Terrific. Thank you. Well, I appreciate the opportunity to address this conference here While I get the opportunity this really represents the work of a lot of people at North Shore I have a lot of great team members. So I'm very excited to share our initial experiences As I was mentioning during the lunch session, I think with the implementation of this We're definitely charting a new direction But that path is still a dirt road and we have yet to pave it So we've learned a lot but consider this version 0.9 not even version point 1.0 of where we need to be and where we want to go So just some quick disclosures here Just for those of you who may not be familiar with North Shore University health system We are our medium to large-sized health care system on the north side of Chicago We are patient catchment areas from downtown Chicago up to basically the Wisconsin border We have a relatively large center for medical genetics with three MDs and five genetic counselors on staff currently But like most institutions, you know, we were asked, you know, the fundamental question Well, how do we really start to scale services over a relatively broad geographic area? recognizing even with a large by many standards genetics Division, how do we really capture the patients that we need to be seen or at least identifying patients who may benefit from? genetic risk assessment and testing potentially we all start faced with a lot of Similar realities that are like local patient population is just demanding these services We're in a competitive area. Our footprint is also One where they demand the the latest innovation and application to their care as well We did have our center for medical genetics, which for those in the crowd may not realize We were actually started initially by Henry Lynch of Lynch syndrome in 1997 so we do have some historical roots in trying to Bring genetics and genetic applications to our clinical care, but like many centers You know, we're limited in capacity with how many patients we can actually see and really this served our clinic as a foundation Well, how do we integrate and expand into other specialty clinics and overcome the same obstacles in a more systematic way? That's preventing us from identifying patients who may benefit from clinical genetic services And really our vision has been now with the Center for personalized medicine How do we really bring genomics to the front lines of care? You know, we used our specialty clinics as a launch pad for this for assistive-wide initiative and really Was the foundation for the creation of our Center for personalized medicine To help us with developing the workflows and the educational aspects both our provider and patient facing that are critical To have success in this arena So we're not immune to the challenges many of us face. There are a lot of time constraints We have to educate not only your physicians, but patients and all their healthcare providers from The administrative staff who helps check in the patient to our nurses to the clinicians and patients themselves Challenging bowels with appointment links in terms of how do you deploy sort of a risk assessment tool? There's many competing initiatives and guidelines that our primary care force have to manage for that are important for patient care and Still there's a lot of realities versus myths that are out there regarding cost of testing insurance reimbursement Awareness of Gina and other protections and where those limitations are in terms of the regulations and Sort of the elephant in the room is how are we really going to integrate this into electronic medical record? One of my goals is help create more seamless workflows We're on an epic-based system and we have a long history of integration across our health system So how do we start to leverage our EMR in a positive way with genetics? Whereas before finding a genetic result could be very difficult in the electronic medical record As I mentioned well There are relatively few of us who are fully dedicated to our Center for personalized medicine in terms of FTE support the FTE's Involvement has to cross many different lines and divisions and so breaking down the traditional Barriers of siloed approaches was key to our launch and in our broader mission within the Center for personalized medicine So having representatives of all these key steaks stakeholders and really how do we also facilitate the handoff from the research in a translational aspect? to the clinical and bedside care So this led to our genetic and wellness assessment Tool it was a pilot that began in 2017 and basically it's a checklist of genomics I check less that's sent to all patients before their annual history and physical care via a North Shore connect So North Shore connect is what we call at our epic my chart application and basically it was approximately 30 questions with Branson logic to help Identify patients, which we know is a challenge in any health system who may benefit from targeted testing So NCC and guideline-based testing etc. And it have either genetic testing presented as an option for Being proceeded with or for to one of our personalized medicine clinics as well The key to this is integrating with existing workflows We couldn't take our primary care physician out of their normal channels and of workflows Workflows once you tell them to go outside the EMR your project is pretty pretty much not going to be a success It also started to provide us with a platform to address some of the educational initiatives giving real-time Information to the clinician of why this is important for the patient and what could come of it? And what are the next steps of action as well? so It also was an opportunity of us to explore That transition and that opportunity from reactive and proactive testing. So what do I mean by that? Well, the reactive manner is you know traditional questions of NCC guidelines is there a history of breast cancer a personal history of breast cancer Oxygenase Jewish ancestry and probing at some of the cardiomyopathy questions with sudden cardiac arrest or or SIDS in the family as well as Or top of the these are things we know we should be asking about there are guidelines for incorporating genetic testing But we still have to do better as a health system of dead identifying these patients But then also moving to well an option for proactive because again There's a growing segment of our population for sure and we start we see this trend across The country a patients who want to know is there something in our DNA or change in our DNA that I should know about because I need to incorporate That into my screening and management Our health the healthy gene panel is our prime example of this And so this is actually if a patient doesn't answer Firmatively to some of the more targeted questions they're presented with an option to do a healthy gene panel And this is in vitae's healthy gene panel. I'm looking at approximately 139 genes related to Health risk as well as pharmacogenomics taking that proactive approach of well I want to make sure I'm on the right medication and while pharmacogenomics is not a crystal ball It's not going to tell the precise dose and the exact drug someone should be on It's another piece of information that can be layered upon traditional clinical parameters and one could argue that pharmacogenomics could also be a reactive We know there's a diagnosis for example perhaps depression that this information will be important as Getting in terms of the next step for the our patients care So practically what what what does this look like? Well part of the experiences It needs to look like it's part of the patient experience as well Just like any other appointment process as well So this is an example of what a patient would see through our North Shore Connect again. This is What we call our epic my chart and basically about five to seven days before Patients encounter they get a message. There's some things you need to do in terms of your upcoming appointment So for example reviewing insurance information, etc The usual logistic things that we need to take care of but then you have a health assessment tool That's here. The reason why it's called a health assessment tool is it's not just genomics initiative But we also have other things for example The depression screen tool that were required to deploy the wooly depression score as part of this initial questionnaire So this is the web view So your physician has asked you to complete this questionnaire and it asks for the knowledge Would you like to do it? This is an optional patients aren't required to do it but provides a way for our patients who are engaged To get this information to have an opportunity to Have this examined It needs to be compatible on a mobile phone or mobile devices many of our patients particularly the Millennials all they want to do is interact with their mobile phone and we recognize this. This is actually me filling it out before my annual history and physical exam What's what's been important is we've also tried to integrate with information that's already in epic So for example when I did this and I completed it here It says what some of the initial questions are do you have or is there someone in your family has had cancer? Someone had heart disease It's pre-populated with yes because it's pulling with them for pulling from information That's already in the EMR because one thing as a genesis that bothers me is when I go for my update my annual history and physical exam Every year I get the same blank family history Questionnaire and it's a little embarrassing as a jenessa that I have to think boy How did I answer it last year because if I get this wrong? This is going to be really embarrassing in front of my colleagues So we're working on the bi-directional aspect of it and that's a longer term ask But again, this is part of the dirt path we're building and we need to pave that road as well So part of this is well, how do we get this information in the workflow of our clinicians? So again, this is during normal workflow for physician Triaging based on the patient's answers and questions and recommends it depending on what the logic dictated a best practice to learn so this is one where we've gone through a variety of iterations as we've tried to You know engage our primary care of physicians Well, what is it what you want out of a BPA and so in the blue for those who can't read from the back Back this is what was answered affirmatively so we know what the reason so that offers an opportunity for the clinician to clarify Is this really what was part of the medical history that was important a little bit about well Why is this important some basic information? So in this case you're talking about the chance of finding a BRCA mutation someone who may have had oxygen anodized ejuice Ancestry then putting information about well, what are the guidelines say in terms of what would I do with this information? And then sort of what would be the next steps? And so part of this is providing a clear path Well, what do I do with this information so the clinician can know and Understand why this is important and sort of what's next and talk to their patient about this So continuing on this there are always There are a variety of options that can occur depending on what the condition is But there's always an option to refer to one of our personalized medicine clinics We're not trying to turn everybody into geneticists or genomics experts, but trying to provide an outlet for those clinicians who Want to be proactive in this manner So Part of it too is if there is a targeted indication there is a smart set that's built for a genetic test order That a clinician can Can utilize if they're comfortable with talking about the issues around genetic testing and that's an ongoing educational effort But for a lot of our OBGYN colleagues, so this pilot or this Program is for all our primary care, which we consider internal mass and family medicine as well as OBGYN Certain clinicians are very comfortable with this conversation in certain domains So with that We've had some some initial great success So again this although the pilot started in spring of 2017 We weren't really live at all our sites until about end of october november of last year. So we have had about 90 000 encounters That were eligible for this This questionnaire to be triggered. We have about 75 percent 77 percent completion rate And then we have about 51 percent of patients Who there was a best practice alert fired We're still working on scrubbing the data to make sure it's accurate. Well, what are these alerts? But it looks like maybe about a third could be related to More of the proactive elements of the healthy gene panel versus The pharma genomics testing so certainly encouraging because patients are you know are Adapting and and or excuse me adopting this and one of this part of their care So as far as you know, where do we need to go in an improvement? We have to get under the hood of the data and so we've created this personalized medicine dashboard That really helps us drill down on the processes and this is certainly Why the morning session with the implementation science really caught my eyes Because this is what we're trying to do use this data and figure out. Well, what are the choke points? We know there are some how do we deploy in a systematic way to overcome some of the hurdles So to give you examples what we're tracking we can look at everything from the patient demographics Who's really up taking us drill down to what alerts are being fired? Where are missed opportunities meaning we're a bpa fired but wasn't perhaps acted on What's happening to the referrals being generated? Are they matriculating to the clinics? Why are we not which labs are being ordered and whether they've been What part of the process they are I think something that's also key to is we're looking at well What's the downstream effect of this from a downstream revenue aspect because there's been a considerable investment Has been discussed. It's not just the cost of the testing but cost of a lot of the other Architecture around it. So what is the downstream revenue associated with this effort to justify? And to make sure that we're not shifting the paradigm in in the wrong direction in terms of our Of cost and care. We can drill down to patients or practice details at Sykes we know there's implementation challenges at different sites depending on the the patient population But also the physician population And so we can drill down at the physician level as well to start to really understand Where where do we need to provide more support or education as a personalized medicine program? So we believe at North Shore that there's a benefit To both patients and North Shore it's a start to a scalable approach. Well, how do we start to achieve system-wide integration? We are identifying patients who are at risk and who are unaware possible carrier status We've already had several BRCA positive individuals who've already Underwent preventive mastectomy as a result of this program We had an adopted patient who did not know the biological family history who was identified with the pms2 mutation and has already seen Our our colonel our our gi experts as well to put in appropriate screening as well as our gyna Specialists as well So we already seen these anecdotal But what we want to do is try to bring this into a more complete picture For the for the genomic community and we're seeing integration of our proactive screening There are definitely some early adopters and power navigators that are interested in information And we see this continuing to grow and we're gaining valuable experience in this effort as well We believe it's a differentiator for primary care We did some marketing analysis or our marketing team did some marketing analysis and about a third of patients had a significant Improvement and impression of the care delivered by the parent primary care physician as well as North Shore when they were engaged in this process I'm not a marketing expert, but I hear it's rare to get a single factor that really shifts You know a primary care Allegiance in such a way and so that's part of the reason why We launched a campaign highlighting primary care In this aspect our primary care physicians, you know, it's an exciting opportunity for them as well because not too many marketing campaigns or Initiatives really highlight primary care as much as some of the specialists There are significant challenges and opportunities that we still have to tackle education education education today list education It's something that You know, we are continuing to work on I myself have been going out. I'm on my second round of going to every primary care site Which is about 30 sites talking to them what's working what's not working We've done more traditional methods with grand rounds, etc. And webinars But I think, you know, we continue to need to ask well, what how can we do this better? Improve patient and clinical team follow-through. We know there's a drop-off at each step So we know we can do this, but how can we do it better now is kind of the key question We're looking at well, how do we systematically do? Where is the best opportunity? And really we think this is um, you know, how do we start to integrate this into somewhere of our affiliate physician practices as well to help, you know, the whole community Which is really, you know, important in our footprint and important stakeholders in their community And create that infrastructure that is necessary for this data sharing across different places that a patient might have touchpoints for their care So goals, you know, we're looking to employ some of the implementation research approaches to really assess these viewpoints From key stakeholders again continuing to support our primary care sites as we continue to educate them on the goals and the mission and improve our pull through statistics as well and ultimately improve patient care So with that, I appreciate the opportunity to share our early experience with this program Okay, uh quick quick clarifying question Could I just ask on the the pcp sites that you're working with? Did you choose them in some way or are you doing everybody or We we chose them because they're North Shore primary care sites. So it's all our primary care sites So we had three initial ones as a pilot But that was about a month and then we started to basically roll out One to two sites every week where I or one of my colleagues was on on site with the when they quote went live And so we did about two to three practices over the summer Going into we finally ended up in october and november where every medical group primary care site is is live And so by primary care primary care again, I mean family practice internal mess and an obgyn Okay, use your right. Sorry. Thank you I just a question with a 36 of respondents who you identified needing follow-up. That seems high What was driving that we have similar experience by way in florida campus. It was also a high when we used a question Yeah, so that's part of what we're trying to figure out. What's driving that response. So it could be a number of reasons Could be some of the elective things it could be was there confusion about the questionnaire And we're taking steps to further validate the questionnaire as as well the short answer is We're we're that's part of our year two goal is to see what's truly driving it We know some early things like we had some melanoma questions that You know, this is where we had to pivot They were not getting the sensitivity and specificity. We wanted and so we had to suppress those so It's a complicated question But we're trying to look at what are the key drivers and I don't have that yet But that's part of what we're building right now with our dashboards Peter thank you. I think we'll move on to Lisa Basterosh from Vanderbilt I'm looking at phenotypic mining in the electronic health records


What's going on, everyone? Sam here with Layton Sports Garage. We've been 22, 23. Peninoir basketball hobby, four box case number nine. Pick your team style. Redopolis of our names and our teams. Bernard H. Magic, Bohia B. Clippers, Boss Z. Sixers. C. Wang with the Spurs. Christopher P. Rockets, Cole P. Thunder, Dustin H. Kings. Eric W. Blazers, Gu H with the Pacers. Harper B. Cavaliers, James P. Lakers. Jason T. Hawks, Jason H. Timberwolves, Joel B. Nets. Joey Y. Pelicans, John H. Bulls, Josh B. Bucks. Kenny T. Celtics, Lee Y. With the Knicks. Mark M. Jazz, Miles H. Nuggets, Pension C. Hornets, Rory W. Warrior, Stanley W. Heat. Steve S. Raptors, Thomas C. Sons, Tom C. With the Pistons. Sai B. With the Gris. Tung Shing C. Mabs. And Weiming H. With the Wizards. So good luck here, everybody. Let's do it again. Three. Chase Field is such a tease. Three to go, NT Divisions, everybody. Three to go on NT Divis. Three to go. Three to go, let's do Noir. Noir time, Noir time. Yeah, for sure. What inning is it in, Vaughn? Yeah, what inning is it in, Vaughn? We haven't had it on. We've had the football. CFP. This just ended? Dang. Okay. All right. We missed a majority of the game. Eh. Where is it at? I'll see. FS1, maybe? Probably on TVOs, yeah, I guess. I think TVOs has all the National Regan box, has the AOs. Yeah, I guess that makes sense, yeah. And then the series is Fox. It's all Fox? I'm pretty sure. I'm surprised they got all of it. Or no, maybe they switch when they go to... Maybe, yeah. When they're... To 99 Andrew Wiggins. And Jimmy Butler, 99. Nice one here, Newsreels is Alonzo Morning. Nice, oh, that's two color. Little bit of purple in there. Some game worn Alonzo Morning. Rats on that, Hornets. It's a good morning. Yeah, as it is. Julius Randall to 99. Game used for the Knicks. This one's cool. Got Showtime signatures. That is gonna be a... Jake L'Arabia, 22 of 99. Jake L'Arabia, I'm assuming this guy's a Laker, but let me double check here. Freeze frame, yup. Card number two, Freeze Frame signatures, Lonnie Walker. Nice one there. Ah, that's cool. Wow. Congrats there, Lakers. Going to Tom with the Pistons. Showtime signatures, Cade Cunningham. There you go, Tom. 12-25, last team taken. There you go. I and M with a Noir, first off the line spot. Yes, yes they do, John. Yes they do. Who's like a cool one? Like, they have like AI is a nugget in this one, which is really cool. You can mad at this, Cade, I would say. Might as well. These Showtimes are fire. Dyson Daniels to 99 for the Pelicans. Okay, it's disgusting. Demontes Sabonis to 99 for the Kings on the base guard. And going to the Thunder, Chet Holmgren to 99 as well. Chet Holmgren. Again, just three to go on NT Divisions, two schools left in Bowman Chrome. You pick your team style, I believe it's Clemson and Clemson and somebody, I forget who the other team is. Oh, Schwabber with a homerun. Oh, so it is Gallon. Did Gallon start the game? Probably. Came right out everything. Beautiful. Schwabomb. Ooh, that's cool. I like this, actually. This is nasty. 50 of 99, reel to reel, James Harden. Thunder and Sixers, thank you, thank you, Mark. Thunder is Cole P and Sixers is, I'm assuming not Cole P. Cole P. Sixers is Boss Z. So yeah, that'll be a random reel to reel. Nice one here, three of five, Tyrese Halliburton. One of the Pacers and Steph Curry to 99. 89 of 99. Nice one here for Charlotte is Mark Williams, two-color patch to 99. Kai Jones' biggest nemesis. Biggest, Kai Jones' biggest op right here, Mark Williams. Steel of the Draft, AJ Griffin, 24 to 25, going to the Hawks, New Wave jerseys. On the patch. I got to come up with something for Kobe Buffkin. He'll be in a product decision. Oh yeah. Got A, Obi-Toppin, ain't no stoppin', Obi-Toppin, 15 of 25. Nice one there. Ferry pickin' up the Spurs and Flux. Nice one there in New York. Got A, freeze frame signatures, Herbert Jones to 99. That'll be going to the Pelicans. Pels, got ourselves A. Jalen Brunson to 99, reigning night signatures. Or the Knicks again, Jalen Brunson. I'm not, no, I'll retire for AJ Griffin. Cause last year it was rookie of the year, snub Jalen Johnson. And then this year it was Steel of the Draft, AJ Griffin. And then I got to come up with something for Kobe Buffkin. But if we pull an AJ Griffin in this year, in like 23, 24, I'll still say it for him, just so you all know. Suki K with some Flux spots as well. Christian Brown, nice one there, reigning night signatures. Going to the Nuggets, congrats Denver. There we go, take some Christian Brown all day. All day, Christian Brown. And to 99, Tyrese Maxi, congrats on that Sixers. But yeah, it won't be Steel of the Draft, Kobe Buffkin. Cause that would just be repetitive and unclassy. That's not what I would do. You're just not like that. No, that would be uncreative. I'm creative. Right, on to the next. Is it over? It did. Harper? Oh my God. It did, and that's Kyle's captain. Thanks to you. So good job. Come on. Good job. Oh, that's so dope, dude.  Wow. Anthony Davis to 99. Kade Cunningham to 99. And Palo Bencaro, vintage art, three of 25 on the frame. There you go, magic. Can we just hit crazy amounts of Palo in this? Let's go over. That's on that. There you go, magic. Ian Hardy on the rookie jersey, going to the maps. Vaughn, you've got a card coming up for you.  Rod Strickland going to Portland, 13 of 99. Well, it says trailblazers, he's got a magic jersey on. It's not like Rod Strickland is still playing and got traded, so that's odd. But again, that will go to the Blazers. That is Portland. I would, yeah. That is gonna be Spencer Dinwiddy to 99. Joe Engels, fortunately not Joe Engels. I don't think he's in this. I would be pretty surprised if he was. Oh, this is cool. Darren Williams, 26 of 99, box office, game used jersey for the Nets. Okay, you can mag. There's two coming, or, nah, just two. I'm not gonna say to mag the last one, but this one you can mag for sure to 99. Shade on sharp, 43 of 99, go into the Blazers. Congrats Blazers. Sharp looking sharp. That is sharp right there, that is a sharp guard. Yes, sir. And how about in back to back cases, RPA's number to five, Wendell Moore Jr., two of five. God, that's so cool. Two of five, Wendell Moore Jr., congrats on that one. God, this card is so sick, dude. I gotta buy one of these. Go into Sacramento, spotlight signatures, Peja Stojakovic, 68 of 99, dude, that's so sick. Peja Stojakovic, holy cow, man. God, that's so cool. And that'll be Sacramento Kings. Come on, Vijay, picking up a spot in NT divisions. Down to two, thanks, Vijay. Let's go. Down to two, that one's fine, by the way. It just seems like a very sentimental player. Yeah, I need one too, Vaughn. 100% need one, that is so freaking cool. It's decided so cleanly too. Two to go, NT divisions. Two to go, Bowman, Chrome, U5, or four to go on Mosaic Choice. Good stuff, everybody, thank you all, appreciate that. Whoa, all right, everything came out, there we go. Very nice. Empty, empty. Okay, I guess everything's on the top. We've got Andrew Wiggins to 10, eight of 10. Peja, yeah, dude, his son's a dog. To 99, Jalen Green for the Rockets. And then Ja to 99 for the Grizzlies. Got Chris Paul, Newsreels to 75, going to the Suns, game used jersey. I can make this next one. Sure. Showtime signatures for the Pacers, eggs, Benedict Cumberbatch, Matheryn. Ben the baller, Benedict Matheryn, congrats on that. Indiana, very nice, there you go Pacers. We've got Andrew Nemard, that is 57 to 99, going to the Pacers, again, congrats Indiana again. Very nice, this is dope. Going to the Pistons, Bill Lambeer. Nice one there, congrats Detroit, 78 of 99, Bill Lambeer, we've got to 10. That is two of 10, Tim Hardaway Jr. for the MAPs. Congrats Mavericks, Otto Noah. Followed by A, Peyton Watson, rookie jersey to 99 for the Denver Nuggets. And then A, Jake Lerabia, that is 79 of 99 rookie jersey for the Grizz. All right, that'll do it for the case, we're gonna start off with this Hardin, random. Thunder, Thunder, 76ers, 76ers. All right guys, again, doing the random for the real to real James Hardin jersey, 50 of 99, between the Thunder and the 76ers. Gonna roll the dice, whatever team is on top, after 10 we'll get it. One, two, three, four, five, six, seven, eight, nine, and 10, going to the Thunder, congrats. Okay, see, Thunder, Lightning and the Thunder, Thunder, Thunder. The Thunder, start with a Joyceys, thanks, sir. We've got Darren Williams, that's dope. Spencer Dinwiddy, a Julius Randall, Mark Williams, Jaden Hardy, Chad Holmgren, Peyton Watson, Jake Lerabia, Chris Paul, Alonzo Morning, and A.J. Griffin, still a draft A.J. Griffin. Non-Magdottos, we've got Lonnie Walker, Christian Brown, Bill Lambier, Pasha Stojakovic, Roger Strickland, Jalen Brunson, Andrew Nemhardt, Jake Lerabia, Dyson Daniels, Herbert Jones, Obi-Toppin, and Tim Hardaway. And then Magd cards, pretty solid overall. Start off with the Palo to 25 on the vintage art frame. We had Benedict Matherin go into the Pacers. That is 225, Cade Cunningham for the Pistons on the Showtime signatures. Shadon Sharp, 43 of 99, RPA, and then Wendell Moore Jr., 205, Nike Swoosh RPA. I'll do it for the break, everybody. Thanks again for the fill. Up next to our photo.


So web filtering is probably one of the more popular P of sense features people have been asking me for now I have a couple opinions on this so you can do different web filtering with different proxies The problem is most sites are moving to SSL or have moved SSL Especially all the major sites and the problem with SSL is you can't see inside the traffic So the filtering is not as easy to do the way I recommend around this is with DNS filtering And maybe I'll do a different video about how you can just block certain websites But of course that's really challenging to maintain. So there's third-party companies for example open DNS Which is part of the umbrella service I believe is owned by Cisco and you can use their DNS and you can do DNS level filtering and that's kind of cool But this company caught my eye they're called DNS thingy and it's kind of a consumer service But it's reasonably priced and we're gonna go over how it works with PF sense I'm really impressed with how well it works. So I had set this up I did some testing at home with it. So I have it registered my personal email. I didn't Didn't reach out to the company. I'm not a paid endorsement at all for this I just kind of thought it was novel and the way it worked in the fact that DNS and a few other routers are supported Visibility where I'm gonna be covering how you load it on PF sense. I'm gonna show you how to load it How set it up and how it works. So let's get started. So first thing we do is get DNS thingy Their price is $7.99 a month your first 30 days are free a supported routers required So they have a clear OS which I haven't used They have a list of ASUS ones that are in here, which are pretty cool So if you have one of these model ASUS ones, it's I believe a replacement firmware is what they do with those But with PF sense choose PF sense 2.3 and Get installation package Nice thing is they made it really really easy to cut and paste this in so we're gonna go ahead and Just copy and paste this normally.  We're gonna paste it in Done now that part's pretty simple. All this does was add DNS thingy Package to PF sense package list. So we're gonna go ahead and we can log out now So once the package is added we go over here and we're gonna log in a PF sense now Alright now one thing about this is Now that we've done this step two in the installation is Updating it and changing a couple things in here. We have to go to the package manager That's not a problem before we can enable it if you notice down here what they're telling us It's kind of weird, but DNS thingy runs as a service on your PF sense box Which means it one and it wants to run on 443. So you have to change Your PF sense box to be on something other than 443 for administration. So we went over here TCP part and they suggest 20443 use whatever you want, but that's fine. We're gonna go ahead and change this over Hit save All right now we've changed the admin port to 20443 and like I said, that's an important step on here to make sure that you do that So now we're gonna go ahead. Let's get some out of date packages We're gonna go to available packages and we can scroll down here or we can filter for us. We'll just type in DNS There's DNS thingy. We just run the installer confirm and It installs like any other package in PF sense. It's uninstalling. We go over here to DNS thingy Go ahead and enable it leave it on all the network interfaces unless you have some custom thing you wanted to do and We're going to save it Apply the changes Now we got to get our box ID. Now what this is what connects it to your account. So here's the box ID So we're gonna copy this Then we go over to DNS thingy and you go to the section that says router once you're logged in box ID Paste it in and hit add and it shows up here box is not online. It takes a second to synchronize All right now. It's updated and refreshed So one of the things to notice is because this is on our internal network for testing It does notice that we're double-naded, but it doesn't matter because it's gonna start logging things on my side here Now I'm only a computer on this because this runs in my own little lock down virtual network But at least we can start taking a look at things. So The rule sets are pretty much at default, which is block adult content identity that Better safe than sorry block risk of domains and top-level block high-risk top-level domains Block behavioral profiling content marketers third-party advertisers Now I haven't played much with this but they have a virtual relocation rule set And that's a so you can get around restrictions. Maybe country restrictions on viewing content, which some Websites do that like if you're outside the US you can't view certain things because of other kinds of rules I don't know what exactly magic they're doing for this I and I don't have any comparison whether or not it really works but make streaming and downloads fast and force YouTube safe mode and force Search engine safe mode. This is kind of interesting and I won't go for all the adult testing that I did on it But yes, if you try to type in certain phrases, they just don't show up in there because it forces safe search on Every time because it's a DNS redirect to the safe search one thought that was kind of neat that it does that And definitely kind of cool. So now that we've got this enabled Let's I'm gonna open up some stuff on another side over here. So we can get some data into this All right now from the pfSense box you have the link to dashboard.dns thingy Which is your dashboard, which we are here and then the other link down here was my tools dot management And this is the logging Well, I'm not actually allowed to view the logs and I'll show you how that works So the logs are actually local you can't view them outside your network, which is that was kind of strange It's actually wrapping things around into there. So we go over here to devices and We have to find my device and add it to the list now because I had this at my house It has all the different Computers that were at my house on here. So we're actually gonna find my computer in the list here So now that we found my computer in here, which I had to expand out the details So I could find the IP address of my computer and we're gonna go to edit And we're gonna say view all logs Now by default you can't view your logs Until you add yourself to the ability to view the logs, which I thought was just kind of strange But that's how they have it set up So you have to find your computer add the ability to view logs even though the logs are internal and you can do the Who am I to find the logs? This is under the my tools that management and we go over to the main log and Refresh it and now you can see everywhere that my computer is going So it's kind of a strange way they look and like I said my tools that management is being redirected and filtered This doesn't work outside your network. So you can't view it Which is kind of weird is that when I first tried to demo this I thought I was gonna be able to demo by setting up at my house and then testing it here at the office But as it turns out the logs are apparently kept local. So they're doing some Kind of DNS masking to make it look like they're logging all this But these logs are actually being stored within your computer. So I think that's kind of neat the way they're doing it that way But at least you can start following everywhere. I'm going now by doing this and let me see if I can find something to make it block All right, and I went ahead and chose pornhub because why not and this is what actually comes up on the page DNS thingy blocks it Blocked by block ads DNS thing this is what comes up.  I figured I'd use them, but you can see how it does now Something else I find interesting is just watching all the DNS look-ups that my system Looks for and some of the other things that it does fail on so last resolver this this and this and blocked content So it's kind of interesting you're watching all the patterns of everything that it's doing so kind of neat the way it works and you can go through later and Examine each one. See it'll log which IP is doing it I'm the only IP on here, but I've tested this at home. It shows all the IPs and all the devices that are In the system and the DNS thingy page is redirected to internally, which is the router So there's also more levels of logging that you can do which is kind of neat. They got a couple other Custom options. I don't know what they all are if I'm read through all the details on that I just wanted to get you started with this tool. It's pretty neat. It works Well, I tried it for just about the whole 30-day trial at my house and it's it's a really simple system You can also manage unblocking things in here So you can do custom blocking you can for your devices in the list that we have under block the bad Let me expand all the details again So I can find my computer in here, but the You can change it to say unfiltered no internet, which is also really neat allow only the good So you can get really restricted down filters And you or you can say this computer doesn't get to have the internet and you can just block it on there Same with the logging whether or not to compute the logs It's pretty neat, especially if you've got kids or little ones that you go You know what? I think I want to filter the internet for them And I want to have control over that or just keep a log of where they're going Definitely something you can do here. So they're actually kind of supporting Using open DNS in the back ends there. They also have some white listing options They have an option to customize it. So if you want to add a custom page into your company We're home to you know, say hey talk to dad if you've seen this or dad's watching you or mom You know, you can make some fun things like that, but this is a pretty simple system. It's only $8 a month. I Think that's well $7.99 a month I don't think that's horrible for DNS filtering and a nice thing about DNS filtering is that it's It's a great way to do it if you're doing it with setting up a bunch of certificates and trust between devices Well, you're for sure coming in or notice is if you have some IOT devices that you may want to lock down That becomes more difficult because they don't accept the Filtering of you know or adding a certificate to them They can only be filtered and locked down via DNS and things like that This would give you that option so you can find all the devices on your network and and see where they're going and check Logs on them and one of the things you may notice here, too. Let me go back to my devices When you're looking at the whole device list, it even has all the phones Emily's phone This is my daughter's friends coming over and things like that. So anything that jumps on my network I can control in there. We had the steam link and Sean's phone just Sean was over So it's kind of interesting to see all the places on it But if you want to lock down a device that gets on your network and say no internet That's actually an option. So you could actually say you know what I don't want them to get internet But I need them to connect to network for something go ahead and check it out. It's a great way to do filtering It's reasonably priced and seems to work really well. I didn't see any easy way around it even changing my DNS I believe it does all the DNS blocking. Yep It does even if you change the DNS on your computer DNS thingy when it installs in PF sense doesn't allow it redirects even when you change to another DNS So it does kind of lock down the system and it's doing this all automatically on there So it's setting up the interfaces and everything. I don't even think it creates any type of firewall rules. Oh, okay Well, actually it does right. Here's the land rules So it forces DNS thingy reject 4 for 3 for ad blocks DNS thingy prevent IPv6 bypass. So yep, they are creating rules at the same time that stop things Stop you from going around the DNS and essentially so like I said real impressed with it. It's good software It seems to work. Well, I didn't really find any issues with it It loads right in a PF sense like I said, it's great So if you like to kind of here like and describe if you're interested in DNS thingy it's dns thingy.com There's not sponsors. So I got no offer codes or anything to hook you up with on it But try it out check them out if you like it Let me know if you have comments or another software you want me to review like this that works with PF sense I'm interested. Thanks


That combination nearly cost me my life when I was a child. My mother was allergic to cats and we couldn't have one. That was like the end of the world to me.  Back then I didn't have internet or anything to keep my attention. Nearby my house was a gully, or at least that's what I think they're called. It was a sloped down area in the woods by a road. A low stream ran through the bottom and my mother warned me away from the place. Some homeless and other less civilized people camped out and spent time by the stream.  So I went into the gully to meet some friends to play. I was the first to arrive and alone. Finding a good stick, I started slashing and breaking branches for a lack of anything else to do. My friends never had a set time on meeting up. We just showed up at random and sometimes others would be there. I found myself bored and alone. Hitting things with my stick could only hold my attention for so long. Off in the low water, I saw something bright orange near the opening of the storm drain it came from. Kicking off my shoes and rolling up my pants, I went to check to see what it was. In my mind, it was a goldfish someone released, which was plausible, but it was just a candy wrapper. I kicked at it, causing it to float downstream. In the past few weeks of that summer, I'd heard my mother's warning about scary people taking over the gully and yet I haven't seen anyone. A few days ago, my group of friends found a tent that looked like it was abandoned. We dared each other to go inside to snoop, but in the end, we all chickened out. The sun was blazing hot and the water cooled down my feet. If no one showed up soon, I would just run back to my house and eat one of the popsicles I'd been saving or take my pocket change up to the store for a different snack.  I was about to leave when I heard it. A sound coming from the open and dark storm drain. The city didn't put a grate over this one either because they didn't know a needed one or because a grate would cause damage from blocking trash from flowing out. I strained my ears trying to listen if I really heard what I thought. Very softly and barely audible above the running water was a sound I would know anywhere. A kitten meowing. My heart started to beat.  No matter how bored I was in the past, I made sure to never go inside that dark opening. Now I had a reason. I took a few steps forward and stopped myself trying to think this through. If I went inside, I might get lost or not find the kitten because of how dark it was. I needed a flashlight. I didn't want to go home and risk the kitten getting swept away by the water before I got back. Then, that tent just a short walk away came to mind. If it was still there and if no one had taken anything, then maybe there would be a flashlight. It didn't hurt to check. If there wasn't, I could run home and get one. I put my shoes back on my wet feet with some trouble and went running off in the direction of the tent. With a huge flood of relief, it was still there. I felt guilty going through someone's things, but it was to save a life. I would just borrow the flashlight. I'd return it when the kitten was safe. Going over to the tent, I opened the zipper with a shaking hand. This really felt like a major crime, even if I was doing it for the right reasons. Inside was an old musty smelling sleeping bag and someone's backpack. A flashlight was in a side pocket, so I grabbed it and closed the tent again without looking in anything else. Rushing back, I only hoped the poor little kitten was still safe by the time I found it.  The batteries were loose and I didn't want to waste time trying to fix it. As long as I kept my hand still, the light would stay on. Too much movement and it would flicker.   My shoes got wet in seconds. I didn't want to think about where this water was coming from. I really hoped it was rainwater and not from the sewers. I would need to have a shower after I found the kitten. My flashlight flickered when I moved it around, so I kept it pointed straight in front of me. My footsteps splashing in the water echoed in the dank space. The further in I walked, the worse it smelled.  I blamed it on people tossing their garbage inside. I didn't see anything living. I always heard that rats loved places like this. There was enough of a ledge for them to walk on, but not enough space for my feet. Aside from the echoing meowing, I didn't hear any other living thing. I pulled my shirt over my nose, trying to block out the smell. It helped a little. Any other person would have given up way before then, but I kept walking along, scanning everywhere for a place a kitten or two might be hiding. When I saw an old half-rotted shoe float by, I started to worry if there was someone waiting in the dark to stab me like my mother feared. I shook the thought from my head and tried to stay positive. In my mind, I was sure that after my mother heard my daring kitten rescue, she would respect me so much she'd let me keep the kitten. Would I only find one? It only sounded like one, but there could be more. I wondered what my new friend would look like. I adored orange tabby cats, but any would do. Lost in my own thoughts, I'd walked pretty far along. The opening of the drain pipe was just a small dot of light and I needed to rely on my flashlight to see. It flickered and I heard the meowing stop, quickening my pace. I kept going until I tripped over something. I fell into the grimy water, getting some in my mouth. I coughed it up, feeling like I was going to puke. Distracted from getting soaked in the gross water, it took me a few minutes to find my flashlight to see what I just tripped over. The light flickered, giving me a few brief glances and my mind was slow to process it. It looked like a bundle of rags, but it was a person. I just tripped over a person on the ground in this disgusting water. My throat closed up and my blood felt like ice. I just wanted to save a kitten. I didn't want to literally stumble over a dead body. I heard a groan, proving the body wasn't yet dead, but he was going to be. Lifting his head up, he looked at me, my dim light shining on his face.   Bile rose to the back of my throat. I was so scared, my hands shook, causing the flashlight to keep flickering. I crab-walked backwards from the man as he lifted a very weak hand towards me. I should have tried to help him, but I was just a scared kid way over my head. I just ran, trying to get away from the frightening sight with tears streaming down my face. I thought I heard his raspy voice trying to tell me something, but over the sounds of splashing water I couldn't make out the words. I kept running without thinking I was going the wrong way. I should be going out, not further in. I forced myself to stop, to let myself silently sob, shaking from fear and the cold. My mother was right about the homeless people. A guilty feeling started to creep through me. Once I calmed down and collected my thoughts, I'd leave. I could walk over him and outside to get help. I wasn't strong enough to get him out on my own and needed the police or something like that. Just when I was about to do the right thing, I hesitated because I heard the meowing again. This time, from right behind me, the sound still echoed against the stone walls, my teeth chattering. I slowly turned around, expecting to see a kitten. My hand shook, flickering my light. A few feet from me, further inside the dark tunnel, was a figure standing, staring at me. It was so tall, its head pressed against the ceiling, at a crooked angle. It was pale, with long, skinny arms dangling at its side. Cold black eyes looked at me, and I thought it was a trick of the light. Until it moved, raising one hand in front of its eyes to shield it from the light, I felt faint from the sight. Then, in a very soft voice, I heard it. The same meowing sound that lured me inside, coming from that creature. With a twisted smile, it looked at me. It took one step closer, and I ran for my life. I ran in the dark, more tears stung my eyes and my heart sank. When I heard that meowing sound above my splashing footsteps, the thing was chasing me. The man I tripped over could have been trying to warn me. My chest ached, but I still ran. And I felt something brushing against my back, something that felt like long, bony fingertips. In the dark and my mindless state, I didn't trip over the man again. I knew I was coming up to the spot where he was, with a monster chasing me. More guilt came bubbling up in my stomach when I realized I had to leave him behind. But his fate was much worse than just being left behind. I knew for certain what happened to that man, because I heard it. The creature chasing me stumbled, crashing into the water. I heard a small cry of shock then, and then the meowing of the creature stopped. The sounds of bones cracking and clothing being ripped reached my ears as I kept going. The man in his weakened state had enough energy to cry and beg to be saved. I was sobbing by the time I saw the light, and I pushed my small body to the limit to get back into the sun. I only stopped when my body gave up. I collapsed, sobbing outside the woods and in the side of the road, soaked and filthy. A neighbor saw me on his way home and picked me up to bring me back to my place. For a very long time, my mother couldn't get anything out of me besides ramblings. What she did get were bits and pieces of what happened, and she called the police. I don't know if they were having a slow day or what, but they came by my house to listen to what I could tell them. They didn't think the monster was real. They thought I'd seen a junkie or another homeless person get in a fight. They didn't scold me for going inside the drain pipe looking for a kitten because they could tell I learned my lesson. I didn't hear much about the aftermath, and my mother refused to tell me, thinking it would traumatize me even more. I only went back into those woods near the golly once more to return the flashlight where the tent once stood. My mother's allergies suddenly went away, or she took something for them because she adopted a cat for us. She must have figured if I had a cat at home, I wouldn't go out getting myself in trouble looking for one ever again. And she was right.


You have just heard that this afternoon and our Chairman's leadership, WRC-15, approved a very important spectrum for flight-checking systems. This is something that the global family is waiting for a long time. You might have also noted during my intervention this afternoon that I choose a conference that has its own procedures and normally it will take some four years that if we have this issues to be discussed by global family, we have to put that on the agenda of the conference and then submit to the conference itself approval. And the time between we set up on the agenda of the conference to the time we really discussed that normally for four years, we had some difficulties when we heard this tragic incident that Malaysia airline MH370 disappeared March 8, 2014 and then the Minister of Malaysia asked ITU to do something to help and then that is already quite late for us to put this on the agenda of our radio conference. However, our members understand the urgency of this issue. They worked very hard to encourage ITU to include this on the agenda to be discussed at this conference, 2015. And we were lucky that last year we did have our plane application conference of ITU which was held in Busan, Korea, October, November and that conference is the highest organ of ITU so that the members all unanimously agreed that we should invite this WRC-15 to add this item on the agenda and to have urgent study. Of course we will not wait until the conference that our experts of industry and administrations come together over the last 12 months and worked intensively to try to find a solution. And ITU R is my colleague Francois Lonsi as the director of radio communication bureau and it's his bureau and his sector who mainly work on the spectrum issue. In a study of four and a study of five of his bureau worked very hard over the last few months and made some suggestions and of course whether that suggestion will be accepted or not depends on the decision of this WRC-15. And fortunately our chairman kept us a lot and he himself when he was nominated as a chairman of conference by informally, informally at the CPL meeting in March this year and he wasted no time to work with our member states, with our industries to encourage them to find a solution at this WRC-15 because the industry will benefit from this decision to make their systems well as soon as they can have the spectrum fixed and the global families, particular aviation families, industries would like to have this one also fixed earlier so that they can make any technical improvement of their system based on this spectrum agreed by our conference. So we worked very hard over the last ten months after we got instruction from a plane and potential conference and we are very pleased this afternoon we have this request of this additional, a new spectrum for flight tracking system would be agreed. So I'm not an expert, we have two experts here. My colleague François Rancy who is a real expert for spectrum issues over the last two decades and he could provide you much more detailed information and of course our chairman of the conference Mr. Doudou can provide you some other information on how we work together to have this agreement reached this afternoon. So without losing too much of your time let me give you some information. Yes today is a remarkable day at ITU at this present WRC-15 the decision on the global flight tracking is a remarkable one because this alone will send a strong signal to the entire global community that ITU is an organization that is responsive to the yearning of the global community. The disappearance of the Malaysian airline could have been any one of us there on board and the importance that the ITU and the entire conference attached to this issue cannot be overemphasized and I believe that today's decision at the WRC will go a long way in projecting ITU as an organization that is ready at any time to respond to any emergency issue. We consider this particular global flight tracking as an emergency issue and so without any waste of time we've been able to discuss, deliberate and agree on a way forward. I know the discussions were not easy but we had to go into what we call a kind of consultation to arrive at an agreeable decision which everyone is aware of the decision that the WRC just took this afternoon and I will hand you over to the director of BR who will go into the technicality of the entire process and I believe that with this particular decision now our aviation industry will witness a kind of improved safety measures with respect to flight tracking on real time all over the globe. Before aircrafts flying through the Arctic region could not be tracked the pilots were on their own but with this decision now it will be possible to track every aircraft anywhere via satellite within the globe and so I will request the director to further elaborate on the technicality of this particular decision that the WRC 15 have taken under my leadership. Thank you. Thank you. Yes in practice what the decision taken by the WRC 15 today will allow is the use of ADSP signals which are currently most aircraft currently commercial passenger aircraft in the world are today equipped with this system but the system can good until now only be received by terrestrial stations so the aircraft to be visibility of a station on the earth which meant as you mentioned that in over the oceans over desert areas over white forests over polar regions there was no no station which could receive these signals and therefore you could not ensure flight tracking so what the decision today enables to do is to have satellites receiving these signals and transmitting them to terrestrial stations and therefore to provide a truly global coverage which was missing at the time of the Malaysian airline tragedy so this is a very important step what this changes is that it allows satellites to be built and to be operated using the corresponding frequencies and this is what we have decided today after one year of studies one year of discussions maybe i would like to dwell a little bit on why do we normally take four years to take a decision the decision of this conference are modifying an international treaty which is the radio regulations this treaty contains all the international provisions for the use of spectrum for all services using spectrum whether you speak of satellites or radio relays or wifi or mobile or radio and tv broadcasting gps whatever all the system that we are using more and more and we have been using more and more in the last 20 years around the world all the system the panel spectrum and the radio regulation is actually how you can use spectrum the radio regulations enable investments to be made in these systems i would like to emphasize that the investments which are made in radio communication system every year are in excess of two thousand billion dollars two thousand billion dollars when you speak of this type of investment you need to ensure the low-term certainty that the investments made are going to be respected and protected universally by every country if you don't have that certainty the investment will simply not be made so that's the essence of the radio regulation and the essence of the process that we are following which is that every decision has to be waited so carefully that at the end of the conference all the 193 countries of the it you will sign the modification to this international treaty and respect it for the next 20 or 30 years what has happened this time is that given the urgency and the importance of taking a decision to achieve this the global community including the civil aviation the IKO and all ITU member states and all the stakeholders in this part of the spectrum have worked very hard in order to ensure a regulatory and technical solution which can be accepted by all member states this is what has happened today and we are very happy and very proud that we couldn't do that it will certainly pave the way for a more safer use of airspace in in the future so with this we would like to welcome questions from you and also I understand from people outside of this room yes good afternoon let me add additional information this decision this afternoon is absolutely important but it's not the only one who will make sure that we will have no such kind of internal in the future repeated what I'm saying is ITU help IKO aviation system to provide them this spectrum to use to to to to to chase those flights in the sky but it's not ITU who will be able to detect which flight in which position is the way this kind of things is done by IKO just like you know anything happened incident to analysis the data in the black box it's not done by ITU it's done by IKO so that IKO will be able and their members will be able to use the new spectrum to chase the flights in the sky but how can we use this data how can we identify those problems that is not in the competence of ITU so I have to make this clear so that is IKO IKO and but anyway if you know they don't have this spectrum they cannot really you know collect the data and to to to to make sure that you know the security will be assured by their systems to strengthen this so this is something I just reminded to keep that in mind when you raise your questions and some of questions you know could be linked with the competence of IKO that we we should try to also find their representative here or somewhere and to ask them to help us to to to take some qualifications or the answers from their side