This is stock number 9J131A. We are here at Summit Automotive in Fond du Lac, Wisconsin. You're new and used Jeep headquarters. Today we are checking out this super clean super good-looking 2015 Jeep Grand Cherokee Overland High Altitude. This vehicle has a 3.6 liter Pentastar V6 motor. From this HD video you will be able to tell that this Jeep is extremely clean all the way around inside and out. Granite crystal is the color. 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 watching it on, turn them on right now because it's like you're right here looking at the vehicle with me. This one comes with the 20 inch painted alloy rims part of the high altitude group and the Goodyear Forterra 265-60 R20 tires. These tires have a little over half the tread left on them so good tread left on this vehicle. Didn't see any denser dings on that front fender. It has the projector lamp fog lamps, the front sonar on the bumper. It also has the adaptive cruise control right there. Get the kind of goldish bronze chrome on the front. LED running lights, H&D headlights, passenger side fender is in excellent shape as well. No scuffs or scrapes or dents and the passenger rim is in excellent shape too. No scuffs or scrapes on that. As you go down this side of the Jeep you can see just how clean the body is, how reflective and mirror like that paint is. We take these HD videos so if you are far away or even if you're close by and just cannot make the trip down you can still see the vehicle, hear the vehicle and have confidence in the vehicle that you're looking at before you even get here. The roof is very clean and you'll notice that it does have the Vista Ruff, the dual pane sunroof. Very clean down this side. I didn't see any dents or dings and this back rim is in excellent condition as well. Back tires have just as much tread as the front tires and as we hop around to the back of the vehicle. No dents or dings or cracks on that rear bumper. It does come with the dual rear exhaust. You got more of that gold-ish bronze chrome looking finish back here. It does have a receiver hitch and wiring. It has the power liftgate. Back storage area is very very clean. Factory subwoofer, no rips or tears back here and it does have the spare tire and jack tools back here. Power liftgate, press that button. It'll beep at you three times and then come on down. You get the blacked out 4x4, the blacked out Jeep lettering part of that high altitude package. It does have the mud flaps on it. As you go down this side just as clean as that passenger side, no dents, no dings, no scuffs, no scrapes. Very very clean vehicle. It has the heated mirrors with the built-in blind spot indicators as well as the directional signals. As we hop inside the vehicle, oh, four-fold disclosure this back rim, no scuffs or scrapes on that either.  There are no rips, there are no tears on these seats. This vehicle has never been smoked in. Both these seats are heated and cooled. It has driver's side lumbar, factory floor mats throughout. Power windows, power locks, power mirrors, memory driver's seat, and the power fold-in mirrors like so. This one also has the auto headlamps, the power telescoping, and tilt. And as we hop inside you can see that this vehicle has 35,302 miles. It has the 7-inch TFT display with the digital speedometer and your compass and outside temperature display. You can also do mileage, miles to empty, all that good stuff. You've got three-quarters of a tank of fuel left in this one. It has the heated leather-wrapped steering wheel cruise controls on the right. This is your adaptive cruise control so you can be going 70 down the highway.  Bluetooth on the left as well as information center controls. This one has the 8.4 touchscreen radio with the factory navigation. This is also where your backup camera shows up. And you can do your heated and cooled seats here as well as your heated steering wheel and then also has AMFM and Sirius XM satellite radio capabilities. Dual climate control, backup sensors, forward collision warning so you can turn that off and on. It has the eco mode and then the stability control. So what makes it an overland is that it has the quadrilift system as well as the Quadra Track 2 system. You get a four-wheel drive low and a downhill assist control as well as a neutral feature for flat towing. So that's in your select terrain with the snow sand, auto mud and rock features right there as well. 8-speed automatic transmission, passenger seat is very clean as well as well as a carpeting, no rips or tears in that seat. Like I said this vehicle has never been smoked in. It is very very clean all the way around. And it does have the power sunshine, sunshade for that Vista Roof. So if you press it once it'll open up that far. If you press it again it'll open up the entire way.  Those are features of the vehicle you never have to pay a subscription for. And we'll take a quick look at the back seats and then check out under the hood. Back seats are just as clean as the front seats. These back seats are heated. No rips or tears back here. Latch child safety system, carpeting and floor mats are very clean as well. They're heated seats, two USBs and a 115-150 watt plug-in. Back seats fold down nice and flat so you get a lot of room back here. And once again very very clean. I'd personally like to thank you for checking out the video today. Hopefully from this HD video you will have been able to tell just how clean this Jeep is all the way around inside and out so that you can make a smart buying decision. I would highly recommend it from a quality and condition standpoint considering the miles on it. This thing is just about as new as you can get. Under the hood we have the 3.6 liter Pentastar V6 motor. Been on Ward's top engine list, top 10 engine list several times and just a really good motor. Engine base very clean, runs very smooth. This vehicle has been fully safe and inspected by our service shop. Has a fresh oil and filter change. All the fluids have been checked and topped off and this super clean 2015 Jeep Grand Cherokee is 100% ready to go. To see more pictures of this vehicle or one of our other 450 new and used cars, trucks, SUVs, minivans, Wranglers, you name it we got to go to our website www.summitauto.com. Full pictures and descriptions of every single vehicle on our lot. Videos of every single used vehicle that we have. All at summitauto.com. Thank you so much for checking out the video today. If you want to make this one yours give us a call<PHONE_NUMBER>. Ask for one of our sales associates to make this super clean 2015 Jeep Grand Cherokee years today. Once again that number is<PHONE_NUMBER>. And if you'd like to check out more HD videos you can go to youtube.com. Summit Auto remember to like, subscribe, and share on this video and all the videos that you see there. In fact in a second you will see a link to subscribe to our YouTube channel on your left. A link to more used inventory videos like this one on your right and if you have not been to our website on the bottom link to this vehicle on our website. Click those check us out and we really look forward to helping you with this super clean 2015 Jeep Grand Cherokee Overland High Altitude Package. Thanks again.


And in entertainment news, Arthur fans were soaked as they waited for the pop star's concert to begin at a flooded venue in Columbia, Maryland on June 8 and made a tornado warning. Local media reported that Halsey was scheduled to take the stage at the Maryweather Post-Pavilion Amphitheatre at 7pm at Sevierweather first venue to delay the show. Stacy Downing created filmed video showing rain streaming in through the roof, drenching in a crowd.


Welcome to us at the beginning of the conference this morning. Is it privatization is very much on the agenda here? And I was eager to come to this conference in part to learn more about what Vietnam has already done and is planning. So let me jump into this. Let's see, so what I'm gonna be focused on here are firm level outcomes of privatization with a special emphasis on firm performance issues. So productivity, profitability, output as consequences of being privatized. I may have a few words to say also about what happens to workers and what happens to the creative destruction process. I'm also going to talk a little bit about the consequences for firm performance of different methods of privatization to the extent that the data permit. And I will also talk briefly about some variation in the effectiveness of productivity at raising firm performance, what we would call the heterogeneity of the effect in terms of a few different dimensions. Now of course there are lots of questions that one could ask about privatization. So while the emphasis here is on estimating the direct performance effects. And so what this means is a change of ownership from a shareholding which is dominated by the state to shareholding including or expanding the role of private owners, private investors. One could also talk about other kinds of privatization about land and housing, about premises for shops. These are certainly very important issues over Bia. In the center of town last night, I met someone who was telling me about problems of land ownership for enterprises in Vietnam and how it limits investment. But they're not going to be the subject of my talk today. I could also talk about new entry. So there are lots of definitions of privatization. One of them encompasses entry of new private businesses. Some people have argued that this is a more important process than privatization. Actually it's not clear that the empirical evidence supports that but in any case I'm not talking about it today. I'm not talking about sequencing, what should be privatized, how quickly or what firms first. Or in general about the relationship with other policies hardening of budget constraints, financial sector reform, et cetera. Nor about the political economy of privatization. The consequences of privatization for political economy and decentralization. Or about the political economy causes of privatization. And in light of the title and the themes of this conference, I'm really not talking about inclusion or sustainability. Although those could be potential topics. I've written quite a bit about the effect on workers of privatization. But one could also analyze issues of inequality and what happens to workers who are laid off and what happens to work conditions. Also there's some research on environmental aspects. So none of those things are part of what I am planning today. So I'm trying to limit my topic but even so limited there's a vast ground to cover. First of all, I'm just going to mention briefly what is probably the prevailing view now about privatization theoretically, the way it works, is by raising the cost to politicians of intervening in enterprise behavior. Under state ownership, the minister can simply call the enterprise manager and order what the director should do. Hire more workers, raise wages or start a new product or whatever. But under privatization, it's more costly for the politician to do that. The politician can still make the phone call but the manager says, well look, we're private, I have owners, I have to answer to. And so what are you going to do for us? And so the idea is that that will then tend to lead to a change in the firm's behavior as a consequence of that. Okay, so there was a lot of early research on privatization that I just wanted to mention. When these topics were hot in the 1990s, there was enormous speculation about the effects of privatization and there were also many empirical studies but they suffered from substantial problems in estimating effects. The sample sizes were generally tiny, a couple hundred observations on firms observed for a very short period of time. And so many questions can be raised about those studies and I include my own studies from that time raising those questions. So it's only more recently when all the furor has died down about East European and post-Soviet privatization that we actually have managed to put together the data sets that allow us to estimate, I would say with some greater degree of reliability. So larger numbers of observations, longer time periods and it's possible now with the larger data sets to compare firms within narrow industries within the same year. And so we get rid of some important aspects of heterogeneity arising for instance if firms from particular industries tend to be privatized more rapidly than from others and there are different performances across those industries. So many studies of privatization are plagued by that problem. It's also possible using longer panel data sets to introduce firm fixed effects and to add firm specific trends also to the model. So we'll be looking at results that use universal data that is for every firm in four countries. There are Hungary, Lithuania, Romania and Ukraine and for Russia the data are more limited in a number of ways that I don't really have time to get into here but it's a caveat for the analysis of Russia. But in general these are comparable samples and variables for these five countries. These five countries were not chosen as a result of some random selection of transition economies, I wish I could tell you that but it's simply on the basis of data availability. Data of this high quality and quantity type that enables us to estimate in a comparable way. And we are using the data on old firms. So old firms we define as firms that are inherited from the planning system and their measure is either existing before 1990 or ever having any state ownership. This is something about the coverage. We have about 600,000 firm here observations and on average in the time series we have 14 observations. So we have a chance to observe these firms from a long time before they're privatized until a long time afterwards which is a basic difference from lots of papers published in say the Journal of Finance that look at privatization all around the world and generally have only very few years of observation on each of them. Here's a quick graph showing the evolution of privatization within this old sector. You can see that we start off zero private. Initially there's a jump there in Hungary where you see some jumps down it means that state enterprises have been split up and this is just simply the fraction of the sample with a private designation. So split ups lead to more state enterprises in the sample but in all the countries there's a big rise in the private share among the old firms. Here private is defined as 50% or more of the shares owned by private owners. We're gonna look a little bit at some alternative definitions of that threshold. So here are some initial results. I said the only table I'm actually gonna show you everything else is maybe more user friendly graphs but the main takeaway here is we can estimate with ordinary least squares which functions only as a baseline maybe comparison with earlier studies that were forced to use ordinary least squares for due to lack of information. We can add firm fixed effects or we can add firm specific trends which turns this into what is essentially a random growth model. But regardless of what we do all of the estimated effects are positive. They're highly statistically significant. Well that's not difficult with 600,000 from your observations but we're also putting in we're taxing this regression with a lot of added variables. And so in the most highly taxed regression we're still getting some substantial positive effects. Let me turn to some heterogeneity issues. This is for the domestic versus foreign ownership and in the rest of the results I'm dropping the OLS just to save space and I'm gonna always be showing you firm fixed effects and firm fixed effects plus trends. The trends of course reduce all of the estimates. They just take a lot of variation out of the data. But in all cases we estimate at least where they're statistically significant we estimate much larger effects from foreign investors compared with domestic. So the bang for labor productivity, for return on sales, a profitability measure and for output are larger for foreign investors. I don't consider these three dependent variables to be equally reliable. My preferred one would be the labor productivity. I also have results with multi-factor productivity which are similar to these but so the foreign effect is much larger which is something for policy makers to think about when they're designing future privatizations. Now I'm going to distinguish three levels of privatization, a 100% privatization. So all the shares are vested in private hands. Then we have majority but not 100% privatizations and finally minority or partial privatizations which have been pretty common in some countries and some people think that they have substantial positive effects. Well, what we find is actually different from that received wisdom. We find by far much stronger effects of privatizing all the shares in the firm. In fact, for all of these, the typically the effect of privatizing all 100% compared with privatizing a majority but not 100% is double, sometimes more than double. So getting the state out entirely is having a much bigger effect than the majority. The minority privatizations are all estimated to be negative, some of them are statistically significantly different from zero. So this mixture, at least for these countries and these data of state and private where private is not in control is actually negative for these firms. As anybody who was reading the newspaper in the 1990s would know there was a great controversy over different methods of privatization, voucher or mass method, MEBO's management employee buyouts, which is typically not really a buyout but a giveaway to the insiders of the company with varying levels of non-managerial and managerial employee participation. Then we have outside domestic investors and we have foreign investors. So once again, foreign investors are dominating here but we also see the second best, so second best to domestic investment implied by these estimates is for an outside domestic investor and MEBO is actually not far behind. So giving the firm to the employees on the basis of these results is not a much worse than giving it to outside domestic investors. Voucher privatization, and I have to caution that here, this distinction among methods, we can only actually measure in Romania. And so Romania had a voucher privatization program that yielded extremely dispersed individual ownership and that effect is typically the smallest among all the different methods. So methods of privatization do matter or that's the implication of this analysis. When we look by country, so we have five countries here, these are the five, Russia, if you're especially interested in Russia is the fourth one over and Russia is frequently having a negative effect overall. It might be because those privatizations were voucher or mass privatizations. I'm gonna come back to talk about Russia a little more in just a second. But in countries that were joining the European Union like Hungary and Romania, the effects are typically where they're estimated precisely, they are, so that's the first and the third of these columns here, typically large and positive, actually slightly larger in Romania compared with Hungary. There's international heterogeneity in terms of how effective privatization has been. Finally, if we look at the business environment and what I'm doing here is using the EBRD's average score of the progress and transition to a market economy made by these countries and seeing how the privatization effect varies with respect to that. The data are unambiguously implying that a better business environment is associated with a stronger effect of privatization. You might say, well, that's obvious, but actually it hasn't been obvious for a lot of people. It was frequently argued that privatization could actually substitute for the business environment. So in the absence of a good environment, so with other kinds of constraints, other disciplinary devices on management, such as financial markets, well-functioning legal system, et cetera, it was argued that privatization might be more effective. So what we're finding here is different from that. Okay, Russian anomalies, Russia's performance effect of privatization tends to be negative. The wage effect also tends to be negative. The employment effect tends to be positive. I'm not talking much about wages and employment here, although I'd be happy to if you have questions. But Russia is basically an outlier in just about any analysis that one does. So it merits some special attention. Well, one thing we can do is, Russia also has the advantage of being a very large country and it consists of 75 odd subjects of the Federation like states, oblasts, they're typically called. So we can estimate a privatization effect separately for each of them. If we do that, we draw a histogram of those. What we find is that, yes, the distribution is centered around zero or a little bit to the left of zero, but we have some oblasts, some parts of Russia where there's a positive effect of privatization that actually looks like central Europe. And then there's some parts where the estimated effect is large and negative. Where are those different parts of Russia with those different effects? Well, it turns out they're all over the place. So here, a darker, this is the estimated effect. So here, a darker color implies a larger effect and it kind of looks here just because we have these huge Siberian oblasts that much of it is dark, but in fact, the dark ones are scattered everywhere here. And so geographically, it's not true that European Russia on average has a stronger effect than Asian Russia. Okay, well, so the results which we published on this topic, which got a lot of attention generated some controversy, used data only through 2002. Unfortunately, Russia stopped the systematic collection and release of data and it was much harder to get, but we've obtained data through 2005. And here what we're doing is we're allowing that effect to vary by calendar year. So most of the Russian privatization took place in 92 to 94. So if we allow the effect to vary by calendar year, what we obtain is, and in fact we had already reported, was this big dip in the late 1990s, then coming back close to zero, but what we hadn't seen was this big rise afterwards. So if you plot this for all the countries, the other countries are going to look like this. So Russia in the early 2000s was essentially catching up to where Hungary and Romania were in the mid 1990s. Foreign privatization effect is basically always positive. We have a small blip down, but not statistically significant with some drop off towards the end. So I'm really hoping we're going to be able to get some more recent data and see what has happened with this, but one interpretation could be this was around the time where Horokhovsky was being imprisoned or first brought to trial. And so foreign investors were feeling less comfortable, less willing to invest than they had been formerly. Okay, so just to conclude some lessons. If you asked me for the average effect of privatization on productivity in these economies, these would be conservative estimates. So these are from the estimates including firm specific trends, so-called those the best estimates. The foreign effects are much stronger and the foreign effects also tend to be more uniform. So even in Russia, there's a strong foreign effect. So it's a domestic privatization effects that vary much more. Methods matter. So sales seems to produce a stronger performance effect than mebos do and those are better than voucher or mass. The more that's privatized, the stronger is going to be the effect on firm performance. Of course, they're trade-offs with speed and politics that are involved here because it's gonna be much faster to do a voucher privatization than to engage in case by case sales. By the way, the employment and wage effects are usually small while the Russian average is masking large regional variations. So maybe it's not really a function so much of the method of privatization, but instead of aspects of the local environment and that's a topic also that we have written on. Finally, the privatization of the business environment are compliments rather than substitutes so it does make sense to try to improve institutions before or while privatizing. And I have some supplementary slides which I'd be happy to refer to if you have questions. Thank you.


LibreOffice is used by millions of people around the world, but it's also developed by a worldwide community with hundreds of people working on source code, user interface design, documentation and translations. Many LibreOffice developers work full-time on the software, but many others work in their spare time providing contributions because they love free and open-source software. Although LibreOffice is a big project, it's friendly and open to everyone. We have many channels of communication including mailing lists, IRC channels and regular team calls. We try to make every new contributor feel welcome. My name is Ashod Nakashian and I'm a contributor to LibreOffice. I would say the community is very welcoming, very helpful. I got assistance immediately and they set me up, helped me with getting the patch reviewed and committed as soon as possible. So the experience was actually very much empowering. I wanted to go for the next one, which I did. To get new contributors familiar with LibreOffice, we have a specialised task called Easy Hacks and we work with students from the Google Summer of Code to introduce them to the project. I'm a Google Summer of Code student from India and I've been involved since the start of this year. It was an awesome experience because there are so many great guys who mentor us into the organisation, help us through the bugs, the easy hacks and all are designed to bring new people into the organisation and that's what's great. LibreOffice is backed by the Document Foundation, a non-profit entity. It employs a small team that works on infrastructure, documentation, QA and marketing and is built upon statutes which govern the project guaranteeing that LibreOffice will always belong to the community. Every year LibreOffice developers and supporters get together for a conference where they share ideas, demonstrate new features and talk about the future of the software. If you're a user of LibreOffice but want to get involved in the project, you're welcome to join. I'm Yona, I'm from Albania. I'm a student at the University of Tirana there. I studied for business informatics. Being just a user of LibreOffice, I thought why not to be also part of the community and to contribute there. So that's why I'm also contributing to LibreOffice and I'm really glad that I had the opportunity to be here at the conference so I can know more people that are part of it and can help me better to get involved with the community. So get involved, go to tdf.io slash join us and choose which team or project you want to help. We really appreciate your contributions and above all we hope you have fun.


Amid the controversy trailing the planned purchase of foreign luxury vehicles by federal lawmaker's chairman of the Senate Committee on Services, Sunday Karimi says assembly members deserve it while insisting it has to be supplied by foreign car brand. Very good morning to you and thanks for joining us on the breakfast. My name is Nyam Gul Aghaji. We sincerely apologize for beginning a little bit late. Well we have so many things to discuss this morning but first of all having said good morning to you and reminding you that this is a Thursday and Thursday we think business in so many quarters. We may not be bringing you a topic directly dealing with business but we'd like to remind you that you need to know how to do a little bit of business not necessarily that which will take you from what you're doing right now because there's so many things that you can do with just a click of the button of a computer or your phone so there's so many things that if you don't know how to do you need to learn at this moment technology has given us the opportunity to have streams of incomes and to also have fun while doing a lot of things that we usually like to do so get up there try to do something try your hands at something there's so many other things that are selling apart from the thing that you're doing right now so if you are someone who is a teacher for instance and you have one or two hours there are things that you can do as well you can do some sales on the internet that you don't even need to leave the comforts of your house to do that so so many things that you can do to put money in your pocket and food on your table that's the basic thing that we need we need the basic things of life are just food shelter and clothing these are the three things that we need every other thing is just um i don't know how i'll call it it's just not necessities but just things that we want the things that we really need is to be able to feed ourselves to be able to find shelter and put our heads you know when we want to rest and then to cloth ourselves and if you can have these basic things then you know that you're a complete person every other thing is just luxury that you want for yourself and there are really ephemeral things that may not even last for long but what i'm saying is that you don't need to complain because there are so many opportunities out there and if you can't find them sometimes we help you find them so if you need help let us know well for today before we go into our top trending we'll just take a short break and we'll be back in a jiffy don't go away you're welcome back um we usually bring you some of the things that caught our attention in the course of 24 hours one of the biggest stories this morning uh on top trending and possibly all the newspapers that will carry is that the supreme court is scheduled to render its judgment today thursday october 26 2023 in the cases of lp and obi attiku and pdp versus aenec but okay uh bola metinobu shatima and apc recall that the presidential candidate of the people's democratic party attiku abubakar and the presidential candidate of the labor party pito b have large appeals challenged in the ruling of the presidential election petitions tribunal pept the supreme court on monday october 23 had its hearing into their appeals filed by the pdp presidential candidate and his lp counterpart challenging the ruling of the presidential election petition tribunal pept that upheld tinobu's electoral victory the judgment date was confirmed by all parties involved next is that uh the president bola akmei tinobu has approved the appointment of nine new resident electoral commissioners regs for the independent national electoral commission aenec for a term of five years each a statement released by presidential media aida during gilali says president buhari made the appointment by pass vested in him by section 154 subsection one of the constitution of the federal republic of nigeria 1999 amended and section six of the electoral act 2022 to make such appointments he gave names of the nominated commissioners as isa shaka a him a him a kni a two state resident electoral commissioner bami delie agbede a kitty state resident electoral commissioner jania damu belu gombi state resident electoral commissioner dr tayi elia su quara state dr bumi o moshi indemi lega state resident electoral commissioner al haji yaya belu nasa our state reg professor mohammed yalwa niger state reg dr anubum onua river state resident electoral commissioner abu baka fawadambo zamfara state he added that president tinobu expects the new appointees to abide by the highest standards of professional and ethical conduct in the discharge of their duties in accordance with his determination to facilitate the establishment of renew and sustainable standard of transparent fair and conflict free electoral conduct in nigeria also the state chapters of the nigeria labor congress and a trade union congress have expressed displeasure at the slow pace of implementing their memorandum of understanding it signed with the federal government to avert its planned nationwide strike the organized labor want that failure to implement the agreement before the october 30 deadline might leave them with no choice but to go on strike adding that they had commenced mobilization of their members across the country now on tuesday they were asked uh tuesday october 24 whether labor was satisfied with the implementation of the mo u the head of information and public affairs of the nlc benson upa said the government could do better and faster and that labor issued a statement a few days ago in expressing and expressing pleasure or displeasure rather with the minister of labor unemployment the national leadership of the nlc and tuc had on october 1 reached an agreement with the federal government to pay 35 000 naira to all federal workers beginning from september pending when a new national minimum wage would be signed into law the sole resolution provided that the wage award would be paid to the federal workers for six months while states were encouraged to extend the same benefit to their own workers this is what they are afraid the federal government is about to renail upon now meanwhile nigeria's minister of health professor ali pati has outlined the need for women to be vaccinated against the human papillom virus papillom virus and countering claims against the hpv vaccine on wednesday october 25 after a visit to the kuchingoro primary health care center in the company of the director of susan thompson buffet foundation professor senaid faseha party disclosed that his four daughters are vaccinated so there's no fear in the vaccination no controversy whatsoever he stated that the vaccine is safe for girls and it would serve as lifelong prevention against the disease he said the focus is to make the this voluntarily or to make this vaccine get to the people and for them to get it voluntarily and there are not enough vaccines and those who choose not to receive are making a mistake for their children because they're exposing them to the risk of having those diseases remember we have done a few programs on this vaccine we hope people will take advantage of this and not have to cry tomorrow because it prevents you from having the kind of disease that ordinarily you would have i think cervical cancer or that so if you are supposed to or you are in the age bracket that you are supposed to get this vaccine please do find time to go and get it and if it's for your child make sure that your child gets it probably from nine years to 25 or 30 or something you fall under that age bracket that you need to get this vaccine so find out the age bracket and if you do fall under this age bracket try to get the vaccine it's free and if you miss it now because it's not so much available there are limited number of these vaccines that can be given to people so if you miss it now you might be missing it for this lifetime and that will not be good enough tomorrow. Also a former militant leader Asari Dokubo has lamented over president Bola Tinubu's recent appointments. Asari said this while reacting to controversial islamic cleric Sheikh Gumi's call for Newsome Weekend to be removed as FCT minister addressing this in the video which has gone viral the former militant leader stated that Abuja was built with oil money from northern regions and he also said that it was built on the premise of no man's land. He went on to lament about other appointments by president Bola Tinubu claiming that it is one sided and makes Lagos look like the only state in the country. Asari who claimed that he campaigned for Tinubu because of his past achievements did not really like the fact that these appointments have been made. Remember that in the past Asari Dokubo had really been the vanguard talking for the president and remember the other time he was saying that nobody dares to oppose the president. Now he also even talked about the fact that when people try to claim that Lagos state is in no man's land it is actually a euro bar land and it should not be claimed by anybody and now Sheikh Gumi said that Wike shouldn't be or shouldn't have been the minister of the FCT because of maybe his religion or maybe where he comes from and northern elders have disowned Gumi regarding the statement that she made. He made rather not that he is no longer a northerner but they said they distanced themselves from what Gumi said because it is not a general opinion of everybody. So now Asari Dokubo is saying that Abuja is supposed to be in no man's land just like some people were calling Lagos a no man's land because it used to be federal capital for Nigeria and everybody was welcomed in Lagos and now Asari Dokubo is saying Abuja is supposed to be in no man's land that is why it was built. Yes every federal government every capital of a country is supposed to be like a no man's land if you know what that means so you know he's not very happy and he's saying that most of the appointments are coming from Lagos or Euro bar land because I'm not sure all the people that were appointed are coming from Lagos they may be Euro bar people they may be people who have worked in Lagos but hey Lagos welcomes a lot of people coming from other parts of Euro bar land or other parts of the country so Asari is not comfortable about that maybe he wanted an appointment as well or more appointment to his people or for his people but whatever it is he has cried out that he does not like what is happening right now regarding the appointments. Well I've seen appointments coming from the southeast from the south south from the southwest from from the northeast west and everywhere maybe he just has particular appointments that he felt that shouldn't have gone to particular axes of the country whatever is his arguments are well let's wait and see what the people so appointed will do because what we look for in Nigeria what we should be looking for in Nigeria is actually competence but how far can we take that confidence when we find that there's also a constitutional provision for what do they call it now for everybody to be carried along there's that provision like that federal character they call it yeah federal character that's what the name that they give to it so if any ethnic group or any geopolitical zone perceives that they are being left out then that provision will be invoked by whoever wants to bring up an argument but that's what Asari Dokubo has said and if there is anything to go by then whoever is in charge of appointing whoever should take note that some people are watching but some people will just laugh over it and say well this is what we saw and this is what you get but we have absolute trust in whoever is at the helm of affairs that he knows what he's doing and if tomorrow we wake up to find out that the dollar is one one Naira to one dollar we wouldn't care where by the people who are in charge of the economy are from we will just be happy that the dollar and Naira are the same right now something a country like Kenya Kenyan Shilling one Kenyan Shilling is 509 Naira so it is bigger and stronger than the Naira and I felt it was a shame when I discovered that and for the fact that we've been told that Nigeria and Angola currencies are the worst performing currencies in Africa right now it really is a shame for all of us so we don't care where anybody comes from but let's see that in the next maybe two months before Christmas we'll start seeing things happening I just spoke to a friend last night and the friend was telling me that this friend is a businessman who sells a lot of things and then he was telling me that the prices of things have gone up almost double within two weeks and it is not even close to Christmas yet well it is close but it's still all to almost 60 days away and things are happening like this what if it enters November what if it enters December can we still be proud of a a chicken lap on our plate or something we don't know we just want Nigeria to work wherever whoever is coming from will not matter if at the end of the day we turn around the economy we turn around the the fortunes of Nigeria and Nigerians and then we begin to see the Nigeria that was proud enough to call itself the giant of Africa well we'll take a short break from here and then when we return we hope to be joined by our analysts that will be helping us look at the papers and talk more on the headlines on the front pages stay with us


I'll stand here and not pace. That was just so lovely to hear from Vivian, I wish she was here for, I just immediately thought of a couple of threads from her work into mine, which I'll no doubt weave into this and maybe I can tweet her later, how lovely. So yes, so my presentation today is building on some theoretical work that you may have heard about for open education and social justice and I want to present today some empirical results that are still in publication. So I have a book chapter accepted and is in review process and that'll be released towards the end of the year in a book about inclusive education as a human right and so this is one slice of the PhD study and it's looking at some good news about some work that really is making a difference and I'm using the lens of social justice to explain why I think progress is really being made. If you tend to look at it through that lens of social justice there is some reason to be happy and so to begin with I want to also just recognise the help I've had from GOGN through the whole course of my study which continues but also specifically funding me to attend. Otherwise I would be remotely speaking to you from Australia. Also I want to acknowledge how supportive the Twitter community has been contributing ideas and feedback on the work as it's developed and I welcome that. I'm Sarah Lambert Oz, I really would love to have lots more people following because that means I can have more conversations and feedback so I really welcome that and feel free to chat that way anytime. When we're doing work on social justice I just want to position myself so you know where I'm coming from. I am a learning designer I have been a learning designer working in a regional uni or my career or two regional large regional unis in Australia and that positioning as being regional other than city dealing with low socioeconomic communities is just a business as usual reality is something that and as a strength you know as a place of innovation and leadership and strength is something that informs my work absolutely but also I'm the first in my family to attend university and that is a big thing for me personally and in Australia there's lots of people of a similar age who were given an opportunity to have free higher education which is no longer there and in the universities where I work there are typically you know in a in many teaching and learning forums over 50% of the people there will say I'm first in family so this sense of social justice in giving back is strong and and it's big for me my mother I will be dedicating my thesis to my mother who did not have the opportunity to attend university and suffered really on all of the levels that you can financially emotionally socially excluding sexual harassment abuse underpayment the whole lot you know and as a single mom I live through that and she said to me get a degree Sarah you'll be taken seriously and it's something that meant a lot and being taken seriously has been a long arc for me in my career and in short I have I have my own struggle juggle death gender regionality all of that's tied together so I have that lived experience of both being included and excluded and the you feel the difference keenly so this is a big topic I don't claim to have any other lived experience of these social justice issues I want to be clear really gender and regionality is something that's lived and other things I just feel connected to and that's what's driving I think where I needed to do this research but I'm still learning be kind I'm still learning I was so thrilled to hear Suming's alternative lens I'm learning so much from collaborators so it's I'm here to listen and reflect so I started this research problem as an open education practitioner who had vested a lot of time in approaching that open education courses as social justice to give back to underserved learners became a kind of difficult reality in about 2014 when the data stomach started to come back that all of that MOOC investment that a lot of us had a lot of high hope wasn't actually hitting the target so I think Diana Laurelard sums it up here and I will just read it so the demographics of massive open online course analytics show that the great majority of learners are highly qualified professionals and not as originally envisaged the global community of disadvantaged learners who have no access to good higher education and from a gender perspective I was particularly frustrated with this sort of Emanuel's research coming out and confirming that particularly within a lot of the topics that were happening in MOOCs which is at IT and business and a kind of technical topics predominantly young males seeking to advance their career I'm like that's great that people have an opportunity to develop but I thought we invested for a slightly different reason and we invested a lot what happened to that aspiration what how do we have that rhetoric and the reality be so different how did that happen and more importantly than how could we do that differently so that's roughly been the trajectory of the research question first how did it happen that was an interesting journey and I have written about that and but this section is about how can we do it differently which is the nicer side you know the the positive news story so in the book chapter I I selected seven case studies of open online education as social justice and five of them were taken from this major empirical systematic review done which is a global search of the literature for cases meeting those social inclusion or student equity objectives 2014 to 17 so there were nearly 50 studies many of them were staff and policy which were really interesting but I did a second qualitative analysis looking at the case studies where there was some evidence for enablement of particular cohorts of marginalized students and the thing that was really fantastic looking at those is the richness and and they did do the job at some cases amazingly so and those programs were reaching over 200,000 disadvantaged learners so it's not an insignificant number and it has potential for this kind of different model which often has blended support face-to-face study groups for example online ones and face-to-face local community partnerships developed out of local needs for people facilitated by local people was a sort of common thing and so there is a potential to scale some of these up but it's doing MOOCs differently or it's doing that that that kind of thing I also did two brand new cases one of them was Sea of Ula and and one of them is an Australian study so I've had to sift through all of that and and the book chapter does seven I'll probably only get a chance to do a couple today but I'm going to leave the details in the slide so you can follow all of the seven at the case I analyze the cases and that sense of success through the lens of a new definition aligned to social justice I'm actually going to read this because it's key to how I'm proceeding so what I suggested in my in my proposed definition is that open education is the development of free digitally enabled learning materials and experiences primarily by and for the benefit and empowerment of non-privileged learners who may be underrepresented in education systems or marginalized in their global context you'll see primarily by and for it means there's space for other options but it just puts a primacy focus of where the need is greater and then I have a success measurement I'm proposing that success can be measured not by any particular technical feature or format but instead by the extent to which they enact redistributed recognitive or representational justice which are roughly speaking the economic the free because it's too expensive side the recognitive the social the multilingual the multicultural the gender identity side and the representational which is the kind of voice of the learner the voice of the community speaking for themselves for example black voices telling black stories not being told by by white voices would be the classic example there or indigenous knowledge as leadership you know not being something done too so those are the frames so you would have seen the textbook broke this is an amazing campaign I watch with some interest from Australia our students are not on the campaign trail yet but they may be soon so clearly you know free textbooks is an act of redistributive justice you redistributing resources from to people who by circumstance have less it's very simple concept it's the most long-standing one but also recognitive justice is so important and I'll read this quote and you'll see that for Ruggeda Ali and it might be able to afford that education but is Ruggeda Ali getting a job at the end in the same way that her peers so after completing this qualification in Australia I applied for many junior positions where no experience in sales was needed even though I had worked for two years as a junior sales clerk I didn't receive any calls so I decided to legally change my name to Gabriella Hannah and I applied for the same jobs and got a call 30 minutes later and this is Ruggeda Ali from Sydney and unfortunately if you care to look this research is long wide and deep and put in every single country so this issue of you might have a job but do you have decent work that pertains to what you've studied and are you getting those jobs at the same rate that people who are called Gabriella Hannah are getting and the answer is no so as educators interested in justice for our students it's not enough to make the thing free we must think about what is the thing saying you know and who gets to say that and I think open education resources and practices can embody all of those things and my study suggests that when we do it you get some great outcomes so I'm not going to drill into that I think I've given enough examples so let's just move through here's the seven cases what I did with this little summation I actually looked at 20 exemplars and then I evaluated them against the three forms of social justice and I did the old the tick box there and then these were the seven that tick the most boxes literally and so these are the ones that that made it into the shortlist so you will see that all of them are redistributive justice where there's a regionality to it they're reaching regional students the second one they're benefiting women primarily and others they are recognizing the social the multilingual so multiple languages and they are allowing a voice to come through that represents marginalized learners so for example in the in the multilingual I see to move for European teachers in that program it wasn't just that it was free in the Recognitive Justice column you have the fact that they're actually participating in their local language with not one not two but seven different local language facilitated groups and that was enormously powerful and I think something that has a lot of potential so the English is the language of instruction their English is pretty good but the confidence to speak in your own language in your own voice with your own people to your own context and that's when the representational justice comes in make it local for your school make a lesson plan that speaks to your community of course that's going to work when you can communicate to your peers as you go along so that's a powerful one the South African multilingual maths and science text this is the sea of all the case for people who know that leading organization and they produced an online platform to help a whole community co-author in multiple languages and so this one allows for example through this diagram you can see that they leveraged volunteer labor they hired hired labor as well to facilitate workshops on the ground to build a community and then the online platform allowed for them to develop their voice together one of the neat things about this platform was that there was no role or rank so well they had very high ranking government officials and very modest regional school teachers in dirt floor schools making comments about how to best teach that and making a better quality thing in a couple of different languages teachers guide in some of the 11 languages so you can see the three levels yes it's free it recognizes the difference and it gives the voice to differences the three levels of justice working together so these are some of the cases that I've been particularly inspired by and there are more that can show those three in action but I think that it shows that free online technologies can give a little more to those who have less but we're thinking about the resourcing the respecting and the voice and I think as designers of programs we can think about social justice as a process in how we develop as well as in an outcome of what we produce so my my data is also showing that community can partnership with social communities not just technical platforms so not just partnering with edX to do a moot but partnering with a community school or employment agency broadening the notion of partnership can actually bring a strength to your program where you're speaking to and for a community and extending your reach to places you just can't go when you're sitting inside a university so that would be my key message today about some of the things coming from these exciting cases where people are doing it differently and reaching students who people are saying it's hard to reach but I say with community together with collaboration and social justice principles and terms as tools I think we can make a difference. Thank you. Well done, lively, lively Sarah. Great insights. Questions to Sarah? Questions, input, concerns? Good stuff. Well done, round of applause to Sarah. Thank you, I might just spend that minute just giving a plug to our GIME special edition open education and social justice so this is an opportunity to surface even more cases letting people tell their story in these different ways so we can all learn to think and do differently so this is abstracts in June papers at the end of the year we will hope to publish this special edition in GIME for OER 20.


Thank you for joining us for our webinar today. I am so excited to be here with you. I wish it was in person, but hopefully next year. But I'm very eager to have this opportunity to introduce myself as medical director of breast imaging at both Riverview and Bayshore Medical Centers, where I hope to build upon what are already exceptional breast imaging programs along with my colleagues, Dr. Wang, Dr. Ko, Dr. Sokolovskaya, and Dr. D'Angelo. So as you all know, it's October. That means fall, Halloween, and of course October is breast cancer awareness month. So what a perfect opportunity for me to be speaking to you today about what has been my personal professional passion for the past two decades, early detection and diagnosis of breast cancer. And I am absolutely certain it doesn't need to be October for us to be aware of breast cancer. I am sure it's impacted all of our lives in one way or another. So during this talk, I'm going to really focus on the W's of breast cancer. Why we screened for breast cancer? Who should be screened? When and how often? What imaging modalities are best? And where is it best to be screened for breast cancer? And then I'm going to offer my own personal approach. I'm an advocate for a personalized approach to screening for breast cancer based on risk, age, and personal goals of breast health. First, the facts.  It's really a major health issue worldwide. It is the most common non-skin breast cancer in the world. There are about 2 million cases per year worldwide in the United States, nearly 230 new cases per year. And for those of us so fortunate to live in a beautiful state of New Jersey, there are 8,330 new cases per year. And very unfortunately, breast cancer is a significant cause of death. Nearly 40,000 deaths per year in the United States and 1,250 per year in the state of New Jersey. And this is some data from the American Cancer Society just to show you that if you look at estimates of new cancers in the state of New Jersey, you can see that breast cancer is the number one most common cancer. In fact, it surpasses the other common cancer, prostate cancer, by about 200 cases, and then lung, colorectal cancer, bladder cancer, and melanoma of the skin. However, breast cancer is not the number one cause of cancer related deaths. For that, you can look at this right hand column and see that breast cancer is fourth in line after lung, colorectal, and pancreatic cancers. So where are the hotspots of breast cancer in the United States? You can see it's sort of patchy in the United States. And if you look on the East Coast and try to find the state of New Jersey, you will see that New Jersey is navy blue. It's a hotspot for breast cancer for reasons that I think are uncertain at this time. Certainly on the East Coast, you can see Delaware, Connecticut, and New Hampshire are as well. What about by counties? So here's the state of New Jersey separated by counties. And you can see Hunterdon County is really a hotspot within the state of New Jersey. And where we all are so fortunate to live here in Monmouth County, you can see that breast cancer cases are rather high. There is about 135 to 144 cases per 100,000 women. So breast cancer is common near and dear to us right here in our community and where we live.   However, there are some differences to be aware of. You can see that white women in the state of New Jersey have the highest incidence or rates of breast cancer followed by black women, then Hispanic women, then Asian and Pacific Islanders. However, the greatest death rate is in black women, which may be multifactorial. We know that black women tend to get more aggressive tumors, triple negative tumors, tend to have a genetic predisposition, and there may be disparities in access to care in terms of screening. But those are the statistics as we know them here and now. The other important thing to know that we talk about breast cancer is one disease, and it is absolutely not. It is very heterogeneous. There are very, very many different types and site types of breast cancer based on whether it starts in the deaths, whether it starts in the lobules. That's the part of the breast, grape-like structures where milk is made when we're breastfeeding, whether it is detected at a time when it's invasive, when it's invaded out of where it started, which it is in about 75% of cases or whether it's in situ, noninvasive, within the duct, contained by the death membrane where it started, different grades based on how aggressive the cells are from grade one, the least aggressive, to grade three, the highest aggressive, whether or not tumors express the estrogen and progesterone receptors or the HER2 oncogene, and all of these differences inform individualized, personalized, and targeted treatment. The good news is out of all the cancers that we may get, breast cancer is highly curable. It's a progressive disease, so early detection is an opportunity to halt that natural progression. If you look at this serodata, you can see that breast cancer is diagnosed within the breast localized about 62% of the time, which happens to correspond with the percent of women in the United States who are screened, so we got to get that number up. The five-year survival is really high, 99%. When breast cancer is detected at a time when it's regional, it's involved the breast and the lymph nodes on the same side, as it is 30% of the time, the five-year survival rate drops down to 86%, and when it's metastatic at diagnosis, as it is unfortunately in 6% of the time, the five-year survival rate goes down to 27%. So why do we screen for breast cancer? I see women very frequently who are a little bit unhappy. They're coming in for a mammogram, their doctor perhaps made them come in or encourage them because they have no family history, so we screen for breast cancer because it is common, and we screen to test a population of healthy women in order to detect unsuspected breast cancer at a smaller size and earlier stage that would otherwise be found perhaps by finding a lump. Why? It increases treatment options and treatments that are minimally impacted to your life and certainly well tolerated. It improves outcome and of course our ultimate goal, long-term survival. Who should be screened? As I said, women need to be screened because the two most important risk factors for breast cancer are having breasts and getting older, and you can see from this curve, which is age and incidence of breast cancer that at about age 30 or certainly by 35, the slope of getting breast cancer, the chances of getting breast cancer goes up in a linear fashion up until the time about the mid or later 70s. So being a woman and getting older, the main risk factor. Certainly some women are at particularly high risk for breast cancer. Women who have been diagnosed are at three to four times higher risk if you have a relative with breast cancer, especially a first-degree relative doubles the risk, greater than one first-degree relative triples the risk, and if you have a male relative with breast cancer, it doubles the risk. A trait that we inherit, dense breast tissue, having fibrous tissue, the composition of our breast is different in all of us, is actually a significant and independent risk factor for breast cancer.  If you have a prior biopsy showing atypia, it can increase the risk from four to 10 times. If you've had Hodgkin's disease and received chest radiation at a young age that elevates your risk to four to five times, and the majority of breast cancers, 90 percent are sporadic, but five to 10 percent may be inherited due to a genetic mutation, and that increases the risk from five to six times. There are other risk associations that may be related to our hormonal milieu or ovulatory cycles, so a greater number of ovulatory cycles may cause ourselves to be proliferative, and perhaps DNA mutations occurred during those times we may be vulnerable, so early menses, late menopause, no children can increase the risk for breast cancer. Postmenopausal hormonal therapy with estrogen and progesterone, it's not a direct cause-effect of relationship, but perhaps estrogen and progesterone may promote breast cancers. Postmenopausal obesity is a risk factor and alcohol consumption. There are computer models that can actually quantify the specific lifetime risk for breast cancer for all of us. The Tire Acusic is the one recommended by the American College of Radiology that factors in your breast density, family history, and multiple risk factors. Why is this important? It can inform personalized screening recommendations, and the American College of Radiology recommends that all women by the age of 30 undergo a risk assessment so that if there's possibility of genetic mutation, they can be tested. If it's discovered or they are particularly high-risk, screening can start at this time by the age of 30. So what is the screening test for breast cancer? Well, despite all of the new imaging modalities that you may have heard of, mammograms remain. The primary imaging modality and the modality proven to reduce deaths from breast cancer, they are relatively inexpensive, they are fast to perform, they're safe and well tolerated for the most part. Even if compression is uncomfortable, it's brief. They're readily accessible to large populations of women. We do mammograms starting early in the morning. We go till 7.30 at night and we even do screening mammograms on the weekends. They're accurate and they have been proven to be effective. And as you know, 3D mammograms are actually now considered the gold standard and probably the most impactful new technology I will see in my career is 3D mammography, also known as digital breast tumor synthesis. Why? It is simply a more accurate, better mammogram.  And of course, 3D mammograms have been available for a number of years. But if the next generation is out and Bayshore Medical Center has the latest and greatest 3D machine, which is not only higher resolution, but it's more comfortable because there is a curved paddle for compression. How do we know mammograms are a benefit? Well, there have not been one, two, three, but six randomized control trials. These trials are the gold standard for proving effectiveness of a screening test. And these have all shown a reduction in breast cancer deaths by 25 to 52 percent in women invited to be screened compared to those not invited. We know that since screening programs have been developed in the 1990s, breast cancer death rates have decreased by 40 percent. And from my perspective, having been in practice for a couple of decades, early detection due to mammography has really led to a paradigm shift in how we treat breast cancers because the overwhelming majority are early stage lymph node negative tumors. This has led to lumpectomies instead of mastectomies. Sentinel lymph node biopsies, just sampling one or two lymph nodes instead of full axillary lymph node dissections, even radiation therapy and chemotherapy now may be optional depending on the specific stage and specific characteristics of tumors. So it's a whole new frontier in treatment due to early detection. Of course, no test is perfect. And there are limitations to screening that everyone should be aware of. Mammograms may miss or not detect about six to 10 percent of breast cancers, even using 3D mammography, especially in women who have dense breast tissue. Mammograms may not detect 20 to 30 percent of breast cancers in those of us who have dense breast and are therefore at higher risk. So it's sort of a double whammy. These interval cancers, interval cancers or cancers that are found by finding a lump instead of being found on a mammogram tend to be aggressive tumors. So we need to find other modalities to add to mammography to find these tumors. There are some harms to screening and those those are called false positives. I call false positives false alarms. Women who get recalled from screening for additional views, it's common. We recall about 10 to 14 percent of women. You should know that if you get the phone call to come back in, chances are everything is going to be okay. The cancers, the PPV1 are cancers divided by women called back are only 6.5 percent. So if you get that phone call, there's a 93.5 percent chance everything will be okay. And even when we recommend a biopsy, 80 percent of the time they're benign. And so we've pushed that threshold for early detection very low. There's lots of things we find on a mammogram, but just because we find something doesn't mean it's cancer. These are called false alarms. And then theoretically there is over treatment. Some cancers we treat may never have caused death. And so generally there's now a de-escalation of treatment. So we tend to treat the woman, her age, and the type of tumor diagnosed. So the current average risk screening recommendations you should know are confusing because those of us physicians that are in different specialties are governing bodies have slightly different recommendations. Because of the attempt to balance the undisputed benefits from screening versus the harms which are these false positives or what I call false alarms. There is a consensus though among all governing bodies and that is annual screening mammograms beginning at the age of 40 undisputedly save the most lives. So that's where I put my focus on. The recommendations from the NCCN, that's the National Comprehensive Cancer Network, the American College of Radiology, Society of Breast Imaging, and Medical College of Gynecologist is annual mammograms starting at the age of 40 in every year. And continuing till a life expectancy of at least 10 years. So mammograms are for healthy vibrant women who expect to live another 10 years at least. If you have a first degree relative who had premenopausal breast cancer, you want to start screening 10 years earlier at the age in which your relative was diagnosed. And also some women would need to consider supplemental screening with MRI as well. And are mammograms enough? Well, as you're very well aware, when you get your letter about your mammogram, you're informed what your breast composition or density is. And that is because we want to inform women who have dense breasts that that may limit how well mammograms detect breast cancer. And it also elevates the risk of breast cancer. And so that's led to an interest and a demand for what we call supplemental screening, not instead of a mammogram, but in addition to a mammogram. And just to show you what different typical breast compositions are like, I always tell women, mammograms are sort of like thumb prints. No one has the exact same pattern as any other woman. In fact, I recognize some of my patients through their mammograms. And the composition of the tissue under the skin really ranges from mostly fat, as you can see in this case, the tissue is mostly dark. Fatty tissues have a darker appearance compared to average a mixture of fat and wispy fibro glandular tissue to what we call heterogeneously dense, whiter areas within the tissue. And then category T by Reds D is extremely dense. The tissue is predominantly fibrous. And so the risk is greater in these two categories, C and D, women who have heterogeneously dense breasts and extremely dense breasts. So this leads me to my personalized approach to breast cancer screening. I'd love to reach the point where we can have the access to risk models so that we report the lifetime breast cancer risk in all women who come in for their mammogram. After all, we are asking you and you are informing us about your age, your family history, your hormone use, and we can calculate your risk, which then informs screening recommendations, we can therefore identify women who have a lifetime risk of greater than 20%. That puts you in the high risk category. We can know whether you should be referred to see that there might be a genetic mutation for genetic counseling. And certainly, if you have a history of breast cancer, we can identify women who are in immediate risk and have dense breasts, they may be candidates for ultrasound. And of course, all of this informs what I call modality specific screening recommendations, which always starts with a mammogram, which should be 3D in all women, but may include other imaging modalities such as breast ultrasound and breast MRI and emerging modalities that you're going to hear about in the future include abbreviated MR, which is a shortened version of an MRI for screening purposes and contrast enhanced mammography. And I'm just going to touch upon these modalities briefly. I'm sure everyone's heard of breast ultrasound, it has so many medical uses, it's used during pregnancy. And it's also invaluable for breast imaging. It's very well tolerated. It's fast to perform. It's completely safe. As you know, it uses sound waves. It's cross sectional imaging. So unlike a mammogram, there's no overlapping tissue. It's not impeded by breast density.  When you do supplemental screening in with ultrasound and women who had dense breasts, we can find additional breast cancers. Generally speaking, it's about three to five per thousand women that are screened with ultrasound. And we do do supplemental screening with ultrasound in women who have dense breasts, who may be at intermediate risk or elevated risk for breast cancer. You should know if you're going to have a breast ultrasound for screening purposes, you want to go to a center that's highly specialized and dedicated and does it all the time because quality of the exam depends on the equipment and the expertise of the people and dedication of the people doing the exam. And I'll just show you an example of a mammogram. This is a 57 year old woman with, hopefully I've trained you and you know that this is an extremely dense breast tissue. There was a family history of breast cancer in her sister. This mammogram is negative and ultrasound detected a very small invasive cancer. Can you see these cases? What about contrast enhanced MRI? So MRI of the breast with contrast really combines two unique features in breast imaging. Number one, the soft tissue detail of an MRI is really quite incredible. It's cross-sectional imaging. There's no overlapping tissue, but what is key is giving contrast. When we give contrast through the vein and then image the breast with MRI, we are getting something we don't get with mammograms or ultrasounds. And that is functional information. What areas have an increased blood flow and abnormal blood permeability because very aggressive breast cancers in order to grow, in order for cells to divide, the very first thing they develop the ability to do is bring in abnormal vessels and those vessels are leaky and MRI gives us that unique information. And so we do do MRIs for screening purposes in a certain subsets of women who are at particular elevated risk. If you have a lifetime breast cancer risk of greater than 20%, you meet criteria for having MRIs yearly. If you have a known genetic mutation, the most common are the BRCA1 and BRCA2 or a first-degree untested relative. You meet criteria for breast MRI in addition to mammograms. There are additional no mutations lying specifically if you've got one of those or you're an untested first-degree relative. You meet criteria for an MRI. If there's a history of chest or mantle radiation between the ages of 10 and 30, those are mostly women who have had Hodgkin's disease. If you have a personal history of breast cancer and you have dense breast tissue or you've been diagnosed at the age of 50 or below, we do MRIs in those patients as well. And here's just an example. This is a former patient of mine who has a known BRCA2 mutation.  And you can see how brightly things can show up on MRI using contrast. So this is an area in the breast that is taking up the contrast very brightly. This was also found on ultrasound based on the MRI. And this is an invasive ductal cancer. I'm very interested in an emerging imaging modality called contrast-enhanced mammography, which combines the incredibly high resolution of our 3D mammogram's digital breast homosynthesis with contrast, which I've already told you is key to detecting particularly aggressive tumors. And here's a diagram. When cells are actively dividing, they have the ability to bring in abnormal vessels. And so contrast-enhanced mammography is like an MRI, but using a mammogram. So instead of a 35 or 40-minute exam where you're laying prone and you go into the bore of the magnet, this is just like having a mammogram after contrast. So it's about a five to 10-minute exam and you get that key information that you get with contrast. And here's just an example of a contrast-enhanced mammogram. We do two exposures, one at a low KV, one at a high KV after contrast is given. We do a subtraction image. And just like that MRI I showed you, you can see rightly enhancing abnormalities of the breast, even in breast as extremely dense disease where this tumor is not seen. It's hidden by that dense breast tissue. So that's an emerging modality that I'd like to certainly implement sooner in the next coming years at both Bayshore and Riverview Medical Centers. So in conclusion and toward the end, where should women have mammogram? Well, women should have a mammogram at an ACR accredited breast imaging center of excellence. Why? In order to do mammography, all centers need to have an accreditation in mammography only. But in order to be accredited as a breast imaging center of excellence, you have to be accredited by the American College of Radiology in not only mammography, but breast ultrasound, breast MRI, and tomosynthesis or stereotactic biopsies. And that assures safety. That assures that you are receiving your care at a center that has dedicated staff, dedicated personnel, physicians who are highly trained and have very high level of expertise in breast imaging. That way you have access to multimodality screening, minimally invasive breast biopsies with, most importantly, a continuity of care. And also access to a multidisciplinary team of specialists, surgeons, oncologists, radiation oncologists, genetic counselors, nutritionists, nurse navigators, and breast tumor boards. And just to introduce you to our team at Bayshore and Riverview Medical Centers, in addition to myself, we have Drs. Juan, Dr. D'Angelo, Dr. Ko, and Dr. Sokolovskaya. They all have a very high level of expertise in breast imaging. They are wonderful, awesome, compassionate physicians, each and every one. And I'm very proud to work with all of them. And I'm very proud that both centers are breast imaging centers of excellence and have recently both centers have just passed both their ACR accreditation and MQSA inspections. So with that, I think I will open this up to any questions you have because I've talked for quite some time. So I think, Kalen, I'll be able to see questions. I think, yeah. Perfect. So I'm not sure if I could hear people ask questions or whether I should just answer questions that people have typed in. I think you can just read out the question and then answer that way. Okay.  I started at Hackensack Meridian Health in June of this year. So the first question is 3D mammography always performed at JFK. So I really do not know. Kalen may know. I can tell you that 3D mammograms are not performed everywhere in the country, but certainly will be quite soon. It's reached the point where they are now considered the standard of care. And certainly since I've been in practice, when I had been consulted to do second opinions regarding cases from the outside, and I believe including JFK, they have all been 3D mammograms. Kalen, do you have any additional information? I actually do not. I'm only at the Short and River View, so I can't answer that question, but we'll make sure to get that answered for you. I'll send you a separate email. Right. I have visited several sites at Hackensack Meridian Health. They have all been 3D. So I'm going to assume, but I don't know for sure that JFK is as well. And then another question somebody had was, can topical estrogen cause breast cancer? So first of all, I'm going to start the answer to that question that estrogen and progesterone are estrogen alone. It's not a causal effect relationship. For example, we know that cigarette smoking causes lung cancer. That is a direct cause and effect. Astrogen and effect progesterone may actually promote certain breast cancers to find a happy environment to grow, to divide, to do their thing ultimately to a metastasis, because it's a promoter more than anything else. Topical astrogens that are used, there is some absorption. Whether or not they promote breast cancer is not completely known, because the studies were done with hormonal therapy, which is generally pills. If you use topical estrogen, by that I mean maintenance on the skin for hormonal therapy, then you're definitely getting absorption and there could be a promoter effect for breast cancer. If you use estrogen, vaginal suppositories, post-metaposly, then the absorption is really minimal and it's probably safe to continue using them.


Hello viewer welcome back and thanks for watching. Today I'm gonna talk some more about so-called wokeness, something that a lot of people seem to think is just being nice to other people who aren't like you, which most of us are for, especially me. I'm all about treating people like you want to be treated so I don't mistreat people. Wokeness is not what it appears to be and there's a clip currently trending on Twitter that perfectly exemplifies that and it comes from a YouTuber named Indy Samarajiva and he's a writer who apparently appears in Sri Lankan media. However, Indy did grow up in America and in this clip, Indy demands that so-called whiteness be abolished and that anyone claiming to be white is actually just a white supremacist monster that in his words need to be put down. I wanted to show you this clip because it demonstrates a few things that folks like me have been warning about the woke movement for a long time, that at its core it's not just anti-white, but even genocidal. Let's take a look. I'm one, Vanakkam, Salaam. Today I'm going to talk to you about abolishing whiteness, which bear with me. It's far less to lose than you'd think.  He appears to be maybe an Indian man, a Muslim. He was raised in America but now he lives apparently in Sri Lanka. But what effect would that have on him since he's not white? He's just targeting another group. I mean, the absurdity of what he's saying already just shows you the kind of level of self-awareness we're dealing with here. So why am I talking about abolished whiteness? So what I'm saying is renounce your whiteness, be a decent human being. All right. This is another point where he's, that's just like an insane statement. He's saying that white people aren't decent human beings. By default, you are not a decent human being. You must renounce what you are. Renounce your identity. Who you are. You must renounce that until you will be accepted into our fold. And this is part of the woke movement. Positioning white people as if they're outside of humanity or something. Well, what does that mean? First off, think about who identifies as white, you know, as their primary identification. You probably don't.   That is what he just said. Now, would this apply to any other group? Is this standard applied to any other group? Of course not. And it's just crazy because this guy is saying basically exactly what we've been saying that wokeism is doing to people all along. When you cast people by their birth, by their skin color, and you broadly judge and condemn them based on stuff that happened in history that has nothing to do with these people, but you've now connected it to them and you've essentially told all the people who aren't white that any problem in their life stems from that group of people.  And the irony of that, of a Jewish man getting on TV and declaring that a whole group of people is a problem. What do you do with a problem?  And again, here's that self-awareness, that lack of self-awareness that becomes dangerous because these people cannot see what they become.  Just use your imagination. I don't think you would ever find yourself, say, in a crowded theater yelling out white pride. And if you're not proud talking about it or yelling it out, then why be it at all? Exactly. And this is the purpose of the propaganda we've been subjected to since I was in school.   I believe somebody tried this with chat GPT and asked it. It's Pride Bat. And with every single group, it says that it's okay to have pride in your group unless it gets to white people. Then on white people, chat GPT says it's not okay to have pride. And of course, that AI and those responses are derived from what is gathering on the internet. And so that is the message that is spread through our media and through all of our institutions. And the outcome of that is obviously going to be that you have a group of people here who a great percentage of the country, not just the country, but the world see as some sort of a problem that's got to be dealt with. The fact is that I don't identify as brown. Sri Lankans and Pakistanis aren't getting together to invade Myanmar based on our shared brownness and brown superiority. We can't even agree on what a biryani is. Whiteness is actually grounded in white supremacy.  Pretty much every group thinks that they're the chosen people think they're supreme. This is not something that is specific to white people. Something interesting to me that I've talked about before is how much what he's saying mirrors what you would call an anti-semitic conspiracy theory or an anti-semitic trope. It's all of these things except for its repurpose for white people.  Exactly. Exactly. This is what they'll tell themselves when they're putting you on a train.  You're not a Klansman, right? You can tell them that all you want while they're rounding you up and putting you on the train, but they will be telling themselves that you are some sort of a monster. He just got done saying that if you identify white, then that means that you're essentially a Klansman. So what I'm saying is renounce your whiteness, be a decent human being.  One minute later.   Telling people that they have to give up their identity in order to be accepted and good people will never work because you're always going to have people who rebel against that. Sure, you're going to have people who are sheep and they're going to go along with it thinking that by doing that they're being virtuous and they will be liked, not realizing that essentially they'll be making themselves third-class citizens and likely they'll end up against the wall as well. But while all that's happening, folks like this guy will be telling themselves that they're getting rid of Nazis. That's the danger of wokeism is that it essentially says that unless you're down with our struggle, then you're an inhuman monster that needs to be disposed of. A white privilege. What is privilege? It's not a privilege if everyone else has it, then it's just a right. Privilege necessarily depends on stomping on someone else's right. And white privilege necessarily depends on stomping on everybody else. Oh yeah, it's just white people stomping on everyone else.  Who knows because he doesn't give any examples. That's what you guys need to put down.   And this is not like my original idea.  Because he's straight up saying that you've got to reject your identity. There's something inherently wrong with your identity if you're white. And that to be a literal good person, you cannot be a good person and be white. You have to reject that whiteness. Join them against the bad white people. And then those bad white people, that's what they're going to put down. You see how this is going to work now. And racism is not just like isolated being mean to people. Racism is part of the system that preserves inequality that causes things like climate change. You can't fight any of these things without fighting whiteness because it's not right. We are literally, like he's literally blaming white people for climate change. Like how do you not see, like how do you not see that you are a Nazi at this point? Like who talks like this about a group of people? The only people I know of who talk like this are like clansmen and Nazis. You see folks I've been saying for years one of the things I repeat a lot is that the reason the left is dangerous because they have no self-awareness. They're constantly rationalizing things as different when they do it because they've been told so many times that when they get into trouble and they do trouble, it's good trouble by virtue of it coming from them. And this all naturally leads to this conclusion that without white people in this world, it would be perfect. It would be a utopia. It's a license to do anything. And that's essentially the license of whiteness.  And that's absolutely true. But in America, especially, the deal has always been that the poorest white person could always, you know, stomp on a black person. They would always have that over them. And that's expressed in many ways. That's expressed in lynchings and so on. All right, I'm just going to stop it right there because he's already said everything I need him to say to prove my point that woke ism is a corrosive mind virus that at its core is nothing but anti white racism and giving justifications for that. All right, folks, thanks a lot for watching. I hope you enjoyed it. Please hit that like button, share, subscribe and make sure to leave a comment to continue the discussion. Thanks a lot again. I'll see you on the next one.