confusing and vague so that you can't understand it so that you just assume that you can climb up the ladder easily or oh it's just like these few steps and then you ring up to this thing and then you get this prize which translates to this new rank and it just it's all confusing for reasons that people never fully understand how much of a scheme it is when she talks about how she was the only one to sign up it's you can see how that would be such a social pressure you're feeling lonely and isolated this is the only community that really understands your experience and what you're going through and everyone is jumping into this and doing it so you feel like you're less than or you're isolated or you're singled out if you're not actively participating in this too the breaking point came when the military spouses finally complained they were beginning to notice that a lot of income was being spent buying mlm items the constant parties were a real drain on the limited finances of junior officers the senior officer spouses were most often not involved in mlm companies but the change from friendship support and bonding to a mlm-based relationship among the spouses was a very dire thing indeed the navy base where we lived worked as a safety net for military families our husbands had no way to return home once they were out to sea if a family member became ill they had a crisis the crew member of the submarine was often not allowed to even know the family was in trouble the crew members of the submarines relied on the other families to take care of any situation that might arise while not officially members of the navy most navy spouses took this role very seriously we were especially aware of our role and watching out for those that our husbands outranked as a young officer's spouses it was our job to help out any enlisted wife the captain's wife of the submarine on which my husband served had a very difficult unpaid job making sure the families survived the deployments my captain's wife saw that though i were all in this together had become you can't come to my movie night as i'm going to be selling Tupperware and you didn't purchase any last party which is so frustrating imagine your husband's away you need some support of support system a network of people who understand what you're going through and you are told that you can't go to an event or a gathering because you didn't purchase someone's mlm product it's so cruel the constant you will make more than your spouse the you will receive a pink Cadillac the you will retire rich from selling essential oils but you have to recruit more members began to erode what the navy family stood for in the captain's wife's opinion she lectured the spouses at a party at her house where nothing was sold now she had no real power but the implication was clear you had parties where everyone was invited from the crew you checked on your fellow spouses you offered to help them whenever possible if you did not follow her suggestion her husband might make a note of the behavior of the family and the next fitness report about the navy officer sadly the enlisted wives while also selling mlm seemed to keep a balance it was the officer's wives with their gung ho and together lives that were the ones that forgot they had an obligation to just be nice i think you know the military has certain ranks there's enlisted there's officers etc and sometimes it has been known that certain military spouses will let that get to their head that their husband has a specific ranking and therefore they feel like they have that specific ranking as well among the other military spouses and that can be very dangerous when it comes to mlms as well i've kept in touch with many of the navy wives over the years none of them retired to some beautiful ranch in montana with private planes and millions most of the families have done very well financially despite the loss of the mlm dream these spouses were great salespeople and worked very hard but the cards are stacked against you in an mlm company a very small percentage make any money at all few i imagine become millionaires and that is correct failure is treated as the fall of the person that joined the mlm hard work though is not enough the reality is when you are selling an mlm item and so is every other spouse there is a limit to the market throw in everyone is trying to recruit each other and you have an endless cycle of everyone buying each other's goods it's really not a lot of fun when friendship is based on sales everyone loses on a military base where family support and friendship can meet the difference between a family collapsing or thriving which is very true mlm can become a danger to all while i'm sure mlm companies will claim they can help make friends those friends are often pressuring you to buy or join those that opt out are left out and that's a huge problem i think one of the best points made in that article is that the military spouse community is a very small community so when mlm spread they eat up much of that community very fast you can only recruit so many people until the entire military spouse community is filled up and then you're competing with literally every single person in that community you know who's all selling the same thing and there's no way to succeed in that it's literally impossible and the fact that a lot of these women go through intense extreme hardships with their husbands being gone away with lack of communication for long periods of time having to single parent deal with family struggles on their own and then they're dealing with this community that is not there to support them that is instead trying to exploit them exploit their pain and suffering for their own profit and gain and the mlm's that they're in is just so sad and disappointing and it needs to change all fellow military spouses who are watching this i encourage you to just talk about this more whether it's sharing this video or just talking about this topic with military spouses you know i'm kind of an antisocial person but i think a big thing that i can do is make more of an effort to talk to more military spouses and spread this message myself i think that there's so much that can change within the systems within the military spouse community within the network within the support so that we can prevent this from happening so that we can prevent women from falling for this for being cruel to each other because it's just not necessary at this time and that's really all i have to say on this topic this is once again a topic really close to my heart as i can relate to so many of these issues and understand them and i just hope that some positive change happens with all of this soon if you guys enjoyed this video definitely give a thumbs up and subscribe and comment below what you think of maybe some ideas you have of how there can be more positive change within military spouse communities if you are a military spouse yourself i'd love to hear your stories with your interactions within mlm's and the experiences you've had in the comments down below let's have a great you know discussion about all of this and that's really all i have to say until next time have a good one


I think I drew the short straw on our committee to make the opening remarks and set the context for I think the discussion, the rich discussion that I hope we have today about whether or not there is value in all of the government agencies participating together in a coordinated national strategy for genomic medicine, if so, how we might proceed. And I thought I'd do this by maybe highlighting a couple of other nations' efforts in this regard and see if we could stimulate ourselves to think about doing something perhaps similar or perhaps even different. Do I control the slides yet? Yes. Okay. So as Rex said, I'm not going to repeat what he said about the last series of GM meetings. Just save to say that it's been an amazing 23 months when you think about it, how productive this effort has been, ranging from a real grassroots series of initiatives that many medical centers have undertaken without the benefit of federal support and now with some benefit of federal support to leading to the demonstration projects, two RFAs from NHGRI, the inter-society group that Rex mentioned, and I hope that this GM5 will be as productive as the last series of GMs and coalescing around some tangible deliverables. Being somewhat of a genome nerd, I thought I'd also put it in this context that 23 or 24 months ago, there were a number of activities going on, fairly independently, an array of genome, genomic medicine activities across the nation. And through GM1 through GM4, we've really organized these into some sort of cohesive map of activities where we recognize some common themes that cut across many of the organizations in this room. And our aspiration is that we might actually coalesce this into a more orchestrated series of network activities. I think there's a lot of potential networks that could be derived from this and hopefully will engage many of you in those discussions in the coming day and a half. As I see it, the opportunity for this group is to really think about how we accelerate the implementation of genomic medicine, genomics research findings, where it is appropriate to do so to improve the quality of healthcare, to also to create some standards where they often don't exist about implementation, about outcome measures across the various agencies that are playing in this field, and also to coordinate a number of the implementation initiatives that we'll hear about over the next day. Think about how we might engage the private sector, which has been significantly absent from GM1 through 5, and also think about the future workforce needs that we will have in order to really realize our common goals. I thought I'd discuss a little bit what the United Kingdom has been doing and the House of Lords implemented or set in motion a human genomic strategy group several years ago to articulate the UK's overarching strategy in genomic medicine to monitor the field and think about what was right for implementation to build the necessary strategies to ensure effective and efficient translation and importantly to create the infrastructure that will allow genome sciences as well as genomic medicine to take hold and also to put in place a series of national genetic testing laboratories that would help serve the needs of the British population to work on training the NHS and the UK workforces to realize these goals to be cognizant of the policy and ethical and legal strategies that would be needed and to also actively engage the public and make them aware of the potential benefits of genomic medicine and I would argue that certainly these probably harmonize a lot with our aspirational goals collectively of the groups in this room. In their report which was released in January of 2012, they put in set to motion I think a fairly bold vision that within the next seven years the National Health Service would be a dominant force in enabling genomic medicine as well as to diffuse and embrace the technologies of genomics for the betterment of public health that this type of information would be tantamount to medicine not just genomic medicine but it would be essentially practiced as medicine with a very engaged and knowledgeable healthcare workforce as well as a very engaged and knowledgeable public. Now arguably the United States is quite a different healthcare system than the UK. They have the benefit of a highly centralized healthcare delivery system in the National Health Service as well as initiatives that have gone on for many years to centralize both the data as well as the electronic medical records in that system. They've also as I've mentioned developed a number of key infrastructure initiatives to support genetic testing across the UK and probably not too different than us a very strong university system with a number of premier investigators in the genomics field as well as a key component of infrastructure which is the UK Biobank. Now the UK Biobank actually started several years before the Human Genome Strategy Group really put its plans in motion but I think it really illustrates the power and the foresight as well as the fortitude of the UK in creating such an initiative. You may recall that Francis Collins I think attempted to create a gene and environmental cohort of about 500,000 several years ago which failed to get off the ground but nonetheless the UK has started this in 2006. 62 million pounds which I believe at that time was about $150 million. They completed the enrollment of 503,000 participants in four years with highly detailed sociodemographic clinical and environmental phenotypes. They've recently committed to 10 million pounds to analyzing the genomes of series of subsets of this cohort and have also received funding to put in imaging data as part of the phenotypic data into the Biobank database and as of March of 2012 they opened up this as a resource to genome science investigators with about 20 projects now well underway so I expect that we'll hear more about discoveries about genetic predisposition, gene environment interactions from this incredible resource in the UK. David Cameron announced in December the commitment to sequence 100,000 British genomes to really enable both sequencing at scale for the National Health Service really help that service, that system understand how to integrate genomic sequencing information into its electronic record system, how it would be represented but importantly how that information might impact health outcomes. So this is very much an outcomes oriented 100,000 genomes project which I'm sure catalyze a number of other corollary initiatives both in terms of the types of skill sets that will be required to deliver on this as well as discoveries that will be made across the cancer rare diseases and other common complex diseases. Now also aligned with this is a significant investment in creating the future workforce for the UK importantly with national oversight something that I think as was highlighted by GM4 is somewhat lacking in the United States with a clear priority to deliver bioinformatic and statistical and quantitative skill sets will be needed to tackle the kinds of data that will be coming from genomic medicine initiatives and expanding the specialist capacity of genetics and genomics to both primary care as well as specialty care as well as investment in innovative learning tools to disseminate the knowledge and keep the workforce up to date. Another country that I think has made a significant investment in this as well as made significant progress in this arena has been Canada. Genome Canada was an organization started more than a decade ago both to provide infrastructure to the country of Canada in terms of genome technologies and centers that would be enabling to a variety of investigators and healthcare delivery systems. I think many of you in the room have probably sat on genome Canada review panels to help them decide which projects to go forward and which not to. And in collaboration with the C I H R which is the NIH equivalent in Canada they had put out this genomics and personalized medicine RFA last year to the tune of about $160 million of investment that would be in part from genome Canada and C I H R and in part from industry. So 17 projects were funded in 2013 roughly at $10 million apiece and these were heavily oriented towards implementation and outcomes research. So you can see here are some of the projects that receive funding this year using mutations to guide therapy for pediatric glioblastoma measuring clinical outcomes. Comparative effectiveness of different technologies for noninvasive prenatal testing. Sequencing of lymphomas to guide therapy with cost effective analyses baked in the use of biomarkers to diagnose and treat exacerbations of COPD again guiding therapy and measuring outcomes. Full-time surveillance of HIV patients monitoring drug resistance and actively changing therapies on the basis of genomic information from both the host and from the pathogen. So I think this gives you a flavor of the kinds of investments that Canada is making in specific projects that are meant to really prove the value of the clinical utility of a lot of genomic technologies that have been discovered by many, many of you in the room as well as others across the globe. Now I also wanted to take this as an opportunity to highlight a group that won't be speaking here today but I'm as well as several of you are on the Institute of Medicine's round table for translating genomic based research for health. I want to acknowledge Adam Berger who you met earlier who has been one of the internal leaders. He's a senior program officer for this round table which began around 2006 and 2007 to really begin to think about what strategies might be necessary for effective translation. As you know, any of you from working with the IOM, it's a neutral convener. It has this capacity as this group now seems to have of really bringing together many, many stakeholders in this arena from government, academia, industry as well as non-government organizations. And the charge of this particular round table was to really explore, define and maybe refine some of the strategies that might be used to improve the translation of genomic information into healthcare. We began in 2007 with three different work streams, one related to diagnostics, the second related to drug development, the third related to public health, all centered around the theme of genomics, genetics and genomic information. This is the current composition of the round table and I think you can see it's widely represented from both academia, professional organizations, integrated healthcare delivery systems, industry, some journals, the military, a very nice cross-section I think of the stakeholders that are extremely interested in moving genomics information into healthcare and healthcare delivery. As I mentioned, molecular diagnostics was one of the main focal areas. I would say that over the last three or four years there have been at least 12 to 14 workshops. I may be missing a few here that have focused on really articulating some of the challenges and barriers and the strategies to overcome them. This one was led by Deborah Leonard, this particular focus area in molecular diagnostics and you can see the products of three of the workshops that took place over the last several years, highlighting the need and the strategies for evidence generation for enforcing the notion of clinical utility of diagnostic testing as well as the path to delivery of diagnostics, particularly highlighting the regulatory coverage and reimbursement challenges and strategies. I should mention that each of these proceedings are available through the NAS website and I think if you're truly interested in receiving copies for whatever reason, you might want to talk to Adam during the break. I led the Drug Discovery and Development Genomics-enabled Drug Discovery and Development workshop or focus groups, working group I should say which has had three workshops and a fourth that will happen later next month. One about the designing the frameworks for pre-competitive collaborations between industry and academia genome-based strategies for targeted therapeutics development, the concepts of data sharing, clinical data sharing and biospecimen sharing and drug repurposing, genomics-enabled drug repurposing workshop which will take place as I said on June 24th here in D.C. The Genomic Medicine and Public Health Group which was spearheaded by Muin as well as Bluesh Blumberg and others focused on early on the implementation strategies for diffusion of technologies, understanding which genome technologies might provide the greatest value and importantly where health IT needs to be in the future as well as what are some of the economic frameworks that are important to consider in thinking about enabling genomic technologies to move to the fore. So I think one of the questions we struggle with at the IOM is what is its impact be it clearly has elevated the dialogue across the stakeholder community. There's no question about that and it has fostered collaborations, some that have actually resulted in initiatives such as the clinical trial comparator arm partnership looking at control trials from and genomic data and biospecimens from control trials of industry-led clinical trials. There have been a number of connections between the policy messages of the IOM and a number of policy initiatives even that the NIH and several groups in the room have undertaken and clearly the IOM is a resource. I would argue that one of the things we might want to achieve in the future not necessarily for this meeting is to make the IOM much more connected to many of the stakeholders and have an efferent arm of activity that might help move some of the IOM's statements forward in the field of genomics and genomic medicine. I just wanted to mention that in the coming year we're slowly disbanding the three focus groups that I just mentioned and we're going to be spending our time on conflict of interest, on education, on the notion that a health care system can actually be a learning health system for genomic and precision medicine and the processes for evidence evaluation when it comes to genetics and genomics. So in closing I just also wanted to highlight the fact that I think that what we have in the room represented by many of you is an ecosystem that's really thinking about how to optimize the synergies between one another, reduce the redundancies, and really perhaps create a more effective series of strategies when it comes to genomic medicine. And one way at least that I thought about to frame this a little bit and you can disagree is to take from the songbook of Muin who has really helped us along with the IOM and the CDC articulate what are the different barriers to translating genomics from the laboratory on the left to health care related outcomes on the right. And you can see the four traditionally now mount iconic barriers from T1 to T4 highlighted here. And I would say that each of the groups in the room is playing along this translational continuum with, for example, the NIH and NHGRI much more in the realm of thinking through how to overcome the barriers to moving the science into man for the first time, the T1 and the T2 spaces, whereas perhaps the VA and the CDC and some of the groups in ARC are really focused on thinking about how does genomics get diffused into the hands of the providers and professionals that need to know how to use those tools to treat patients as well as how do we measure, importantly measure the outcomes that demonstrate the value proposition for the entire community, not just the patients, the providers, the payers, but the whole health care delivery system as a whole. And I think one of the opportunities we have today is to really think about how to perhaps better organize this such that we as a team of federal agencies can be more effective. So maybe to echo some of the things that both Brex, Terry, and Eric said, I think what we are here to do is try to understand your issues in where you're focused in the area of genomic medicine, what are your major challenges in enabling this strategy. And then through that dialogue, perhaps achieve some hopeful consensus about whether a strategy is really the way we should coordinate a strategy is something that we should consider going forward. And if so, what would be our priorities, what may be some of the obstacles and challenges that we might choose to take on together and what would some tangible next steps be at the close of the meeting. So with that I'll stop and maybe take some questions or whatever our chairs would like us to do. Yeah, let's have some comments or questions. So, Caroline Clancy, just thank you for a lovely presentation. I downloaded the Cliff Notes version of the UK strategy late last week. And one thing I noted was that at least in the Cliff Notes version it really puts a great deal of emphasis on equity. And I would think as government agencies working together that we would want to retain that focus as well, particularly as our country gets more diverse. Yeah, and the notion of making sure that if I understand the term equity that we're not we're really addressing how genomics might create disparities in medicine. Yes, absolutely. So I was interested both for the UK and for Canada. And I don't know if you're going to know the answer and we have a lot of military colleagues here, maybe you know the answer. And those two countries, does the military get their healthcare on their own or are they part of, especially like in the UK part of the NHS? And the reason I'm asking that question is I'm curious if the activities that you describe will naturally sweep in the military or whether it's a situation like we have here where there might be different things going on in different parts of the country. And I would just like to look by analogy and try to see whatever lessons might be learned there. It's a great question. I actually don't know. Because NHGRI has had several, actually multiple conversations with different parts. In fact, some of the people at this meeting, different parts of the military to try to coordinate or just learn from each other. And so it's an area that we're very interested in. And I just wanted to see if there was any lessons that could be learned. I mean, in the UK, for example, I mean, does anybody know if the military gets their medical care from the National Health Service there? Yeah, the UK and Canada both rely on the civilian sector for the predominance of their care. So we're different in that way? Oh, we're very different. Very different. I know we're very different. But I'm talking that way. Okay, thanks. Great. Well, and if I could just comment that it seems as though in a way that the military medical systems may be a sort of a little NHS in and of themselves. And so in some way, I mean, you know, looking at it sort of from the outside looking in, even though I do practice over at Walter Reed, do you see yourselves as being a little bit more flexible and a little bit more perhaps in control of the kinds of things you do unlike trying to tackle the entire US civilian health care system? Ma'am, I would address one aspect of that is, and that is a lot of what we do is operationally related in terms of support to whatever mission. So if it relates to optimal performance under the sea in the air or on it, those are issues that we would first prioritize. And there's the beneficiary aspect, which includes the dependence of the military. And that is a much more broader spectrum of care that's provided in the MTFs. But if your question is do we target certain areas of those beneficiary care sector? I'm not aware we do. Yes, sir. Thank you. Once again, I'm John Forsberg from Naval Medical Research Center. We over the last decade or so have been collecting genomic information from wounded service members and translating that information from wound biopsies, serum, and also pathogenic information into clinical decision support models. Now, one of the main challenges we see is integrating those models similar to the challenges in the civilian community into usable interfaces that clinicians can actually use. And one of the barriers really is our electronic medical record. So maybe that could be one focus area for this group to address. And I know the VA system also has a very robust electronic medical record. And it seems to me that these would be amenable to decision support applications. But you'd be surprised as to how many challenges arise as you go forward. I think this short conversation highlights the fact that the military has healthcare delivery challenges for their personnel and their families just as much as a place like Duke or Geisinger have to deliver healthcare to their patient population. So while it's not to Eric's point, the military is not part of receiving care in the public sector as it is perhaps in the UK, I think one of the common themes we'll hopefully see is that military healthcare delivery systems are similarly challenged and have similar inefficiencies but also some great capabilities that might help inform some of the other programs in the public sector. I'd really like to echo the comment that was made about decision support and actually several other NHGRI funded projects are exploring, such as the Emerge Network are exploring exactly how do you put genomic information into electronic health records, provide decision support for physicians. And so I think there's already a common basis for some really interesting interactions. Yeah, just to continue on that theme, I mean one of the underlying principles for trying to do this in electronic health records is standardization. And it's been somewhat difficult to move at least through the Office of the National Coordinator given their priorities relating to meaningful use. Some of the standards that are going to be necessary to support representing genomic information in data warehouses that can make access by electronic health records in order to drive clinical decision support. If there were a group, hint, hint, that could actually take some of the nascent standards that have been developed by groups like HL7 and some of the others and actually make it into an operational standard, I think there would be a lot of enthusiasm beyond that to adopt since we're really desperate for standards that everybody can use which will ultimately be needed if we're going to have interoperability because the one thing that is different about genomics than most other healthcare data is that it's persistent. And so we need to have information that can follow the patient really throughout a lifespan so that that information can be reused in an efficient manner. I might also comment, as Rex did, that Emerge has been working in the space and a number of other groups are as well. But Mark, there's apparently a clinical decision support society that I just learned of but others might want to know about it. The clinical decision support consortium actually is an HRQ funded activity that is in its third and final year of supplemental funding so it is about to sunset. It's led by Blackford Middleton who's now at Vanderbilt and over the course of the last year the EHR Integration Group which is a part of Emerge has been collaborating with the clinical decision support consortium around some of the issues related to genomic medicine. Geisinger is also a member of the CDSC so I've sort of been the go-between. Interestingly enough, one of the projects, sub-projects of this clinical decision support consortium has been one related to pharmacogenomics and so I've been sitting on that group and they will be putting out a paper including some clinical decision support artifacts for two pharmacogenomic use cases and that will be appearing in the very near future since they are sunsetting I think as of the end of June. The issue there as with many of the types of things that we talk about is the sustainability. There's a lot of good work being done but then how do we keep this going when the seed funding in this case the federal government goes away? What's the business case to kind of keep this going? So while there's a lot of enthusiasm we really haven't developed a sustainability model although the hope is that with Blackford at Vanderbilt that is intimately involved in Emerge and others that we can begin to at least take some of the work that they've done and piggyback that into the work that Emerge is doing and move forward a little bit faster. It's not all about decision support either I wonder if there were any other comments from anyone before we moved on. Jeff? No thank you. Do you have something to say? Brad? Can I just ask on the as these big health systems get tied in like the UK project do you know are they also tackling the conundrum of returning results in a big research project like this? I mean we always have a little trouble. Yeah. A little too. So I cannot speak to the specifics the answer is yes but I can't tell you where they are with that dialogue and I think this will be part of you know and we alluded to the fact that there will be an international meeting coming in the fall and a number of these themes that will be brought up today I think or that you've brought up and others will be part of that discussion as well. Carolyn? I guess the last point I'd like to make on your T1324 I don't see how we get to identifying true benefit unless we have payers and others as part of this dialogue. Researchers absolutely can't do this alone and my apologies to Eric who's heard me say this before it doesn't matter how great the genomic interventions are they're going to be lost in a messed up system which is what we have at the moment. So to that extent I don't think it's too early to be anticipating what venues we might be exploiting to engage that voice. I might just add to that for information purposes that as an outgrowth of I think it was GM3 there was a meeting actually convened by NHGRI with payers that happened last October and so there is some work being done that's followed up on that. I think it's a very important point it's a critical stakeholder that we've got to engage fully or we're not going to succeed. Totally agree and we're going to hear an update on that later in this meeting and also we have the benefit of Naomi being here representing a very important pair constituency so hopefully there are at least ears and maybe a voice at the table for your point Caroline. So I just want to follow up on some of the discussion I'm glad this meeting is happening because it's taking almost 15 years where we had sort of a number of similar efforts in the past but I think the time is right because of the sequence being available. I think the issues around equity the issues around evidence the issues around payers I mean we've kind of been exploring them and you know the question I wanted to ask Jeff and others I mean how do we see this kind of interaction going on between the feds because in the past we had advisory committees like SACGT, SACGHS and it's all sort of in a way to not force but get the federal partners together because they all have one boss which is the Department of Health and Human Services and those attempts were done in the past and those committees have come and gone and now have been replaced by non-binding groups like Iowa and the groups, Newborn Screening for example which is an arm of genetics and public health have organized their world around their own secretary's advisory committee that essentially decides what tests should be included in the Newborn Screening Panel or recommended for the 50 states so you know it's easy to implement genomic medicine in the context of Canada and the UK because of their healthcare system it's much more complicated to do it here given that researchers are doing the research and payers are not paying for these services and the evidence is lost in between so one of the things we need to explore is how would that interaction look like as we move forward? Well I think that's an excellent theme for this meeting. I mean I think we recognize that there are lots of differences between the US and some of the countries that I mentioned I don't want to presuppose the outcome of this meeting but it could be something around a constitution of genomic medicine that harmonizes the various states if you will but I was really pleased that in the last meeting that we took a lot of fairly independent and potentially competing groups if you want to look at it that way and really coalesce them into a coordinating society around the professional organizations maybe we could do something along those lines but I think that's the topic for this afternoon that Rex and Eric will lead is really to take the information from this meeting and begin to drive it with a fine point on the exact issue you raised so thanks for bringing it up again. Jeff, as you and I have discussed one of the stakeholders that was central in the Canadian effort is the pharmaceutical industry and sort of an industry more broadly in terms of developing biomarkers commercializing discovery that individual academic laboratories make and it occurs to me that we have that's a constituency that probably needs to be at this table or some table and we as a GM advisory group haven't done that yet but we probably need to add that to our to-do list. I agree, I mentioned it in passing but I think we need to do more than a passing mention of it. All right, I think we should move on but this is actually a nice segue the next presenter will be Debra Leonard who's going to talk about the College of American Pythologists Genomic Policy Framework.


The front-end loader plays a critical role in road maintenance activities, and without it, work can come to a complete stop. A skillful operator and a well-maintained loader can increase job productivity. Helping to keep your equipment working at its best means following your daily operator maintenance procedures. Following these procedures will provide efficient performance over a longer period and extend the service life of the equipment. Each agency has their own specific maintenance checks. It's your responsibility to ensure that they are followed on your machine. This videotape will show you the correct procedures for operator daily maintenance on front-end wheel loaders. By using a check-off list, you can divide your checks into four groups of activities. These activities are the pre-start check, the equipment warm-up check, the daily operation check, and the shutdown check. If during these activities problems are discovered, follow your local guidelines to determine corrective procedures. Follow along as our operator begins with the first activity. The first activity consists of the pre-start check. This is a walk-around inspection for damaged or worn parts, fluid leaks, and the engine's air filter system. It also includes checking the equipment's fluid levels. Starting with the tires, make sure they are properly inflated. Maintaining the correct air pressure helps provide maximum tire service life. Also look at your tires for excessive wear, cuts, and sidewall damage. If your equipment is fitted with directional tread tires, make sure they are mounted correctly. With the operator standing at the front of the front-end loader, all tires should be mounted with the point of the V pointed toward the ground. Tires mounted in this manner will provide maximum traction when loading the bucket with material. Now that you have checked the tires, you can look for loose or worn parts. Give special attention to the bucket's cutting edge. This is where the majority of wear takes place and should be inspected daily. If your bucket is equipped with teeth, they should also be inspected. If the cutting edge is worn back to the bucket or any teeth are broken, notify your supervisor. The next inspection during the pre-start check is to look for fluid leaks. Fluid leaks will affect the safe operation of your equipment. Leakage can often be found by looking on the ground under the front-end loader. If you see any wet spots or stains, look above the spot to find the source of the leak. Hydraulic brake fluid leaks may be found by looking at or feeling the inside of the wheels. Look for hydraulic oil leaks at the bucket lift and tilt cylinders. Hydraulic leaks are most likely found at the cylinder seals or at the hose connections. Fuel and oil leaks may occur at the filter bowl seals or at connections. Feel the bottom of the oil and fuel filter bowls to see if there is any fluid running down the side of the bowls. Coolant leaks may be caused by loose hoses or a damaged radiator. As part of the pre-start check, you need to inspect the engine's air filter system. Your loader may be equipped with a pre-cleaner. Let us begin with this inspection. If dust or other material has accumulated in the bowl, clean it. Dump out the dirt and wipe the bowl with a clean rag. Be careful if the pre-cleaner is plastic. It can crack or break if you hit it against a hard surface. Daily cleaning of the pre-filter will greatly reduce clogging of the air filter elements. After this has been done, you should check the air filter. The air filter has an indicator. The indicator warns you when to replace the air filter element. When the indicator shows red, the operator should replace the air cleaner element. If no new elements are available, you can clean the old element in the following manner.  This should remove most of the dust. Don't pound it on a hard surface. It could damage the element. If tapping does not clean the filter sufficiently, use compressed air if available. Directing the air up and down the pleats and blowing from inside to outside will help to clean the filter element. You can check to see if the element is clean by placing a light bulb inside and viewing the penetration of light through the pleated paper. If a light is not available, hold the element toward the sun and view the penetration of sunlight passing through the pleated paper from the outside of the element to the inside. After the filter is clean, reinstall the element, making sure that the housing is correctly sealed. This will ensure proper air filtration for the engine. Never operate the engine without the filter in place. This can cause extensive engine damage. Now that we have inspected the front-end loader's air intake system, we must be certain that the fluids are at the correct operating levels. Start at the engine. You should make sure that the oil is at the proper level on the dipstick. If the oil is below the mark, do not run the engine until the proper type and amount of oil is added. The fan will control the temperature of the engine. Proper operation of the fan depends on the fan belts. Hand test the fan belts for tautness and examine the belts for wear. You should also look at the engine coolant. Make sure that the fluid in the radiator is at the level required for your particular machine, as specified by your supervisor. Add more coolant if needed. It is good practice not to perform this check if the engine has recently been operated, since the coolant might be under pressure. This pressure, if released by removing the cap, could cause serious injury to you. Look at the fluid level in the hydraulic oil tank. A dipstick or a sight gauge is provided for this inspection. In this case, it is a sight gauge. Hydraulic fluid is necessary for the proper handling of the front-end loader. It is also necessary for the proper operation of the bucket. And hydraulic fluid if necessary. Important additional inspections are at the battery. If needed, fill each cell to just above the top of the battery plates with clear distilled water. Never fill battery cells to the top of the filler neck. A word of caution. Batteries give off explosive gas. Therefore, no open flame or smoking should be permitted around the battery. Follow your local guidelines when working with batteries. Make sure the battery is securely fastened down. Inspect the battery cables, clamps and connections for tightness and corrosion. Now that you've checked the levels in the fluid systems, you will need to drain condensation and sediment from the fuel tank. To do this, a drain cock is provided at the bottom of the fuel tank. Open the drain until all condensation and sediment have been removed. Never perform this inspection while smoking or with an open flame in the area. Now, for your last pre-start check, record your hour meter reading. The hours registered will determine when you need to notify your supervisor that periodic maintenance of the front-end loader is needed. Before we go on to the next set of checks, you may wish to stop the videotape at this point and review the pre-start inspection steps. In the last segment, we finished our pre-start check. Now let's go on to the second activity, the equipment warm-up check. The equipment warm-up check helps you determine if the loader is operating properly before you leave the parking area. Before starting the engine, be sure all persons are clear of the loader. All control levers are in the neutral position. The parking brake is on and the bucket is grounded. Now, start your engine. Let the engine warm up for 5 to 10 minutes, even in hot weather. This allows the oil pressure to build up and lubricate all the moving parts of the engine. It also allows the cooling system to reach its operating temperatures. If your equipment uses air pressure, this warm-up will allow the air compressor to build up pressure in the air tank. Listen to your engine.  The panel gauges give information about the engine operation. Look at these gauges to make sure they are operating in their normal ranges. Does the app meter read positive? Is the oil pressure in the safe zone? Is the fuel tank gauge functioning? Is the tank full? Is the temperature gauge reading in the safety zone? If your loader is equipped with additional gauges, these should also be checked to verify their operation. Before making any additional checks, be sure that anyone in the area is a safe distance from the machine. First, lift the bucket from the rest position. While doing this, you can also check the bucket's performance. Move the bucket through a normal series of operations. Does the bucket raise and tilt normally? Do the pistons extend smoothly, allowing full bucket extension? These movements are important during daily use. An additional part of the hydraulic system is the steering. Does it have a smooth and even movement in response to your controls? For our last warm-up check, test the brakes before starting out. Release the parking brake, put the front end loader in motion, then apply the foot brake. Your brakes should feel solid. If they do not hold, or if they need to be pumped, shut down your equipment and notify your supervisor immediately. All of these pre-start and warm-up checks are critical to safe and efficient equipment operation. Don't leave the parking area until the list has been completed and all checks have proven satisfactory. The third operator maintenance activity, the daily operation check, is carried out while the loader is working. During these operations, you should monitor your equipment's performance. Specifically, listen for unusual noises. Check your gauges and be aware of changes in the performance of your equipment. We can look at these individually. Listen for unusual engine and equipment noises. These noises warn us of problems that could damage the front end loader. Look at your gauges during operations. If any gauge reads in the danger zone, shut down the loader and check the system. Be aware of any changes in your equipment's performance and report them to your supervisor. The fourth and last daily maintenance activity will be your shutdown check. The shutdown check helps prepare your loader for the following workday. If your agency provides a fueling station, pull in there and fill your tank. Filling your equipment's fuel tank is a good maintenance practice. It minimizes the water condensation. When refueling, be sure all equipment is clean. This prevents any contaminants from entering the fuel tank. Since these are flammable liquids, do not smoke or have an open flame in the area. Many agencies have designated cleaning areas for their equipment. If one is available, drive to this area and clean away any excess dirt or material from your loader. After the cleaning has been finished, find a level area to park your equipment. Rest the hydraulic bucket on the ground. And set the parking brake. This secures your equipment and prevents injury to anyone tampering with the machine while it's parked. Now let the engine idle for approximately 5 minutes before shutting down. This reduces the pressures in your hydraulic system that could cause leaks or damages to the seals or hoses. After the engine has been turned off, record the time registered on the hour meter against the time recorded at start-up. This is important in keeping a record for your equipment's periodic preventive maintenance. Now, using a grease gun, grease your mechanical joints. Proper lubrication extends the operating life of your front-end loader. Follow guidelines for proper lubrication procedures. One way to make it easier for you to identify the daily lubrication points is to have them marked. If your water pump is equipped with a grease fitting, don't forget to grease the water pump shaft. That completes the detailed description of the four major daily operator maintenance activities. Now let's review each activity once more. The first activity is the pre-start check. This is a walk-around inspection. Look for damaged or worn parts, such as bucket, cutting edge, teeth, or tires. Check for fluid leaks from the lubrication, cooling, hydraulic, fuel, and brake systems. After inspecting for leaks, you should check the engine air filter system. Also check the fluid level in the engine, radiator, battery, and hydraulic tank. Finally, drain the fuel tank of dirt and condensation. The second activity is the equipment warm-up check. This is made from inside the cab while the engine is warming up. Be sure to read the gauges. Listen for unusual noises. Test the hydraulic system before leaving the parking area. The third activity is the daily operation check. Operating checks during the workday include reading gauges frequently, listening for unusual noises, and being aware of changes in the performance of the equipment. The fourth and last activity is the shutdown check. Fill the fuel tank. Clean away dirt and debris. Park the loader on a level surface. Rest the bucket on the ground. Set the parking brake. Idol the engine for approximately five minutes prior to shutdown. Record your hour meter reading. And grease all mechanical joints. These procedures are general and may be modified to meet the individual requirements of your agency. There may also be additional safety inspections required. Check your operator maintenance guidelines. This concludes the program on front-end loader operator daily maintenance. Following these procedures will help ensure that your front-end loader is properly maintained and stays in good operating condition.


As January 2021 comes to a close, it's worth taking stock of the historic events over the past three weeks and highlighting the words of the Joint Chiefs that pertain to our responsibilities as members of the profession of arms. Last week, we witnessed the 46th presidential inauguration and history was made as it is every four years. On January 12th, the Joint Chiefs signed a memo in reaction to the violence at the Capitol on January 6th, and Admiral Gilday sent the message to every officer, sailor, civilian, and contractor in the Navy. I've quoted part of their memo here for all of us to continue to reflect on as we start the week. The American people have trusted the armed forces of the United States to protect them and our Constitution for almost 250 years. As service members, we must embody the values and ideals of the nation. We support and defend the Constitution. To our men and women deployed in at home, safeguarding our country, stay red, keep your eyes on the horizon, and remain focused on the mission. We honor your continued service and defense of every American. Lead well this week.


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