Yeah, so I basically changed the buffer size to be four times as big as it was and Ardor crashed So it does that sometimes Okay, let's load the session Good coffee. Come on Come on ideas in my head. I want to put them on the project dude Can't wait here And blow my nose is this happening? And listen, okay, man. What you doing? Yes, come on. Let's do it Go what is going on? That's clash is so bad But I think I can fix this Yes, I think I can fix this. It's activated. See if we're gonna have extra Just a little bit, but I Think we're good. I think we're gonna make it. Okay. Let's transpose this and this to Semitonsons down. I think this is the amount and you need to do that To semi tones down. I think I think it should mesh now Interesting. Yeah, it does it does fit. It's not it is not expect it. It's not It's not simple, but it works. Wow. Wow happy.  This back this filter is just awesome It's all kinds of awesome. Let's try it again. Okay. I think we can freeze this again Let's freeze it because It's so it's so CPU intensive, dude Okay, let's let's do this Crap, okay, I think I won't manage to do this. I actually need to start recording again Give me a second. Okay. I'm back. I switched to free wheeling mode For a while to not have any extras, but I don't know what's gonna happen to audio sink in video with that That's active. So then I disable it. This is freeze frozen. I can deactivate this track and see my DSP load go Into whoa still pretty high. What's the cake? Okay now it's back to reasonable values. Yeah, and Then have this thing Let's see So freaking awesome. It's finally mashing together, dude It's awesome Makes one a saying but I can't because that's gonna disqualify me. I Mean I could make like a vocal version of this. Okay. This is again gonna take a while I guess I could make a vocal version for this maybe use this track in my album Make a song out of it after the After the the FM challenge is done. I don't know I like it And also I finally crossed the one minute mark which Qualifies me to submission because the track has to be between one and five minutes Now finally I can submit it Okay, can't wait for this. Oh why it's taking so long For the final thing I think I'm gonna unfreeze everything Give it a solid render and then correct any mistakes if you want to just Copy this and make an echo of the melody, but on a different instrument Let's move this up down. Okay, there is a pad Yeah, well, sorry. I'm scrolling frantically What the fudge?  Reese is not in gonna work Or will it? Well, if I move the filter Maybe it's pretty It's pretty cool sound. Wow I wouldn't expect this to sound like that. I Think I need to start reeling Reese's as a lead sounds. I don't want this side chain Sight-chain trick. I'm gonna just disable this and this too Da-da-da-da-da-da Da-da-da. How about the FX2? What is it doing? You know reusing things Among the truck makes different parts connect between each other, which is good Just works.   Good. Good. I want to make the Reese brighter Like this. Yes interesting things Happening.  It should be Shit, I can't really restore this because it was different. I think that's gonna work better Fortunately, this one is also lost. I need to add letters to the names to Make it not disappear in the next file Okay, let's save it. Something's missing here. I wish I could That's a meter motherfuckers That's all smooth as a meter smooth as a meter smooth as a meter People let's move it before wolf shaper. That's gonna be interesting, huh?  Let's make this all to make the bull Automata blue is It's a parameter Do let synthesis or a Automata blue. Let's try to sorry. No, no No fake French. No. Oh nice.  Nice. I need to add a compressor up to that What what's going on? Interesting. Let's copy this Automation I'd like to snap to bars Snap to bars. I don't mean drinking bars. I mean musical bars. Let's add some multi-band compression Really crush it try to make it as hard as possible Awesome. Nice. Nice. Nice. I think this part needs to be longer because it's cool and it's not enough I think it should be longer, of course with some variations. So let's copy this everything Maybe if I can if I have time I'm gonna try to make a complex tropal part with tons of different sounds playing a Hockett of melody. Let's copy Let's point my cursor and taste and hope for the best But this is pretty reliable actually, I think I'm gonna try to transpose this Make it sound cool fresh new and different Yep Sweet Wow Using Reese's for leads is amazing. I need to do this more especially with hideous distortion I want some kind of a crash symbol Try to make it with oxy FM synth. Yeah, we have quite a big Delay Latency because oh Oh Okay, oh, yeah, this one isn't able to cool Great crash symbol. Yay Hey, let's try to make it. Okay. No keyboard sensitivity for all of you like No, not not a single one pretty realistic You can go with this. Oh release Or so Okay, I think I need to make it go for the rest of the operators to I think it's pretty Good, I don't hear a difference. All right. Nice. Nice. Nice Now what I need is Some hideous Metallica reverb. Let's go with call for reverb. It's pretty metallic. Let's go small. Let's go all wet Yep, it's metallic. Now. I need the dynamic filter envelope filter The calf envelope filter I'm using a Lot I should favorite it Now we need a low pass Not yeah, not a steep low pass and I want it all wet That's pretty good Pretty nice. We're nice. Maybe I should move it before the reverb. No, no, no The reverb is part of the sound now a cue Let's make it steeper You use it the answer to make sure it doesn't hurt too much Okay, let's call this a crash Now I don't know if I should push it into the drums boss Yeah, let's try maybe it's gonna work. Oh What's going on? Why is it so quiet now? Oh cuz the cuz the drum bosses Yes, it's using I okay. Oh, let's add some reverb Secondary reverb, I mean Let's go verb Lots of it. There's one tone. I don't like in this sound and I want to hunt it down Well at this one There's pretty fine Reason base is too loud. I think and the kick to and the snare You know what try to tune again this crash Yeah, like it better. I also want to compress it because the tail fades out pretty quickly I want it to be longer. Just just want this to last longer Too much to ask Oh Crap that's too much. My goodness It was me with this one How about taking out something from here? I don't know maybe making this bass simpler. I Don't know. I don't know Maybe melting it. Oh, no, no, please don't I don't want to have all of these plugins working again Twice as much. No, no, no. How about changing the? Let's disable the freezer. Maybe let's on Let's activate it think what can I do to make it? How about just changing the velocity of these nervous transform? Velocity to exactly Lee let's go 32 to 2 so it kind of means Well, that doesn't sound too spectacular Let's go and Transform it again Make this Wheels of the chair, okay, there is goes this at velocity to exactly. Let's go 64 again That doesn't work. I pretty much think I can just I don't know bypass something. I Know I should disable the side chain trigger Also, have I muted the bake? What if I put this off? Thinking thinking thinking thinking What if I muted The hi-bat. Oh, yeah, yeah, yeah, that's nice. Let's do that active too. Yep And now let's just make it play It is active We want to be active here, but not there and I wanted this to be gone. Also, what if I automate the Try I'm a bit afraid my mind can generate some clicks transition one yes It's three hundred and eighty Hertz. Let's do that 180 We are 90 is closer than 360. So let's go with that and I'm just let's solo it and see what we can do As you can see the amount of automation is totally ridiculous right now. That's good Things interesting. Is it really doing something? I'm sure if it's actually Do the doing things is it It's not what's going on if this is exposed for automation. It should be automated a bowl, right? right or It's not maybe I'm automating the wrong thing wait a minute. Oh, yes Yes, I'm just automating the wrong crossover Okay, so let's make it. Maybe let's make it 180 as it was And then clear this clear and remove and yeah Because I'm using more than one Sometimes it was the first crossover. That's the second crossover. Yeah, this one. Yeah, this one. Ah, yes Okay, now that this makes sense Let's go with that see what we can do. It's gonna be cool or not I don't know not really sure if that doesn't it generates tons of clicks, but I actually need to bake it to make sure it's not X runs and really it's It's the The automation causing the clicks, but I am pretty certain it is the automation causing the clicks so let me pause this and Bake it and see I bake it freeze it and see what happens. All right. It's frozen frozen Okay, never mind. I didn't mean it. Let's listen. Ah, no, it's really bad. I'm gonna I'm gonna report a bug. Oh, wait a second Okay, here's my bug reports. I'm gonna send it Yep, let's get back to it. Okay, so I am going to clear this automation make it a static 380 Hertz and remove this also ever. Oh, yeah, we're playing from the freezer. I'm gonna have to refreeze it again All right How about doing this? Okay, okay, I think I need to freeze this because it's so Yeah, my this is below this near 100% so that's no good. I need to freeze it. Okay away again Alrighty, this is frozen so let's disable this track and Listen, I think this is really nice and actually what we should be here is a breakdown Because I don't have too much time to do this track. I would maybe Finish it with a with an atmospheric ambient like part Maybe yeah, I think Yeah, I'm pretty glad with the results so far and save this track Now excuse me for a moment.  Oh this G actually, I would like to Reduce the latency because it's really hard to work that way Yeah, give me a second All right, I'm back changed my latency back to my buffer back to 1024 samples so it's much more responsive Give me an I in it patch my in it patch dude, but I would like to make some bass sound here.  How about this?  Oh? No, no, how about this? Like it me likey Let's call this sober bass For some reason it tastes sober feel sober Not sour that's sober sour, sorry, but it's Let's add this one mm-hmm. Yeah Maybe let's Give it some reverb too because why not? Oh, that was interesting I'm not sure if I want to emulate that actually, but I could About a band or I haven't used bender yet. Oh, that's awesome. Let's use it I eat one and eight hundred and one I need to And one one one now That's the that's the neutral position. Let's go with that That's gonna be cool cool.  I wonder if I can change the influence of the But a pitch wheel I don't see any way to change it I can send the modulation wheel something somewhere. Hey, well, it's like How about using it like I Head that it's moving two points. Okay, I think I think it's now way better. Let's replace it. Whoa too much No, I pressed space. I didn't want to insert it. I need a I want a notch filter Notch filters are great Wigs makes me feel good. Hey, Ben reject. Yay Cool Automation big a big about yeah, okay, let's put it here Make it I would like the two operator on the part where nothing else moves. So like this maybe how about this?  Why? Why two points I grabbing one points. Let's copy it over Our times. Whoa, I think I missed. Whoa Yeah No, it actually is good. Okay. Okay. Oh, well, it is it. Ah I Didn't actually consider this. I Somehow need to move it back up Some point see let's listen Okay, this part is good. Yeah, I think I need to copy it and paste it again Also, let's do this here. Let's go like this copy paste paste paste Good. Good. We're good. I think I want to do something else with maybe with call pulsator Because I'd like to automate Let's make no No offset Yeah, this is gonna be awesome. Look at this Fabulous, it's maybe not make it go all the way Because that's gonna make it silent at times and we don't want add this to be so So radical and that's gonna be very cool Oh Frequency there it is play two Hertz. Okay, three Hertz No, I won't go less. Oh, yeah, it's ramping up to How about this interesting? I wonder if there is a way to reset the LFO position. Ah, yeah Huh Can you automate that because that would allow me to you know have reproducible results Of pulsator. Oh, yeah, sure can send an impulse Great Nice. So yeah, so this should reset the thing Mmm, I could reset it. Let's let's check it. Let's let's look Does this does work what how I think it works? Yes, great. So now I can just copy this and this and it's going to reset every time I Move this automation up, which is great because I can have reproducible results. I want to make this More aggressive, however Yes, and this I want to go down very quickly. Very nice Okay, I guess we're gonna add some drone bass beat to that because why not This is what we do. You know what? I'm gonna try and work Okay, I want yeah, let's let's all the drum bass lip this and now To fake this and try to you Hopefully wanted to Yes, great. Okay. Now. Let's have it to bars by four Let's make it grid not magnetic but grid. All right. So I need to cut it here How about we copy loop this whole thing? Oh, this doesn't sound well Without this last thing. I think it doesn't sound good because Art or doesn't loop it perfectly not because it's not good Yeah, because of that. That's exactly the reason why it didn't work. Can we do here? Well, that's doesn't sound as I expected All right, let's see if I can break this thing up to Nope, how about a little tiny ghost note? Okay, kind of works see if it works to here also. Oh, yeah, nice like it Let's copy it Four times Oh three times. No double double kick here. Let's just go with More snares Yeah Hmm. I like it. Let's disable solo and see what it sounds. That sounds like with the bass Fantastic Can I make this base kick deeper or longer? I don't know. Let's move it down. It doesn't work. No, it doesn't do anything Let's undo Yeah, we've Instead of the kick I want to put here a real snare Fantastic that's I'm reaching entirely different level of broken beats I'm really glad. I'm really happy. I'm super excited. All right. Let's copy this over to the sidechain trigger. So You can use it The sidechain trigger and let's see if this base can go to the sidechain And will it sound good kind of I think no, I think I want to I Think I want to make it have give it its own sidechain Actually, I want to what I want to do I want to do the thing I told you I'm gonna do I'm gonna use calf envelope filter filter Env Env not Evn. Evn. Oh, yeah, there is and I'm gonna use that to cut off the bass Once the kick hits, so let's do it. Let's go pin out. I'm using the sidechain trigger To trigger this No, no, let's just move the kick Awesome, I'm not affecting the high so it doesn't feel like it's ducking But it is ducking and it's making room for the kick so they don't clash. This is fantastic I just don't want yeah, I need to fix up the reverb. I'm gonna make a separate bus for this. Oh I have a free bus cool. Let's use it for this Let's take this reverb out and make a sand. Yeah, I could be here why not Sand it all the way and now on this sand. I know what I'm gonna also do Put this reverb here. Oh, it sounds so harsh. Why? Oh, because I'm actually doubling it. Okay. No, that's understandable Do you know what also on this? I'm gonna add a sidechain compressor Tie it to the sidechain trigger So the reverb will also go away completely when the kick hits or the sidechain trigger hits Just gonna be cool. It's loud


So when we started in 1997, the startup scene was not so glamorous like how it is these days. It was a very difficult time for startups. There was no funding available. And you had to just build the business organically by putting all the hard work you can and with the little money you have. When we analyzed this entire home advertising space, we found that on one side, it is dominated by large advertising agencies. And on the other hand, it is completely fragmented with a lot of small media owners across the country. So we saw that and that's how we started offering a pan India solution to large clients. In a way, a specialized OOH agency completely stand alone and independent was started by us and then that became a trend. So after a struggle of a couple of years, we started seeing a lot of business coming from very large international domestic clients. Around 2005, 2006, we started to feel that we will need some funding with us because a lot of new opportunities were opening up with the validation of airports and metros coming up, various new infrastructure being built and things like that. And finally, we could receive private equity funding, which was the first of its kind for an out of home media company in India. After 2006 funding, we got a lot of new contracts. We got Hyderabad Airport, Atlantic contact. We got Dubai condition bus shutters in Dubai. And then in 2008, we did another round of funding with World Top 5 private equity company, which was another high which we achieved. I think these two rounds of funding was first ever done by an Indian company and back to that level. So I think it inspired a lot of people. It really created a lot of excitement around our company and the industry.


with Tyron Matthew. He was chit-chatting about the end of his chief's run. He said he was heartbroken. He said, listen, agents are going to do what the agents are going to do. They're going to try to give me as much money as possible. But I would have taken the Justin Reed deal that they offered to the Texan safety that came in at the end of the day. I would take, it was like a $31.5 million deal they offered to him. Did the chiefs think they wouldn't be able to afford Tyron Matthew again? Did the chiefs want to move on from Tyron Matthew? And Tyron Matthew did not want to? It sounds like that's the case if you listen to how Tyron's speaking, because he said he was heartbroken by the entire situation. He is still a free agent right now. Allegedly numerous teams have made offers and are interested. He was at the Saints looking at their facility last week. He put out a tweet that said, I don't think the Saints need me, but I would love to come back home or something like that. What does that mean? Allegedly the Colts made an offer, but him and the Colts are a little bit differing pages on how much money. I mean, I just assumed they both understood, hey, we're moving on for whatever reason. That's not the case it sounds like.


So I'm Mason Crane, I'm a research and extension officer for the Australian National University Sustainable Farms Project. We're going out now to have a look at the progress of some of our research plots where landowners have fenced off farm dams, just to look at the progress and see how the biodiversity is going. We're out here on a property near Holbrook. We're on a farm where the landowners invested a lot of money into the infrastructure such as fences and roads, and one of the big highlights on this place is how he managed his farm dams. So they fenced off their farm dams, put hardened watering points in, which is having a really big impact on the quality of the water, the life of the dam, but also the biodiversity. Now it's been fenced off, they haven't once had to clean the dam out, the water stayed clear and crisp. Even through the millennium drought, it's still clean where the dams that aren't fenced on this place are going green, there's quite a lot of algae, and that has direct implications for stock health and stock performance. The project has been very heart-filling from a farmer's point of view. In dry times and times where you question your management, it's always nice to walk up through your tree lines and see that things are surviving, the cycle, the ecosystem still keeps going around and we're really only a rain away from making the whole farm do that. So it's quite uplifting doing these projects.


Hello. My name is Sue Peppen and I serve as the Director of Health and Clinical Partnerships at Arizona State University. I want to welcome you all to the second of our four events in our biomedical innovation series. I want to thank the Arizona Biomedical Research Center for sponsoring the series and ASU Knowledge Enterprise for their work in fostering innovation through research and discovery. The structure today is going to include some remarks by Dr. Lee, followed by discussions. Please go ahead and start putting questions into the questions ability on Zoom, and we will try to get to those later. So it's now my great pleasure to introduce to you, Dr. Vivian Lee. Dr. Lee has had an incredible and varied journey in her career. She is also a health care executive and the author of the long fix. Solving America's health care crisis with strategies that work for everyone, which we're going to talk about some today. She is a senior lecturer at Harvard Medical School. And she is the president of health platforms at Verily Life Sciences. Prior to joining Verily. She served as the dean of the medical school and the CEO of the University of Utah health care and integrated health system with a budget of over 3.6 billion, including about 1400 member physician group and health insurance plan. During her tenure in Utah. She really led to change in health care delivery at the system with real innovations that enable higher quality at lower costs, and with greater patient satisfaction which we'll hear some about. Prior to Utah, she served as the inaugural chief scientific officer and New York University's long game long gone medical center. She's elected to the National Academies of Medicine as over 200 peer review publications. I could go on quite a bit, but with no further ado. Welcome Dr. Lee. Thank you so much. It's wonderful, really wonderful to be with you and for those of you who have known Dr. Pepin for a long time, you will share my admiration for her. And you may not know that actually I think we've known each other for a long time now. I don't know if I really want to share how many years but it's been a long time. It's just so wonderful to be able to be with you today and thank you for inviting me. As you mentioned this, I am on this virtual book tour, and I really enjoyed the opportunity to talk with people from all over the country, whether it be some brand rounds or speaking like this at a university setting, or with medical students or in the community. By talking about the book and by having discussions like this, it really gives me a chance to reflect more and particularly get a sense of your thinking about health care. And so I'm really looking forward to the discussion with Sue and with all the community today. I was particularly drawn to writing this book and I'll just show you. I was really drawn to it because I found this issue of our health care system in the country to be just a really fascinating question or really a real paradox to think of our times. And I think as most of you know, and I wish we were in person because it's just so much more fun to actually see people and have that engagement, but hopefully we can do one. But as most of you I think know the real paradox of health care in this country is that we are just spending so much money on health care. In this country, per person we spend around two, two and a half or even three times as much per person per year than other high income countries. We would expect us to be two, three times better. But in fact, actually our performance always comes in among the lowest of other high income countries. And that can be measured in many different ways from everything from infant mortality or maternal mortality to life expectancy. So for example, the average baby born today in the US is projected to live for five or even six years less than the average baby for example born in Italy or in Israel or in Australia. And so, unlike many of the other really challenging problems that we face in this country, like poverty and education, you know, this where we are significantly under resourced, you know, there's really a major issue with the fact that we just don't have enough resources for those problems. In health care, it's really the opposite. It's not that we're not spending enough, we're actually spending too much. And with the ultimate irony is that many of the people who you would think would be benefiting, you know, the physicians, for example, administrator. They should be really, you think they'd be happy because somehow this money is pouring in, but in fact they're actually among the most frustrated and most for that. And so I think what we conclude is that our industry, our business, unlike most other industries just isn't really working efficiently. It's really, we're not getting the market efficiencies that we would expect, where innovation and competition and capitalism will be driving to better and better outcomes at lower costs. Somehow it's just not working for health care. And trying to understand why that is is one of the main reasons why I wrote this book. I actually really loaded for our medical students because I was trying to explain to them what was happening in health care in this country because I feel that the future is in their hands. And so I wanted them to be a little more equipped than I felt like I was when I came out of medical school at residency. And the good news is that the solutions for how we can get to a better, more efficient, more effective healthcare system. I think the ideas there are actually pretty well defined among the people who have been thinking about this for a long time. Kind of remarkably, especially in this week. I would say that there's actually bipartisan support, and it's very much a shared vision for the way forward in health care, really moving away from a fever service model to a model where we are paying for better. In fact, when I interviewed people for the book I interviewed about 100, over 100 people in the course of writing this book and you know people who have come from all different walks of life in health care. And I asked them what's the one thing if you could just wave your magic wand and fix one thing in healthcare. What would that be and the vast majority of them said what I just shared with you which is the business model change the business model. And that was the most important language so what I then spent a lot of time thinking about in the course of my career and then in my years sabbatical when I was working on this book was, well, what are better models that could work in this country and what are the things that are already have already been going on that already have the data of successes, and how can we leave together the stories of those successes into a coherent national strategy, and do it in a way that actually addresses each of our individual roles and responsibilities, whether you're patients, whether we're clinicians, no hospital administrator type people. So that's really what what the story is about and I thought what I would do is read just one just a segment of the book was one page or two that maybe gives an example of new ways of thinking about practicing medicine and some of the lessons that you can draw and also what's happened during COVID actually with those. So I'm going to find this page I'm going to read a short section from early part of the book. It's in chapter two this chapter is called an apple a day keeps the patient away. And it's about my interview my conversation with a guy named Christian man starts like this with a quote. Go see that crazy Chinese doctor who takes care of all the poor Cubans. Christian grins as he told me how people used to read about his father's clinic in Miami. His father had started as a typical primary care doctor and private practice. He was paid fee for service, which meant the more patients he saw the more he earned. Then in South Florida in the early 1990s a few insurance companies started experimenting with new ways to pay doctors. Instead of fee for service, they gave them a fixed amount per patient for you. If a patient needed expensive imaging costly drugs or long hospitalizations that added up to more than that amount. It was the doctors. Chris's dad, the doctor, and his mom, the office manager, experimented in this new model. They welcomed referrals, but other doctors sent them only their frailest and forest patients, the ones they knew would be grossly unprofitable under this new way of paying. That's how Chris parents began the 250 of the sickest people in Miami. They told who would have been almost impossible to keep well at any facility at any place. It looked as if the chance that signed up for a financial suicide mission. Because resources were scarce and their patients needs were many the chance decided to focus on primary care and prevention. Their fragile elderly patients had to be seen frequently by doctors. Once they got sick, it would be too late. So they set up monthly visits, even if there was nothing wrong. The clinic would be tough for many of them. So the chance provided free door to door transportation. They worked out that averting the cost of just one ambulance ride and stay could pay for a year. They opened a pharmacy in the clinic so their patients could conveniently cheaply and reliably focus. And since their patients often had complex needs, physicians in the clinics conferred several times a week about how best to treat those who weren't doing well. So that crazy Chinese doctor and his wife, not only provided outstanding care for the patients, including many who often didn't have enough to cover co-pays with the doctor. But they also managed to make them healthier. They reduced hospitalizations and even more moving they broke even financial out of desperation, the chance invented a better way to do this. So the model that I described that Christians family developed has evolved into a business called Chen Med and Christians the CEO of that business. And it's now the program that is run by Medicare called Medicare Advantage. Medicare Advantage is now covering about one third of all seniors and it's expected to grow to as many as 50% by 2025. So it's an example of how changing the payment model from what traditional Medicare does, which is fee for service, which is, you know, the model where every time a patient comes in you have to do something to them in order to build Medicare for that visit. So it's led to these very rushed visits with many procedures often associated with Medicare Advantage by changing that model by paying the physician to fix the amount of money and then giving them the autonomy and the latitude to decide how to spend those dollars has really radically changed the way in which they run the business and Chen is just one of many, many organizations that are now so that was an example that I wanted to share of how moving from a fee for service model to paying for better health can not only do good, but as a business model, it can also be very successful model. And in the rest, much of the rest of the book, the, while in this example I'm talking about care for seniors and really focusing here on keeping them out of the hospital. In other parts of the book, I talk about examples of what the same change in mindset paying for better health, what that would look like for hospital based care, and what that would look like if we help the pharmaceutical industry and other industries like the big data industries, accountable for delivering better health outcomes instead of thinking in the future service. And then later in the book, I also take the perspective of the payers what how should payers people who are paying for health care, be doing things differently if they were really expecting more of a model of better outcomes. And particularly I focus on employers who cover health care for about half of all Americans, and then a government based system actually look at the military health system, and then finally wrap wrap all of that up at the end of the book with some policy lessons. So, I'm happy to maybe now turn podium or would turn this back over to you and have more of a conversation soon. Well, thank you. And we so much we could talk about we need, we need a full day. What I find really powerful about the book, and you being a really good person to write this book is because you've practiced in medicine, you've been, you know, the chief scientific officer with overseeing research and discovery, you've been in leadership roles of education and future workforce but also in, you know, of a healthcare system, which branches, of course, well beyond medicine, or, you know, the doctors, but all of the allied health surrounding that and now you're in technology. Just like health care, it needs all those components to work together to move in a direction that is increasing access better outcomes and reducing costs. So I'd love to hear because you've played roles and have experience and all those, all those places. Tell us a bit about you and what drives you and and how has your drive evolved so to speak, in the span of your work. Well, you know, while I have been in the technology space now for two years, of course I spent my whole life in the university setting. So where most of your audience is rooted so I will start there by saying that I think that I'll tell you a little story about how I ended up getting into healthcare administration and even thinking about the job and you talk, and it came from this visit that I made when I was the chief scientific officer at NYU. I went up to the Mass General to visit an old friend, Greg Meyer, who you also know, who was at the Mass General and I was actually doing a field trip to learn more about how their research administration works since I was just new at this job in NYU and I wanted to learn more about it for them they were really very generous about that. And at the same time during that visit, a Greg who was responsible for safety, quality and safety of the Mass General. Pulled me aside and he was just showing me some of the work that he was doing. And I had kind of an epiphany when he was taking me through this because what he shared with me was, they had built their own homegrown electronic system. And of course they were only able to do that because they were in this very rich academic environment with people who had expertise in biomedical informatics and data. And so they could actually conceive of building their own HR. And then from having built that HR, and they decided, I don't know who actually had the idea but they decided that they would start negotiating with the state of Massachusetts to be paid differently. So until then they've been paid for service and every time somebody came in, they built the state and got paid. And instead he said, we thought we should be getting paid for improving health outcomes. And so we negotiated with the state to say that if we were able to improve the blood pressure of our patients by a certain amount on average overall, then we would get a bonus from that. And because they had this EHR, they actually had data about how they were doing, and they had reasonable access to those patients to be able to intervene. And so they had some sense of where they could probably move the done. And so they really opened up this entirely new way of contracting the state and pushed I think the whole field forward into a more of a paper performance model here. And because they had their EHR and all these really brilliant data science type people and wonderful clinicians, they were actually able to meet and succeed those applications so they did well financially for the hospital as well. And it was that point when I thought, why aren't more academic clinical centers leading in this kind of healthcare transformation. We have incredibly talented people across all of the areas of expertise. We have kind of our own built in consulting teams. When I was at the University of Utah, we really wanted to move through this whole 16th Sigma kind of training program, we being a state institution could not really afford the big consultants, you know, a bazillion dollars an hour. And so instead we reached out to our business school where we happen to have some outstanding faculty in operations with graduate students who wanted to write papers about us. And so they came in and they serve as essentially consultants for us. So I think they're just that those, it's the intersections of these different areas of expertise that universities happen to be really concentrated in, which I think makes them incredibly exciting places for innovation in any space but especially, especially. Part of the inspiration for this speaker series was using the lens of Phoenix as a location that is an up and coming biotech center, and that cross between, you know, universities, industry, the city, but also arts and culture and living spaces and you know thriving cultural events and residencies we have this area in Phoenix right now we're calling it the Phoenix biomedical area. So talk to us about what your work was like in Utah I know you had a similar experience and while CEO of the hospital system and Dean of the medical school. Sure, that's, you know, Phoenix is a beautiful place. And it's so nice. So, and there are so many things to do there so I think this idea of the strategy is a good way. So, so Lake City also had its own attractions which I hadn't fully appreciated until I moved there so. I'm going to take the most advantage of that if you can. We had some really interesting innovation is that took place as a result of both what was possible within our academic entities, as well as in partnership with the community. And maybe I can give you an example each so we had so at the University of Utah we have an integrated health sciences campus, so it included the School of Medicine, as well as pharmacy, nursing, a college of health, which was essentially a college of outside health, speech therapy, nutrition, and so on. And then we actually started a branded dental school I understand which was actually really fascinating. Plus, of course the help to deliver systems so it was when we got together there was a lot of, we put a lot of energy into thinking about how can these different teams learn from each other we had all kinds of really interesting retreats and off site. One of my favorite projects that I learned about in that early days was a project that had been funded by the NIH. It was a big program project grant to the College of Nursing to help monitor. And it was a very simple program when it started. It was simply that the nurses would call the patients or call their caregivers at home once they got there and to check on them every day. Actually was automated. Now that I think about it, it wasn't even a person but it was one of those press one if you're feeling good press two at the other issue things pretty low tech right this started to start maybe 20 years ago.  Also, it turns out that it was very positive for the caregivers, just that know that somebody was checking on them and if something was going wrong that they could actually that there would be somebody that we'd be following. We first learned about that project you know it's just academically interesting that we had that but then of course we connected them with other parts of the system. We actually over time partnered them with the video gaming folks who could write apps and make it was more digitized rather than voice. And that even led to some really interesting work within the system on hospital and building out kind of more of an intensive home based experience. So that was an example within the university and then the university to the community was also very important it sounds like it could be an opportunity for you as well. In Utah. Now it's really grown into this silicon slopes idea a lot of work with tech companies, as well as with the community. And one of the areas that was a high priority for the community was increasing access to rehab facilities, which didn't have enough to have facilities. We actually had some folks in the community, including donors who stepped up and said, you know, we really want to build a new you have facility. Maybe, and how can you really make this a compelling, compelling case for why it should be done at the university as opposed to somewhere else. And actually it was our one of the really compelling arguments that you were able to make was our video game team, who came out of the College of engineering computer science and media arts. It was a very much a main campus group, and they came in and they really inspired everybody with these ideas about how video gaming, for example, you know you're a post stroke patient.  So this could actually be used to not only measure, but also interact with the video games, so that you were doing the right kind of physical therapy that was necessary. Right rabbit was stealing your rabbit, your carrots from the right coming from the right angles so that you have to be right. That vision of bringing video gaming into rehab was what I think took this over here to actually get supported. I was one of many factors, but it was a very important one. So I think there are a lot of opportunities. Yeah, thank you for that. You know I don't want to miss the fact that your background your PhD is in medical engineering. And that's really was a foundation for you that we so many of our efforts at the universities are connecting, you know, biology with engineering health care. And engineering in the solutions that connecting engineers to clinicians can be developed and that's with ramps out to industry and startups but can you talk to us about your experience. Now that to will, I'll attach that to what you're learning at Verily. I'll tell you all a little bit about Verily I don't normally I would ask for a show of hands I don't know how to do that here unless you want to type it in the chat box. If you know anything about Verily I'm curious because we've had a pretty low key approach generally so verily for those of you that I want to talk about is is a company that was originally called Google Life Sciences. It's a part of the alphabet family. And when Google became alphabet we were one of the bets that was spun out, and then we were rebranded from Google Life Sciences to do their research. And we were purpose built to commercialize life sciences, and now health care products. And so I joined two and a half years ago to really need the health care side. What I find, and maybe I'll just say a word about why I decided to do this because I had really been planning on staying within health care and I was actually getting ready to go and meet another healthcare system. I was actually very excited about this new system. When, when I had to follow another conversation again with Verily, and it actually comes back to this book because when I was talking with the CEO about why he really should find someone else because I was. Okay, just to give you a sense of it I still have until six months ago I still had my blackberry. So just to give you a sense of where I am on the tech spectrum. And, you know, he came when he came back and talked to me about why I should think about doing it. He just said, you know, you should just come and do your book. Your book is supposed to be about fixing health care. And that's what we want to do here, except that if you go to a health system, if you're lucky, maybe you'll help improve that one health system in that community. What I'm going to do is really do things at scale. And that's actually, I found that really fascinating that idea. And so that's what convinced me, I guess, to have a go with this technology side. And in terms of what I've really discovered what the realization now that I am in this company and I can't speak for all technology obviously I can only speak for my real experience here is that the technology is one piece of what is really, I think interesting, we are seeing it a lot for example we can talk more about telehealth and digital health solutions. But the other piece that I find really fascinating in this company is the mindset about how the company thinks about people, thinks about patients and physicians and pharmacists and people that we work with. In the sense that it's really a company that is a consumer based company and I think embraces this idea I have this. There's this idea that I talked a little bit about in the book called co producing health that as healthcare providers I think traditionally we've often thought about healthcare as, as like something that we kind of control and will work with you and will help you but we're the ones that give you your health, you know, like in the hospital in the intensive care unit we restore you to health. But I think for most of healthcare, and most of ambulatory care certainly it's really co production it's really we help patients produce their own. And that mindset is very much how the folks in technology think about consumers, at least, you know, at least the folks like the ones that I work with who are looking at software apps. And what it leads to is a very different way of interacting with people so the way in which we build our products, the user experience researchers the user experience designers these are really behavioral psychologists. The ways in which they think about how we interact with people to help them achieve the better health and understand what's important to them, what are priorities to them, rather than I'd say a more traditional healthcare view which is we know what's best, we're going to just tell them what's not connected with them, etc. And we know that generally that. So I think what what's been interesting to me is the combination of data and technology with these insights about how people actually actually thinking how. And we're starting to get some really, really thoughtful questions and I want to try to combine them that when the areas that I want to cover, you know, with the, to follow up on that with the increased use of telemedicine and digital health. Obviously there's been an increased focused on remote monitoring and home care for people particularly with chronic medical conditions and high risk pregnancy patients. How are outcomes being evaluated and do you see those metrics being utilized in addition to being baked into a value based care model. Great question, really great and very important question because I think we're at the cost of digital health really moving into more of the mainstream of healthcare. And so these questions of how are we measuring outcomes, how are we making sure that we think about digital health as a value tool as a, you know, as a set of tools that really drive better health outcomes, rather than as devices where we just charge per click. For example, you know this is a really, really important set of questions. So, we've been thinking about it a lot here now I'm going to maybe just shift, just where my barely hat for a few minutes just to say about the, the experience that we've been having with respect to the digital technologies that we are actually in the market with, and we have a product, which is called on duo, which is a digital health solution that started in type three diabetes, and now includes other conditions like hypertension, and I will say, you know, I'm not trying to advocate for there are other products very similar on the market like Tomata, Verda, Livongo. So we're one of these we were what differentiated us in the beginning was we were one of the earliest to have a continuous glucose monitor as part of the technology and now many of the others also have it. And just for those of you who maybe don't know much about the space I'll just explain it to you very briefly kind of how these technologies generally work. I think there's something about these metrics, but just so you know what we're talking about. Or narrowly at this point I would ask you for show me as like how many have actually tried a digital health solution, or a wellness app, because I try to encourage everyone to try one, you know, even if it's one of these I think that we're, as I said, we're on the cost and pretty soon I think these are going to become things that people just prescribe and order and it's important to have a sense of what they're about. For the diabetes space or hypertension this kind of chronic disease space. The diabetes is a good example because it includes a new sensor. So this continuous glucose monitor technology and multiple vendors of these technologies and, and they all do essentially the same thing which is their kind of the size of a key fob. Say, like, like maybe about this size, and you put it on your arm or your abdomen and it automatically measures your blood sugars for.  And then you take pictures of your meals and snacks because your diet is so important in terms of your blood sugars. And so you can now visually associate what you with how your blood sugars are tracing up and down. And of course also with your exercise and also how you're sleeping. And so it's just transformative in terms of people's understanding of their own biology. And what we're seeing pretty clearly is that everyone's biology differs significantly. So if we ate the same meal, for example, our blood sugars respond very different. So there's that first just your own insight in your own learning and awareness and then that's enhanced with some AI. So we can see patterns, you can make no recommendations we can say well for you to you know maybe we notice soy milk, we were doing way better with soy milk or vidian, you know, skin stick to skin, that's better for you. Those kinds of observations are actually very helpful. And then there's the telehealth so chatting with a coach or video conferencing with a physician, for example, and having that, you know that professional interaction is important. So when you take that all together, what you see pretty consistently across the literature in across these very products is they work. They really do improve people's blood sugar control. And it's not surprising when you see them working it's really not surprising at all they're actually working. What's interesting about this now getting back to your specific question is, how do we. How do we actually think about these not only as disruptive or innovative models in the way in which we care for people but also innovative in the way which we think about the business of health care. And I've been thinking about that a lot because I'm now responsible for this company, and we started last year, just changing the way in which we're paid so ordinarily, we would be paid a per member from us, you know, we get paid for as many people can get to sign up for this thing doesn't really matter ordinarily it doesn't matter whether you make them better or not you just get paid if they sign up, but we decided to do it differently and say you know what we only, we're going to go 100% at a time where we're only going to get paid with people's blood sugars actually come down. It's if they're high if they're, if they're good and they need to stay good. And we look also at cost of care we're going to do some other metrics that are never considered and I think that that I'm actually really excited about it, it's a little risky so ask me in a year or two how we did. We have some data, you know we have some words of optimistic about it of course, but I think it's an example of trying to hold digital technologies accountable for actually delivering them. And I hope that pairs will adopt this, this kind of approach because the last thing you need to do is to recapitulate people service in digital health is an opportunity for us to move forward. To shift the paradigm and use a model for outcomes not just action fee for service that's fabulous. Let's go a little deeper on health care costs. I, you know Americans sort of have this idea that their health care should be paid for costs are often covered by about 50% by employers or by Medicare. But the reality is we're really all paying for health care, both individually and across the society. And over the last five decades as you have already mentioned we've been paying more and more. And about 8% of that goes to administration of health care. And while fifth of our GDP is spent on health care, we have incredible health disparities in this country. I'd love to hear your thoughts on some solutions in that space. That's really the pressing issue for us now, especially COVID post COVID and the economic impact that COVID is having on this country. The wide need disparities, because of the way in which COVID is affecting our communities. It's becoming, we really are. We really are in that crisis mode where we need to go through that and start changing things very quickly now. The opportunities, if you just alluded to, are huge because we are outspending any other high income nation in terms of how much we're putting into health care, 18% of our GDP, that's far more than most other countries. So it's not an issue of finding more money, it's a figuring out how do we reduce the ways to improve the efficiency. And one of them is really through reducing administrative costs. And I think that the, I'll give you, this is a little bit, so for those of you who are not super into health policy, and I only dip into this very briefly because it's a little bit of a policy walkish kind of a topic, but what happens every year in health care is what I call the trillion deal. And what I mean by that is every year, as employees and our employers, we pay our premiums for our health insurance into health insurance companies or third party administrators. And so there's a big pool of money, it's like a trillion dollars. And during the course of the year, there's this tug-of-war between the insurance companies or administrators or employers who want to hold on to the money, mostly through these insurance companies. And then the health care delivery systems who want to keep billing and charging so that they can stay alive and so they want to bill, bill, bill so they can collect that money. And the back and forth fight between the payers and the providers is a significant driver in these administrative costs because, you know, every time you have denials and then you have to make the claims or you have these barriers where the providers actually have to fill out all the sort of extra paperwork just to justify getting an MRI, for example, getting a referral. All of those leads to an enormous amount of ways. And it's, it is about 8% of the health care dollar, which is significantly more so mostly European countries always see donations, it's about 3%. There's a lot of money that we're wasting. And the problem with that waste is it's really what's making physicians miserable and large part contributing to the physician burnout. And when we can't resolve that tug of war, it falls to the patient. And that's how we end up with these surprise bills and bouncer's that that are leading to so much suffering so many people need an bankruptcy. So one direction forward is if we go back to the way in which I was talking about how Medicare Advantage is paying for healthcare. So Medicare Advantage, in theory, the idea is they pay a fixed amount of money to these medical groups for the year. And, and then it's really up to the medical groups to keep people healthy they have to meet certain quality metrics, and patients have to be satisfied because if they're not they don't have to review after a year. And so in theory in that model, there really shouldn't be the need to do all this coding and billing and, you know, excessive in my view documentation. They still have it in there now because it's sort of residual from Medicare generally how it's administered. But imagine if we really moved to that model. It shouldn't be necessary to do a lot of that administrative paperwork and there won't be that fight because for once in that Medicare Advantage model, both Medicare and the administrator, you know the insurance companies that are administering it, and the doctors are all in line everybody wants these patients to be healthier stay out of the hospital they can and get their costs down. There's a lot less that will be squandered and fighting. That's just one example in the book I talked a lot about other areas of the ways about cost, how we actually can get costs down in terms of care. I talked a lot about safety, medical mistakes are very costly, not only financially but of course massive suffering that's completely unnecessary. There are many other many others but administration is one of those where I don't think anybody would argue in defense of law administration. I think we could all be very joyful. Yeah, and yet we are still where we're at, you know in chapter 12 in your book you start out with a quote from Vice Admiral, Raquel Bobo, which reads, we should be targeting the readiness of all our citizens to do what they're supposed to do in support of our society. There should not be partisan because everyone has a stake in health, and yet it has become. We talked to us about healthcare as a problem with bipartisan solutions. I've been happy to do that. You know, one of the things that I think is so interesting about the healthcare problem is that I do believe that there is an enormous amount of bipartisan support for many of the changes living in two places. And the most obvious example is the move in the payment model. So the payment model move from a fee for service model to more of a value based payment model is that that idea has been around for a while. Many of the ideas that were originally in Romney care were adapted into Obamacare and are now continued to be moved forward under Secretary Asar and Sima Burma. One of the individuals who influenced this book a lot was Mike Levitt. Mike Levitt was the secretary for helping services under Porsche. He was a governor of Utah, three term, and Secretary Asar was actually his deputy secretary back in the day. And he's actually the reason why this book is called The Long Fix, because he's the one that actually planted this idea that these changes, the evolutions take about 40 years. And he convinced me that we were, before COVID, about halfway through one of these 40-year cycles. You know, it was a long fix. So the arguments for changing the payment model have been there across administrations and even now, despite all of the rhetoric around, you know, many other issues in this country. The health policy community, health administrator community is, I think, stronger than ever with the urgency of moving to more of a value based payment model. I actually, one of the lessons from COVID is just the fact that these more value based models are actually also more resilient in the face of the pandemic. So I caught up with some of these folks, like the Chen Meds and Iora Health and the Presby, several of the groups that have that same model.  And actually, it's proven really much more robust. So for example, in a fee-for-service model, once the clinics shut down with COVID in April, March, April, May, you know, we were hearing about hospitals teetering on bankruptcy and furloughing. I think in April, we furloughed almost one and a half million doctors and nurses in this country is sort of unimaginable. These folks, the Medicare Advantage type programs continue to get their monthly payments from Medicare because of their business model. They're not counting on, you know, every patient has to come in and I got a bill for that. They have what Chris Chen calls a subscription model.  They already guaranteed monthly payments from Medicare and they were able to use those dollars to be much more proactive about getting patients, whether it's providing more care in the home setting. The folks at Presby were telling me about how they were able to manage a lot of patients with mild COVID even in the home setting with an oximeter and thermometer and regular checkups. They delivered medications to their homes. They converted their clinics into urgent care centers so that their seniors didn't have to go to the ER. So not only did they not have to furlough people, but they were able to use those, you know, the income from Medicare in order to actually provide better care for their patients. And so that's yet another reason why I think there's a lot of support for moving to this model. And the hospitals that are paid in this way, like the military health system or the VA health system, also did much better than the hospitals that are moving through for service throughout this pandemic. So for the first time, I've actually heard the American Hospital Association saying, oh, yes, we are actually welcome discussions about more global payments or capita dependent models, more basic income models. So I think there's a lot of momentum and the fact that the economy has taken such a hit with COVID creates even more urgency. I want to follow up on two points there. One question from from our participants related to, you know, bipartisan needs. Why do you think the Democrats in Congress support ACOs to control spending and Republicans support Medicare Advances programs. And both are really quite similar in philosophy yet they cannot agree on a compromise model. Isn't there a way to get what you suggest that could be bipartisan. I think there's going to be a, you know, I will be the first to say that none of these programs, you know, although I think Medicare Advantage is much better than a fee for service Medicare program. I think we were learning a lot about how that program and the same thing is of course true with ACOs from the beginning. But what we are seeing out, you know, within the, within the agencies themselves, the people who are who have been working in this space for a long time are building on those lessons and continuing to refine how the programs are, are developed in order to kind of make the programs better. What I'm hoping will happen in the next year is an acceleration of that tweaking, because I think the tweaking is been very slow and very incremental. But the need to really change our healthcare system has become much more urgent, much more pressing. The Congressional Budget Office just announced last month a revision in their projections around the insolvency of the Medicare Trust Fund Part A which is originally it was slated, you know, so that's the money, you know, comes from our taxes, and then is used to pay hospitals for Medicare patients and it was originally going to run out around 2026, 2027. And the revisions show that it's going to run out by 2024. So of course it won't, it won't run out. There's a figure something out, but the urgency of figuring out how can we be more aggressive about the way we use these programs. I think that's really happening. And I'm not, I'm not particularly, you know, the Medicare Advantage, well, we can learn some of the, we can learn a lot from what's worked for seniors, we can learn about what's worked for ACOs, and have already been learning about this course a lot. And then we can start to really share those and kind of take the next generation forward. I also want to follow up on another point, you know, you wrote this book, and it came out in early summer so it would have been, it would have been done with it before the pandemic, at least took hold, maybe not before it started. And it sounds like really it's reinforced a lot of your thinking in the book. But certainly, what a stress test this pandemic has been on our healthcare system, to say the least, has your thinking shifted in the last six to seven months with COVID. I think it's, it is definitely highlighted some areas that I did not focus on that much in the book, it hasn't, it hasn't changed much of the underlying thinking, because as we just said I think it's just made it even more apparent that we can move away from certain models to other models. So there is that I didn't have thought much about or hadn't written much about even I have thought about them. They came even more, even more obvious during the pandemic, and are actually things that I'm writing about now for the epilogue so I've been asked to write an epilogue for the paperback version. And, you know, since as you said this, this book doesn't talk about COVID, the epilogue will talk a little bit about post-COVID exploration, and here I'm focusing on areas like thinking a little bit about nursing homes and long term care. And what are we doing in this country to address care for our frail elderly who want to go to this little home. And the fact that nursing homes were hit so bad, and maybe about 40% of all COVID deaths in nursing homes, even though only about 70% of cases have happened there. I think that's really worthy of a lot of attention. I think thinking a lot about rural communities and rural medicine. And then I've been thinking a lot about health disparities, of course. And reflecting on how those disparities are exacerbated, not only by COVID but also by the way in which the economic impact of COVID is affecting our country. It's not affecting you. And what can you, what can you do about that. And so, I think there are new areas to think about as well or new areas to discuss in the book. Many of us have been thinking about for a while that COVID is showing me brighter and more partial. But I think they are many of them still come back to the same things which are that, you know, the health of our country, it's affecting the quote that you read from Admiral Bruno, you know, health is essential, it's essential to the readiness of our country, not just the health of our military to defend our country, but the readiness of all of our citizens to act in whatever roles are acting like teachers or firefighters, local grocery store owner. And we can see that so clearly now. And so if we don't, you know, we just absolutely must think about the health of our population as a strategic imperative for this country and it's not just a financial item. It's really the health that we're primarily looking for. And that's why one of the areas that I talk about at the end of the book is really how would we think about the government's responsibility for health. How would we think about it primarily as like a benefits program that has to pay for health care, or do we really want a government is to that is responsible for improving the health of our population and really measured against that. And obviously you can tell by the way I'm speaking it needs to be both. But we really do primarily focus on better. COVID really hammers that home. I want to get to a one or two more, we have some really good questions from our participants. One is there are many pockets of good practice in the US and elsewhere, but to an outsider the strong cultural attachment to individuality in the US militates strongly against the more collective approach that is needed to underpin a focused approach on population health and you talked to us about use what you see as a political route to reform. One of the that's an interesting. There's a lot in that one pack, I think I would be a little bit more generous I do feel that Americans are very individualistic that's true. But I think Americans also care a lot about the communities, the families and the communities. I think this connects that I see in in the way in which we think about health care is this idea that someone else is paying. And, and as you I think alluded to earlier to one of the points that I make is that actually, we are all paying for health care if you think it's, oh it's my employers paying or my insurance company is paying so I'll just go and, you know, bring my insurance company because I'm not the one paying, then you are pretty, pretty sorely mistaken we're paying for it not once not twice but actually three times we pay for it. Out of our chances obviously as I mentioned Medicare or state packages and federal tax. We're also paying for it in terms of out of pocket costs now those have actually risen those of us who are fortunate enough to have health care for our employers are actual distribution to that is increased to over 30%. We are actually now paying for ourselves. Yes, and then, of course, the most insidious has been the fact that it's actually coming out of our wages so over the last 50 to 60 years. While the economy has grown, our wages should be going, our wages have essentially been flat. And the reason they've been flat is because the whole Delta has been gone gone to pay for our health care. And even some of our retirement needs now are actually being signed off and gone to pay for healthcare so while you may not think that that extra visit or that extra MRI maybe you don't you're not paying for it in the end it's it is coming out of all of our benefits, maybe not today but next year. And I think we need to all recognize that we have a collective individual responsibility for for managing our own health like just in terms of looking after our health, but also making sure that we recognize that more isn't always that you know you don't always need the extra prescription or just in case scan or whatever it is. You're not. Yeah. Well, Dr. Lee, we are so appreciative of the time you've taken to share with this community in Arizona and beyond. But I find your book is really important and what I really really resonated is lays out what each and every one of us can do. And that is so important that we all have responsibility in this, and it takes, you know, multiple sectors but it really takes all of us. So I would just ask in closing what's your final message for us. So, well, I think your final message is. I guess probably what I just said earlier which is that we all have our own role to play in this. What I alluded to earlier was our role as individuals as patients and this family members to be accountable and responsible for our own health but I know in this audience. There are many of you who are in healthcare or in research education. One of the reasons why I have at the end of every chapter and action plan that actually specifically talk to different people is because I think wearing those hats we each have a different different responsibilities as well, whether we're clinicians it's really you know are we delivering the best outcomes we actually know the cost of what we're describing what we're doing because we are responsible we're running the business and we're payers, how are we holding clinicians accountable and our employees accountable for providing them health and lower in cost and of course if we're policy makers have to be accelerating and really push with the way we're accelerating that change. So I think there's a role for everybody and based on what what we're seeing with coven and beyond coven. There's no time like the present the really, really important. I think I remain always very optimistic so, and I appreciate the time, and I should just say that I do have a webpage if you, if I didn't get to a question just feel free to reach out to me on the website I'm happy to follow. Thank you, that is very generous and I know there are probably some that will because we didn't get to all the wonderful questions. Again, thank you all for for joining us in this conversation. I do hope you'll come back next week for for another Friday at 11 in our series. And I hope everyone stays safe and healthy. Thank you so much Dr Lee.


Hello everyone, I'm Chen and I'm an engineer from Intel visualization team. I also maintained the Kolo high availability solution and recently working on eBPF related things. I'm going to talk more broadly about rethinking the cumul and why bringing the power of eBPF to cumul. This page is gender. First of all, let's get some background information, the generic eBPF technology. Then we will introduce what and why for the uter space eBPF technology. The next session is the key point. We will introduce the design and implementation of cumul uter space eBPF. Because of the QM forum generally focuses on traditional virtualization felt, I would like to bravely cover what is eBPF for those of you who never heard about it or are curious about it. This is essentially your first touch point. This is the public definition of the eBPF. It can run sandboxed programs in a privileged context such as operating system kernel. It has a long history from extended Berkeley packet filter in BSD kernel. Port and extended to Linux kernel have been widely used, but which is no longer an example for anything. eBPF being able to execute the code in the kernel when some event happens. And the very common one is when system call is happening and then instead of the system call being performed automatically by the kernel, we can execute some code. This is a common example here on how the system call transfer works. It is used to safety and efficiently extended the capabilities of the kernel without requiring to changing kernel source code or load kernel modules. Someone said eBPF is to the kernel, what JavaScript is to the browser. Do you remember what the first web page you opened in the web browser and what the current web page shows? It has lots of dynamic effects. Compare the picture from Microsoft's website, you can easily know the difference. We went from simple web page showing nice pictures to massive application running in web browser. What enabled this evolution in roughly 20 years? I'm a visualization developer, so I'm not actually familiar with all of their JavaScript frameworks, but it makes sense and it's basically what allows this to happen. Obviously, it is the programmability that enabled to go from pretty much static websites to application running in web browsers. Why does this matter and why does that matter to kernel and QML? We will get to that. This page shows the new innovation project based on kernel eBPF. Many projects are already in production. It will make a new way to solve some problems from new areas, including Facebook, Katron, Thelium, and Netflix, BCC, BPF trace. Okay, that's into user-space eBPF technology failed. First of all, we need to answer a fundamental question. Why is having a user-space version of eBPF? eBPF is famous for enable user can run code in kernel context. Please rethink about the Linux kernel eBPF. Why we introduce eBPF in kernel? Do we just need a new way to execute code in kernel space? Linux kernel already have system call, netlink, system FS, or probably a new kernel module to do that. The real reason is eBPF provides programmability, extensibility, and agilities. So, for the programmability view, eBPF is to the QML, what JavaScript is to the browser. This page are more interesting. User-space eBPF based a project. The first one is OKL, an extension of OpenWasteWaste dpdk that provides long-time extension with eBPF programs. Contributed by Orange. The next one is Solana. That's a blockchain-related truth. Contributed by Solana Foundation. The next one is dpdk eBPF support. I think almost everyone heard dpdk. It's a site of libraries and drivers for faster packaging processing. Contributed by Intel. And the last one is dpdk for Windows support. It's a work-in-progress project that along existing eBPF two-chance and APIs familiar in the Linux ecosystem to be used on the top of Windows. Contributed by Microsoft. That means Windows already like Linux kernel support the eBPF infrastructures. Before we look at a couple of programmability essentials. What does it mean to create a programmable system like JavaScript in a web browser? First of all, we need some motion of safety. If we are long on trusted code to run in a web browser, that needs to be isolated. That needs to be sandboxed in some way. It needs to be secure. And the next one, we need continuous delivery. There's no point if we extend our application to require the user to install a new version of the web browser. Nobody would ever use any application. It would be very confusing to use it. We are no longer use this. We will use to pretty much automatically get an update for both websites and browsers on the fly. Probably you don't even notice when you upgrade your Chrome as a point. And you definitely don't notice unless there's some virtual appeal or some virtual changes that the website has changed in the backend. For example, this is all happening continuously and seamlessly. If you deploy a new version of your application, you will have potentially millions of users on the website at the same time. You want to seamlessly upgrade. Back to the visualization, CSPs may run in thousands of machines at the same time. We can't tell users, please hold your task. We need to reboot the VM to upgrade. Any programmable system needs to have some notion of continuous delivery and seamless upgrade. The last aspect is performance. If we can program abilities and we will sacrifice performance, the program abilities is probably not worth it. A good example of this is early stage or early years of Java. When there was a huge performance penalty, a lot of that went away later on, but initially. The cost of running Java with different running AC application was huge. Fortunately, human-use-based eBPF supporters have jet compiler to make code native execution. Just in time, compiler, we are some notion of generic bad code is being translated into what the CPU that your machine is running actually understands. So we are getting to as close as possible to native executed speed. Let's go to the key point. QML-use-based eBPF. In addition to the general problems mentioned earlier, let's go into QML development process. What will do if you want to change any aspect of that? What option do you have if the QML does not provide what you need? You'll probably much have two options. You can do upstream implementation or write a downstream or local code maintained by yourself. And we will look at both. Upstream support means changing QML source code. It means going upstream to the QML development mailing list and convincing the world that this change is really needed and whatever complexity you are adding. The rest of the world should be paying. It means exposing some sort of configuration API to actually expose that and to actually enable it. And then you have to wait years of time until all your users actually upgrade to the latest QML version. This is nice way, but years of time have passed. The whole world will basically have this capability. The problem with that, we don't really have time for that. Nobody want to wait their years. The second aspect is downstream, which is a local implementation that you can update it to your own QML at down time. That will extended the functionality, which means if you apply an internal patch, it will break with probably every single QML release update or need to take effort fully maintained internal version of QML. Users with EBPI for QML have three advantage. Flexibility. Ability to extend certain type of functionalities without limit of exposed API. And agility. What I mean can generate custom solution without the delay. Even no need to reboot the VM. And the last one is performance, native execution. Yeah, that's from Jet compiler. Let's introduce the QML user space EBPI design components. The UBPF project is a key point of our design. It includes an EBPI assembler, disassembler, interpreter, and Jet compiler. Used by Windows, EBPI support, and other projects. Maintained by Iowizer and we will share the library loaded by QML. The next one is the preload project. This is a user space EBPI for verifier and contributed by Microsoft. But maybe QML EBPI just need parts of it. I will make it as optional below because if someone already has permission on the host, they have many ways to bypass it. We will go into the kernel EBPI, not a deep dive, but a simple quick introduction to kernel. How does the latest kernel EBPI looks like? Roughly, there are two pieces. We have a user space and kernel people like to put that on top. Then below, there is the latest kernel, the operating system. How do we define the actual program? There are many ways to do that. The one we used the most is to write it in a higher level from a BPF perspective, high-level language. So just say code and then use the column with the BPF back in target to generate the bad code. You can write the program similar to one of the examples we have seen earlier. Wrong column and what you will get, the generic BPF bad code and you will have your controller program. Which will open that, generate the bad code file and load it into the linked kernel using the system call. The verify will actually verify it and the jet compiler will compile this into your native CPU and then attach it to the system call or to the hook that you define. We show this picture just need to compare with our QML BPF arc. Let's compare with QML user space BPF arc. We implement all the BPF execution contacts in QML field. It can reuse some developer tools with kernel BPF like LLVM column and naturally gain new features from LLVM such as P4 language to eBPF bad code spot. From a user perspective or from a developer perspective, we can use column to inject arbitrary program at hook points on the actual runtime. So what will wrong on the system? Obviously, you don't need to run column on the system where you actually load the program and where you attached it. For example, run column on your laptop and generate the bad code, ship the bad code and load to the tagged hyperweather. What QML user space eBPF can do? From a principle and technical point of view, packet of fielding, tracing, classification and static collection. This is original BPF did. We can do it better. And new additions can evolve at a rapid pace, much quicker than normal QML development, especially for zero-day issues. And enabled QML hot patching we always dreamed about. This needs developer many hooks points in the future. And enable P4 program language to QML network filter. And the eBPF already have 100% modular and compostable, inspired new innovation based on eBPF. We will into detailed QML user space eBPF development. The current development is still in a very initial stage. It can be divided into three related parts. Introduce eBPF project to QML. It means we need integrated eBPF project to QML. The original idea is to make eBPF as a sub-model to QML. But got community comments, we need a wide this way for complex, compare related issue. So I load it as a shared library currently. And the next one is at eBPF infrastructure and helpers. Mainly in QML, eBPF, eBPF.C. It provides a basic operation interface, like load eBPF bytecode running it in eBPF sandbox. Exactly. And the last one is add the first effect module. Start from introduce eBPF-based module, Hux, eBPF filter for network packet filtering and tracing. This is the architecture about how the QML eBPF filter works. QML net filter framework already finished before. We just create a new filter module, eBPF filter. It can load user-defined eBPF program to decide the real function in network data paths. And it supports multi-model on the same one data path. It can attach on VM's net device to handle all the guest on the XTX packet and cannot support Vhost. And this is user-specific eBPF filter benefits. Make it mean our ability to create any local policy for each VM to filter corresponding package according to business workload. For example, do DDOS mitigation or package feature recognition filtering. Let's show a demo and write your own eBPF program and load it to QML user-space eBPF filter and make a VM handle it at runtime. We can see the eBPF through C code. Let's define the IPv4 headers. And just our target is destination IP <IP_ADDRESS>. Current eBPF filter supports match any off-field of packet depends on your own eBPF program. And next, we need to use our VM column to compare this eBPF C code to the beta code. This step is the same with kernel eBPF and load it to QML eBPF filter by QMP commands, HMP commands. No need to reboot the VM. The new policy will take effect at runtime. This page shows our current stage. We already submit the RFC version to community, including load eBPF as shared library and the first effective module, Network eBPF filter. The initial version focuses on programmabilities. No probable eBPF verify support. We will discuss it in the community later. Let's talk about the future of QML user space eBPF. The first of all, we will collect community commands for the initial RFC version and make it merged to QML. And the next one is add more helpers to add more functions for eBPF code. And also need to add more helpers points for hotpicks and other features. The next one is if you have maps support. That's all. Thank you.


I'm doing it now all right all right I'm keeping you with you oh you thought you could beat me no don't ever steal my moves how's it going everybody dots it right here and that's right we are back with some more dragon ball fighters ranked matches this time with the main team of Jiren Krillin and Yamcha that's why I always forget the Krillin's behind this mode Jiren it's just been too long we've played a lot of variety teams lately I don't know why it has me ranked as eighth place in West Coast 3 BP I'm not even on that server right now but I ain't you know eighth place is still pretty good oh we'll take it dude I've been playing too much guilty gear recently I forgot about the thrill of the fighting oh wait no vanish beats vanish that's fine stay in the corner oh should have went ahead and use my skill instead I'll just use the option there to pick up a no I dropped it no what an accidental drop Jiren Jiren lost it I lost Jiren because of a drop oh wow that felt unnecessary oh man oh poor no it's fine we're still gonna win this we still have the sparking advantage or I thought he was about I really thought he was about a bar doc is right there just the quarter circle forward mix ups you see it goes down there dude come on this is a little after just a trick of the old I alright I'll take that to Krillin time you know the combo you already know the Krillin routes Krillin the long-standing main alright can I get can I get off cheap here 1 2 3 hopefully that kills didn't want to spend an actual level 3 it does which is good don't get me wrong but I don't want y'all should be out here so I'm a risk it all wasn't even that big of a risk beam ah beam beats the structure is a hundred percent of the time steal in my moves a I might have to show you how to actually throw destructive this come here come here oh I would have had the sickest punish for that that would have been sick alright don't focus on that mix ups oh I like that it's worked both times mix ups oh I'm gonna spark right here we were saving spark for oh nice use of the barrier stop me in my track like I was saying we were gonna save spark for the the sick punish but you know I have other hobbies such as being turned into a cupcake and getting bitten okay threw me away and guess I wasn't you know like I said I did want to show you what I want to show you what destructive this actually look like so come here usually I'd be a bit more reserved but hit him with all five why not you know what I'm throw out all five and neutral one of these games that's the goal I'm gonna hit you with the full five destructo it is the maximum power of killing mix ups no I mix myself up guard cancel that's fine as long as we don't show we should be totally okay I'm gonna Super Dash Yamcha and that's gonna be a pickup right there look at the turtle hermit duo just running at you I wish I could have said trio but Super seeing Goku was nerfed a long time ago unfortunately it's just a fact of the matter you know he's not around with us anymore he unfortunately lost his 2m and never fully gave oh dude the 18th specific you know you don't have what it takes to beat oh he was whining and dining us and then hit us with the curveball okay he wants to hit us with the man wow okay he kind of meant it you kind of meant it counter no I accidentally reflected you'll have to forgive me my my thumbs actually this is not an excuse because I should be able to power through it I've been playing so much fighting games recently that in doing inputs it like hurts like like my thumbs are just not ready for inputs but that's fine dude Jiren doesn't need complex inputs Jiren doesn't even understand input counters give me that I counter oh you vanished I didn't even see that Yamcha doesn't combo but does set up the pressure oh just gonna vanish that just gonna have to vanish that rock you from downtown I love when they get hit by the rock the sound effect the flinch and pain it all just feels so good level three with Jiren why not do a level three all right does he spark here reads oh it wasn't a read but I'm not going to drop it this time just power through power through grab this man Jiren combos eventually I'm gonna full spin I shouldn't have gone full spin shouldn't have gone full spin that was greedy that was greedy counter a counter I was wait nope I'll just vanish I'll take a bar that's the thing about Jiren is yeah you could you could try to find oh that was great patience and the knowledge to hop over the yamcha cyst that was really smart really good play can't be upset there uh I'm gonna be upset anyway I'm gonna choose to be upset over Jiren he unfortunately didn't move on but like I said I got five destructive discs you call one assist oh you call baroc assist oh I miss both dude it's more threatening than you would think oh I couldn't even back dash that no joke okay I'm doing it now all right all right I'm keeping you with you oh you thought you could beat me no never steal my moves don't steal my moves from me my moves are better than your moves yamcha get this guy let's get this guy yamcha come here everybody's trying to steal the stroke though it is from Krillin why are we stealing don't steal stealing really in 2021 we're stealing techniques I threw a bean backwards that was a mistake all the confidence I had has been taken from me I lost all the confidence it's fine wait let me style a bit oh I'm bad at the game I'm really bad at the game oh nice conversion oh didn't even convert wait wait wait wait we fine what's the mix what's the mix couldn't back dash tail reaches too long bean's gonna go right under it's fine as long as we don't choke and the sparking should be going away relatively soon so we'll have an opportunity to get back in the game it's just that Krillin might be gone are we gonna see the cross-up here that's what I want to know yes yes we do see the cross-up and even though I predicted the cross-up I said it out loud my hands were like nah no way no way he crosses us up here do the keyblast then if you wanted to do the keyblast come on do the keyblast then all right yoncha be very smart about oh I'm bad at the game oh you want to do keyblast oh wolf fang fist you got a blog that was sick we'll take it to oh the wolf fang fist it's just too nice dive kick just start wolf fang fisting dude Krillin's been the real MVP though Krillin's been great great game so that opponent obviously but Krillin is on it today damn gojina in the fusion stance already all right I like to see it but will he run into this counter yeah all right it's looking like he wasn't going to do it rock assist rock assist I still drop it the oof that sucked all right well we have a good chance of uh getting this combo off now I'll say dude I just want to you know what we're gonna go for it if people are gonna try to steal the technique I'm going for level five destructive disc all day dude I'm just gonna go for it every time don't go for the full spin remember all right now it's time to bring in Krillin do I have to slightly lean up for this no okay I always forget what you're in level one that knock up I always get a little bit scared but usually it works out it's just when when it doesn't all the impenetrable wall of UI Goku A assist also I have to remember this gojita does have a c assist on he do oh combos oh he was okay you are styling accidentally did a y auto combo that was my bad nice oh yeah we're rocking that jiren b assist today the a assist is good but I wanted to try out the b assist I've heard good things haven't been a personal user of the b assist but the impenetrable wall of b assist I mean a assist oh my god we clash with don't oh this why is this gojita the scariest character on the field do I have to play gojita why why is this guy making gojita look so fun I mean gojita oh 2s 2s they never expect 2s and would you look at that it's time to throw some destructo disc all five every time and you know what I actually could use a lunch break hold on no my sense of being my lunch break he even ate my wow he killed me and ate my lunch that was all right I thought you I goku fought for his friends but this is uh clearly this is an outrage it's just I'm not taking that dude I'm not taking ironically though I've been uh I feel like dragon rushes now I can see them so clearly I just can't take them but I can see them my brain sees them and reacts to them with fear but not with clicking a button so if I could just train fear into clicking that tech button stop oh that was disgustingly sick that was clean this guy's a this guy likes his combos dude he likes his techniques oh my this guy's flexing right now but I oh oh what is happening dragon ball fighters has chosen me so I'm going to live up to its expectations all right I'm trying to kill sparking time so I'm gonna go nice and slow made a mistake there I'm going to give myself a little credit and say it looked like it maybe lagged a bit but also I made a mistake vanish nice beat him in the vanish he's gonna try to EX just don't let him nice get up there get some claws in his face don't let him EX man that was that was almost bad dude that guy all right we might have won we got flexed on a little too hard for my liking the flexing wasn't saying oh no not the goji to stay up that's a great team you got there do we get a rematch do we don't oh my god what is with people in threatening stamps today it's not like you would want to I should have held it I should have held the counter all right let me get this combo man no counter I'm gonna have to get the combo it's gotta be one or the other counter or combo just take that thank you for the jeering buffs I pre oh I'm so glad he didn't hit a button there that was awkward all right we're gonna knock him down into the rock so I can get hopefully a big enough spin he's gonna spark here reads no no reads all right well no spark I'll take goji to anyway all right we're one gojita down that was the easy gojita though blue gojita is the one that flexed on me he wouldn't run into a counter what he no it didn't last long enough should have canceled out into an ex male uh melee one damn good combos but he drops it ah they all know he converted off the assist as well all right that was pretty sick please please oh no no no no no two s all right lock him down we've got assist for that you see he knew he'd have a little bit of free time there if it was just jeering but with the assist we have we could just throw those out and they'll work out most of the time I'm gonna level three I should have switched out in acrylic level three to sense you being jeering but I'm not worried about it he's probably gonna counter I'll safe jump it oh yeah oh it's combo time come here come here let me talk to him let me talk to him just a bit any uitec uitec huh people just be using uitec oh he did it twice I was getting ready to say I'll read every uitec but I was mistaken oh the beam yep that's gonna erase me from existence totally fine all right we do have to help leave though I'm not too worried he does have a spark which is why I kind of sighed a bit there and the CSC oh no way he used the 2h to get out of that block stun oh my Krillin always lands exactly where he's needed uh could I possibly extend this I got greedy got greedy I could have spent the bar made that a guaranteed kill but I think you'll see why in a second why I didn't want to do that and yes it involved five destructive this that's right I haven't I got flexed on again I got mixed I'm getting 6m oh dragon rust thank you jeez man you never know if this guy's gonna flex on you or not why why would the flex man all right here's what it was for here's what it was for do you believe oh no he didn't do a button that's fine oh it's not fine can he just kill me oh that did so much damage so the plan was to TOD him with five destructive disc and I feel like I may have just lost the game that would be a very me way to lose but he just whips the standing heavy hold on hold on let me freestyle real quick neo wolf fang face let me go to work up on me that was sick and a great way to end this video a bit of a short one but when you get that that's they have that damn the arm just smile how else are you gonna end it hopefully you guys enjoyed this one if you did definitely let me know down below in the comment section while you're down there make sure to like button and subscribe if you like these videos and want to see them keep coming other than that I have been doctor do it and I will see you in the you are planning that went all along I'll see you guys in the next one


In the spirit of the season, positive realty is spreading local joy and brainered in Niswab. Positive realty is donating $500 to the sharing bread soup kitchen in Brainard and to encourage others to do the same, Cocoa Moon in Brainard served customers free coffee today while positive realty employees collected donations for the soup kitchen. Positive realty also spent time at Adrian Dac Coffee in Niswab as well. This is an awesome opportunity for us to raise needed funds and also to get our story out into the public in terms of who we are and what we do. So we're so appreciative to Positive Realty, Jeremy and all of the crew. This is the first year we've actually brought in a charity type organization. I think it's a fun one especially when we've got local people involved. We've got Cocoa Moon here and then we've also got Adirondack in Niswab and then we're also helping a local charity like the soup kitchen and so all the money stays nice and local. The sharing bread soup company is located on Oak Street in Brainard for those who wish to volunteer their time or donate there. If you've enjoyed this segment of Lakeland news please consider making a tax deductible contribution to Lakeland Public Television.


My story started in 2017. I went to a festival and a group of guys took non-consensual photos of my crotch on the hands of two of my legs. I ran to the police and the police kind of said, you won't really hear anything from us. And I looked into the law and I found out that obscurity was not a specific sexual offense. I decided, okay, this time I'll just try and do something about it. So I started a social media campaign and then we changed the law in April to make upskirting a sexual offense. It was really important for me, I think, to be someone who actually tried to do something for once. So just pointing fingers and saying, okay, this should change. Pointing the finger back and be like, okay, well, maybe I'll just try and do it. Maybe I'll give it a go. So we are the people to solve them. So you can do it. I said that for her human rights. I hope you do. Go for it.