I think I2D makes an extraordinary contribution to development. It pulls together the expertise of the members, which include administrations and huge companies that are doing things all over the world. I think it combines those resources and puts them at the disposal of its members and beyond. We all know that ICTs are an enabler of all kinds of economic development. It enables, of course, governmental services, education, health, and I would say most of the industry people who are contributing to this dynamic environment are members of the ITU. And as I said, we come together, we share knowledge, people put projects together, and all of these things contribute to socioeconomic development. We're in the sector that I think is a very strong engine for all of those things. I think that digital literacy is an important thing for everyone. I think that some of the young people are the most digitally literate that we have. I take your point about innovation. I think that as we look to improve the things that we're doing as member states and as sector members, and we use the tools that they use through social media that we use Twitter and we communicate them in the ways that they are communicating with each other. I think that even just in giving them the information can inspire them to become full digital citizens. I think we have to speak their language and in using some of those tools and translating the things that we're doing I think can help them to continue to take the mantle on. And we know that the ITU does all kinds of things with youth. We've seen the things with the girls and ICTs and we have all of those different kinds of programs. I'd like to see them to do more, but I think that kids now, at least in the United States, don't listen to the radio anymore. They get all of their music digitally. They listen to the radio via the Internet. And so I think we have to use all of those tools because that's where they are. They're not reading print. They're not tuning the regular radios. They're all on media. And so the ITU has to be there. I see ITU in the future as an important multilateral organization. I see it as one that is going to underpin the ways that decisions are going to be made in the future. That is global decisions with everyone coming to the table and sharing their various views. Decisions in the world I think are not going to be able to be made in isolation. It's an organization where everyone has a voice, all of the countries as well as sector members. We're also thinking about where it's appropriate to have some of the voices from academia and other places to enrich the discussions that we have here. But in the future, now and in the future, people have to communicate with each other and they have to, there has to be a place where that occurs. There has to be somewhere where that's facilitated. And that's never going to be something that won't be needed. So I see the ITU as continuing to play that role to give of voice to members and hopefully to collectively, together we can have a very important and positive and constructive impact on the world.


Alright. It's great to be back. I'm Phil Abernathy. I live in Melbourne at the moment, but work out of Vienna, because a lot of my work is in the Northern Hemisphere. And Bangalow was where I grew up. So I'm coming home in many ways. I spoke here around five years ago. And today we're going to talk about my experiences over the last, I would say, 12, 13 years in coaching and see if I can share some of my ideas and thoughts there and what good and bad experiences and see where we go. So don't we all feel like this sometimes, you know? When we walk into a room and walk into a training group, you see, yeah, the teams know so much more than you as a coach sometimes about the subject matter that they're busy with. And you walk in there and you think, okay, what am I going to do? How am I going to coach and what's the best way to tackle this? So I'm going to break it down and take it from there. In 2007, I was brought into a company called Sunco in Australia. And the message there was, oh, we need to start a transformation, set up a transformation team and get going. So the whole concept of coaching in Agile was very strange. Even just 10, 12 years ago, we have all the belts taken up by the Six Sigma guys and girls. And Lean has their own sort of practitioners. So I guess Agile came up with this term, what are we going to call our gurus and the people who teach the people? And they came up with the word coach, which was a very nice word in its sense that it positioned it quite freely. But it has a lot of connotations because as you will see as we went through the whole process, we started getting this sort of connotation happening. So are we a life coach style of person? Or are we a sports coach kind of person? And it's very, very different. So to understand the models that we can adopt, you have to understand the purpose of coaching. So the purpose of coaching as I see it and the teams that I've worked with is about creating high performing teams that deliver great business results. You're not there to teach them and coach them stand ups and sit downs and all the rest of it. That's not important. What's important is the business results. So you're going in there and the two models are very, very different. The life coaching model is very much based on a grow model, you could say, which is you set your goals, you look at your reality, you look at your options and then you find out the way forward. So how many coaches have we got in the room here? People have coached. Okay. So I'm in a great company and haven't you felt sometimes? Do I use that model where ask these leading questions? You can't be directive. You have to ask leading questions. But that's not what Alex Ferguson does. Imagine him trying to coach Manchester United with leading questions. How would you like to kick the ball? Yeah. Would you like to? Oh, yeah, try it. Try it this way. And now you try. That does not work. And remember, we're also going into a team. And if you look at the shoe hard read process, most of the coaches walk in when they're in the shoe process in the shoe stage, which is they don't know much about agile. They've got years of maybe waterfall experience, maybe years of no waterfall experience. And then suddenly you're in there. So what do you do? And if you go in with asking open questions to get them to develop it, you could have a problem. They do expect you to tell them what to do. And there's a sports coaching model, which are very directive, very clear, et cetera. And if you look at football teams or basketball teams or whatever, they've got the coach and then they've got specialists. They've got somebody to look at the psychological part. They've got somebody to look at, you know, the movement and the stretching and everything of that sort. There are specialist coaches under them. So how many of you here would consider yourselves DevOps coaches, technical coaches? Wow. Not one hand. One, two. Fantastic. Fantastic. We've got two hands. And previously we had maybe 25, 30 hands up. So what does that say? That says when you go into a team, and most teams, if you're coaching a technical team, so let's assume we're doing app dev teams, application development teams. Because when you're coaching an infrastructure team, it's very different. If you're coaching a sales team, because Agility now has jumped the whole boundary of IT, you could be coaching a marketing team, it's very different. But let's just talk about an application development team. You need DevOps experience. You can't get better, faster, cheaper, and therefore happier customers, shareholders, and employees if you don't train them in DevOps. You just can't. Forget it. You can do all the stand-ups and sit-downs, all the retros you want, and you're not going anywhere. Yeah? So how do you do that? You have to be able to get in your specialist coach. So look at this picture. Now the coaching styles vary based on where you are. So if you're coaching, let's say, the team below, that's you. You've been brought in as a coach. You work with the leader and you're coaching the team underneath. So if you look at team one, I've called that team two. And that's the key point here. For every leader in a team, every leader has two teams. They belong, the team under them, I call team two, not team one. And then they're a part of their team. Now very few coaches go in to team one. And team one goes all the way up. And you say, yeah, that's executive coaching. But do you really teach and consider the executive group, team one, as a high-performing team that you need to coach? Almost impossible.  Yeah, you can go in and you can talk to the group and they'll invite you. You know, during our operations meeting, we'll have the coach will give you one hour. Yeah, really? So this is our challenge. Now the styles you use as you go up the tree will be more life coaching styles. You try using sports coaching styles to the exec, let's say the executive leadership team, the CEO, the CIO, or the CIO and his or her team. Whoa. First you have to have the permission for that. So most of the coaching takes place down below at the team level. Now do you include the manager or not? So at that level, if you include the manager in team two and you're brought into coach team two, then the sports coaching model, according to me, works much better. But there are a lot of things that you need to set in place in order for that to work.  And I'm going to talk to you about those few things. So this has been my go-to book in terms of guidance. It's a fantastic book. If you haven't read it, please do get it. And he talks about his success of the last 27 years and man you and everything. So you can't just go up there and say, I'm here to teach you. Now my whole philosophy right through this, I think, has been that the coaches are absolute leaders. That is what you are.  Forget all those things.  You have to lead the team. Oh, but I haven't been. I'm not the manager. You don't have to be the manager to be the leader of the team. If you do not assume a leading position, if you're not a leader, now that doesn't mean with authority. It can be with respect. Then you're going to struggle. So every single coach that goes in any place, if you're in a sports coaching model or even in a life coaching model, you are a leader. So what does that mean? I've broken down the leadership capabilities which I talk to actual leaders themselves and to coaches and they fall into three buckets. The first is the need to provide absolute clarity of purpose. You have to give your teams clarity of purpose. You have to help them on that journey. And I've had so many coaches are, you know, they come in and they go, well, you know, my team's not clear because their boss is not clear and there's no vision from the product owners and they're struggling with. That's your job. Your job is to help them get that clarity. That means talking to the people outside the team, talking to people in the business, going up, going down, working through, not just working with a team and telling them you need to go and find your strategy. You have to show, not tell. So the first one is that and I'll go into a little more detail with that. The second one is clarity control without controlling. Wow. He used the control word. It's almost become a bad word in Agile. And that's what's doing us a lot of disservice. Imagine leaders not having control. Imagine that. Imagine managers not having control. You're finished. You have to have control. But as Agiles, we're so scared of using this control word. I use it openly and I suddenly see the relief drain into the people there. Oh, my God. I can have control as a manager. Yes. You have to have control, but without controlling. So how do we do that? I'm going to give you a few tips on that. And finally, you have to help them design for flow. It's only you that can do that. It's not about just teaching them the practices. So agility just in brief, in my view, a set of values on top of that, a set of principles and a whole buffet of practices. The buffet comes from lean, from design thinking, from Agile, from XP, from Scrum, from SAFE. It doesn't matter. You pick the practices to suit the type of team you're working. That's my definition of agility. So it's very broad. But there are design principles as well. And I'll talk to that in a moment. So let's just drill down into the clarity of purpose thing. This is one of the most important slides in terms of clarity. It's come from a Harvard Business Review study. And that was published in the Harvard Business Review in 2013. So it's not very old in terms of management principle. But it's the concept of how you cascade strategy down. How do you create clarity? So if you look at this picture, at the top is the group level of the company. You have a vision. And there are your OKRs, your objectives and key results. To get your key results, you must have a strategy. The strategy from the level above cascades to be the objectives of the level below. This is vital. If you don't get this right, you'll struggle. Yeah. So just to give you an example. Company X wants to open out in Southern India. They want to grow in Southern India. So the objective is to grow revenue by 300%. Their strategy is, okay, we're going to target Southern India. So the business unit owner for let us say the retail business now takes the strategy of going to Southern India and sets objectives for it. So they say, okay, I'm going to target small, medium enterprise in Southern India. And my objective is to grow my revenue to $10 million. And how is he going to do that? What are his key results? What are his plans? Pass it down, pass it down. So where do you think we are when we go in as coaches? Where do you think we sit? We're sitting down below at the operational team level.  I don't know what the strategy is. It's the problem of the person above. Everyone points up. And when I was working with IBM, you go right up to the top, which is 400,000 people. So these layers go down 11 or 12. It's not four. You go up to the top and the person who was grouped right at the top says, it's these people at the bottom. They just don't get it. So you will find this comment everywhere up and down the tree, up and down the tree. In every company. This is nothing specific to one company or another. Yeah? So your job is to work with the people to try and clarify what is their purpose? What is the objective? What are the, what is their strategy? And how are they going to achieve it? So let's take an IT team. You're sitting in an IT team. You're trying to coach them. And you're working with the group that is, let's say the digital mobile app group. Let's take a new world business where most companies have somebody doing digital. Yeah? So you're with the digital squad. And what's the purpose? Yeah, yeah, we're working with retail banking. Retail banking have an app. So you'd have to talk to the retail banking business as the coach together with, together with the leader. You're going in. You're facilitating it. You're helping them showing. That's you're not telling you're showing. You're not just going and doing it yourself. But you will have corridor discussions. You will go and have coffees with the different people that were different people that you need to get this information from. So this is one of the key things that you have to do. You also have to ensure that the team finds what's their clarity of purpose. What do they want to do? So what does that mean? What does better, faster, cheaper mean for me as a team? Yeah, not too sure. What are my key results? I'm not too sure. So in this segment, you have to baseline their current measures. If you don't have a baseline as a coach, forget it. There's no point in doing anything because if you can't measure, you can't see improvement. Your job is to show improvement, build a high performing team. For that you must measure. So you do your assessment, say how long do you take to go put something in production? How long is your deployment cycle? What's your cycle time? What's your throughput? What's your employee set? What's your customer set? The four key measures. 90% they won't be there. So what's your job now as a coach? Here come the sleeves. Up go the sleeves. You start measuring it with them. Get in there. Show them. Dive in. Let's take a pulse. Let's measure it. Put the first chart up. And I'll talk later of how you let go because you can't become the coach crutch. You have to step back. So you set clear objectives for that team. What are their key results? They have to own it and together in a facilitated workshop you have to set it up. Then comes control without controlling. Now you can't control without controlling if you don't have those measures in place. So one of the key techniques for control without controlling. You've got two levers. The first lever is your measurements. That's what gives you control without controlling. You don't have to micromanage. You just have to look at the walls. The second lever is what I call the wisdom of the crowd. You have to be there in the sessions. You have to be there listening to people. You have to see what's happening. They will be telling you in their sessions what's really happening. You don't have to say anything. You just have to be there. Management by walking around 1980s. Most of us will remember that. Yeah. It's an old technique. Go there. Be there. Yeah. And talk to people and listen. This will tell you what's happening really on the ground. Now what's your job then? Because once you find an issue, I had one coach walk into me and said, I've got a problem. I've got a toxic person in my team. I've got a very how many of you have had that experience as coaches of one person being toxic? Almost everyone. Yeah. And the bad apple will be there. Yeah. And yeah, as a coach, you don't have the authority to do anything. You can't fire them. But it is your job to hold them accountable. It is your job to hold them accountable for the values that have been agreed by the team. One of my key principles is that trust is nothing but the box of expectations with the ribbon around it. That's what trust is. Yeah. And if you tell somebody, I trust you. I trust you for what? I trust you to do this, do that, do this, don't do this, don't do that. That's what you that's what trust is even in a relationship, even in a private personal relationship. You tell darling, I trust you. Yeah. Darling has you have some expectations of darling and darling of you. So it's not it's not anything else but that's you have to define these expectations with the team in the clarity of purpose section. What are the values? Do your social contract. First thing before you do any stand up, do your social contract. Set it up on the wall. Okay. So now you have that there. Hold them accountable to the values. And these are tough. Come to Jesus discussions. These are what leaders have to do. This is what you have to do. Don't do it in public. Please don't don't belittle them. Don't make them look bad. This is not what we're about. Take them in private. Have a chat with them. First, the nice chat. It's the understanding what's happening. Try to understand their position.  They will not respect you. You have to absolutely care for your people and your team 100%. So as you have the chat, there may be a valid reason. Maybe something's going on. Maybe there's a but they may also not be valid reason. In which case, you have to say, yeah, I'm sorry, but this would not work. You can't go on like this. I had one person who was the head of a mainframe team. She was in the group for maybe 20 years doing this job. She knew the mainframe inside out. And in fact, she could have coded every story faster than anyone else. So she was fantastic at doing it. Fantastic. One of the best performers. And terrible. Would not let anybody else in the team did not want Agile, would not come to stand-ups, did not participate, did not collaborate. Every rule you can think of was broken. But they can't let her go because she knows everything. You just can't, oh my God, if she goes, the whole mainframe will come down. Really? Will the mainframe come down?  You just have to. If you want me to coach this team, you have to let me try something. And this was in 2008. So at the very start of the Agile journey. And I said, give me three months. Transfer her to another team. Three months. So do you think the mainframe crashed? No, of course it didn't crash. Everybody picked it up. The team became a high performing team. And for the person itself, it was the best thing that ever happened. For the first two weeks, she hated me. She would not look at me. She would not talk to me. That's fine. But three months later, she came to me and she thanked me. Said that's the best thing that ever happened because she started learning new stuff. Which she had stopped completely. So you have to have the discussion. And be careful of these metrics. They'll try to fiddle the metrics all the time. The walls will change. Whatever you measure will improve at the cost of something else. So you have to balance your measures. If you don't balance your measures, you're going to get all sorts of funny things happening. When you balance them, if you try to cheat on one side, the other side, you'll see start being balanced. So it will, let's say, correct itself and you'll be able to see it. So watch the measures. It's very important. Now, design for flow. This is an important bit that you have to watch out for because when you come into a team, they'd have set up a design for you. Most coaches, when you go in, if you're not coaching at executive level and you're not leading the transformation, you'll have very little say in the team structure. Around about that same time, 2008, 2009, I was called into a company in Melbourne that asked me to help them on their Agile transformation. They wanted to try it. And they said, I'd like you to work with the BAs and the developers. The testers, we're not including now because the leader doesn't support Agile. So can you please do just these two parts? How do you think that went? So I said, no, thank you very much. You please call me when you're ready to do Agile and then we'll talk. I actually got called back last year. So it took them quite a few years to realize that and correct. So now the testers are in as well. But it's important that you set up the basics of good design. You should know the basics if you're going in as a coach. Small, persistent, cross-functional teams, pulling work from a prioritized funnel. If you just look at that piece, you sometimes have to help them with that. So the first thing you have to do is set up your skill matrix. What are the missing skills in your team? What's the skill heat map? Very few teams have a skill heat map. Yeah, I have three devs, but I'm not a full-stack team. So I've got all these handoffs between multiple squads. Design for minimal handoffs. You have to know where the blockages are. You have to know where the waste is. That's what design for flow is. And you have to help them. So you have to look at the statistics and help them. And now you're thinking, where do I find time for all this? Well, you're the coach of the team. You have to be in the team, not outside. I was just at the company last week in Miami and I was sitting there writing a report for someone else, for some other project, and the coaches were sitting opposite. 80% of the time the coaches were in the coaching den, as we call it, themselves. That's not the place for them. They should be out by the teams, with the teams, living, breathing, drinking, partying, and sweating with the teams. That's when you're a leader out there. So you have to know the principles of good design and you have to help them with that good design. So these three things, the clarity of purpose, the control without controlling, and that's holding people accountable as well, and design for flaw. There are three things you have to do as a coach and as a leader, because that's what you are.  So I've got eight tips here. There we go. We've got ten minutes. So I've got eight tips and I'll try and rush through them as soon as we can. The first is set clear expectations. Absolutely. If you don't do that, you're getting nowhere. Now this is, are you the coach? Do they want you there? Do they accept you as a leader or not? You can't say, do you vote for me to be your leader? No, that's not how leadership works. They have to literally believe that you are leading them. You have to inspire them. You have to make them believe in themselves and everything. But that starts with setting clear expectations. Now that means do you have the buy-in when you go in from the company to coach a team? How many of you have that buy-in when you go in? A few? Yeah. You can't parachute into a team as the coach if you haven't been asked to coach them. So forget that. Just don't go anywhere near the team. Now giving tips, mentoring, helping, do that every single day, do that everywhere. That's not what I mean. I'm talking about a formal coaching role with a team. The second one. You have to inspire them. I see so many coaches with no energy, no energy to energize the teams. You have to bring energy to the team. You have to set B-hags, big, hairy, audacious goals. So if they say, yeah, we can do 20 story points, how are we going to do 40? Not you have to do 40. How are we going to do 40? Do you think we can do 40? I believe you can do 40. Now you're starting to get the juices flowing and you'll find resistance. You'll find all those things in there. But that's what a leader's job is. A leader's job is to build great leaders. That's what you're doing. You've got to inspire them to be the best they can be. You have to bring that there. You're not just there as a coach. So what do you think is the best way to get the story points? No. It's out there in front. That's why I call it coaching from the front of the room. Yeah. And it is about setting targets that are really high. You get so much of this whinging in agile teams. I can't tell you how much of complaining. The coaches complain, the BAs complain, the devs complain, everybody is complaining about something and the management is complaining. And your job is to set these big targets, these big high achieving goals for them so that they feel absolutely inspired to reach for that. That's your leadership coming out. I think the coaches role, yes, on Sunday I was in the group or in the coaching workshop here and it was so fantastic to see that if you get a chance to be a coach, it's nothing but leadership training for you. It's not a role, it's leadership training. That's what it is. And if you don't feel comfortable being a leader, then coaching is not for you. At least not agile coaching. Yeah. So this is the next one. I can't tell you how many times I've got complaints from the team about arrogance of coaches. Yeah. I do a little practice when I go into a workshop or go into a session, a facilitation session or whatever. I tap the dough, oh no I almost shook the hell out. I tap the dough outside and I walk in. And it's just a little memory jar for me to leave my pride outside the room. Leave my arrogance outside the room. Go in with humility. Now that does not mean you don't know what you're telling, what you're craft. That does not mean you can't give them direction but you have to be humble. Yeah.   I was working with a team that was remotely distributed and this coach is insisting on all of them standing up in front of their cameras. They're all sitting in their homes. No we're going to do a stand up. You have to stand up. And the cameras are pointing here now. How do you like that? Yeah. No. Use your common sense. Yeah.  As a leader you're learning every day. Believe me. Yeah. You're never finished with learning. So be humble. Now this one accountability. You have to go in with moral accountability for the delivery. You have to have moral skin in the game. I get so many coaches that say we're not responsible for delivery. The team is responsible for delivery. I'm just here to coach. No you are morally responsible for delivery. You are morally responsible for building a high performing team. If they fail you fail. That's the thing. That's the first one. The second one is you have to hold them accountable for that. That means having those difficult discussions. It's not about being liked. And some of them are not going to like you. That's okay. If they break the values and principles that they agree. Remember you've set the expectations up front. It's your job to hold them accountable. This includes the manager of the team. And that's a difficult discussion.  Now work ethic.  I see so many coaches. They land up and they disappear. Then they're in their own coaching den. They're gone at five o'clock. You can't be a leader if that's the example you set. You can't expect them to follow you. You have to work harder than them. You have to be there at seven thirty. You have to finish at five thirty six thirty seven thirty when the last one goes. And then you'll get the total respect of the team. Believe me. I know some fantastic coaches in the world. One of them is a guy by the name of Frank Fox.  The first one in the room. The last one to leave. Doing stuff with the team. And then you step back. After you've done it for a week, two weeks. Now you've got your understudies doing it. And you're watching them. You're giving tip. But you're there. You're not disappeared. MIA. Missing in action. So many coaches missing in action. I'll talk in a moment about scaling agile where coaches have been given ten teams to coach. Yeah. Now how do you think that works? Yeah.  You go in. You know.  And then you think you're giving them guidance. You are busy with building relationships. I have some of my best friends. Our friends I've gained at work. People have coached. People who have coached me. Teams I've worked with. You are building relationships. What does that mean? That means connecting. That means going out. That means talking, laughing, drinking, working, sweating, crying with your team. Now are you their leader? Or their coach? You are their leader. Not everyone's the same in a team. So one of the key messages is you never coach a team. You always coach individuals in the team. So if you look at the sports metaphor, every single individual in the team is getting specific coaching. If you're the goalie, you get a different set of coaching skills taught to you than if you're the striker. And if you're the striker on the left and the striker on the right, you get different skills. You have to know who's each one and how they play and what they do. What are their strengths? What are their weaknesses? And this takes a little bit of time. And lastly, please do not go in to try and coach somebody if you don't know what you're coaching. If you don't know your craft. I see so many people who have been an iteration manager maybe for a month or two months or six months and now they suddenly become the agile coach because demand is outstripping supply. So they're agile coaches all over the place who've just got certificates. It does not matter whether you have the certificate or not. What matters is that you totally understand the craft that you're trying to coach. You don't have to be an IT guy or an IT girl. You can be from any other line. You can be a philosopher, a psychologist, an ex-project manager. It doesn't matter. But you must know the craft. If you're coaching an infrastructure team, you better know how infrastructure works. If you're coaching an application development team or a sales team, you better understand sales. It doesn't take long to understand sales. But do the hard work. Sweat it, learn it, understand it. Talk to everybody. And the last one, figure out your exit. You can't be a coach. Coaching is in some ways a thankless job because at the end of the day you will go. Even Alex Ferguson had to leave. So whether you retire or you're asked to leave or you move on to another team, you will leave. Set up the teams for success. Define your exit strategy when you go in, literally. You have to know what's your plan to go out. And with that, I'd like to talk a little bit about, while these eight are up there, I'd like to talk a little bit about scaling. So most companies that are currently on this journey because we're in that sort of middle adopter stage. We're talking companies that are 1,000 people, 2,000, 5,000, 20,000, 50,000 strong going at y'all. You can hire every coach in the country and you still won't have enough of coaches. So what do you do? In my humble experience, the only model that will work is to use the minimum set of coaches to train a set of champions. They can be the leaders, the iteration managers, scrum masters, or just people that are passionate in the teams. In every team, you have to have one champion. And you as a coach work very closely with them. They have to be leaders. Remember, those people must show leadership skills. They don't have to be experienced managers. I'm not talking about that. Pick the leaders, the managers as well, train them. And that way, you can get a little bit of distance, but you still have to follow these principles, these tips. So it's an interesting blend between one and the other. And lastly, you have to be the change you want to see. Thank you. So I've got a few minutes for a question. Thank you so much for the wonderful session and reiterating some of these fundamental things is very, very helpful. One of the questions or problems that I've been facing with some of the coaching is how do you see when people work from home and they're coaching teams remotely and not being with the teams? So what are some of the, you know, we've been trying to address that problem in many ways, but we don't want to be restrictive of people's freedom and liberty to work from locations that they want. But how does that apply to a coaching model? So I've had the fortune or misfortune of working with totally distributed teams. 910 people spread over 910 continents, all in different time zones working from home. It's very, very, very, very hard. It's almost, let's say, very difficult to do because they're not even following the basic agile principles of, you know, working closely together and collaborating if you're on so many time zones. Now, two locations, try and go with that. So I talked about design for flow. That is not design for flow. Forget it. It's not. Now, two locations, okay, we can manage. We can do something. So use your common sense there. Now, if they say, I want to all work from home, you're already starting to face challenges in the design. Now, so what are you coaching them? What is it? You're coaching them to be a high-performing team, yeah, to deliver great results. So you have to find the best route possible for these people who are working from home. Now, getting to know them is very difficult, yeah. I think if you've got a couple of people working from home, that's great. But if you've got every single person working from home spread over multiple time zones, it's a lost cause. And you might as well back out because that's not going to be a high-performing agile team. It's not. For the rest, you just have to make do with, by the way, just one little tip on the distributed teams. Forget the telephone. You have to use video. The least you can do is look in their eyes. The least you can do is look in their eyes. Was that a yes or absolutely? You must use video, yeah. If you pick up the phone, not work. And now you can use Zoom. It's one of the best there is. By the way, I'm not getting money from Zoom. But yeah, it's definitely, and it's for the, there is a free version as well. So there's no excuse for not using Zoom or not using videoconferencing. Sorry. Go ahead. One more. Thank you. I'll hit the questions today. So the organizations have recognized the importance of agile now. They all understand that the engine has to be there irrespective of how strong their strategy has. I think the question I want to ask you is that, what differentiate, so when you look at the organization, right, what are the key things you look at the organization when you think that this organization is ready to transform? You trust upon little bit upon the expectations and all. But what granular level you look at the organization which are good to go through the transformation and which are not good to go through the transformation? So this is a good question. Actually, tomorrow I am talking about setting up crafting an organization for transformation. How do you craft a transformation journey from scratch? So it's a long answer. I don't have time. But all I will tell you is the key thing is, are they ready? Do they have the pain? Do they have the desire to transform? You can't as a coach create that, yeah? So that's the only thing is the management. And it is a belief for me. It's a belief and it's a strategic decision. So a strategic decision is always a belief. That means if they say to you, can you prove to me that agile is good, walk out the door? You're not there to prove anything. If they don't believe that this is the route and I'll talk about options and everything tomorrow, they don't believe that this is the route. It's not your job. Thank you very much. In the interest of time, I don't want to let this run late. I'm on LinkedIn, Phil Abernathy. Please contact me. I'll be here today and tomorrow as well. All the very best. Thank you.


Rwy'n dim bydd ymwneud ar y disciplineau digwyddwyd, dyf nid yma yng Nghymru yn meddwl. Yma gynnal i ddau'r gweithgol maen nhw'n ddiddordeb gyda hollol. O'r ghythm ni ddiddordeb ar y ddiddordeb sy'n gweithgol maen nhw'n ddiddordeb sy'n ddiddordeb. Eulog y gweithgol efally er mwyn drwy'n meddwl, sydd ymwneud agor ddiddordeb i gydag unig o gyrfa newyddol, ..di'n gwybod i'n cael ei ddefnyddio yn y ddechrau rhywun yn y lleol. Yr rymdyn nhw'n gweithio, mae'r cyffredin iaith yma ymlaen y'r Cathau ac Roeddwn Cynllun. Mae'n cymryd yn cymryd rydyn i'r cyffredin iaith ymlaen ymlaen i'r cyffredin iaith ymryd o'r Cynllun. A'i ein bod ymlaen i'r bobl, mae'n cael ei bod yn y cyffredin iaith ymlaen i'r cyffredin iaith ymlaen i'r cyffredin iaith ymlaen i'r cyffredin iaith i'r cyffredin iaith... Margaret is one of the regulars at Buddies. I like meeting Jenny and all my friends. I really like it here. Especially right now I've been living on my own. It's nice to come somewhere where you can be yourself. It's very important that there is a place that people feel they can just drop in and ask for help at any time. If we're not here they know the telephone number to ring, if there's something that's actually bothering them and they would like some help to sort out. It's also very vital on the social side of things because sometimes people just want to come in and have a cup of tea in a chat and talk to somebody else and we try and cover that sort of service by doing some activities such as bowling or going out for a meal as well. In the Chichester area my network is run by the Ataldram Centre and is based at the Chichester Boys Club. Some adults with learning disabilities need additional support to help them live independently in their own homes. This is provided by the My Network Plus service. Every My Network Plus customer is assigned a key worker who can give one-to-one advice and support. My Network Plus is a service that's available for many of the people who use My Network. They have to be referred by a social worker from their community team. The idea is that's for people who are perhaps living in their own tenancy and who need some regular help with things like paying bills, managing their money, dealing with correspondence, perhaps keeping their flat in a reasonable condition. Both services have proved themselves to be extremely popular and have made a big and positive difference to the lives of many people in the county with learning disabilities.


I want to talk for just a few minutes about SEO, Search Engine Optimization. It has such a mystique for small business owners, you know, a lot of business owners, they spend what I believe is unnecessary money on SEO. And let me just, I've been in business now for eight years, I've coached hundreds of entrepreneurs and business owners. And let me just say this, SEO, the work of doing search engine optimization is really best used when you have a medium-sized business. When you already have a lot of people buying your stuff and you have a lot of traffic already, SEO will help to amplify that to much greater heights, it can. But when you are just starting out or when you have a very small business, you just have some clients, you're making a couple thousand dollars a month. SEO, when you just have a couple thousand visitors to your website a month, SEO in my experience has been a waste of time and energy. And not just that, it's really, I think it's a waste of time and energy because when you start getting into SEO and learning about it and trying to do it, you can become inauthentic in your business because now you're just doing what other people want you to do. You're just doing the Google searches to see what people are searching on and therefore I'm gonna do that. You start to become a chameleon rather than being authentically you in your business, which is really where your strength comes from and it's what makes your business sustainable because if you start becoming a chameleon and don't need doing what others want, sooner or later you start to despise your business because you've lost your soul. Now, let me give you a little bit of tips in terms of how do you do SEO from an authentic perspective? And I'm gonna have a whole, a lot more notes in the description of this video so be sure to look at that. But I'll just speak for a minute about SEO from an authentic business perspective. So the keystone of SEO, okay, search engine optimization, how does Google or YouTube or Facebook figure out what to show you when you search, when anybody searches a particular term in a search engine, right? The search engines, Google, YouTube, Facebook, I'll just talk about that. They know what to serve up to you as a result by seeing what other people have linked, what resources other people have shared and that's what they show highly in the search results. In other words, if you create a useful resource for others and they start to share it forward, they start to link to it on their website, then Google, then YouTube, then Facebook, will show it highly in the search results. So in other words, be of use to others and your SEO will almost take care of itself truly. That's what I've discovered, okay? Now, how do you be of use to others? This is where a little bit of searching and researching can come in handy. If you go to Google and you first ask your clients and your potential clients, so if you are trying to look for a service like mine, what would you search in Google? What would you search in Facebook? What would you search in YouTube? Okay, first get the opinions of some of your, maybe some of your friends are your ideal type of client type of person, right? Or some of your clients you've already served, ask them. What might you search in Google or YouTube or Facebook to find information about someone like me or to find helpful articles that someone like me would write? What would you search, right? And then try searching those terms in Google and YouTube and Facebook. And as you type things, the search engine will start to suggest what you might wanna finish typing. And those suggestions are really helpful because that's what other people have been typing. And in Google, for example, once you've finished typing something and press enter, you'll see the search results. If you scroll down to the bottom of the search results, you'll see related searches and that also tells you what other people have been searching. Now, here's the key. Once you know what other people are searching and you search for those results and you see what the search results are, what articles come up highly in the search results, then it's your job to create a resource, create an article that is even more useful than the articles that are being showing up highly in the searches.  And then you see what the top videos are and you watch a couple of top videos and you go, hmm, how can I make a video that's even more useful than these search results? And then once you've created that video, that article, then you can go and share that online and as you share that everywhere, people will start to pick that up and start sharing it as well and they might link to it on their website and that's the most authentic and simple way to do SEO. Now, I have to say one important thing. I'm actually not trying to do SEO anymore. I really am not. I'm not even doing the research like I've told you. I'm just making my videos in my own authentic way because right now I'm just saying this in case you're wondering, George, how come your videos don't get thousands of views and how come your web articles don't get hundreds of likes or whatever? I'm not trying to do SEO anymore. I'm actually quite content with where my business is right now and I'm quite content at the gradual rate of growth that I'm having because I don't want, I can't handle more clients than I currently have already. So just in case you're wondering about my own results, I'm perfectly okay. But if you are trying to grow more rapidly then I would recommend that you follow the advice that I've given you in this video and be sure to look at the advice in the notes of this video. I give a lot more information about authentic search engine optimization.


In this video, we will see what my Stardust Dragon graded. What's up guys, in today's video, we are coming to the end of a journey, a journey that we went on through multiple videos, live streams, boxes, packs, thousands of packs to pull the Starlight Stardust Dragon. It did take us over 130 booster boxes. There was disappointment, regret, and finally, excitement at the end of this journey. But we're not all the way to the end yet. We still need to see what the card graded. So before we do that, let's flash back to the poll. Are you guys ready for the reveal? This could be the card that I've opened, 130-something boxes to get. Woo, here it is. Is it going to be the Starlight? Please be the Stardust. Come on, will this be it? All right, let me pull it off right this. Now that you guys have remembered the moment, just in case you forgot, we can get into the results. I have not peaked at these. PSA graded one card. Fortunately for me, I sent it in at the $200 rate, and then they made that announcement. Now it's only $150, so that's fantastic. Today's a little bit of money there. Let's open this thing up. Today's return is not really that important what the grade is, because this is the card that I will be keeping. The journey that we had for this, the craziness we went through just to be able to pull this thing, there's no way I'm selling this card. So we want the 10, but at the end of the day, we're just here for the card. So let's see if we can not spoil it. Here it is, the Starlight Stardust Dragon that we pulled in the live stream. Let's pull it out of this thing. Let's check it out, see how it looks. We've had some pretty good luck with PSA returns recently. That doesn't mean anything now, but hopefully that means we will do okay here. So it looks like there's nothing in the case, which is fantastic. You love to see that. Maybe a tiny little dot right there. But other than that, pretty good. The corners are looking pretty fantabulous over there. Let's check that one out. Yeah, okay, it is. Pretty nice. Okay, who is ready to see this card again? Starlight Stardust Dragon. Let's check out the sintering on it. Sintering maybe top to bottom is not absolutely perfect. Pretty good though. Side to side, pretty good. The only thing is that I remembered from the pre-grade was these corners are not fantastic, which is pretty normal for, I can't even see this one very well, but it looks pretty good. It's pretty normal for Starlights, but yeah. So what do you guys think this got? Put it down in the comments. If you guys went into the giveaway that I have not announced yet, I will mention at the end of the video. Yeah, let me know what you guys think. Let's see. Will it get the PSA 10? Will it get the PSA 9? Stardust Dragon, Donna Majesty, The Ultimate Chase. We've opened hundreds of booster boxes. We opened thousands of booster packs, tens of thousands of cards to get this card. And what did it get? A mint nine. Okay, yep. All right. Well, as I said, this is not one that I'm going to be selling, but still pretty sad.  Yeah, so pretty cool card. It's nice to have it slapped up. It looks absolutely amazing. So that mint nine, you know, we've had some pretty good returns. I can't complain too much, but pretty cool card. I hope you guys enjoyed the short PSA return video. If you made it to the end of the video, you guys have a chance to win this super miscut Gold Rare Ginzo. Just like the video, be subscribed, and let me know what you think about the PSA return. That's going to be it for this one. We do have to shout out our Ultimate Patreon and YouTube members, which are TCG trusted cards, Stanley, Mike Nantz, and Mimic Gecko. Thank you guys for the support. And I will see you guys in the next video. Peace.


Get all of this done, and move on. Vote Conservative on Thursday.  What? Well, they're arguing, they just need to get it done. I'll get it. Hi. Who is it? It's...it's Carol Singers. Give her a coin and turn the bugger off. Let's get this done.


This is stock number 9296X. We are here at Summit Automotive in Fond du Lac, Wisconsin. Your new and used Ram headquarters. We are checking out this extremely clean 2011 Ram 3500 crew cab long box Cummins diesel. From this HD video you'll be able to tell that this truck is in extremely nice shape all the way around. Deep Cherry Pearl is the color over white gold. It has General Ameritrac tires on it. These are 235 80 R17s. You get the steel rims with the chrome covers and these tires look like they have roughly about half the tread left on them. Frame and underbody is extremely clean on this truck. We shoot all of our videos in 1080p so if you have HD capabilities on your computer tablet or a smartphone device or whatever you may be viewing this video on, turn them on now because it's like you're right here looking at the truck with me. Passengers side rim is in excellent shape and as you go down this side of the truck you can see just how clean the body is, how reflective and glass like that paint is. We take these videos so if you are far away or even if you're close behind you just cannot make the trip down but you're still interested in purchasing the vehicle. You can still see the truck, hear the truck and have confidence in the vehicle that you're looking at before you even get here. We sell a lot of these trucks out of state so we want to give the most accurate representation possible so that when you get here there's absolutely no surprises. See the lower lips and rockers look really good on this truck. I wanted to get down here this low so you can see this duly tub. They got this 3M tape on here so it keeps your paint nice and clean because that's usually it gets pretty bad road rash but it looks really good. I didn't see any chips or anything on the paint. This back rim is in excellent condition and the back tires have just as much tread as the front tires. See the frame and underbody on this truck is in really nice shape. We'll get all the way underneath here. I just said we want to make sure you get the most accurate representation. You can see it has all the remaining factory exhaust and that the frame and underbody is in just an exceptional shape. Considering this is a 2011 once again those lower lips look really good it's like that all the way underneath. Didn't see any dents or dings on the duly tub on this side. Rear bumper, you get the backup sensors, full towing package which includes receiver hitch four pin and seven pin wiring. The tailgate is in excellent condition, no scuffs or scrapes or dents, backup camera locking tailgate. It has a spree and bed liner with a gooseneck hitch also the seven pin wiring for that gooseneck hitch back here as well so she's all set to tow whatever you may need and the bed itself is in really nice clean condition. Finally as we go down this side of the truck just as clean as the passenger side. Didn't see any dents or dings on this side. Paint is in excellent shape this back rim just like the others. Once again that duly tub is in really nice condition and I didn't see any dents or dings down this side of the truck. These mirrors they fold out like so has the heated mirrors they also fold in like so. Inside the Laramie package gives you the tan leather interior. Both of these seats are heated and cooled. There are no rips, there are no tears, there is no wear. Memory driver's seat. This truck's never been smoked and we got factory floor mats throughout. Carpentine is like new underneath. Power windows, power locks and power mirrors. Factory brake controller, auto headlamps on this truck as well. And this truck is so clean because it only has 28,474 miles on it. You get the heated leather wrapped steering wheel. No scuffs or scrapes on that. This one has the Alpine sound system, the 430N radio which gives you the factory navigation. You also have Bluetooth audio capabilities. You also have a hard drive in here which gives you 28 gigabits of sound storage. You have an AUG as a USB jack and finally your backup camera shows up right here. We have factory exhaust brake, tow haul mode, your plug-in which is right here, 115 volt, 150 watt. You can turn those backup sensors off if you don't like them. Dual climate control and of course all your climate controls right there. Turn dial, four-wheel drive, passenger seat is absolutely perfect. No rips or tears. This truck has never been smoked in. Smells extremely clean. No pets. Just a really nice truck. You got dual glove boxes and the Alpine sound which is kind of a neat deal. In the back they got speakers in the ceiling as well as a subwoofer. Back seats are just as clean. No rips or tears. These back seats are heated. Your buttons for those are right there. And you have a power sliding rear window. There are those speakers in the ceiling to give you that extra oomph on the sound. Storage underneath the seats and then underneath that side is where that subwoofer is. You got in-floor storage right here. Two of these bins. These come out for easy cleaning so you can put ice and drinks and stuff in there and avoid having to carry a cooler with you. Finally latch child safety system for your car seats back here. Once again no rips, no tears. Absolutely perfect on the inside. On a scale one to ten I'd give it a 9.9 for the interior cleanliness. Outside I'd give it a 9.9 as well. Super clean. Engine bay very very clean as well. This truck has been fully safety and inspected by our service shop. Has a fresh oil and filter change. All the fluids have been checked and topped off. Truck has been gone through mechanically 100%. Even the little light works on the hood there. And to see more pictures of this truck or one of our other 400 new and used cars, trucks, SUVs, minivans, Wranglers. You name it we got it.  Videos of every single used vehicle that we have. All at SummitAuto.com. Thank you so much for checking out the video.  Ask for one of our sales associates to make this truck yours today. Once again that number is<PHONE_NUMBER>. Thank you so much again. And if you want to check out more videos go to youtube.com slash summit auto. Remember to like, subscribe, and share on those and this video. In fact in a second you'll see a link to subscribe to our YouTube channel on your left. A link to more heavy duty truck videos like this one on your right. If you haven't been to our website on the bottom a link to this truck on our website. Click those checks out. Check the truck out and we really look forward to help you with this super clean 2011 Ram 3500 crew cab long box duly Cummins diesel. And once again that number to call is<PHONE_NUMBER>. Thanks again.


My name is Tyler McCarty and I'm a Denver Public Safety Cadet with the Denver Sheriff Department. One of the great opportunities we get as cadets is working out here at the vehicle impound facility. We get to work with K-9 units, we get to search cars that are getting ready to be sold for auction. I am searching this car looking for weapons, drug paraphernalia, any type of personal information that we need to remove from the car. Making sure it's safe so that they can sale it. I wanted to be a cadet because I really looked forward to working in public safety. I knew it was going to shape me into being a more well-rounded person. It gives you friends that you're going to have for a lifetime. It gives you so many opportunities to better yourself. I love the Sheriff's Department. I like wanting to do something that's hard enough that other people kind of don't want to do. And I like that I know that I can do it and that I'm able to do it.


Well, thank you. Well, in a comparable format, I'm going to do a reaction to what you just heard, but I was also asked to do one other thing, which is to provide a brief overview about how coverage decisions are made, specifically about sequencing. And to do so, I'm going to give a brief overview of that. But I want to disclose that I am not a payer that may disappoint some of you, but I study payers, and I also try to engage payers in research. So with that background about my perspective, I'll begin. So I thought about what Dave shared as slides ahead of time, and I've been reading about CSER. So these are some of the key payer questions that I would think about in terms of clinical sequencing. And that's how to evaluate the benefits and risks of tests that analyze different genes and variants at one time. So this is inherently a clinical utility question. And thinking about what CSER does, what are the valid study designs for assessing clinical utility? We've heard a lot about randomized controlled trials, and payers certainly have heard that that study design, while desirable, is not feasible for clinical sequencing. So what are the alternatives? Is it large cohort studies? Is modeling, as Dave suggested, is that acceptable? What are the valid study designs? All of you certainly have the expertise to help payers with that. But fundamentally, before we talk about clinical utility, and I am going to confine my remarks to clinical utility today, because that is something that payers are uniquely asked to evaluate. How can they be assured that the analytic validity and clinical validity of the test are established? Not only for an individual test, but across laboratories, because we know that many, for example, panel-based tests are offered by different labs for the same indication. Let's say breast cancer inherited risk testing. And I share with you on the right-hand side a publication recently that I'm sure many of you saw in the New England Journal of Medicine, where, at least in the opinions of these authors, they felt that some of the commercially available gene panel tests for inherited breast cancer risk did not include some clinically validated genes for breast cancer risk. So that's a concern that payers have. And they don't necessarily feel that they are qualified in all cases to know if the tests are analytically or clinically valid. And when evaluating a test for a particular indication, why are more genes better? So, for example, why a whole exome or a whole genome sequencing-based test rather than a targeted panel? So what is the value, as Dave has just defined it, of adding additional genes? And then thinking more globally, how can they support appropriate clinical integration of these tests with providers and with patients? So as I think about how would all of you define appropriate use of the test if they do cover it? So I think it's important to put it, all of the discussions that payers are thinking about these tests as they're asked to cover them into sort of what's going on in the recent past. In general, personalized medicine tests, as all of you know, have had difficulty gaining coverage. And people have attributed that to a lack of evidence of clinical utility. And there's been certainly notable exceptions, and I put some of them up there. There's certainly a lot of predictive tests to guide drug therapy decisions. But I think the field in general has felt like there've been some important gaps in evidence generation to demonstrate the clinical benefit of a non-sequencing-based genetic test. And I think there are three potential reasons for that. There either is no benefit, that there's a lack of incentives for researchers and test developers to conduct the necessary studies. And I think that is a very important point about lack of incentives. And or the definition of benefit of clinical utility is too high of a bar and needs to change. And we heard Robert sort of discuss three different definitions of clinical utility and suggest that the most restrictive or narrow definition is the definition that payers have been using and saying that it's a very high bar. And whether or not you agree, that is indeed the definition they've been using. But I just wanna draw your attention to the present now specifically, so that's sort of the backdrop, the context for coverage of decision-making for clinical sequencing. There is recently and work funded by NHGRI outside of the CSER program recently been conducted a Delfi study where I've been collaborating with some folks in the room about what do they consider the top barriers to clinical adoption for sequencing. And of course reimbursement came to the top. And right here you can see sort of the top three challenges that they think that payers have different evidentiary standards for assessing clinical utility leading to inconsistent coverage and reimbursement policies. I think you'd all probably agree. They think that payers refuse to cover clinical sequencing because specific patient management decisions that should be informed by the testing is unclear when the test is ordered. And then basically this is the failure of the reimbursement and coverage framework to keep pace with the rate of sequencing based genomic discovery. And this was a Delfi that was conducted of many different stakeholders. There were payers in the mix, but it was a very diverse group of sort of all of the usual stakeholders. And many of these people when asked about the policy solutions felt for the top priority that different payers have different evidentiary standards that it really would require a multi-stakeholder group to help come together and develop those standards. But the idea was to get rid of the variation and have a more predictable reimbursement pathway. There's also another study funded by NHGRI to actually look empirically at how are payers making coverage policy decisions about sequencing based test. And the first look that we're taking a look at is how are payers making coverage determinations for panel based tests specifically? So we're taking a look at that in the largest payers in the United States. So we will get some answers. So I said I would talk briefly about coverage. And I think it's just worth saying that coverage is just one aspect of how you get something paid for in the United States. Many of you know this, that there's actually three parts. There's the coding piece of it as well as the payment piece of it. But I'm only gonna talk about coverage today. And really it's a more complicated picture. It's is the technology part of the defined benefit package? And what is the evidence? And then that's the first thing. So it has to be part of what the employer sponsored plan or what Congress says is a part of the defined benefit package. And then if yes, what is the evidence to support the conclusion regarding medically necessary versus experimental and investigational? So that's the framework. That is how payers are evaluating clinical sequencing. So all of you know these three things of analytic and clinical validity and clinical utility and we'll go through it. But I just highlight for you here that only payers are explicitly charged with looking or have chosen to look at clinical utility. And right now the definition that they're using, I apologize for my voice, I have a cold. Does use of the test lead to improved patient outcomes compared with the alternative? And the test has to impact clinical decision making. So it's the definition that you've heard all day today. I'm sorry to say that, but that's the definition that most payers are using. So the criteria that they're using right now on the left, I wanna point out a few things. These are the Blue Cross, Blue Shield Association criteria that they use, but many other large payers sort of follow either these criteria specifically or sort of generally. I wanna point out a couple of things. One is that it's evidence-based, that it's comparative. And that basically that those are the main two things that I wanted to point out. And that the sources of evidence that they go to is that studies have to come from the peer-reviewed literature. And that we've heard today as well that criteria have to be that the evidence it is relied on that they usually use evidence from professional or specialty society guidelines, for example, that's important, as well as typically evidence that's looked at could be FDA-labeled documentation, lots of independent technology assessments, they may use technology assessments done by EGAP. Sort of much lower down on the scale of evidence that have been looked at would be looked at would be what the test developer themselves may have produced if it's not in the peer-reviewed literature and may even look at guidelines adopted by other healthcare organizations. So Dave pointed out when you ask payers, would you cover sequencing or what evidence do you need to actually approve a technology, sequencing-based technology for coverage? And it's difficult to answer. The premise is somehow that sequencing is different. And I tried to lay out here for you and I gave you a couple of references. There's a really nice paper by Julia Trossman and colleagues about sort of all of the things that all of you in the room think are really great features of clinical sequencing and I would agree about with that, that it's efficient, that it has future utility, et cetera. It doesn't necessarily fit the coverage model that I just laid out for you very well. Payers, for example, can't really assess the efficiency of testing or future utility is medically necessary. If you get a single test with multiple results and some of those results are actionable or have clinical utility, but many of the other results do not, as we've heard all day long, and those other results the patient would better, are better seen in the research context than the entire panel is viewed by the payer as investigational and not medically necessary. And we've seen many coverage policies like that. That's just for panel-based tests. And I would agree with Dave that many payers right now then see whole exome or whole genome sequencing as experimental because there's not necessarily a specific clinical indication for that. Sorry about that. And then the whole idea that there are other studies other than randomized controlled trials. So people come and tell payers, well, there's N of one studies or basket studies or in silico modeling or other things that can show the value because it's just not practicable. They're not familiar with those methods and I would say that people in this room could actually help payers if see the value if more and more of those studies would become published in the peer reviewed literature. So this is my summary of what Dave has said that the CSER consortium is doing and I applaud you for that. Designing the clinical utility states for specific clinical applications absolutely and then using a variety of approaches with the advisory board and having site specific and consortium wide comparative studies using common data collection tools, et cetera. Exactly right. So here's my specific reaction. I think it's critical to engage payers. I think that having a payer advisory board to help the NHGRI CSER group and CSER 2.0 do priority setting would be critical. They are very familiar with this. Payers are involved around the country already in developing evidence. Some of you may have heard of groups like Optum Labs. It's a collaboration between the Mayo Clinic and United Health Group. They're already helping develop evidence. We know other payer groups are already doing that. Pares have been helping to develop coverage evidentiary standards. So they're not unfamiliar with this. They would be I think more than willing to help in priority setting and even giving advice on specific studies. I think it'd be great for NHGRI to continue to develop the infrastructure methods and evidence for demonstrating clinical utility. And I just chose a few indications of why they occurred to me. Pharmacogenomics because the variants are common and certainly for generic drugs or for tests that are already on the market, there aren't incentives for the private sector to do the studies. So I think again, there's a role for NHGRI to do those types of studies. We prenatal testing would be another area where there isn't a big investment there now, but commercially, payers right now, that's the one area that payers are paying for testing right now with non-invasive prenatal testing. And then disease risk prediction for all the reasons that we know of how to deal with the incidental findings. I think individual sites could adopt varying approaches to evaluating and help payers think through what are the other analytic methods to and help inform the field regarding how to either to interpret those studies because other than randomized controlled trials, what else could they be doing? And if you truly believe that the definition of clinical utility needs to evolve, then I think you need to actually demonstrate what is, how to actually measure and interpret those other definitions of clinical utility. I think there is gonna be an ongoing need for federally funded studies because even if there were consistent payer evidence standards, there's still gonna be major evidence gaps because the test developers are not incentivized to do the studies. We know about rigorous cost effectiveness studies that are dependent on effectiveness. So I think it was important for you to understand how coverage decisions are made and recognize the ways that clinical sequencing conflicts with the concept of medical necessity. And if you design studies recognizing sort of what the end game is, what the payer evidence needs are, I think that you're gonna definitely be a long way there. And I think it's only NHGRI and groups like this that are gonna help in understanding how sequencing achieve its disruptive potential, particularly in community-based care and in diverse, hard-to-reach populations like we heard in our last presentation. But unfortunately, even if we had consistent evidence requirements, there's still gonna ultimately be variation in how payers make coverage decisions as each insurer interprets evidence in their local context. So we're never gonna have perfect certainty at the end of the day because payers make local decisions. So thanks very much.


Good afternoon. Good afternoon and welcome everybody. Welcome to the audience in this room today and to everyone who is following us online on Zoom. Welcome to this first day of this two-day workshop on technology transfer in life sciences, organized by Human Technical, NetVal and Yus Pavia. I am Nicola Nozingo. I am the editor of Nature Italy. I'll be moderating this first day of this workshop. I will only say before starting to introduce our speakers today that as a journalist covering science, research and innovation in Italy, I am extremely interested in the topic of this two-day event because technology transfer is an essential element for the future of Italian science and ultimately of the Italian economy. We spend a lot of time with science journalists and scientists alike saying remarking how important it would be to increase the investment in research, either basic or applied in Italy. And of course, that's a very important topic and we are right in keep saying that. But that's only one of the wheels of the mechanism that turns science into an engine of growth for a country. Another essential wheel is technology transfer. Not coincidentally, the Italian recovery plan, the PNRR, PNRR puts a lot of emphasis on the topic of technology transfer and it is essential to improve the mechanisms and ultimately to improve the culture around technology transfer in Italy. So this two-day event is the beginning of a project and of a new role that Human Technical will assume with respect to the Italian community on the topic of technology transfer. And over these two days you will hear a bit about the topic of technology transfer in life science in its various aspects and also a series of case studies of scientific projects that made it into becoming innovation projects, companies, successful companies and so on. Now to tell you a bit more of the meaning of this workshop and of the larger project that Human Technical has, I would like to invite to the stage Fabio Terragni with a member of the Management Committee of Human Technical in particular in charge of technology transfer. Fabio Terragni has been involved in innovation in various capacities as a professor, as a consultant, as a manager of public and private innovation ventures and he will tell us a bit more about Human Technical's project in this field. Welcome Fabio. Thank you and welcome here in Human Technical to all the present audience and to the people who is following us online. It's a pleasure for me to welcome you and to thanks the people who organized with us this first initiative in technology transfer. That's Netval, that's the National Association for the Valorization of Science and use the superior high-study school that will be presented much better than what can I do by Ricardo Pietrabiça in Paria. Together we organized such a workshop because we wanted to emphasize that in Italy there is not only a very good science in life science and not only but there are also a lot of interesting and wonderful experiences in the technology transfer of the knowledge that has been acquired in the laboratories. So we want to support the growth of the technology transfer I can say movement and helping all the young researchers, all the researchers and all the institutions who are involved in this venture to do the best with our small support because even Human Technical is a starting venture so we want to stay with you and with the existing institution to reinforce to strengthen the technology transfer research movement. I want to introduce you what's going on in the Human Technical now in the first slide we can see in the following slide we can see okay thank you sorry we want to recall what's our mission Human Technical has been established to carry out frontier research to improve people's health and well-being with a setup of large-scale laboratories where we started to build with interdisciplinary laboratories we research infrastructures and it wants to be an open hub to all the community of researchers in Italy and not only in Italy and one of the mission of Human Technical is also to develop industrial collaboration and technology transfer activities. In the first years of activities of the Human Technical we have been able to develop some starting points such as first of all the choice of the main directors first of all Jan Matai is the scientific director of the Human Technical he comes from the European Molecular Biology Laboratory in Heidelberg and has a very strong experience in developing and managing such kind of institutions in the following months we develop you know offices and laboratories and now at the end of 2021 we reach the number of 200 people of staff part administrative staff and part research staff and we hope to reach the number of 450 people at the end of 2023 so it's a growing hub doing research working with the national health system and industry and now we have been appointed with a new role that has been a low the low decree number 2034 of May 2020 giving us the role of establishing a center for innovation and technology transfer inside the Human Technical and to promote collaboration in the field with existing institutions so we are doing both such activities this is the first initiative in the field of technology transfer and we are very happy to have a high-level panel and we want with this initiative motivate young researchers to do their best in you know developing their research and transferring to the market so very briefly we will take care of IP management of dissemination research results of networking in the field and strategic development in life science as I said this is the first initiative it will be followed to with a by a course I would like to call a course of training in technology transfer with more detail that will be developed together with netval in the following months and there will be other initiatives that we will present in the following in the next few months that's it thank you again I give back the floor to the moderator thanks for coming here and have a nice time with us thank you thank you thank you very much to Fabio Tarragni for this introduction I'm sure I'm sure the initiatives you have just presented will be extremely interesting interesting for the Italian scientific community and for the many researchers who have a potential innovation waiting in their labs and on their tables


it being 1015. It is it is time for member statements. The government will come to order. I recognize the member from Michigan. Go walk James Bay. Thank you Madam Speaker. Speak on behalf of small truck business operators in Northern Ontario. Speaker owner operators as we call them are independent family owned operations. It is a business that is passed from one generation to the other. But the current insurance regular regulatory framework is killing the small business speaker. Ontario regulations imposes a three year benchmark for truckers, which means that business operators may have to pay a premium that may be five times higher. If they wish to hire young drivers or anyone willing to enter the business, there are extreme situation like Peter Lavotte in the writing of Tamish Kamin Cochran, who cannot hire his own 30 old son. Even if he has completed the provincial mandated training, received 200 hours in class and on-road training, and has operated a tractor trailer for more than two years. Speaker, business operators like Peter LaRocque, Guinele, Guettin-Dorval, and Don Gadal are those heroes that ensure the food was on their shelf. The medicine would arrive at our pharmacy during the early period of COVID-19 pandemic. I demand the minister of finance to once and for all side with small business owners of this province and put an end to the insurance underwriting rule that are killing small independent business. Thank you, Madam Speaker. I recognize the member from Don Valley East. Thank you very much, Madam Speaker. As we know, social isolation is becoming a bigger problem for people as COVID continues to spread here in Ontario. I'd like to take a moment to really thank one of my constituents in Don Valley East who literally stepped up and who's trying to change the behavior associated with social isolation. Abdul Rashid Athar, immigrated from Pakistan and he's a Canadian that lives in my riding of Don Valley East and lives in Flemington Park. He's an avid walker and he puts in 14 to 15,000 steps a day, something he learned from his father. Looking at his community during the pandemic and noticing that more and more people were becoming isolated, he started to get out there and talk to people by putting up posters and meeting people and letting people know that they could actually get out and start to walk. He got a grant from the Balsam Foundation and more and more people started to join him in this initiative. Collectively, through this initiative, Madam Speaker, they've put in 23 million steps and covered almost 18,000 kilometers around Toronto. It's this type of initiative, Madam Speaker, that I think as legislators we need to recognize in this house as heroes step up and actually motivate people in our community to get out of their homes and to practice, of course, to make sure that they're safe, but at the same time get the physical exercise they need. Thank you very much. I recognize the member from Mrs. August Center. Thank you, Madam Speaker. It is a privilege to rise today to speak to an important and symbolic day of recognition of Francophones in our province. September 25th is Franco-Ontarian Day, a celebration dedicated to recognizing the history and strength of Franco-Ontarians. On this day in 1975, the Franco-Ontarian flag created by history professor Guetta Gervais and political science student Michel Dupuis was first flown at the University of Sudbury. I'm also proud to say that thanks to my bill, there was a past in third reading, this flag awaits proclamation to recognize this official emblem and this is something that I will remember for the rest of my life. On this day of Franco-Ontarian day, we will recognize a founding community that is present here in this province since over 400 years ago. On this occasion, we recognize a number of contributions to social, cultural, economic. We commit as legislators to continue to work to ensure that Francophones can have their linguistic rights protected. When the beautiful Franco-Ontarian flag will join the others in this chamber, as a reminder to all future MPPs and all future generations that will visit this house of the rightful place of Franco-Ontarians in our province. Vive la Francophonie. Merci. Merci beaucoup. Member Statements, the member for Windsor to come see. Speaker, allow me to tell you a current story about our living history. We all know the First Nations people were here long before we arrived. Some of us accept that we need to consult with the First Nations on major projects we undertake on their ancestral lands. Case in point, the new International Boarding Cross, Border Crossing, the Gordie Howe Bridge between Windsor and Detroit. Native artists and volunteers from the Walpole Island First Nation are involved with the bridge builders in a massive undertaking. They're creating huge panels which will be erected on the main pillar of the bridge on the Canadian side. Painted panels on all four sides of that pillar and speaker, they'll eventually rise to something like 800 feet in the air. Just imagine. The panels are working on now depict four bears, white, red, black and yellow bears, the sacred colors of the First Nations medicine wheel. Below the bears, there'll be four arrowheads sticking into the brown ground representing ancestors who walked these lands long before we came along. Another panel being prepared is of the familiar Eagle Staff. Island artist Teresa Altiman is creating these panels. 17-year-old Daisy White is working on the Turtle Island creation story and Caldwell First Nation artist Naomi Peters is also doing a panel with the hoop dancer. These panels will rise with construction timetable and possibly be repurposed after construction is complete. Speaker, it's an amazing undertaking and an exciting way to acknowledge our shared history. Thank you. The next member statement, the member from Mrs. Saga Malden. Thank you, Mr. Speaker. Mr. Speaker, as Canadians, we love sports and our love turns into a passion when our athletes win medals. When I think of a value of a medal, I truly believe that we can't put a price tag on the medal because the prestige that comes with it is priceless.  Every time our athletes win a medal, it brings the whole country together, celebrating the success of our athletes as their victory and success. Supporting athletes from playground to podium is an important part of making Ontario the best place to train and play sports. That is why through the quest for gold program, the Government of Ontario is providing 6.36 million in direct financing, financial assistance to 141438 high performance athletes to ensure they can pursue their dream of excellence at home in Ontario. Mr. Speaker, I would like to say thank you to Minister of Sports, Culture and Sport Minister Lisa McLeod for supporting our champions. Quest for gold funding benefited 83% of the Olympic and 95% of the Paralympic athletes from Ontario who participated in 2018 games. I want to give a special shout out to the four recipients from Mrs. Saga Malton, Radane Wright, Navarit Suhan, Mary Dwarquah and Kyle Duke Simpson. I'm proud of you. Congratulations on being a Quest for Gold athlete. Due to COVID-19, this year has been challenging. I wish best of success to all recipients of Quest for Gold this year. I hope this funding allows you to reach the stars and the medals you want to push yourself to be the best you can. We look forward to your success as your success is our victory. Thank you, Mr. Speaker. The Member for Algoma, Manitoulin. Thank you, Speaker. Speaker, you believe in miracles. I believe in miracles and miracles have names. Name like Landon, a little boy from Manitoulin Island who survived his cancer treatment. Name like Elijah. I call him Lil Bean. He's from Elliott Lake. He's my little heart warrior. And just last night, I had Drew, who came into my condo and spent the night with me along with his mom. He's a two-year-old boy. And by the way, he sang me his ABCs last night and he did a little bit of a fashion show for me. But his mom, Alicia Allaway and Dylan Spooner were also there. His grandma, which is Oma, who normally comes down, unfortunately, she's in the Sudbury District Hospital and getting treatment. I hope you're doing well. Oma, I'll see you next time during Drew's visit. But Oma surprised me with a visit last night.  And he's getting some, he's got, since he was born, he's had some esophagus challenges and multi-cystic kidney issues. He's got a variety of issues. But the reason why I raised this, and I want to go back, remember when I talked to you about miracles? Those miracles happen. And they happen just down the street from here over at Sick Kids. There is some amazing things that are happening there. And day in and day out, over the course of the years that I've been elected as member for Alcoma Manitoulin, I've seen, I've lived, and I've experienced all these miracles. I want to thank the doctors, the nurses, and all the health care professionals for your care, for your love and your attention to all the great people of this province. Thank you. Thank you. Thank you. Thank you very much. Member Statements, the member for Scarborough Center. Thank you, Speaker. And this is just a quick tribute to the people of Scarborough Center and Scarborough more generally. We're going through very difficult times, but the people of Scarborough are truly rallying, and I just want to give a few shout-outs to some of our Scarborough superstars. Jadonce Dance Studio held an outdoor recital where they rented a huge stage for their kids, just so that they could see each other and dance. Baskets. Robin is running this place amazingly. They are seeing growth. She's hiring people, and I was actually visiting when she announced to four staff that they're getting raises during this time. Casco Designs is working so hard to get signage that all of our businesses need to the community. Energy Shack.  I am one of them. And Nova Racerante, the winner of the Big Hearts Award. Even as you're struggling, you're still committed to charity and helping the community. And I just want to thank all of the amazing and resilient people of Scarborough Center. I saw many of you on my ice cream tour, and I was so happy to connect and share in the common experience that we're currently going through.  And although we're going through unprecedented and extremely challenging times, this too shall pass as all things pass. And I know in my heart that the people of Scarborough and Scarborough Center will come back stronger than ever. Thank you. The next statement, the member for Toronto St. Paul's. Good morning, Speaker. During COVID-19, my community has mourned the death of loved ones, devastating loss of income, small businesses, and for some the loss of their home. Many seniors and disabled neighbors have seen their cupboards bear. But we are still here. Our community is as strong as the shofar, and to borrow from the teachings of Yom Kippur, the holiest day of the year in Jewish tradition, we continue to cry out with a full throat in our commitment to each other. Thank you, Joanne, for dreaming up our first community food table. Thank you, Sherry, Hani, Rob, Murphy, Robert, Ingrid, Profitus, Abdisah, Ginny, and Megan for joining us in scaling this project. Our message was simple. Take what you need and give what you can. Thank you to our 100-plus volunteers who have helped us grow. And thank you to my staff and to my amazing Riding Association. Speaker, we have about seven food banks that serve our community, four hot meals program, six out of the cold program, drop-in shelters, and several community gardens, but it's never enough. Many of these supports shuddered during COVID. Stomps still are. And for some, that has meant social isolation and a lack of access to the very basic needs that make us human.  Her words continue to haunt me. St. Paul's, I see you, and I will continue to stand with you. Thank you. Thank you very much. Member Statements, the member for Niagara West. Thank you very much, Speaker. I rise today to draw attention to an important date for tourism here in Ontario and across the globe. On September 27th, the world commemorates the 40th anniversary of World Tourism Day. This year has been designated as a year of tourism and rural development to promote the potential of tourism to create jobs and opportunities in rural areas like my riding of Niagara West. Mr. Speaker, it would be an understatement to say that 2020 has not been the best year for tourism here in Ontario or frankly anywhere else in the world. Tourism has always been a key economic driver here in Ontario, supporting more than 400,000 jobs and generating over 36 billion dollars of economic activity. Tourism supports a spectacular double bottom line, contributing to the economic growth of our province and to our cultural identity and pride of place. But this sector was hit hardest, was hit first, and will take the longest to recover. Throughout this crisis, our top priority has been the health and well-being of the people of Ontario, as it should and it will remain so. But World Tourism Day gives us a chance to thank Ontario's tourism and hospitality workers for all that they do and to acknowledge all they've been through in this difficult year. So on World Tourism Day, we recognize the important World Tourism Place in smaller rural communities in Ontario, in the north and other places across Ontario. These areas and sectors that are heavily reliant on visitors internationally and from the U.S. have suffered greatly and I know that the Minister is working with them to ensure to discuss the impacts of COVID-19 on this industry. So I invite all members of the House to celebrate World Tourism Day this coming Sunday, September 27th, and to remember that Ontario is yours to discover. Thank you. The Member for Willowdale. Thank you very much Mr. Speaker. Today I rise to recognize the small businesses, non-profits, and community organizers who've stepped up during the last six months to provide essential support and PPE to those in need. To all our communities, through all of our communities, I've seen thousands of Ontarians deliver food, run errands, connect with seniors and vulnerable people during COVID-19 as part of the government's partnership with Spark Ontario. In my writing of Willowdale, hundreds of volunteers have been generously giving their time and money to serve our community through the Willowdale COVID-19 Response Network, The Kindness Project, Valley View Day Program and other groups. Small businesses such as LugLife and Levelware have donated PPE to organizations like the Canadian Helen Keller Centre and Willowdale Welcome Centre. Most recently, I was invited by my constituent Andy and his mom, Mrs. Chung, to visit their family-owned small business, Saletta Dry Cleaners, to pick up over 500 cloth masks. Masks that will be donated to Eva Satellite, a youth facility in Willowdale that helps provide shelter, transitional housing and programming for young people. When I arrived at their store, Andy and his mom were hard at work sewing and packaging masks in between serving their regular customers. When asked why they were donating, their reason was simple. They said, we want to support our community because our community has always supported us. Mr. Speaker, I want to thank Andy and Mrs. Chung. They truly embody the Ontario spirit, the people of Ontario's compassion, grit and willingness to assist one another is what makes me proud to call Ontario home. Thank you very much. That concludes our member's statements for this morning. The member for Mississauga Centre is informed me she has a point of order. I'd like to wear our beautiful Franco-Ontarian Pins. I'd like to encourage all members of this assembly to wear theirs proudly as of this afternoon. This will become an official emblem of Ontario. Thank you. The matter is seeking unanimous consent of the House to allow members to wear a Franco-Ontarian pin today. Agreed? Agreed.