Thank you. Thank you again for the kind information. Today, I'll be speaking on Pirates and also staging of prostate cancer. It's quite, you know, a bit lengthy topic, but we will go pretty, say, a concise manner. So let me first give you an object to what we'll be covering in this topic. So basically, I'm going to provide a brief overview of ACR Pirates' scoring system. Then followed by, we'll see some illustrations of anatomical and imaging principles related to local staging that includes EPE, SV involvement, and also tumor-involving other key surgical landmarks in the pelvis. And then we're also going to discuss how this local staging and staging of prostate cancer impact management in terms of radiation or surgical. So as we all know, ACR actually adopted Pirates over the past couple of years now. So with the introduction of Pirates, basically they started giving a structured report in terms of having a clinically significant disease in the prostate gland, especially when you have focal lesion. So in order to help and have a uniform language across the radiologist and the clinicians, and who refers to these cases for us, have a uniform reporting standards, Pirates basically helps us to speak a lexicon that is uniform and across the board. So when we talk about the Pirates' reporting system, we basically divide the gland into various segments and sectors. So if you look at the gland, basically we have apex, mid-gland and apex. I mean apex, mid-gland and base, and also we have seminal vesicles. Again, at each level, we have a peripheral zone and transition zone that is again segmented into a anterior zone, posterior zone, especially in the TZ. Whereas for peripheral zone, we have anterior haunts, posterior and posterior medial segments at the base. Basically the area around the seminal vesicles is central zone at the mid-level and again apex level. We'll come more when we see the illustrative cases. In order to maintain uniform reporting standards, Pirates also specifies what kind of technique we should follow when we're actually imaging prostate for localized disease or localized lesions. So basically we have a small FOV sequence and also we have a large whole pelvis staging sequences. Small FOV prostate-specific sequences has basically helps us to identify focal lesions in the prostate gland. So that includes after opening and localizing sequences, we obtain a small field of T2 in a three orthogonal plane that is T2 sagittals, T2 axioles and T2 kernels. And we also obtain same field of view DWI, including ADC maps. And we also have a post-contrast sequences with pre and post-contrast injection. Especially for the DC sequences, we need to have some technical parameters to achieve a good temporal resolution. We say at least 10 to 15 seconds and also having to go over two minutes, a little over two minutes. So this is a simple protocol, but again it varies between the institutions, between the vendors. So the key things to consider here is having a small field of view for a prostate-specific sequences and having a small slice thickness without any space between the sequences. That's a key thing to achieve, especially for anatomical sequences. So as I said, Pyratz is a like-art score, basically having from Pyratz one to Pyratz five. Pyratz one being a very low suspicion for having any clinically significant prostate cancer, versus Pyratz five is very highly likely having a clinically significant prostate cancer. In order to achieve this or to get this scoring system, we basically utilize key sequences for both peripheral zone and transition zone and derive a composite figure that basically tells us a risk certificate, risk assessment. For example, when you look at the T2 weighted images, we use a different scoring system for peripheral zone and transition zone. Many of you might have already seen this in the ACR Pyratz document. I'm going to quickly look at the high risk or high likelihood of disease. So in the peripheral zone, when you call it as a Pyratz four for a T2 weighted sequence, it's supposed to be having a circumscribed homogenous moderate high point in its focus. It should look like a nodular lesion and it should be less than 1.5 centimeter in the greatest dimension. And if it's anything more than five centimeter and having the same features, it characterized as Pyratz five on T2 weighted sequences. Whereas in the TZ, it's a little different. Especially if we have a BPH changes that basically tells us it's as two or three depending on how the nodules are. But if the lesion is non circumscribed homogenous and has a moderate high point in signal of less than 1.5 centimeter TZ lesions we could classify that as four. And again, typically again, lenticular shape lesions that is especially along the surgical capsule also qualify to be called as Pyratz four on the TZ on T2 weighted sequences. So that's a key thing to remember especially when you're scoring on sequence based. So and again for DWI on DWI sequences signal abnormality is characterized on both PZ and TZ in the very similar way. So basically when to call it as a Pyratz four on DWI sequence is supposed to have a focal high point intensity on ADC and mark the hyper intensity on high V value. And that basically qualifies a high suspicion score on DWI. If anything less than that that means if you see only hyper intensity on ADC but do not see hyper intensity on high V value or vice versa those will be classified as Pyratz three on DWI sequences. Again, anything linear, wedge shaped looking like a sequelae of prostate is they all come under two and again, no abnormality is usually typically normal. So once we derive these scores on T2 weighted sequences and DWI sequences it's again to apply a kind of algorithm to basically get to the final score. So in the peripheral zone our dominant sequence is DWI.  So if you have DWI one, it basically one overall Pyratz score vice versa. But if you look at Pyratz three on T2 weighted sequences DCE basically helps us in this category. If it's a DCE positive and had a Pyratz two, Pyratz three on T2 weighted sequences we can upgrade it to on overall score as four. And whereas for other sequences or other lesions any other sequence findings may not matter actually. In terms of again, transition zone again, focus on T2 two scores, three scores where we again have to look at again in transition zone our dominant sequences T2 weighted sequence. And again, if you have a mild suspicion or intermediate suspicion always look at DWI. If DWI is scoring high that's where you upgrade them to three if it is two have abnormal DWI it becomes three if it is abnormal I mean three score on T2 weighted sequences and you have abnormal DWI you upgrade it to three I mean it's remains three especially in the T2 TZ lesion of three. So these are the key little bit of a confusing scoring system that often gets in the clinical practice. So now again, I just want to show here peripheral zone dominant sequence in DWI and for a TZ dominant sequence T2 again, these are the key areas where other sequences matters especially when there is a intermediate score here. This basically if you're reading it workstation keep this at one slide at your desktop it's help you to actually come to a final score just looking at all the information at one slide. So let's review some examples. So in the peripheral zone this is just a normal gland we don't see any abnormality maybe some linear abnormalities it just sequelae of prostitutes we don't see any other abnormalities in the corresponding areas in the other sequences. Again, this is a linear orbit shaped focus in the peripheral zone and we do have some abnormality on the sequences but because of the shape it's again, I've been in finding overall pirates three here peripheral zone lesion we have a focal abnormality that is non circumscribed and maybe some ill-defined margins and has abnormality in only one sequence. So only ADC has a little bit dark but also on high B value and I think there's not much even mild enhancement again, overall category is pirates three here. Pirates four as told clearly is a focal lesion has a redistricted fusion and also enhancement. Pirates five as in size wise it's bigger than 1.5 centimeter that's why it's qualified as pirates five. And again, the TZ lesions again, this is a normal central gland central gland is basically TZ and CZ at the mid gland level central gland is only TZ. Here we see diffuse hyperplastic changes maybe some heterogeneous nodule here and again, all these changes are just to be patient nodules and so it's a TZ pirates one. Again, here we can see some nodules maybe some thickening of septa in between nodules but again, this is again called without any focal abnormality on other sequences it is pirates two on TZ sequences. Here it's a three mainly you can see we see a focal abnormality in the transition zone anterior on left side corresponding area has some redistricted fusion but not much of a high B value abnormality against enhancement this again, not significant especially when scoring TZ lesions. So based on having only on one sequence it's again categories as pirate three on TZ sequence. These are the atypical nodules. Basically it looks like a B patient nodule with circumthrived margins and having a maybe partially encapsulated margin and has a high signal intensity and high B value and also this is diffusion that's why it becomes a though it looks like a T2 on T2 weighted sequence it looks like a two but because of its high signal abnormality features on DWY and ADC it's again upgraded to overall pirates three. Very similar case with in this time this is more of a lenticular shape long base atypical capsule with a restriction diffusion that becomes four very thing by just by size criteria. So again to summarize pay attention to sequences when you're characterizing them depending on the zone. So DWY is our main sequence peripheral zone lesions and transition zone lesions it is T2 and again DWY makes a much difference when assessing TZ lesions and again DCE sequence plays a role when you have intermediate T2 weighted and peripheral zone lesions. Again there are some cancer mimics and pitfalls while interpreting focal lesions and the prostate especially using the pirate system. So those are basically anatomically we can have a hypertrophic fibromus stroma that is especially antiretlant they can have a thickened asymmetric thickening of surgical capsule that can also can sometimes mimic periprostatic venous plexus and fat lobules sometimes have a tissue diffusion and may mimic like extra prostrate extension or if the lesion that exists next to it sometimes neuroversal bundle posterior pseudo capsule lesion tear drop sign those things and also help you some of the these pitfall anatomical pitfalls to avoid. Again BPH depending on the amount and the extent they also can mimic some of the aggressive features. Informatory infectious pathology such as chronic prostratitis abscess, ground limitous prostratitis can sometimes mimic as a prostate cancer if we are interpreting them in a blind way without having to know any prior histories or any BCG installations in the bladder any of such histories will definitely help us to identify or narrow down the nutritional diagnosis. Variant histopathology also is very difficult to apply pirates routes because again, musinus or ductal or neuroendocrine differentiation all this atypical histopathology variants have a different morphological features on MRI and may not follow pirates routes. Of course, hemorrhage and calcification sometimes can also compromise image quality and also cause pitfalls in interpreting. So again, a pirates has a good performance is one metanalysis pooling about 13 diagnosed accuracy studies since it is over 80% and again specificity is over 70 with Irish 2.1 we are much higher than this especially at the high volume centers. Moving on to the second half of the talk on staging. So when you talk about the first part was about when you see a focal lesion when you are screening a prostate for identifying cancer that's where you apply pirates but again, if you know that there's a cancer exist in the gland based on your pathology, biology biological assessment then the key is to stage tumor. So there are different prognostic factors to actually assess prognostic significance. As we know, Gleason score is one PSA values and of course, T staging is the one that mainly helps us to categorize our prognostic factors. Looking at the T staging itself so we have a localized disease I mean, T1 disease we don't see an MRI if it's a T2 it's basically how much it is involving the gland with the focal tiny T2A on behalf of the gland it's T2B if it is more than I mean our majority of the gland both sides if you come T2C and again, if the tumor is gone beyond prostate it is T3A if the tumor is beyond prostate it involves some vesicles it becomes T3B T4 is basically going beyond prostate involving a bladder wall or rectal wall or geodaphram so these are the things that becomes T4 disease. Again, there are some nuances depending on microscopic, platonic invasion all those things especially pathologists if you have a detailed analysis I think that way the pathological staging that helps actually further prognostify after the post prostate to me. Based on these factors again, NCCN group actually further risk-statified and their prognostic value on that we have basically very low to very high depending on T stage depending on PSA values depending on again, at least in grade grouping on the biopsy pathology. So coming to the treatment options depending on the what stage and what risk factors you obtain so we have various options we can remove the gland entirely by surgical techniques or we can give the radiation and combination of ADT and the radiation therapy and of course depending on again variant pathology and variant Mr. Pathology these may also get some chemotherapy as well. The goal here is to match the treatment intensity to the level of aggressiveness. If you have a glistened six disease and you are treating them very aggressive with surgical and radiation that's okay. Then if you have a glistened eight disease and treating them with active surveillance or watching them or giving them ADT is again a overkill. So we have to match the intensity of the tumor in the gland with appropriate treatment options. And again, the goal is to avoid over treatment and under treatment. I won't go into details here radical cross-sectional basically we remove the gland and again there are different techniques nerve sparing and non-nerve sparing depending on functional outcomes that surgeon or patient would want to preserve after management. So basically if they remove the all nerves that is non-nerve sparing that has a side effects in terms of retinal dysfunction and incontinence. If you're sparing it again the chances of you spreading the tumor especially beyond prostate. And there's reason the nerve sparing to be performed with very caution also very good surgical staging or with a pre-surgical MRI. The key thing to note here is to avoid positive surgical margin and that basically increases having to have a recurrent disease. The key areas that actually prone to have a positive surgical margin are postulatory based apex in the bladder neck. So those are the areas that we as radiologists also pay attention and inform the surgeons if you see the tumor at these locations. Of course, radiation therapy we need to be a very, very clear about tumor extent especially the tumor involves some of the vesicles or surrounding structures surgical management is somewhat contraindicated and try to go towards radiation therapy and medical management versus surgical management. So here again choosing various different options having to have a pre-treatment MRI is also very helpful to decide on these different options. The goal again, he is to identify when you have a staging MRI the goal here is to identify primary lesion and also extent of the tumor. When you again identify the tumor in the gland key is to have how well we can reset the tumor without leaving any tumor behind and then how well we can achieve functional outcomes that is in terms of maintaining erectile function and also a continence of the bladder. So because sometimes the patients would prefer to have these functional outcomes versus having to have aggressive treatment. So that need to be always factored in when you are counseling or providing the various treatment options to the patients. That's where pre-surgical MRI plays a very important role in terms of deciding on those treatment options. Of course, especially when you have intermediate incision risk groups patients there are multiple options for them to choose depending on what kind of lifestyle they prefer to have after main treatment. And of course, if you're looking for overall staging we work with other motorists for metastatic work beyond pelvis that especially PET CT or bone scan things would help to identify disease beyond pelvis. Our goal here is to have a local staging, lymph node staging and bone staging as I mentioned local staging preferably with MRI lymph node staging MRI plus PET or CT. Sometimes PET is more preferred especially with the PSMA being widely available now in the US. Bone staging preferably usually done with the bone scan but always get again a PSMA scans as well to define on depending on the aggressiveness of the tumor that was identified both in biopsy and also on prior images or MRI. Going into key local staging features that exist now for MRI to identify that maybe one is extra pressure extension that we need to be clearly identifying define it and locate it that basically helps us to help the surgeons to actually have a nerve sparing surgery or nerve sacrifice and surgery. Again, similar surgical involvement as I mentioned it is again key factor to decide on surgical versus radiation management and other key side surgical landmarks or the pelvic floor involvement or rectal involvement or pelvic sidewall involvement sort of see each one of them. So EPE is basically the tumor extends beyond the surgical capsule I mean so beyond the pseudo capsule there's no true capsule on the prostate so basically it's basically a pseudo capsule. If it goes beyond the pseudo capsule we usually call them as extra pressure extension every extra pressure extension will have a lot of base that usually involves some of the physical if it is involving the periprostatic fat or neurovascular bundle that we call them as involvement of neurovascular bundle here we can see neurovascular bundle as a small tiny dots with a T2 dot signal. EPE is a spectrum of finding it's not a yes or no or in a presenter absence it's actually a spectrum invariably begins with a microscopic extension beyond the prostate and then you can start seeing them on MRI as a various direct and indirect science and then obviously when it's really beyond prostate that way it's actually a DRE examination you can actually identify it so that's a spectrum depending on where the findings exist we should be able to identify it either by MRI or by DRE examination. Here is one case where very subtle imaging findings in one case if you look at the MRI they look very similar there's a tumor on the left side peripheral zone and maybe have a capsule abutment but obviously we don't see anything beyond but one had a positive model in this case there's no EPE on histopathology and this case had a histopathology positive EPE so that basically tells us especially when there is no proper disease outside prostate gland we should be very, very cautious in terms of calling it as EPE and preferable to have a ligar score again to give you a likelihood of suspicion. In this case we can see the peripheral zone ending here but there's a tumor going beyond peripheral zone that's where the clear obvious typical EPE that exists beyond prostate gland. This is a spectrum I sold so direct sign is when tumor is extended beyond prostate margin and involves a very prostrate tissue whereas other signs are all indirect signs depending on what you see your ligar scoring system will affect so just a bulge or just capsule abutment that's very early sign of having to have a microscopic extracurricular extension what's a scapsular bulge having a contour irregularity depending on the amount of tumor and obviously this tumor is beyond the prostrate margin so those are indirect signs and direct signs there are different scoring systems usually the one first introduced was a European society heurologic radiology scoring system almost like about a decade now but combining some of these factors NCI actually proposes another gradient system based on multiple factors just having to bulge or multiple bulge and irregularity and obviously over disease outside prostate so especially when you have these findings you are having a risk of EPE is about 66% and they are caught then it goes less and less as they have only one finding versus multiple findings and again some of the key locations as I mentioned those are high risk for surgical positive margin pay attention especially when you see the tumor these locations they are prone to have a extra prostrate extension and positive surgical margin the one is you have a posterior lateral aspect of it in the apex you know anteriorly and also this is something called invaginated extra prostrate space around the senile vesicles ejaculate ducts, sorry so these are the key areas to be paying attention especially when you see the tumor at these locations clinical implications as I mentioned if it is a gone beyond prostrate we don't do a nurse paring at that site and if it's again involving senile vesicle it impacts the decision on tradition management a few words about positive surgical margin it's again a tumor that exists on inked margins you know usually if you've seen the grossing of pathology prostrate specimens they basically ink them on both sides to identify the site and if anything is beyond inked margin or touching the inked margin that's where you call them as a positive surgical margin depending on how well the surgeon intersected very prostatic fat you can actually identify them going beyond prostrate margin but invariably usually we see them as a inked margin positive and again risk factor as I said for having a positive surgical margin is a tumor location it's relationship with the prostate and again volume of the prostate volume depth of the tumor depth of the gland in the pelvis because sometimes if the pelvis deep and the prostate is deep in the pelvis it sometimes is difficult to dissect and also with the technical difficulties of resecting it we may leave or we may some tumor in the pelvis itself so all these factors combined with the surgeon's experience volume of the tumor pathological stage at least in grade you know PSA levels and all these are the other factors that were modeled into the risk stratification next one is similar physical involvement as you see the tumor involving some of the vesicles here MRI has a good sensitivity specificity in terms of over 60 percent sensitivity and over 95 percent for specificity again T2 weighted sequences corresponding DT2-BY and enhancement pattern helps us to identify ISV involvement so key is to again identify ISV involvement by looking at multi sequences multiple sequences and planes so for example a few cases I'm going to show future will show you as agile images and these are corner images this one example just show various patterns of ISV involvement so one is direct spread if the tumor is at the base level it can directly spread into the adjacent pediplastric fat and get involved in some of the vesicle in this case tumor is through the capsule and again involving going beyond and involving these other vesicles this is asynchronous that means you know tumor is in the similar vesicles this is an agile images DT2-BY tumor is in the similar vesicles bilaterally DT2-BY and DC sequences but whereas there's nothing exist at the level of base so tumor the bulk tumor was at the apex but the tumor deposits were in the similar vesicles so these are the atypical and again discontinuous tumor involvement of similar vesicles these are the common patterns but this is the most common one this is the second most and this is one of the greatest one again this year you can see the tumor at the level this is a coronal image you can see the tumor at the level of base that upwards the ejaculate ducts and similar vesicles this is agile images the same tumor may be surrounded by SV and if you look at this again very similar findings you can see here as well but when you look at the histopathology here one was positive this was actually having a similar vesicle involvement on pathology this was did not have so basically that basically tells us just abutting the similar vesicle on sastral and coronal MRI is not a direct sign of similar vesicle involvement so again on pathology to call it a similar vesicle involvement they're supposed to have a muscularis property involvement so all these things are nuances that you know you get to see as you see the advanced cases and seeing the more cases of similar vesicle involvement and again analyze them on multiple planes impact depending on the extent of involvement VPE and SV they may not qualify to get a especially brachy and EBRT there are other additional landmarks that we need to be paying attention that is extra urethral sphincter at the apex level blood and neck at the base level neurovascular bundle posterior laterally and bilaterally anterior muscle stroma anteriorly that's again from the common pitfall as well to interpret rectum posteriorly and gudiform inferiorly around the apex so quick link going on some of the findings here this is external urethral sphincter that basically at the level of apex this is coronal image we can see a normal strated muscles that and the long parallel manner and we can also see a donut shaped or if the south Indians are around what are shaped structure here in the apex that basically compromise normal external urethral sphincter this is key surgical and radiation on college related landmark because having to spare this anatomical part will improve much outcomes in terms of unary symptoms so if the surgeons can spare a good amount of apex and have a good anestomosis they can actually maintain a good functional outcome after surgery and if the radiation oncologist can avoid this area of implanting radiation seeds or radiation they will be seeds they can actually avoid burning iteration things of a that nature and they post radiation life so that's reason this is one of the key relevant anatomical sequence that people need to be identifying and helping the surgeons and radons to avoid any overprevent and treatment of it bladder neck this again critical structure difficult to identify sometimes on sequence on imaging I mean involvement of bladder neck I mean so on anatomical images definitely you can see it but because of lack of any tissue planes between the prostate and the bladder it is very difficult to identify bladder neck involvement prospectively when especially when it is settled the tumor as you can see here this is normal bladder wall T2 dark signal and glands also extends into the bladder neck but if the tumor signal exist in the bladder when at the base and if you have a discontinuity of the bladder wall that's one of the signs of having the bladder neck involvement again this is very difficult and prospectively to identify especially when you have a abnormal signal in all sequence in the tumor is at the level of base and extending into the bladder neck again it's something to call and again help surgeons to avoid positive syndical margin as I said neurovascular bundle that exists postural laterally on both sides again there's a lot of anatomical variants there are again theories on how these bundles form some theories that you know basically a focal anatomical structure that exists along the postural lateral aspect superiorly and inferiorly some say it's a diffuse from the base to apex some say that exists across the prostate you know but again depending on the what pattern you see on the particular patient usually it's along the postural lateral aspect of the tumor that exists next to it can actually compromise and extend into it that just because these structures basically pierce the capsule that is pseudo capsule and have an easy weight to a tumor sense to spread along these tracks anti-fibromastom fibromastoma as I said this is again thick T2 high point in signal and anteriorly this again pitfall if you again see standalone finding but often correlate with our disinstructors and see when your tumor signal exists and that exists beyond that and if you have any essentially thickening always call it as a tumor otherwise typically if you have a symmetric finding and it's a especially on the base it's usually a pitfall surgical versus nonsentrical management I briefly told earlier but again when you have a structures like a rectal wall geodiafrome involvement those are definitely you know cases for nonsentrical management in this case at the apex level you're seeing at the bulky tumor here the tumor is involved with rectal wall as you can see muscle property has been pulled here and actually measures in the rectal coil here you can see the tethering of the rectal wall to the apex and the tumor is here so this again direct sign of rectal wall involvement especially when you do not see such a direct signs here it's very difficult to prospectively call in those scenarios always look at sexual sequences both on T2 and T1 weighted sequences especially on T1 fat may appear sometimes bright and have a clear line between wall and the posterior prostate margin that helps you sometimes to identify a clear plane and fat plane this again old case where there is a bulky tumor in the prostate again goes beyond prostate involving the rectal wall tumor also in the rectal lumen that you can see and all sequences and post contrast we can see heterogeneous networking areas as well another lesion where tumor is directly involved in the geodaphram infinitely as you can see apex and transferred apex is compromised tumor is gone beyond here you can see normal levator muscle on the right side but on the left side you can see the compromised signal and the tumor is in the musculoskeletal layer I mean in the muscles here tumor gone beyond and went in ahead and spread into the bladder wall this is a direct bladder wall environment this is the word cases you can easily identify them so in this case tumor is basically traveled along the posterior lateral aspect of the gland and again involve the bladder wall so to summarize basically we have a key anatomical key areas that is extra prostrate extension neurovascular involvements universal involvement rectal wall extra neutral sphincter geodaphram bladder neck and the bladder wall these are the key areas to be in mind when you are interpreting a staging MRI for prostrate cancer and again lymph nodes as said we can definitely identify local regional lymph nodes especially in the pelvis but whereas beyond pelvis we need additional images either CT or pan depending on the risk stratification so here the most common findings we see are the obturator and external lactic chain and again it can go in any chains in the pelvis and again go into retropytonium and commonly I can retropytonal parietic nodes again as I think we heard Dr. Morani mentioning it depends on depending on your aggressive tumor in the prostate if you don't see anything or if you see a very low grade tumor or a very small amount of tumor in the prostate it's again very unlikely to have any node in the pelvis to be called as a prospectively a number node again there are other differential diagnosis including lymphoma leukaemia and other reactive nodes can also sometimes appear bulky and need to be always in the differential diagnosis when you have a low pre test probability of having a bulky tumor in the prostate again bone metastatist we can only see in the pelvis and we have two sequences for staging especially the whole pelvis T2 T1 and in our practice we obtain T1 sequence but some practices in my fellowship we used T2 so depending on what you obtain be familiar with the bone findings and often these findings are difficult especially when you have a limited sequences to evaluate a bone metastatist often these findings are evaluated with a bone scan or with a pad scan and again end up having the biopsy as well especially having a bone disease is a again a significant risk startling factor for management so it excludes all your local treatments so that's the reason they often get them you know undergo biopsy before giving them a definitive local therapy so again to summarize second part of my talk basically on staging so local local regional staging of prostate basically influences in SCN risk certification and which directly informs prognosis and management that's main reason when you are having a talk with a patient about management decisions this plays a very important role and again EPG is not a yes or no question it's a multifactorial likely good scale should always give you all the factors in consultation give them always like at school unless you have a gross EPG again always look for key anatomical landmarks or on the prostate when you have a bulking disease to identify key structures and their involvement


Good morning. So that was actually kind of lame, I have to apologize. One more time, good morning. Good morning. So my name is Jim Shelton. As you heard Martha say, I am what's called the Assistant Deputy Secretary for Innovation and Improvement at the US Department of Education, which is way too long of a title. It is my honor and pleasure, and it is actually especially my honor and pleasure to come with Martha. One of the things that's interesting is, as you might guess, we try to divide and conquer a lot. So we actually don't get to hear each other do our things very often. And I love working with Martha. It's great to work with her. She, as you can tell, has a great energy. Makes everybody feel comfortable, but also has a nice firm hand that kind of pushes through all the things that happen to get in the way. And make it possible for the kind of innovative work that you're doing and that we're talking about to happen. I know you've heard from her. And so the big question is, what is this guy got to talk about? And I really am here to do two things. The first is to say everything that Martha said about the context is very true, about our aspirations, about what the president desires, about what we're trying to do with our policy. But the reality is that as federal bureaucrats, what we can do is create the context for great people to do great work. And ultimately, it takes an ecosystem of people who have nothing to do with the government in most cases to actually make everything happen. So the question is, are we going to do what it takes to create that ecosystem? And I have a very particular point of view, given my role, about what it's going to take to have an ecosystem that really drives open educational resources from something that is currently on the fringe to something that actually dominates the sector, that transforms the way our young people learn, that transforms the opportunity across the globe for us to educate people to their highest possible level, for us to accommodate people who are caught in the industries where, in fact, we are finding that the life of industries is getting shorter and shorter every day. This is the opportunity before us. And as you hear from the president on down, we believe even though we talk about America being number one, that this is not a zero-sum game, we believe in the growing the pie. And in fact, all of our economic futures is about growing the opportunity for people around the world. And this is one of the ways in which to do it. One of the things that I want to highlight though is that, as you heard the commissioners say, this has to be about improving teaching and learning. It can't just be about open and free. If we do the same old thing in a cheaper form, shame on us. And so I talked in March at the Hewlett convening on open educational resources about four steps to try and move to this new system with a very clear and intentional focus on actually improving better outcomes, making better teaching and learning outcomes and improving access to effective teaching and learning resources. That is the basic game. Here are the four steps. And what I want to do now is just to do a quick status check on where we think we are and also to get up and new about what's missing and what we need to do and what you're going to do to move things forward. Now I have to say I had two versions of this. One was the high-risk version which had a lot of embedded technology and then I decided that was not a good idea. So you're getting the lower risk version of this so I'll have to voice over a couple of things. I just finished talking about the importance of us shifting the value proposition. OER when people first start talking about it, you heard a lot of emphasis on free. Free, free, free, cheap, great, but it has to shift to OER being better. That it actually is producing better outcomes and that we're, because of the different things that you can do when the resource is open, the access it provides, the flexibility it provides, the timeliness of the resources and the embedded science, we can make it better. We're seeing people move in this direction. I'm sure there are examples throughout this room. Since I'm happened to be here, I figured I'd give a shout out to David to setting the bar on what quality looks like is got to be an important mission for this ecosystem, for this sector to step forward and say, not only are we cheaper, we are better. Currently, most of our resources open or not rely on the old paradigms. I won't go through all this, but if you read it quickly, you'll see that it is mostly true. So then the question becomes, how do we get better as a sector at making educational resources that actually improve outcomes? How do we embed everything that we know about how people learn? How do we advance the science, the science around how we identify and describe what people need to learn? I'll ask this in a number of rooms. How many of you are familiar with cognitive task analysis? In our rooms in the future, all hands need to go up. When you're talking about our standards and the way we set them in education, we tend to ask experts to get into a room and put labels on the wall and figure out the dependencies. Well now, we have the ability to start empirically understanding what it is that experts know and do. And to refine that with our understandings through their interactions, both real and in the context of learning, the next steps. These are things that we can learn. These are things that we can improve. These are things that we can prove. Same with our assessments. Same with our design of instructional resources and other kinds of experiences, whether they be gaming or otherwise, to allow our students to master things. These are all areas that actually deserve significant research and development, whereas we move forward as a sector, we should be creating an infrastructure that allows us to learn much more quickly. We should be putting forward best practice examples. And we're seeing this start to happen with OLNet, which I was gonna take you into, but everybody here already knows about OLNet. But also things like the worked examples, where people are actually in the process of showing their work or creating transparency around how well it's working, what the issues are that they're struggling with and sharing that with a community that can help them refine their work. You all already know about the work that Carnegie Mellon has done, that's gonna came up this morning, but also in partnership with Creative Commons, the support they're providing to the folks that actually won that $500 million in TAA grants that Martha talked about. If we are do this right, the science and research that has come out of all of your work now, the work Carnegie Mellon in that we're starting to aggregate will make its way into that $500 million worth of resources. If in fact we don't do it, shame on us. But the opportunity is to not only build it into what we have this year, but we've got at least three more years. There ought to be a common set of resources that people as they're putting together their applications next year, should be able to draw from. So as they are designing their programs, as they're designing their applications, they are drawing from the best in the world. There are not many things that we have in our resources at the federal level to compliment the things that already exist in the private space in this particular area. This is where we need you to move much more quickly than we can. And then obviously we need many more best in class examples. We'll come up with these investments that we'll make with the TAA and other areas, but that's gonna take time to show up. Your work is showing progress and impact today and we need to figure out how we move that much more quickly. The basic infrastructure to get rid of barriers. How do we make it easier? How do we actually make sure that the precious resource that everyone here is expending is leveraged against the resource that everyone else is spending? How do we put in place the things that make it easy to share data, to share learning objects, to help each other perfect the systems that we're using to deploy and offer these tools? To create utilities that allow us to, as learning registry will do, to find things that actually allow us to find the resources that match our specific needs, that are used in the particular ways that are gonna benefit the most students. There's much work going on in this space. With the work of digital learning now here in this country, we're starting to see a regulatory framework happen at the state levels. Utah is on the cutting edge of setting a frame that lets us understand how you get rid of some of the barriers to open educational resources but to digital learning overall. Some things in the overall platform that I can't agree with but most of it is about how do you create an open space where digital learning can take a foothold and actually gain traction and ultimately transition from the print world that we live in to digital? Similarly, big grant programs like TA are gonna change not only in the K-12 space in the higher ed space but also how we think about training in the workforce and how we actually make the resources available to those community-based organizations that are doing hand-to-hand combat every day trying to help people who are struggling with employment find ways to get connected to jobs. They can't afford to act like big corporate training firms but they still need to be able to access the very best that we have to offer. And then finally, just recently we've been struggling in the past the elementary and secondary education act otherwise known as no child left behind in this country to pass a new version of that. Well, as a sign of good news, last week out of the Senate committee came a opposed bill that included a number of things. One of the important things that it can includes was the inclusion of what's called the Attain Act. It basically is a promise, a promise to invest in the infrastructure that we need to support, especially low-income children in having access to digital technology. The kind of resources that they will need to be able to access these resources that we're all trying to create. That kind of policy framework supported by infrastructure, supported by standards, that ecosystem, which you play an important part in creating, has to be there. Your voice and your expertise will matter. So then we say, so where are we now? What's missing from this picture? Well, Martha talked about how do we create the kinds of private sector, non-profit, for-profit, whatever, enterprises that are gonna help us to figure out, take these things to scale. They're gonna allow it and make it easy for systems to make the adopt these kinds of resources, for teachers to understand how they deploy these resources in their classrooms to the benefit of their students. How do we create the enterprises to actually do that and what else needs to happen for that to happen? What else is missing from the picture? I'd love to hear that from you. You heard Martha talk about what's in the way. Are the things that we're doing at the federal level that are stupid? Are the things that at the state level are inhibiting the progress, like only allowing textbook money to be spent on paper, things like that, seat time, things like that. And more importantly and most importantly, who's stepping up? I gave a few examples. Obviously everyone in this room is a living example of people doing great work in this space and the question becomes, who is doing this work and can carry it forward? President Obama and Martha and Arne are gonna continue to try and create a great context for this work. But ultimately it comes down to every day. What university? What school? What school district? What teacher? What researcher? Is going to do what to add to this ecosystem? How hard are we gonna press? And when the time comes, are we going to raise our voices? And I wanna be careful here, but I wanna make a very specific point. One of the things that is interesting about the education sector, especially when you study innovation, is that our sector does some things that are odd. Just plain odd. Let me give you one example. So can I tell you how many lobbyists, the pharmaceutical industry sends to the hill to get more research and development dollars for the beginning stages of new pharmaceutical drugs, new health interventions. They spend tons of resources trying to get more dollars invested in research and development so that they can take that research and development and create new enterprises from it. Our sector, not so much. In fact, often they send people to say, don't let them spend that money on research and development. That's just not a good idea. They might create things that somehow undercut what we already have, that might push the envelope into what the next generation ought to look like. That is just plain odd. And especially if we wanna make progress, a different point of view has to hit the table. A different point of view that is shared, not only nationally, but globally, about how are we actually gonna advance the field and what the new models look like that are win-win all around. This is not rocket science, folks, but if we don't get on our game, the game will be over before we start. And with that, I'm happy to open up for questions and thank you for your time. Questions, anyone? Anyone? Be a little bit. Yes, ma'am. Your dollars paid for OER. Yes, so, and, Martha, you may wanna chime in on this one. I'll let you hold it. No, no, I got it. Just if I get in trouble, I need, you know. So, recently, as everyone knows, the TAA in particular, as Martha mentioned, had a very particular set of language in it that says everything should be CC by. I was mentioning this peculiar behavior that our sector has. So, there are a set of folks who actually went to the hill and asked for a very particular amendment to be made during the appropriations process, which is when you get money. It basically says that, sure, you can do all this, but you have to do a scan that makes sure that you're doing it in an area where there is nothing that exists today and there is nothing in development that will exist that the thing that you're gonna give a grant to will support. So, in other words, if there is an existing, let's say, developmental math curriculum, for example, this would say, hmm, you can't give a grant to someone who might wanna do some work around developmental math or developmental literacy or if there is a job training program for IT and technical skills, you wouldn't be able to give a grant to that. So, the universe of what you can actually give a grant to do shrinks to maybe not the null set, but pretty close to it. And so, the bill is still there. The law is still there. You can fund it if you still want to, but it won't mean anything. We can't ignore it if it gets passed, but it's only on one side. So, right now, it is only in the house side. It has to get past the Senate to pass. So, for those from not from the U.S., two parts to our legislature. One side proposes it. The other side, right now what we have is the other side definitely doesn't. And then they negotiate to figure out where they land. So, this particular issue was proposed on one side. It will be negotiated. The question is, where is it gonna come out? Martha. I would just add to that that this same language was introduced last year and didn't go anywhere. So, you know, we, at the federal level, you learned pretty quickly, Jim and I have been here about two and a half years now. We learned pretty quickly that, you know, Congress is the ultimate decider. The president does have veto power. We have differences in the Senate and the House. It's very rewarding that an elementary and secondary act bill actually came out with Senator Enzi and Senator Harkin co-signing that to author that.  There's no perfect bill, but we've seen this amendment before and we're tracking it very carefully. And we hope to get a positive conclusion for our purposes like we did last year. Yep. Yes, sir. Sure. So, one, I would say, I think it's really important for people to pay attention to the recent guidance that we have put out around FERPA. We are very much aware of this particular tension. We're also aware of the urban myth, frankly, that governs FERPA. And so, and for those outside the U.S., FERPA is the law that governs our privacy and whether you can share data. It is interpreted at the state level in some cases in pretty significant ways, like, for example, it's against the laws of privacy to exchange data from high schools to colleges, things like that. And so, what we've done is said, look, one, let's clarify what FERPA actually says and be clear about the ability to anonymize data and use it for research purposes. We're also trying to give examples where we're sharing data in forms that are not personally identifiable, that make it available to developers and researchers to create open tools and resources. And then, third, we're trying to identify folks that have already crossed this threshold, that have identified and created sandboxes for researchers using depersonalized data, also looking to protect against mosaic effects and things like that. So, make sure that everyone's privacy is protected but also empower the actual research that needs to happen using that data. We need to get a lot better at it. We need a lot more use cases. We need a lot more science, frankly, and study around how you do this well and how we enable... And this is what I said in my presentation. Creating an infrastructure that supports this kind of work so everyone's not reinventing the wheel will also be really important. How many foundations are there in the room? One. I know my friends from Gates would be here later. One of the things that I'll say as a former foundation person is that this is a space that will truly benefit from a few strategic common platform and tool place that could release the field dramatically to move forward. And so, I hope over the next three days some of that stuff will come to the surface and as people are putting together plans, they'll think about how to do that. And I will try to figure out how to help from the federal level along with Martha, I'm sure. Sure. The question was, I emphasize in my PowerPoint that we need to shift the value proposition from just free to being better. And what ideas do I have for that to happen? So a number of the things that I actually laid out, I think, are a part of that. The ability to... Some of the things that are obvious, right? Things that don't sit around for seven years could be easily better. Things that allow for the kind of interaction that captures feedback and leads it back to the student and to the teacher should be better. Things that leverage what we know from cognitive science and have taken into consideration things like cognitive load and things of that nature should be better. All of these things are tools and resources that we have at our disposal already today without doing a one cent more research. And if we incorporate them into the design of our resources and get it into the basic DNL of our ecosystem in this sector as we move forward, then what will be created should, by definition, be better than what's out there today because most of it doesn't consider almost any of that. Not to disparage anyone in particular. So those are some of the things. I'm happy to have a broader conversation, but you all are into the work. I'm sure you knew better than I do. Your best ideas will be much better than the stuff I am talking about. And I'll come back to you, sir. Go ahead. What you can do as the government is to set context and create conditions within which the community can operate. So, recommendation, and I know I'm preaching to the choir here, but what the government can do with the optional grants that you release, and you just listed a whole bunch of best practices. So use the Department of Labor grant as an example and sort of a requirement there for an open license. That's extremely positive. There's one of the requirements, but it's not all of it. So there's no requirement to deal with grant, for example, for anything about technical interoperability. So even people who are building things and they're openly licensed with a CC5 license, there's no guarantee that you're going to be able to use it if you don't have a particular proprietary system. Some suggestions in the grant about collection of data analytics, best practices of construction design, but it's not a requirement. So my advice and suggestion would be because you've got the power of the person, the power of the policies around grants in DOE and other agencies, and as grantees who are looking at optional grants where you don't have to give us the money, we don't have to apply for the money, there's a unique opportunity there to set the requirements and then people will either apply to the grant under those requirements or they won't. That's the first thing. In next grant, you can also advantage those who apply that says, I'm going to build on great work of others. So I'm not just going to build from scratch, but I actually acknowledge the best practices and I can see it, it's already been built here in, say, Wave 1 of the DOE grant and so for Wave 2 or the next DOE grant to advantage folks who are willing to say, I've moved beyond not inventing here and I've moved to proudly borrow from there. I'm willing to take other people's grant. One, thanks for that input. I mean, fantastic input and what I'll say is, hear you loud and clear. You hear you loudest during the comment period for these competitions. And here's what I'll say, this is just the real brass tacks of it. Your voice is carried incredibly late. There's a process by which they are heard. They are heard when you speak directly to your representatives. They will believe your stories much more than what they hear from us even when we drag along our data and our thick reports. We will hear, have a mechanism for hearing you through comment periods and we also now are using more and more the kind of websites and blog posts and other more open mechanisms for collecting feedback that the department has. So I'll carry that around, but what happens in the real process is there are a whole set of priorities that lots of people think are important that are getting shoved at any one particular competition. And then the question is, so which of these things are we going to require people to do and which of these are going to be kind of loose? And depending on who and how many people think something is important, plays a big part in how it actually gets shaped in the end. So, appreciate the advice, it's fantastic advice, but as you all become important, increasingly important players in creating this ecosystem, I want you to understand the rules of engagement so you can be as effective as possible. Yes sir. Sure, so the question was two things. One is how are we thinking about common interoperability standards or interoperability standards in general? And the second is how are we thinking about tools and platforms for assessing efficacy? Is that it? Okay, so two things. One is I will say I personally came in with a very, having looked at other sectors, a very light handed perspective on letting industry set the specifications for its interoperability standards, letting these standards body come together and work it out, et cetera, et cetera. And engage many conversations and encourage many folks to try and find commonality with the different standards that exist today. That has not worked. For whatever reason, the folks that are driving our basic, the standards that we have, the primary standards that we have out today, have not been able to come together to work out their differences so we can actually move together as one sector. So I would love any suggestions about how to encourage those folks to have some of the conversations and finish the conversations that need to happen for us to wind up with common interoperability standards that we can use broadly across the sector. The second thing is on the common tools and resources for assessing the efficacy. There are two efforts underway. One is Karen Cader, who Martha mentioned, is driving an initiative where we are looking at, frankly, the broadest question of how do you think completely differently about gathering evidence, giving the new capabilities that we have? What does evidence really mean when you can collect data real-time and at the pace and scale that we can? And how do you use that capability in a very different way to redefine what we're looking for when we define rigor at the early stages and evidence at the later stages? That's a little bit different than the basic assessment of independent learning modules, but what I think is that what it will do is it will allow us to inform the conversation for the people who are actually building those platforms. So like Inter and others, people have heard about SLI from the Gates Foundation and some of the others that are working to collect that kind of information, where they will then be able to plug that into an infrastructure that quickly starts to analyze it and provide feedback on what's working and what's not. The analytic engines are still going to, I think, take a little bit of time to catch up, but I think we'll be well ahead of where we are today. Good deal. I think this is probably the last two questions. We're okay, actually. Let me ask about this. When I met you last at the human conference, we heard from a lot of OCW providers. Now, I'm Peter Ramm. I work with Open Study, and we work with many, many OCW partners. And what I keep hearing from them is very clearly a lack of funds. And you know that Hewlett left the initiative in supporting the OCWs from many institutions. But again and again, I hear from these fine institutions. Even MIT is struggling. That there's just not enough funding to keep growing the OCW initiatives. And I think that's a pretty good deal. I look across the ocean at places like Korea and Japan. The OCW efforts there are just growing like crazy. So what, and since you folks have both said that you value the OpenCourseWare initiative and you work with MIT, what are you doing for my friends in OCW institutions everywhere? So they can grow and thrive in the same way. Fantastic. I mean, I can just tell you, I just came back from two days in London talking with international folks about a different way to look at funding. Because all of the countries, some of the countries like India are prospering, you know, eight, nine percent growth a year, et cetera, et cetera, U.S., we're stagnant. You know, can there be innovation funds created that would be international in scope that business partners would put in a part? Institutions would put in a part? The government's plural would be put in parts. And so I think we need different frameworks because it is not going to be the same game, at least in the U.S., in the next year or two. I hope that we end a war and I hope revenues will come back in and can be used for things like that. But we have to be smarter about what we have. And frankly, you know, I think it's important for us to look at existing funds. Every existing fund we have that we give out, can we do things differently with those funds and can we think differently about them, put different requirements on them, announce them, get the feedback from all of you, and then move ahead. So those are a couple of things that we are doing. Yeah, I mean, Mark has said it all. I mean, the reality is at the federal level, the things that we have are the programs that we run today. As you can tell, we have some tension about how aggressively we are in using those resources. I think the more we get people comfortable with that basic notion and get people to be smart about how they leverage private resources to take advantage of the opportunities, the better off we'll be. And then the thing that's really important is, this is another thing about knowing how to engage, what we don't say is as important as what we do say. So for example, let's say there's a competition that focuses on scaling innovations that are either new or proven. And it's very odd that I don't see more applicants putting in specifically that they are CCed by, for example, which then gives them an advantage, hopefully when explained to peer reviewers, for how they see the ability of something to spread broadly to serve lots and lots of audiences. These basic things that could happen to it that would automatically advantage an applicant if they were doing them. I don't think the community hasn't figured out exactly how to leverage them in their basic applications. Back here and then Frank. Yes. So for those of you who didn't hear, he picked up on this little tension that we have, which is we want to be number one in the world and we want to be open and work and partner with other countries. I was hoping no one would really call us on that. Two and a half years into DC, I'm way past the political life of a normal political pointee. Here's the deal. The deal is, is this being streamed? Not live. Anyway, here's the deal. The deal is, I think every leader in every country talks about their country being number one. Not many leaders get up and talk about, we want to be number five. Right? But when you watch what we do, right, when you watch what we do, when you watch how AID and state are investing in educational resources, how the department is hosting the combined summits with India and others specifically, not only to talk about collaborating on education but collaborating on innovation and education, collaborating on open educational resources. When you hear how we talk about cooperation and collaboration on a global basis on these resources and the standards and all the things that go with them. What you hear is a philosophy. And that philosophy I said when I talked, which is that we believe not in zero sum but in growing the pie. And that, in fact, our economic future is tied to growing the pie in a way that expands opportunity within the U.S. and without. And the one of the reasons that the U.S. is stagnant when other countries are growing in the middle class. What we have not figured out how to do in this country, given the stage of development we are, is how to continue to grow our middle class. What you also need to recognize, and we need to recognize as a country is, and this is why the President has emphasized increasing our exports, is that as other countries increase their middle class, their desire and demand for goods from your country should increase as well. So we see the symbiotic relationship between the growth and the prosperity and the education of people all around the world, especially in those countries that are trying to grow. And having thoughtful partners on the supply side as well as the demand side and in terms of working together to create these things so that they can be made accessible to the broadest amount of folks. We see that very clearly. We're acting on it in our actions and our funding is following our words. But our President is always going to talk about us being number one. And I would hope you wouldn't expect something different. Fair enough? Frank? I have a dicey but simple question. Do I represent one of the funders in the room that the pedagogical movement put to flip the classroom to create efficiencies, pedagogical efficiencies? And I wonder, one of the impediments for the funding community has been policy to possible impediments. And I wonder, are there any movements that put to flip the house or flip the hill? Look for efficiencies that you all are feeling, obviously you're currently objective in a great aspect of the system, the federal system. Is there anything that you can comment on that give us a better sense about the movement for education and the correlation in efficiencies? Sure. You want to start? Okay. I think there's three big things. One is a lot of the things, at least in my mind that are the big levers are state level. Right? So the ability of everyone to be working on resources across the country that are focused on common targets, common standards, like states have to drive that, but that is going to be a policy change that's going to have a significant impact on the ability of people to create educational resources that can scale quickly. The ability to detach seat time from credit, from gaining credit is a state level decision, both on the higher level and in K-12 level. Even in our regs, most recently where we defined the credit hour, which had some components in it attached to time, there's a lot for people to be able to propose equivalencies that would use other kinds of competency-based progression models. And so we're trying to create that space and opportunity. A lot of it has to happen at the state level. So this is why I'm really encouraged because one of the reasons I highlight digital learning now is that that's former Governor Jeff Bush from Florida and Governor Bob Weiss from West Virginia working in a bipartisan way to create the context and set up a state policy framework that says we want to transition very quickly as a country, from print to digital. You states get on board, you governors take leadership, you state legislators get on the ball and the hope is that the folks on the hill that represent these states will follow suit as well. I was encouraged to find that there is a digital learning caucus that is formed on the hill or a learning technology caucus that is formed on the hill that is also bipartisan. So we'll see. Yes, sir. So what I would suggest is to pick a slice. Certainly content of the change. We're guys very good at bringing together folks in the summit of a conference. I make sure that all of the standards, the relevant standards representatives are at the table. They do. There are standard groups of politics that we might incentive for the group to do some sort of a rationalization in terms of what are the strengths and Can I interrupt you? I apologize. Sorry? I just want to interrupt you. I apologize. Because we've been trying that. We've been invited them in together. We've encouraged them to talk to each other. We've tried to create incentives. We don't have a lot to offer them and it hasn't worked out. So my thought is not that we will mandate anything, but my thought is that in fact it's the user community that's going to have a conversation because we are of no consequence to them. The user community on the other hand is a consequence to them and we'll make decisions that will drive their behaviors in different ways. But continue please. So I think that we should provide some justice for why you're making that. And it's perfectly fair for the department to say we're going to derive some sort of maintenance by which we evaluate whether the standard you're recommending is appropriate or if you're trying to start looking for a framework I guarantee that the standards buys will come right. So I'd love to talk to you more about this offline. And would love to learn more about that particular suggestion. I will try whatever it takes. One more question. Yes sir. No. I mean don't want to take anything away from the work that's really important that is happening. Again watching other sectors where when opportunities, especially big opportunities arrive they come to conclusions in months or weeks even not years. I'm just anxious. Just anxious. Not recognizing whether I got 14 months or 62 months to get stuff done. I'm anxious. Good deal. Alright and that was the last question. Thank you everybody for your time. Now you are now free to stand up.


Mr. Chair, heads of state and government, ministers and distinguished delegates, I am honored to participate in this special session of the UN General Assembly. A few weeks ago, in preparation for this event, I met with a group of NGOs in Ottawa. There were lawyers, doctors, and highly articulate activists, but the most powerful voice of all belonged to a mother. She was there to tell the story of her young daughter who lost her life due to complications of substance use. She described watching her daughter slip away as she struggled to access the treatment and services that should have been available to save a beautiful, fragile life. Stories like this are far too commonplace. Countless lives are cut short due to overdoses of licent and illicit substances. Today I stand before you as Canada's Minister of Health to acknowledge that we must do better for our citizens. I am proud to stand up for a drug policy that is informed by solid scientific evidence and uses a lens of public health to maximize education and minimize harm. As a doctor who has worked both in Canada and in sub-Saharan Africa, I have seen too many people suffer the devastating consequences of drugs, drug-related crime, and ill-conceived drug policy. Fortunately, solutions are within our grasp. In my own country, I am impressed with the work of INSITE, a supervised consumption site where people with addiction can access the care and support they need. I am proud of how quickly we are making naloxone antidote kits available to save lives from overdoses. I am proud to work together to find solutions that are for large cities and communities that are remote. I know that this good will is present abroad. I have been encouraged by the recent report of the OECS President to put health and well-being in the center of a balanced approach to drug-related drug use. Our approach to drugs must be comprehensive, collaborative, and compassionate. It must respect human rights while promoting shared responsibility, and it must have a firm scientific foundation. In Canada, we will apply these principles with regard to marijuana. To that end, we will be introducing legislation in the spring of 2017 that ensures that we keep marijuana out of the hands of children and profits out of the hands of criminals. While this plan challenges the status quo in many countries, we are convinced it is the best way to protect our youth while enhancing public safety. Canada will continue to modernize our approach to drug policy. Our work will embrace upstream prevention, compassionate treatment, and harm reduction. We will work with law enforcement partners to encourage appropriate and proportionate criminal justice measures. We know it is impossible to arrest our way out of this problem. Addressing problematic drug use is a shared challenge. The solutions are also collective, involving governments, indigenous peoples, civil society, youth, scientists, and key UN agencies. I acknowledge that other countries and cultures will pursue approaches that differ from Canada's. I believe that if we respect one another's perspectives and seek common ground, we can achieve our shared objective, protecting our citizens. Better yet, we can improve their lives. Thank you. I thank the Minister of Health of Canada.