Live from Orlando, Florida, it's theCUBE. Covering Pentaho World 2017. Brought to you by Hitachi Ventura. We are kicking off day one of Pentaho World. Brought to you, of course, by Hitachi Ventura. I'm your host, Rebecca Knight. And along with my co-host, we have Dave Vellante and James Kobelius. Guys, I'm so thrilled to be here in Orlando, Florida, kicking off Pentaho World with theCUBE. Hey, Rebecca, twice in one week. I know, this is very exciting, very exciting. So we were just listening to the keynotes. We heard a lot about the big three, the power of the big three, which is internet of things, predictive analytics, big data. So the question for you both is, where is Hitachi Ventura in this marketplace? And are they doing what they need to do to win? Well, so the first big question that everybody's asking is, what the heck is Hitachi Ventura? What is that? Maybe we should have started there. You're right, you're right. And we joke, some people say, well, it sounds like an SUV, you know, okay, Japanese company, blah, blah, blah. But when you, we talked about Brian Householder. Well engineered SUV. So Brian Householder told us, well, you know, it really is about vantage and vantage points. And when you listen to their angles on insights and data anywhere, however you want it. So they're trying to give their customers an advantage and a vantage point on data and insight. So that's sort of kind of interesting and cool branding.  Certainly Hitachi America, which is really not a brand they use anymore, but Hitachi data systems. Brian Householder talked in his keynote, when he came in 14 years ago, Hitachi was 80% hardware and infrastructure and storage. And they've transformed that. They were about 50-50 last year in terms of infrastructure versus software and services. But what they've done, in my view, is taken now the next step. I think Hitachi has said, all right, listen, storage is going to the cloud. Dell and EMC are knocking each other's heads off. China's coming into play. Do we really want to try to dominate that business? Rather, why don't we play from our strengths? Which is devices, internet of things, the industrial internet. So they buy Pentaho two years ago. We're going to talk more about that, bring an analytics platform, and just sort of marrying IT and OT, information technology and operational technology together to go attack what is a trillion dollar marketplace. Yeah, that's it. So Pentaho was a very strategic acquisition. For Hitachi, of course, Hitachi data systems plus Hitachi insights plus Pentaho equals Hitachi Vantara. Pentaho was one of the pioneering vendors more than a decade ago in the whole open source analytics arena. If you cast your mind back to the middle millennium decade, open source was starting to come into its own. Of course, we'd already had Linux and so forth, but in terms of the data world, we're talking about the pre-Hadoop era, we're talking about the pre-Spark era, we're talking about the pre-TensorFlow era. Pentaho, I should say, at that time, which is, by the way, now a product group within Hitachi Vantara. It's not a standalone company. Pentaho established itself as the spearhead for open source predictive analytics and data mining. They made something called WECA, which is an open source data mining toolkit that was actually developed initially in New Zealand. The core of their offering to market, in many ways, they became very much a core player in terms of analytics as a service and so forth, but very much established themselves Pentaho as an up and coming solution provider taking more or less by the book, open source approach for delivering solutions to market. But they were entering a market that was already fairly mature in terms of data mining, because you're talking about the mid-2000s, you already had SaaS and SPSS and some of the others that had been in that space and done quite well for a long time. And so, kind of had to the present day, Pentaho had evolved to incorporate some fairly robust data integration, data transformation, all ETL capabilities into their portfolio. They had become a big data player in their own right, with a strong focus on embedded analytics as the keynoters indicated this morning. But there's a certain point where in this decade it became clear that they couldn't go any further in terms of differentiating themselves in this space, in a space as dominated by Hadoop and Spark and AI, things like TensorFlow, unless they're a part of a more diversified solution provider that offered, especially, the critical thing was the edge orientation of the industrial internet of things, which is really where many of the opportunities are now for a variety of new markets that are opening up, including autonomous vehicles, which was the focus of Ella Hilloff. Let's clarify some things a little bit. So Pentaho actually started before the big, before the whole Hadoop movement, right? So that's kind of interesting. And then, they were a young company when Hadoop sort of just started to take off and they said, all right, we can adopt these techniques and processes as well. So they weren't too legacy, right? So they were able to sort of ride that modern wave. But essentially, they're in the business of data, I call it data management. And maybe that's not the right term, but they do ingest, they're doing ETL, transformation anyway, they've got analytics, they're embedding analytics. Like you said, they're building on top of work. In the first push of BI as a hot topic in the market in the mid 2000s, they were a fairly, became a fairly substantial BI player and that actually helped them to grow in terms of revenues and customers. So they're one of those companies that touches on a lot of different areas. So who do we sort of compare them to? Obviously, while you think of guys like Informatica, who do heavy ETL, you mentioned BI, you mentioned before like guys like SAS, what about like Tableau? Well, BI would be, you know, there's Tableau and ClickView and so forth, but there's also pretty much Cognos under IBM and of course there's the business objects portfolio under SAP. Right, and Taland would be? Taland, oh yeah, in fact I think Taland in many ways is the closest analog to Pentaho in terms of a predominantly open source, go to market approach that involves both the robust data integration and cleansing and so forth in the back end and also a deep dive of open source analytics on the front end. So their differentiation, they sort of claim is their sort of end-to-end integration. Yeah. Which is something we've been talking about at Wikibon for a while and George is doing some work here, you probably are too, but and it's an age old thing in software. Do you do sort of best of breed or do you do an integrated suite? Now, the interesting thing about Pentaho is they don't own their own cloud. Hitachi Ventara doesn't own their own cloud. So they do a lot of, it's an integrated data pipeline, but doesn't include its own database and other tooling, right? And so there's an interesting dynamic occurring that we want to talk to Donna Perlick about obviously is how they position relative to roll your own and then how they position sort of in the cloud world. And we should ask also, how are they positioning now in the world of deep learning frameworks? I mean they don't provide, near as I know, their own deep learning framework to compete with the likes of TensorFlow or MXNet or CNT and so forth. So where are they going in that regard? I'd like to know. I mean, there's some others who are big players in this space like IBM who don't offer their own deep learning framework, but support more than one of the existing frameworks in a portfolio that includes all the, some of the, much of the other componentry. So in other words, what I'm saying is you don't need to have your own deep learning framework or even open source deep learning code base to compete in this new marketplace. And perhaps Pentaho's or Hitachi Vantaro's road mapping, maybe they'll take an IBM like approach where they'll bundle support or incorporate support for two or more of these third party tools or open source code bases into their solution. WECA is not there as either, it's open source. I mean WECA is an open source tool that they've supported from the get go. And they've done very well by it. Just kind of like early day machine learning. Yeah. Okay, so we heard about Hitachi's transformation internally and then their messaging today was of course. Well, exactly. And that's where I really wanted to go next was we're talking about it from the product and from the technology standpoint. But one of the things we kept hearing about today was this idea of the double bottom line. And this is how Hitachi Vantaro is really approaching the marketplace by really focusing on better business, better outcomes for their customers and for obviously for Hitachi Vantaro too, but also bettering society. And that's what we're going to see on theCUBE today is we're going to have a lot of guests who will come on and talk about how they're using Pentaho to solve problems in healthcare data, in keeping kids from dropping out of college, from getting computing and other kinds of internet power to underserved areas. So I think that's another really important approach that Hitachi Vantaro is taking in its model. And the fact that Hitachi Vantaro, in other words the Pentaho solution, has been on the market for so long and they have such a wide range of reference customers all over the world in every, many vertical. That's a great point, yeah. Willing to go on camera and speak at some length of how they're using it inside their businesses and so forth speaks volumes about a solution provider, meaning they do good work, they provide good offerings that companies have invested a lot of money in and are willing to vouch for. That says a lot. Right. And so the acquisition was in 2015. I don't believe it was a public number. Because Hitachi limited, I don't think they had a report but the number I heard was about a half a billion, which for a company with the potential of Pentaho is actually pretty cheap, believe it or not. I mean you see a lot of unicorns, a billion dollar plus companies. So, but the more important thing is it allows Hitachi to further its transformation and really go after this, you know, trillion dollar business, which is going to be really interesting to see how that unfolds. Because, you know, while Hitachi has a long term view, it's culturally, always takes a long term view. You still got to make money and it's fuzzy how you make money in IoT these days. Obviously you can make money selling devices. Open source, anything, you know, so yeah. Right, well, but they're sort of open source with a hybrid model, right? And we talked to Brian about this. There's a proprietary component in there so they can make their margin, you know, nuts. But, you know, Wikibon, we see this three tier model emerging, a data model where you've got the edge and some analytics, real time analytics at the edge. And maybe you persist some of that data but they're low cost devices and then there's this sort of aggregation point or a hub, I think Pentaho today, they called it a gateway. Maybe it was Brian from Forster. But a gateway where you're sort of aggregating data and then ultimately the third tier is the cloud. And that cloud, I think, vectors into two areas. One is on-prem and one is public cloud. It was interesting what Brian from Forster was saying that basically he said puts the nail in the coffin of on-prem analytics and on-prem big data. I don't buy that. I don't buy that either. No, I think the cloud is going to go to your data. Whatever the, wherever the data lives, the cloud model of self-service and agile and elastic is going to go to your data. A couple of weeks ago, of course, we, Wikibon, we did a webinar for our customers all around the notion of true private cloud. And Dave, of course, and Peter Burris were on it, explaining that hybrid clouds, of course, public and private play together where the cloud experience migrates to where the data is, in other words, the data will be both in public and in private clouds, but you'll have the same, you know, reliability, high availability, scalability, ease of programming and so forth, wherever you happen to put your data assets. So in other words, many of our, many customers, many companies we talk to do this, they combine in a zonal architecture. They'll put some of their resource, like some of their analytics will be in the private cloud for good reasons, the data needs to stay there for security and so forth, but much in the public cloud where it's way cheaper, quite often, but also they can improve service levels for important things. What I'm getting at is that the whole notion of a true private cloud is critically important to understand that it's all data-centric or it's all gravitating to where the data is. And really, analytics are gravitating to where the data is. And increasingly, the data is on the edge itself. It's on those devices where it's being persistent, much of it, because there's no need to bring much of the raw data to the gateway or to the cloud if you can do the predominant bulk of the inferencing on that data at edge devices. And more and more the inferencing to drive things like face recognition from your, from your Apple phone is happening on the edge. Most of the data will live there and most of the analytics will be developed centrally and then trained centrally and then pushed to those edge devices. That's the way it's working. Well, it is going to be an exciting conference. I can't wait to hear more, more from all of our guests and from both of you, Dave Vellante and Jim Kobelius. I'm Rebecca Knight. We will have more from theCUBE's live coverage of Pentaho World brought to you by Hitachi Ventura just after this.


The COVID-19 pandemic upended life as we know it, plunging many Europeans into crisis and uncertainty for the present as well as the future. But with societies under strain, people of all ages learned in 2020 that solidarity and social support were more important than ever. We also saw a new kind of response from European governments. In many places, support schemes were simplified, improved and broadened. This was crucial to protect our health systems and avoid an explosion of poverty. Unfortunately, many were still left behind and help for others arrived far too late. As we look towards rebuilding our societies, one idea gaining attention is the European basic income. It could not only benefit people, but even the European Union itself. How? First, it would be a redistributive and anti-poverty measure, allowing all residents to benefit from the collective wealth generated by European integration without administrative obstacles and limited coverage, without the risk of social stigma linked to conditional incomes. Secondly, UBI would significantly reduce some of the economic pressures for internal migration within the European Union, reducing brain drain and social dumping. It could be a great tool to fight the deep population currently suffered by many European regions. Third, it would be a solidarity mechanism between member states, reducing economic and social imbalances, to bring greater stability to our currency and region as a whole. Finally, such a shared and tangible benefit could increase the support for the European project, strengthening people's sense of shared values and belonging, and showing clearly what the EU can do for you. Imagine that European basic income was in place in 2020. It's sure that many people would have been able to face the shock. A growing number of experts and organisations are convinced that it is an idea worth exploring and are feeding a debate on basic income across Europe. So join the Green European Foundation in this conversation.


Now today's webinar, so advanced to the next slide, is the Global Importance of Frailty and Prefaility in Middle-Age Adults, a Pure Study. Let me introduce our speaker, Dr. Dale Leong. His current positions are as assistant professor in the Department of Medicine at McMaster University, a staff cardiologist at the Hamilton Health Sciences and an investigator in the Population Health Research Institute. Dr. Leong graduated from the University of Adelaide Medical School with Dean's Listing and Honors for Academic Excellence in 2000. He completed his cardiology training, Doctor of Philosophy, Master of Public Health, and Master of Biostatistics Degree at the University of Adelaide, Australia. He's completed a post-doctorate fellowship in cardiovascular imaging at the Leiden University Medical Center in the Netherlands before relocating to Canada. Dr. Leong has received a number of accolades, including the E.J. Morgan-Campbell Career Award at McMaster University 2014. He is a clinician scientist at the Heart and Stroke Foundation of Ontario. He's published over 100 articles and peer-reviewed journals, including the New England Journal of Medicine, Lancet, JAMA, Circulation, European Heart Journal, Journal of the American College of Cardiology, and Blood. So now we welcome Dr. Leong to begin his talk. So thank you very much everybody for your time today and for joining me at your lunchtime to hear this, hear our presentation and thoughts on this topic. So to start with, and please do interrupt me if you have any questions or anything I say is unclear or not coming across well technically or information wise, but is that slide, there seem to be blank. Can anyone see the slides? So I have what is frailty and one bullet point. There we go. Sorry, there's just a quite a lengthy lag between when I click next and when the slide appears, but there's the title slide that I see now. So hopefully everyone can see that. And so really the first question that I thought I would try to address is what is frailty? And I think that everybody has some conception of what frailty actually is. You have a mental image of it, but it can actually be defined by something like this definition here and there are numerous examples of these types of definitions available. We could consider frailty and aging associated susceptibility or vulnerability to poor outcomes when you're challenged by a physiological stressor. And so that makes a fairly good sense. The issue is really how can we measure this for the purposes of research? And I'll advance to the next slide, but it isn't appearing on my screen. Can you see the next slide at all? Here we are. It's just very slow. Apologize. It doesn't seem to be laggy, but we'll deal with it. We'll deal with it. So for the purposes of research, we can actually measure frailty in a number of different ways. And if you look through the literature, there are at least 25 different scoring systems for frailty. And I think the important message that tells us is that there is no perfect tool, there is no gold standard for evaluating whether an individual or a participant in a clinical study is actually frail. So with that in mind, what I thought I would do next is show you, when the slide appears, some of the approaches that we have adopted and that others have adopted as well. For the purposes of our research, we adopted two different approaches to measuring frailty. And I think it's fair to say these are probably the two most widely cited approaches. The first is an approach called a cumulative deficit approach or cumulative deficit index. And when you do this, what you do is you count for each individual in a study how many so-called deficits they have. And you express that as a proportion of the number of deficits that you've counted in total. So you might count at least 20 of these so-called deficits and ideally at least 30 to 40 of them. And I'll go into some more detail about what constitutes a deficit and what you can consider a deficit. But basically these are symptoms or physical signs that are abnormal, the presence of previous diseases or laboratory abnormalities. Because you're expressing these deficits as a proportion of the number of deficits counted, you then have a ratio or a fraction at the end of your count. And this fraction is what's known as your cumulative deficit index. And typically there are thresholds that have been described in the literature, whereby if you have less than one tenth of a point one of the counted deficits, you're considered non-frail. If you have more than 0.21 or some references more than 0.25 deficit index, so more than a quarter of the deficits that are counted, you are considered frail. And between those, you can be considered a state called pre-frail, which is between being non-frail and being frail. So that's one approach there. The other approach is what has been called a phenotypic approach, where you measure a number of characteristics that each participant has. So they're phenotype, if you like, and you can count them up as well. So for instance, with the classic phenotypic approach that was described by the degree almost 20 years ago, you measure muscle strength. And if less than the lowest quintile muscle strength that's considered to be low strength, you can measure physical activity in various ways, including a physical activity questionnaire. You can measure gait speed with a number of tests of walking speed. Typically, for instance, one might use a time to get up and go a test. And there are simple questions that you can ask to see if an individual has lost weight unexpectedly. And the sort of threshold that might be used would be, say, four kilograms weight loss unintentionally over the past 12 months or so. And lastly, we asked about exhaustion, which is very much a subjective complaint that an individual might have, whether or not someone has that. And so according to Fritz's initial description, if you had three or more of these characteristics of frailty, you were considered to be frail. And if you exhibited one or two of these characteristics, you were pre-frail, and none of the characteristics you were considered non-frail. I'm just waiting for the slide to tick over. I hope that's going to tick over. Is anyone able to see the next slide? They're actually coming through pretty well for me. Are they? Yeah, really not for me. So what I might actually do is if everyone's able to actually see these slides except me, it may be my internet connection. I'm going to open up the presentation separately so I can actually see what I presume that you're seeing as well. So the next slide that I have should be a slide asking the question, what constitutes a deficit in this cumulative deficit index? And so basically, as I said before, what I've listed here are the properties of something that you might want to consider as counting as a potential deficit in the cumulative deficit index that you're generating. A deficit should increase with age, but it should not saturate too early. And what we mean by that is we look at characteristics that tend to become more common as you get older, but we don't want them to be so common or develop so quickly that everyone by the time of say middle age has it. Secondly, you want these deficits to be associated with health. So for example, there isn't a very strong association between I don't know the presence of wrinkly skin and health outcomes, hypothetically, let's say. So even though wrinkles do increase with age, they're not specifically associated with health. And so they would not be an appropriate thing to count as a deficit as an example. Thirdly, we like the deficits to really cover in total a range of bodily systems. So you don't, for instance, want all your deficits to be focused on just the heart. You want to ensure that you gather information about a range of physiologic parameters for an individual. And lastly, most deficits are considered binary. So if you have them, then you get a score of one for that deficit. And if you don't have it, you don't get anything for that deficit. But some can obviously be weighted. As an example, you might consider muscle strength. I think we generally accept that the stronger you are, the greater your muscle strength, the better your physical condition. And so you might choose, if you're measuring hand-grip strength or muscle strength in participants, to divide up that one point, the lack of muscle strength, into a range. So for instance, if someone is in the top quintile of muscle strength, you might say that they have a score of one. If they're in the second quintile, a score of 0.75, the third quintile, a score of 0.5, and so forth there. So those are the sorts of ways that we approach trying to sort out what could be considered a deficit and how to use it in a cumulative deficit index. So on the next slide, I've actually shown some examples. As I've indicated on this slide, for the cumulative deficit index, I think at least 30 to 40 deficits are desirable. And the sorts of things that may be quite relevant to include in such an index include, for example, a past history of things like cancer or myocardial infarction, subjective feelings that the participants might express, like feeling depressed, feeling fatigued, and so forth. You can include functional parameters. So for instance, if they respond yes to needing help dressing or yes to difficulty on the stairs, that would be considered a deficit. And finally, you might consider actual physical measurements like group strength that you can take or blood pressure. And as I kind of alluded to before, what may not be appropriate for a cumulative deficit index is things like needing glasses, because we know that it's very common by the time you're middle-aged or older to need glasses.  And similarly, hair color is something that increases with age. It doesn't necessarily saturate too early, but it's not specifically associated with health and so is not so relevant for a cumulative deficit index. So hopefully that is something that's in clarity into how we construct these things. So on the next slide, what you've seen, what I've demonstrated is a group strength as an example of a measurement that might be included in the phenotypic index. So I'm actually turning my attention now to how we construct a free type of frailty index based on participants' physical measurements and characteristics. And the point I wanted to make with this slide is to address the question, how do you determine that someone has low group strength or low muscle strength? Because we've indicated in that freed index you might recall that low muscle strength is one of the five criteria that you use. And I wanted to make the point that this is not entirely clear.  The challenge that we faced in our research was that as you can see from these graphs, in both men and women, muscle strength actually varies not just with age, as I said before, but also with where you come from and what your ethnicity is. So you can see that, for instance, folks from Europe and North America have significantly higher muscle strength for the same sex and age compared to folks from South Asia on the graph presented there. And so what we don't really know, and because global research into frailty, I think is something that's fair to say is in its infancy. We don't know whether we should use one global cutoff for individuals of a particular sex and age to determine what low muscle strength is or whether we should use ethnicity specific cutoffs, for example. So this is something that we need to do further research on and we haven't completely resolved. So while that might not exactly help you with research that you're doing, it is something that needs to be thought of and needs to be, I think, evaluated in a couple of different ways through sensitivity analysis. On the next slide, you see a similar principle that comes to physical activity. So this is data from the pure study that I'll describe in more detail later on that Scott Lear's published. And again, it shows that there is substantial heterogeneity amongst countries of different income as to what level of physical activity is considered normal. So you see that in high-income countries, some of us prize folks in general are more physically active than in lower-income countries and also the source of that physical activity varies. So recreational physical activity is seen almost exclusively in high-income countries, much less in lower-income countries. And so again, when you refer back to that free frail index and you ask yourself, is a particular participant low physical activity or not, the next question is what cutoff do we use for physical activity? Do we use a reference range that is really catered towards high-income countries or should we use something that's specific to where an individual comes from? And the truth is that, you know, levels of physical activity have not been studied as well in low-income countries as compared to high-income countries. And so those reference ranges, if you're going to use country specific reference ranges, are a little unclear. So these are some of the challenges that we currently face and that we need more research to try to clarify there. So having given you that kind of background about how we evaluate frailty and what some of the challenges are, I think the next question that's pretty intuitive is how common is it? And really, the answer to that question is that it depends. It depends as I kind of have been talking about, how you actually measure it. And it also depends what population you're looking at. So on this next slide here, we demonstrate some of the other previous work that's looked into the estimates of frailty prevalence. And there are a number more of these that I haven't presented. But I think you're going to get the idea that most of these studies come from older men and women from North America predominantly into a lesser extent Europe. The other thing to take away is that all of these studies evaluate frailty in different ways, in one of those 25 more indices that I mentioned at the beginning of my talk. What does come through though is that amongst older men and women from predominantly North America and Europe, it doesn't really matter how you measure frailty. Frailty and its precursor, if you like, pre-frailty are common. So if you look on the right hand side of this table, you'll see that a sort of Rockwoods scale there of three indicating someone who's quite frail is present in one in 20 adults aged over 65 in Canada. And Cawthon in the bottom row found similar finding in the U.S. Woods actually found a substantially higher prevalence of frailty using the freed phenotype, which obviously does differ from the cumulative deficit index. But I think it's based on the frailty and pre-frailty are certainly common in these data from older individuals from wealthy countries. And the next intuitive question is if we accept that frailty is common, does it actually matter? So I would argue that yes, frailty is very important. And I don't think that will come as a surprise to anyone. And here is some data to support that contention. So from those same papers I presented on the previous slide, you can see there that as frailty increases using the Rockwood cumulative deficit type of index, the risk of death increases quite steeply. And similar findings can be had from other studies, whether you measure frailty using a phenotypic type approach or another type of scale. The presence of frailty is associated with virtually a two-fold increase in the risk of death. And that's fairly consistent, irrespective of how you measure frailty. So given that background, and I think that that background may be somewhat familiar to most people who would be tuning in today. I think the real interesting questions are what do we consider to be the major knowledge gaps when it comes to frailty? And the specific knowledge gaps that I think exist when I read this sort of literature are as follows. Firstly, given the sort of relative paucity of information from global populations, are there actually differences in the rates of frailty amongst people from different parts of the world? Secondly, frailty has traditionally been thought of as a condition affecting older individuals. But to what extent does it actually affect people who are younger than that? Because that may actually be the seed. It may be the starting point for the development of later frailty as you get older. And finally, what I don't think has been explained very well is how frailty actually leads to premature death. We saw from the previous slide that it certainly seems to, but we don't know exactly how. It's not like a disease where you can die clearly of a heart attack. You can have a cancer that stops your vital organs from working. But we don't know how frailty actually leads to death. And so we'd like to try to address this in some of the research that we've been done. And we'll start by talking about the global prevalence of frailty. So there's a little bit of research done into this. As you can see here, this is some data pulled from a systematic review looking at the prevalence of frailty in middle-income countries according to the World Health Organization classification of country incomes. And it is limited to four countries outside of high-income countries. Again, as before, it's limited to all the populations in these countries. And they have sample sizes which are moderate, I think it's fair to say. What they show here is that frailty once again appears to be fairly common. What is challenging, though, is whether we can or whether we can compare these prevalence rates that we've indicated on this slide with the prevalence rates of frailty from high-income countries or indeed compare frailty prevalence amongst the countries on these slides. And the reason is that firstly, the approach to measuring frailty differed from between studies. And secondly, even though they included as a general rule older populations, if you actually look at the age distributions of these populations, they do differ from one another. And so it's very difficult to conclude that one country or one region has higher frailty genuinely than another country or another region and exactly what the prevalence is. Here's another piece of evidence that might help inform us. This is data from Europe where they mentioned frailty using a cumulative deficit type of approach in community-dwelling adults aged 50 and older. And they plotted the wealth of the country on the horizontal axis against the frailty index, that ratio I mentioned before, on the vertical axis. And they found that there was a genuine sort of inverse relationship whereby the higher the country income, the lower the prevalence of frailty, if you like. But once again, this data is actually limited to a fairly narrow bandwidth. Most European countries are really high or middle income with very little information on low middle and low-income countries. And also it's using an approach which does have some limitations that we can speak to. So I think that essentially the bottom line from my take on it is that we have somewhat limited information on how common frailty is globally and how it compares in different regions. Secondly, does frailty begin from middle age? So there have been a small number of studies that have tried to address this, but only really one that I can find that really looks at a younger population. And that is again a study by Ken Rockwood looking at adults in North America aged over the age of 20. They didn't really try and divide these participants up into frail versus non-frail. But what you can see from the frailty indices that were reported in this paper is that even in middle age 45 to 64, there's a suggestion that frailty may actually be reasonably common with a mean frailty index of 0.16, remembering that a frailty index of 0.21 or more might be considered to be frail. But aside from this data, there really is a very limited amount of information about how common frailty is in middle age and what it actually means if you're found to be frail in middle age. Lastly, how does frailty lead to premature death? That is something that I think there really is a substantial gap in knowledge about and something that we hope to be able to address in our research moving forward. So to get on to the pure study, which is really the title of my presentation today. For those of you who don't know, pure is a study of nearly 200,000 adults from 26 countries around the world. It was initiated by Dr. Selim Yusuf, who's my mentor here at McMaster University. And it now spans every inhabited continent except Australia, which is a source of frustration to us, but be it as it may. Pure recruited adults age 35 to 70, with a median age of 50 years, it turns out. And these folks were all living in the community. As it turns out, just the slight majority of these participants were women. And it is a study that's been being conducted for a long time now, so that the median follow-up across all all participants is approaching nine years. So this is a fairly substantial study. Amongst a number of measurements taken at baseline from pure participants was grip strength. We measured it using a hand-grip dynamometer. And you can see the image on the on the screen there. And what we found in previous work that we've done was that grip strength alone varied significantly between countries and obviously between sexes. And you can see the various pure countries at this stage. We only had 21 countries with hand-grip strength measured. Grip strength varies markedly between, let's say, countries in local areas and countries more high income like Canada and Sweden. But it was really this piece of research and what I'll present on the next couple of slides that piqued my interest in frailty as a phenomenon. So having measured grip strength at baseline and all these individuals, we examined the relationship between that measurement and the subsequent risk of death. And as you can see here that for every five kilogram reduction or lower grip strength that participants had, the risk of death increased by 16%. And that was consistent for both cardiovascular and non-cardiovascular death. And this tells us that grip strength may not be something related to any particular disease stream, but it might be something a little unrelated or independent of a particular disease. And we went on to look at the relationship between grip strength and your case fatality. And so what we mean by that is if during the course of those eight years or the time we did this study, six years of follow-up, you developed a disease, be it an MI, a stroke or a cancer, and you can see those displayed on the horizontal axis there, the grip strength where you just to divide up into high, middle, and lowest grip strengths. You can see the on the vertical axis, the case fatality rate, which is the risk of death after the development of any of these conditions. And what we're showing is that no matter what disease you've got, whether it be an MI or cancer or pneumonia, if you had low grip strength in the blue bars there, your chances of dying were substantially higher than if you had even middle or high grip strength. This tells us that grip strength seems to be very much a protective factor or muscle strength, I should say, as a protective factor against dying from some sort of insult or disease. And that's a nice thing because that actually ties back in with the original definition of frailty I mentioned before on the very first slide where it looks as if muscle strength is telling us exactly what we hope it would when we think that it's a marker of frailty. So since doing that initial research on hand grip strength and developing an interest in frailty, we then have gone on to measure frailty in the pure cohort in two ways. One is using a cumulative deficit index using 47 characteristics that are measured in pure, and we use those thresholds that I mentioned before considering someone pre-frail or frail. We also measured frailty using a phenotypic approach. In pure, we have only measured grip strength, physical activity using the international physical activity questionnaire, and there was a simple question on whether there was unintentional weight loss of more than three kilograms in six months. And so we considered someone to be frail if they had two or more of those three characteristics and pre-frail if they exhibited one. So shown on this slide here are the characteristics of the pure participants divided into whether they were non-frail, pre-frail, or frail and how we measured frailty by phenotype or cumulative deficit index. What you can see is that the proportion of individuals who are non-frail, pre-frail, and frail are reasonably similar irrespective of how we measured frailty. Similarly, there wasn't much discrepancy between men and women, and it didn't seem to matter too much how you measured frailty. Perhaps women were slightly more frail when evaluated with a cumulative deficit index. What we also find is that as one might expect, frailty increases with age, so that's nice because it tells us that there is some face validity to what we're measuring. And what was quite interesting is that frailty is inversely related with level of education. And as we all know, education is an important marker of socioeconomic status as well. So that if we consider the frail phenotype, for instance, the higher the education achieved, the lower the prevalence rate of frailty.  Similarly, with the cumulative deficit index and the bottom right cell, you can see that there was more than a halving of the prevalence of frailty as folks became more educated there. So it seems to be an important factor in what leads to the development of frailty. What we also find is that there is a complex relationship between alcohol and tobacco use and the occurrence of frailty. And I think it's fair to say that no very strong or clear pattern emerges. What is always complicated when measuring alcohol and tobacco use in these sorts of research is that the group that were formerly drinkers or formerly smokers have often quit smoking or drinking for health reasons. And those health reasons might play into why they might be more frail than people who are current drinkers or smokers, for example. So these sorts of data, while interesting, can be a little challenging to interpret. But what we show on the next slide I think is really one of the key findings from our point of view. And that is that it doesn't really matter how you measure frailty again. As you move from high income countries on the left side of each of these bar graphs to low income on the right side of each bar graph, the prevalence of frailty adjusted for age and sex of the population increases and increases fairly substantially. And I think the great strength of PURE is that because we measured frailty in a very consistent manner across these different populations, we can be very confident in these conclusions, whereas other trying to sort of extrapolate from previous work that only measured one population and comparing that with a different study using different methodology is a little more limited. What we show on this slide here is the relationship between frailty and the risk of death after five years. But what we've also done, understanding that the cumulative deficit index is in some respects a measure of multi-mobility because it includes in it many diseases. We've measured frailty here on that sort of access going into the slide using the phenotypic approach. And we've subdivided that into whether or not the individual had one or more or no diseases at baseline. So we're looking here at the relationship between frailty, level of multi-mobility and risk of death at five years. I think what the skyscrapers show us is that frailty and multi-mobility seem to have an additive effect so that for every level of let's say frailty, if you have more diseases, your risk of dying is high or put the other way for any level or any given level of disease, the more likely you are to die. In this Kaplan-Meier curve here, what we present is the risk of death in individuals who had no diseases at baseline that they knew of and who did not develop any disease like myocardial infarction or cancer or pneumonia during the follow-up. And what was really interesting is that again it doesn't matter how you measure frailty and this is a recurring theme. It doesn't matter how you measure frailty but the more frail you are, the more the risk of death is irrespective of whether or not you seem to develop or have any disease. And so this is a really curious funding because it does beg the question how does one actually die because of frailty. Here in this analysis we did something similar, we excluded those with any chronic disease and we looked at whether or not being frail and pre-frail predicted death as well as cardiovascular and non-cardiovascular death after adjustment for a range of confounders and those confounders you can see are listed there. And what you can see is the relationship is still pretty strong. If you are frail, even accounting for differences in age, sex, education and so forth as you can see, frailty is still associated with nearly a two-fold increase in the risk of death as compared to someone who is non-frail and that seems to be independent of whether or not you have a non-chronic illness. What we also found which is quite interesting and almost puzzling to us is that the frailty phenotype was not strongly associated with the risk of developing disease. So on the left hand column you see diseases whose incidents were measured during those eight or nine years or well eight or nine years of follow-up. And you can see that there really was not a strong relationship between being frail at baseline and actually contracting one of these diseases with some exceptions. So there is, for instance, a trend towards a positive association between being frail and developing heart failure, pneumonia or COPD. These didn't reach statistical significance, however. But interestingly there was no real strong association between being frail and developing marcal infarction or being frail and developing cancer. And in some respects that is an encouraging finding because there is some face validity to it. I can't imagine a mechanism by which being frail in and of itself would predispose us to developing cancer. Whereas if let's say we had found a positive association between cancer and frailty, one might be concerned that there could be reverse causation where it was the cancer causing the frailty. So while that is reassuring in some respects, what it still doesn't really tell us is how frailty causes death if it doesn't in fact cause a whole range of diseases. What we did find impure though is, as we presented for the group strength, being frail increases your risk of dying if you develop a disease. So again we have those incident conditions listed on the left of the slide and shown here are the case fatality rates depending on whether you are non-frail, pre-frail or frail. And what is very apparent as with the graph I showed before, the bar graph, is that the more frail you are the higher your risk of dying should you develop some sort of intercurrent illness or disease. So basically to try and summarize what our findings are shown here in this slide is what I think is the classic model of death and that is we all start off let's say healthy. During the course of our lifespan we will have or develop various risk factors for disease and they may eventually lead to the development of disease. If you develop disease you can either die from it or you can survive and it may leave you disabled but that surviving individual is always going to be at higher risk for future disease and so feeding back into this sort of cycle which eventually leads to death and that's how we were taught at medical school to think of how one develops disease and dies. But I think that our research shows frailty maybe have a very important role in this in this model in that if you develop disease frailty increases your risk of death there and so it seems to be a facilitator of death if you have a disease. But also we found that individuals who are apparently frail and have no disease that seem to develop a disease during follow-up do seem to be at increased risk of death and I think this is a source of much interest to us and we need to understand this population better. So I'm just going to finish up with a last couple of slides to speak to where we're heading with all of this. I think when we if we acknowledge that frailty is an important phenomenon then we next need to ask ourselves why do people become frail and I think there are a number of players that might feed into why people become frail and we can classify these as to some extent biologic for instance you know time itself is likely to contribute to frailty but so too might diseases and multimorbidity and then there are a range of modifiable determinants like your behavioral risk factors and non-modifiable ones like you know whether you're a man or a woman for instance and so you might actually subdivide those categories of potential determinants of frailty even further and people have done lots of research into these different categories of determinants for example there is a clear association between shortening of the telomeres and the chromosomes and biologic aging relationships between mitochondrial DNA mutations and biologic aging in the next column you see you know I think that there is almost by definition a relationship between a physical inactivity and frailty and so forth so these this is how we can conceptualize potential determinants of frailty what we're currently doing to try and get to what are the most important causes of frailty is we are in the process of measuring frailty amongst the pure participants on the left hand side in those who survive 10 years and what we want to know is if you are robust or non-frail at the beginning of this pure study and you then subsequently become frail what has led to that? Incidentally I should mention we have a similar dataset that we're developing in prostate cancer patients as well and so we consider frailty as I kind of alluded to before as you know a number of potential contributors to it and what we are doing is looking for potential biomarkers of frailty and these can be categorized in a number of different ways and I've listed one here that's occurred to us as we've done a scoping review of literature on the biomarkers of frailty and again there are you know many dozens of these listed in the literature but what we eventually hope to do is use advances in biomarker analytic techniques called multiplex analyses whereby we can analyze hundreds of these biomarkers with very small quantities of biospecimen or plasma to then identify patterns of biomarkers rather than what is traditionally done identifying single biomarker associations at a time and we feel that these patterns of biomarker associations kind of using the categories I showed in the previous slide may actually be more relevant in predicting who's going to become frail than any one biomarker by itself obviously this is a big undertaking we are measuring as I mentioned hundreds of biomarkers and they can be categorized in different ways and they will have relationships with the development of frailty which needs to be adjusted for by a number of confounders and so we are starting to develop these very very complicated biomedical models to describe how frailty develops and I think that these sorts of analytics can very easily and rapidly get beyond the brain capacity of poor folks like myself and so I think that we are going to need to leverage things like artificial intelligence to enable us to understand these complex relationships as we move forward and as our research keeps up to date with the available technology for doing the research so really to wrap up and allow some time for a discussion I think it's fair to say that both frailty and pre-frailty are common I think we've shown that they are more common in poorer settings and in lower income countries it's very clear that frailty can be identified from middle age and has prognostic significance from pure even from middle age and it's also clear that frailty leads to death by increasing susceptibility should you develop an illness but also seems to potentially play a role in leading to death independent of disease and I think we need more research to understand why that observation it might be the case and so lastly I think that the take home message for me is that reducing frailty given how common it is and how important it is may really be an underexploded way of reducing mortality and I haven't spoken this likely disability that can complement our existing efforts to prevent and treat disease and so on that note thank you very much for your attention thank you that was really a great presentation um I'll go ahead and open it up to questions just a reminder muting remains on that you can enter your questions into the chat box at the bottom right hand corner of the web next window at any time and we'll read through your questions so um Nicole I remember asked curious if frailty could be an indicator of recovery time and quality of the recovery so um would you like to speak to that so recovery I might have missed part of it was that recovery from was it recovery on quality of the recovery yeah okay I'm gonna take it the question is curious if frailty I'm sorry Dr the young can hear me sorry yes I can hear you yes I'm gonna take it that you meant recovery from let's say an illness or even an injury and I think the answer is almost certainly yes I think that the less frail you know the more frail you are the less likely you are to recover um and the slower you are going to be to recover uh from any major illness or injury I think we certainly see this clinically and anecdotally and you know this is something that could certainly be measured in research and and almost certainly has but I think that that conclusion is almost certainly correct to speaking speaking to the definition of frailty or the resilience or ability to recover from illness injury exactly so the vicissitudes of exactly so by definition frailty is a characteristic that enables recovery from illness or injury really the more pertinent question is to what extent are our tools and methods for measuring frailty able to detect that and if you are able to show that these sorts of tools are predictive of recovery time then again you have added face validity to how you measure frailty certainly well while we wait for a couple more questions again and I'll go ahead and pose one um so you know you you showed fairly well that that frailty does differ across countries it seems to be an important indicator of frailty did you look for groups across countries did you did you stratify based on on income country to country and look at that yes so you can divide stuff in a number of ways you can divide it up by country income which is what we did it you can divide it up by also by things like level education so irrespective of where you come from be it a high or a low income country the more educated that you are there is you know a generally pretty good relationship or correlation between education status and social economic status and so when you do that even cutting across countries there's again a very positive association in between level of frailty and education so clearly there is something about a level of wealth be it in a given community or be it in individual level wealth that seems to protect you if you are wealthy from a wealthy community from developing frailty exactly what that is i'm not entirely sure and i think it's likely to be multifactorial and we need to do more research and and we are doing this research to understand why you know you might hypothesize for instance that it is things like physical activity if you are wealthier or from wealthier communities you're more likely to be able to undertake recreational physical activity play sports it may be to do with diet quality so for instance you can afford to eat fresh fruit and vegetables which are notoriously expensive in lower income settings it may be with more education that you know that smoking is a bad thing and so you don't do it and you don't develop the risk factors and diseases that can lead to you becoming frail so i think it's likely that these sorts of wealth related questions about what is it about being wealthy that protects you from disease and frailty i think they're likely to be complex and multifactorial answers i think that these relationships are very strong and very true but we need some more sophisticated analytic approaches to understand exactly how well i would take the opportunity to do is make the point that it speaks very much to social equity and i think that if we want to improve health outcomes across communities in canada or wherever we happen to live it is important to bear in mind that the more equitable the distribution of wealth in the country the more likely it is that you have a homogeneously good level of health and in contrast if you have a society or community where there is a marked disparity in people's level of wealth you're likely to equally see a marked disparity in their level of frailty and in their level of diseases and illness and i think we can all think of examples of countries where that exists and so i think that this is important for health researchers and global health researchers to bear that in mind and try and advertise this very prominently and you that's probably speaking also to how frailty may be a facilitator of death and not not just a predictor of diseases that lead to death i i think so yeah absolutely that'd be fair to say yeah very interesting all right another question uh what preventive methods are best for reducing frailty so you're talking about blood tests for frailty you're talking about predictive models for frailty if as a health policymaker or a doctor that you say someone's frail or is at risk of being frail what would what could be rolled out to actually reduce yeah good question uh downside effects of frailty so there's been quite a lot of research done in typically short duration trials like about three to six months looking at exercise and diet and those are fairly obvious candidates and it doesn't really come as a surprise that if you can exercise intensively enough and you supplement especially if you have a nutrient deficient diet with things like a high quality protein that you increase muscle strength in that short term and you reduce markers of frailty the challenge really from a public health perspective is how you implement that and to give you some insight into the complexity if we talk about say diet i think again most of us will know what constitutes a healthy diet there is a lot of pushback or resistance to necessarily implementing that so if you consider fresh vegetables being a part of diet to get them to remote and rural communities requires refrigeration to get them to keep them fresh it requires a lot of cost because they are more expensive than foods that have a very long shelf life because they're full of preservatives and salt so there are substantial difficulties in providing that plus there are interest groups so there may be groups and lobbyists within the community whose interests are not to necessarily promote fresh fruit and vegetables and high quality protein but whose interests may be more to promote food which quite frankly is of poorer quality and so when you put all of these ingredients into the mix it does become very difficult for governments to legislate for healthier food choices and practices and to institute things like taxes or tax rebates to encourage that because there are lots of different facets to these sorts of arguments now with exercise it's a slightly different story because i don't think anyone is going to debate that exercise is a good thing and there is not i would imagine anyone who would be promoting a sedentary or unhealthy exercise lifestyle but the question really comes down to one of time accessibility and adherence just to give you an example i've heard that in sweden they actually the government provides tax relief for companies that allow their workers an hour a day where they are supposed to do dedicated exercise and i put myself that is a phenomenal public health policy and probably speak to the white swedes have you know such a high level of health across their country and so i think innovative approaches and solutions to things like physical activity like what they do in scandinavia is something that we could consider implementing if there's enough will and that would likely help with preventing or reducing frailty certainly well let's do three quick questions and then say goodbye i'm wondering if you adjusted for health care infrastructure public versus private health care access across different countries and whether there were any differences in prevalence of frailty and their associations with death so health utilization or care across countries a great question we to some extent that is incorporated into you know when we adjust for things like education and country income but as you rightly point out it's not completely it doesn't completely account for differences in health insurance and coverage these are data that have been collected in pure at you know a sort of a community level and it's certainly something that we could look into and that was from lily robert mine as part of a cumulative disease and do you not have complete confounding when you're analyzing rates of disease leading to death so maybe a little methods explanation for it yes so we've done a number of different iterations and i left this out for the purposes of keeping things simple we've done a number of iterations of the cumulative deficit index one that includes that it is like you know a history of cardiovascular disease a history of cancer and one that does not include a panel we've also done analyses whereby we exclude individuals who have any any chronic disease at baseline and actually irrespective of how you cut up the pie the findings are still the same and the effect sizes do not change very much from a risk of death of about two with frailty so you wouldn't necessarily think it but that's what we find okay and we have a request to review your biomarkers one last time the slides you mean yeah if i go back to this one here i think so just maybe give a quick brief overview of of your biomarker set yes this is not actually necessarily our final list we're currently doing a scoping review we're about a third of the way through to really get a bird's eye view of what people have done in the past and linked with frailty and again like i said the traditional approach has been to measure one of these markers or maybe two or three and compare it with some sort of marker of frailty usually in a cross-sectional manner the problem is that you know biologists are complicated and when you measure just one two or three markers you don't really capture the complexity of what a human a human being is so given these new sort of o-link platforms that we have available to us at phri where using just a few microliters plasma you can measure i think up to about almost a thousand biomarkers simultaneously we now have the capacity to actually measure a vast array of biomarkers and we're in the process of tabulating what list we actually want now that these that the platforms that you use are customizable to some extent but probably not to the extent that we would like having said that i think that we'll be able to come to a nice list the panel of biomarkers that gives us a good idea about the physiologic changes that are occurring that eventually lead to the development of frailty so this is kind of work in progress that we're presenting here certainly yeah that's fascinating well thank you very much dr now for such a really really great talk i enjoyed it and i think our audience did as well we appreciate your participation in the clc webinar series our problems thanks for having me thank you so i'd like to remind everyone that the clsa data access request applications are ongoing the next deadline for applications in september 24 2018 please visit the clsa website under data access to review available data for the information in details about the application process oh we have the survey back online it was about to say due to technical difficulties that we sent out but um it looks like it is up and running online remind everyone to please say located in the polling option we would appreciate your help with uh having our surveys delivered back to us either now or after uh we send it anonymously if you have any questions or concerns that we can help with about that write to us in the chat box and we can help um and also please remember that clsa promotes this webinar series using the hashtag clsa webinar and we invite you to follow us on twitter finally today is the first of our 2018 2019 monthly webinar series and we will have our next webinar in october uh talking about the canadian urban environmental health research consortium our canoe and its data linkage with the clsa we have uh three speakers we'll be welcoming jeff brock the canoe scientific director elinor satin the canoe managing director and danie doron canoe dating linkage specialist to speak so please go to our clsa website to register for our webinar webinar series soon and join us for next month's webinar thank you everyone for attending today's presentation


10 amazing infrastructure projects that are changing Africa. Infrastructural development across Africa is on the rise. The building of bridges, airports, hospital, and much more has seen a rise in Africa in the last decade. Africa is the world's second largest and second most populous continent, both after Asia. It covers approximately 30.3 million kilometers square including adjacent islands, accounting for 6% of the Earth's total surface area and 20% of its land area. With 1.4 billion people as of 2021, it accounts for roughly 18% of the global human population. Despite the devastating effects of a global pandemic, many mega-construction projects are underway in Africa. Do you wish to know which the infrastructural projects that are transforming Africa? Do you also want to know in which countries these projects are found? Then watch till the end to discover for yourself. Some are government-funded, while others are funded by the private sector. These initiatives also include long-term and short-term transportation, healthcare, and urban development plans. The African construction industry is thriving. Do you have any reservations? Then, discover these 10 incredible construction projects that are changing Africa. Please remember to like and subscribe to our channel as we ride along. And also comment on which project is the best. 10. Soil Thermal Power Station Phase 2, Angola Soyo-I Thermal Power Station is a 750 megawatt natural gas-fired thermal power plant, currently under construction in Soyo, Angola Sayur Province. The upgrade of the Soyo power plant is critical to the Angola Energy 2025 vision. Since its completion in 2017, the original power plant has produced approximately 750 megawatt. With two 360 megawatt units, it barely meets the country's needs. But the planned upgrade includes two additional units. As a result, it may be able to meet the majority of Angola's electricity needs by 2024. By then, all units will be running on locally-sourced liquefied natural gas, rather than diesel. 9. Kigali Central Sewage, Ruhanda Kigali is experiencing alarming levels of pollution in both the Soil and the Nyabugogo River as a result of the 1 million strong population's reliance on septic tanks and latrines for sanitation. The goal of constructing Ruhanda's first sewerage system is to address an urgent public health issue. The plan also has a positive environmental impact because it includes the construction of a wastewater treatment plant. In 2017, Ruhanda received loans from the African Development Bank, a FDB, and the European Investment Bank, EIB. The project was supposed to begin in 2019 and be completed by 2022. The City of Kigali and the Water and Sanitation Corporation W, a SSE on the other hand, are still looking for a contractor. Furthermore, some informal settlements are impeding progress. The City of Kigali and the Water and Sanitation Corporation W, a SSE on the other hand, are still looking for a contractor. Furthermore, some informal settlements are impeding progress, which presents an excellent opportunity for upgrading. 8. State Olympic Doran, Algeria Oran Olympic Stadium is a multi-purpose stadium in Belged, a suburb of Oran, Algeria. It was completed in 2019 and is mostly used for football matches. It will be able to hold 40,143 people. The stadium is part of the Olympic complex mylawed Haidfi. In the stadiumdb.com stadium of the year, 2021 poll, State Olympic Doran was ranked 18th. It is a sports construction marvel among the world's 23 stadiums. The stadium's location was the most difficult because engineers had to build it on a slope. It's no surprise that it was delayed several times between 2010 and 2021. The steel structure that surrounds this Olympic sports complex is the first thing that catches the eye. It has a capacity of over 40,000 spectators. It is also connected to an athletics sports hall and three swimming pools. 7. West Africa Cable System WSCS The WSCS is essentially a 14,500 kilometers long fiber optic submarine cable that connects South Africa, West Africa, and Europe. With 15 terminal stations, the heavy-duty cable passes through 13 countries, including Namibia, Angola, and Ghana. This transcontinent submarine cable is operated by 18 reputable telecommunications companies, including Cape Verde Telecom, Telcom South Africa, and Vodafone. It is most likely currently serving millions of users. The WSCS is made up of four fiber pairs. It was originally designed with 128 wavelengths per fiber pair, operating at 10 gigabytes per second per wavelength, and a capacity of 5.12 terabytes per second. WSCS's initial investment is approximately $650 million. Huey Marine completed a WSCS upgrade one, upgrade using 100 gigabytes per second technology in May 2015, increasing the WSCS system design capacity to 14.5 terabit second. The WSCS upgrade was completed in February 2019 with Huey Marine Solutions to support 3200 gigabytes per second from South Africa to Portugal. The construction of the Balkatanga East District Hospital is part of the government's Agenda 111 to serve undeserved districts with the help of private investors. When completed, the hospital will serve as a springboard for providing distinctive healthcare to all Ganyons. Furthermore, seven other hospitals are under construction as the government commits to providing more healthcare services in areas where there are no hospitals. The construction is still going on, but we don't know when it will be finished. 5. Kano Kajner Rail Project, Nigeria The Kano Kajner Railways Project aims to bridge the 203.8 kilometer gap between Kano and Kajner states. It also forms part of the larger Nigerian Railway Modernization Project, which also includes the Laicos Kano and Laicos Calabar Railways. Unfortunately, the Chinese contractor CC ECC Nigeria Limited appears to be meddling in Nigerian politics, which irritates the federal government. Once completed, the railways will connect Nigeria's northern and southern regions. It will boost the economy by making passenger and cargo transportation safer and more efficient. The project is scheduled to be completed in 2023. 4. Tadu City, Kenya Rendever developed Tadu, a 5,000-acre special economic zone. Tadu City is also a member of the World Free Zones Organization. It provides affordable housing options for Kenyans in the middle class. Construction is currently expanding to phase 3 to add more housing units. The current population is 150,000 people, and it is expected to grow as new developments take place. There are also universities, businesses, and shopping malls in the city. In a nutshell, it's one of Kenya's and Africa's fastest growing smart cities. 3. Mesob Tower, Ethiopia The Mesob Tower project will showcase Ethiopian culture to the rest of the world. It aims to boost the country's already thriving hospitality and tourism sectors. The Mesob Tower, standing 250 meters tall and occupying 20,000 square meters of land in the heart of Addis Ababa, will be a site to behold. Along with hotels, shopping malls, and other amenities, the tower will house a cultural center representing various Ethiopian traditions. It will be open to the public by 2027. 2. Mediba Vaccine Production Plant, Seneca The Institute pastored the Dakar hopes to provide 300 million COVID doses made in Africa in collaboration with Biotech. Seneca will be one of six African countries chosen by the World Health Organization to produce mRNA vaccines locally as a result of the EU-backed initiative. Teen Europe committed nearly your 425 million to the construction of the Mediba facility, which will serve as an extension of the Institute pastored the Dakar. 1. New Capital City, Egypt Egypt is constructing a new capital, which is a massive African construction project. With 21 residential districts available, the smart city will attract approximately 7 million citizens. With 25 commercial districts, it will also attract businesses. Most government agencies and other administrative organizations will relocate to the new capital, reducing traffic congestion in the old capital. Egypt is considered the capital of Africa by some as the oldest civilization. Egypt's capital will be an economic hub not only in Africa, but also in the Middle East. These are just a few of the amazing projects that are transforming the continent of Africa. There are several others that we have not mentioned, so if there is any project that you know of that we have not mentioned, please mention it in the comment section. Please make sure to like this video, subscribe to Africa Reloaded, and turn on the notification icon to get updates of our new videos.


Okay, so now we're looking at the front of the face. So we'll start kind of up top here. So here's our frontal bone We've got the glabella right here between the eyes Super orbital ridge kind of where your eyebrow would be Super orbital foramen and or notch Got your two nasal bones again Okay, so inside the orbital here so our eye socket you can see way back in the back There's this large crack right back in here. Okay, so that's our superior orbital fissure Right down in the middle of the nose here is your perpendicular plate off to the side This is my inferior nasal conch So you can see it here as well as here and you have a middle nasal conch Which is another ridge just above that it's a little deeper inside there so harder to see We got a look down in there Our maxillary bone here. So we have our infra orbital foramen Along the margin where the teeth come in. So this is my velar margin. So it's on top as well as on bottom Okay, so on our mandible here. We can see these little holes here on the bottom So one here on here.


Good afternoon, everybody. I'm Tommy O'Brien, coming to you live from TFNN, 4 p.m. Eastern Time on Friday. We reached the closing bell and the market's charging higher today across the board. We have the S&P up 7 points right now trading at 44.45. NASDAQ 100 finishes in the green by 13 points. All the market's pretty steady update from the open as we came into the open and negative territory. All the markets traded lower, excuse me, higher throughout the day. You see the action in the Dow there. The acceleration really begins at 9 a.m. We trade up to 34,725. We finish right near that area right now in the Dow and the Russell. The only index actually in the red, Russell trading at 22.45. Back to the S&Ps. Pretty remarkable action when you back it up to last Friday, which is kind of where the sell-off began on Friday, accelerated on Monday, of course. We make a low of 42.93, but we've basically not just gotten back the losses that we had on Monday, which was really the day, whether you're talking about 1.5 to 2.5 to 3% on the major indices, but we almost get it all back. What Friday's action included, remarkable when you look, we basically trading at 44.50. You're talking about 150-plus points and the S&P is down and back up over the period of just one week. Commodities, crude, quite an acceleration as well. $73.98. You have gold struggling this week down to 1747 to end the week. We have to talk about Bitcoin a bit. $42,500 on the dot right now. Take that offer some clarity. You drop down to 41,000. There's your acceleration begins at about 4 a.m. having to do with China. Basically making everything to do with crypto illegal overnight. Watch out for that coming into the weekend when volatility spikes sometimes in the crypto sector and notes and bonds continuing the trend to lower prices and higher yield. We'll put it back on a daily and you're looking at a 10-year right now trading at 132.01. You see the drop that we had yesterday. There's not another bar on this chart that's as big as the drop we had yesterday.  You really got to go back to February to see the kind of drop we had when we first accelerated to lower price with the yield of about 1.5% market might be going back to about 1.5%. Right now you're sitting at 1.458% yield on the 10-year and talk about volatility getting sucked out of this market. My goodness, you accelerate to 2879. We end the week at 1788. Thanks so much for tuning in, folks. Thanks so much for watching all the programming. Come on back Monday morning. I'll kick things off at nine in the morning. Stay tuned. We're going to have a replay of Larry's hour and thanks for Mr. Pezzavento. Larry doing a great job filling in for Tom this afternoon. Have a great weekend. Everybody be safe out there. We'll see you back Monday.


How's it How's it? And today we're looking at the work of William Eggleston, a pioneering color photographer who began in the late 1960s. Famously dismissed by Ansel Adams, his work has gone on to achieve international recognition and remains as divisive today as there ever has been. Hi there, I'm Alex and thank you for joining me today on The Photographic Eye. William Eggleston is famous for his vibrant and lovely sumptuous prints in color of the seeming mundane and ordinary that surrounds us. As a young photographer in Memphis he complained that there was nothing to photograph in the town because everything was just simply too ugly and his wife responded by saying that he should go out and photograph the ugly and he certainly made that a hallmark of his career from the late 1960s. Now that Eggleston is in his late 70s he kind of you know obviously has a bit of a retrospective look across his career and a lot of people have considered that there must be hidden meaning and structure to his photographs and one of the things that I really love about Eggleston is that he doesn't try to to overthink anything about his his images and he just says look they just happen and Wiley believes that there are things in them that people can discover for the most part he's just happy with it being a photograph that he likes and doesn't really want to overanalyze anything. Of course the irony is that we're going to spend this video sort of looking at Eggleston's work and we're going to be sort of discussing it whereas the truth is that we could I could just show you 10 minutes worth of his images and let you make your own decision about about whether you like his work or not whether it speaks to you. This is a really important thing to to consider when looking at any photographer's work is is ultimately you know do you like what you see does it does it move you does it does it inspire something within you to try and like photography because it's got you know perfect composition or exceptional exposure or the focus is just so. I think Sunwood removes us from the idea of what photography ultimately should be and that is a way of responding and seeing the world that is around us in a way that helps other people feel something. Looking back at the Eggleston's work with with modern eyes it's hard to sort of see where the difference where all the controversy comes with with his photography. You know you sort of look at with modern perspective and think well I like this or I don't. In the late 90s and 70s you know it was sort of late 1960s rather the the art photography world was dominated by by black and white. Color was something that commercial photographers used and and people making holiday snapshots used. It certainly wasn't for the serious photographer and it certainly wasn't for somebody who who was an art photographer. When Eggleston had his solar exhibit at the Museum of Modern Art Ansel Adams famously wrote to somebody and and complained bitterly that that the Eggleston's work wasn't of any sort of consequence or any sort of substance because it was all in color and of course having this work in color and it was it was a first sort of solo exclusively color exhibition paved the way for a lot of photographers to feel that they were allowed to to photograph in color. Some people have come before sort of Erb Saul Leiter and and and some others but this was the first time that really a photographer had mounted an exhibition or maybe an exhibition had been mounted a photographer's work and and the shackles had been taken off. The young Eggleston was influenced to a degree by Robert Frank and Henry Cartier-Bresson and he met Cartier-Bresson a few years later who also added to the list of people who did not like Eggleston's work. He recalls sitting at a table with Henry Cartier-Bresson at a function and Cartier-Bresson turning to him and saying look you do realize that all of your work is just BS because it's in color and and and you can imagine that's quite a put down but Eggleston recalled that he just kind of went well thank you ever so much got up and and went to go and party elsewhere which it seems like of course a natural response for somebody who has made a career out of not really given a damn and and just doing what whatever feels to come naturally and you see this throughout his photography it is just all there it's just a response to to the world around him and and you know I think the world would be a better place or certainly the photography will be a place if there were more people who managed to just go with their gut and photograph what's around them in a way that that didn't try to have context and meaning and you know making a mission statement if you will. William Eggleston is a great example of somebody who you could look at their their photography and and begin to train your eye you know there are so many people who go they think that the camera is the way of becoming a better photographer but really that the best tool that that a photographer has is are their eyes and when you look at somebody like like Eggleston he is he is not crafting things you know from from props and and and setups and what have you he looks with his eyes and he brings the camera up to his face and he takes a photograph and somebody asked him you know why do you your process do you bring the camera up to your eye and and then realize it's not a good photograph and then you see you put the camera down and and he's like well no I will bring the camera up to my eye because I've already taken the photograph with my eye and and and that's that's a really great way of I think of looking at photography certainly if you if you're interested in this kind of photography is is not constantly seeing what it looks like through a viewfinder but it's learning to see the world as a photographer as somebody who can frame and compose an image with with your eyes. Eggleston's use of color is in my opinion absolutely beautiful he got it he has such a strong sense of of how the color works together and I think you know again we talked about this this kind of looking through through the lens of history at this remove it's it's hard to I'd imagine really grasp the impact that Eggleston's color photography had certainly in the early days when the world in which it inhabited or which it was elbowing its way into was it was a purely monochrome monochrome world where large black and white prints held sway and and here comes these young upstarts with their their brash and bold color prints you know and and Eggleston at the forefront and and it must have been a real shock and it must have been surprising in a way that that that we can't really grasp today but if you look at these photographs they still hold an impact for us even though they are images of the mundane and they're images of a world that does not exist anymore you know if you look at them all the stuff obviously they have very much of their time they still reach out from the page and they still grab us and and Eggleston has said that even you know even today that you know he hasn't seen any decent reproductions of of his prints and because of the the way that they were printed back in the late 60s and early 70s with with the with the Dysart process printing the lesson that we can take from looking at Eggleston's work is that doesn't matter that where we are or what confronts us as as photographers or even as non-photographers we can look at the world and see not beauty but but interest and and and things that are intriguing to us so long as we just are happy to let go of our shackles about what we expect and what we believe should be the correct way of of looking at photographs and and that's what I love about Eggleston's work that he he just reacts to what he sees and he photographs it and he says without comment either you like this this photograph or you don't and if you don't jog on if you do fantastic but that's all that there is to it and and don't try and scrape under the surface and find meanings that Eggleston has somehow secretively injected into his work because it isn't there whatever you see in his work is what you have found within his photography I think it's now more important than ever to to look at the work and the photography of people like William Eggleston to see that the mundane can be elevated to art if we just allow it to be and of course art can be anything that we want it to be a good place to discover more about William Eggleston's work is his monochrome William Eggleston's guide which was the accompaniment to the 1970s Museum and Modern Art show and that that's a really good sort of yes starting point so if you are interested go and check it out that it's fully available it's not out of print is it's really easy to find thanks ever so much for joining me here today on The Photographic Eye and I really hope that you enjoyed this brief look at the photography of William Eggleston if you are new here and you haven't done so already please hit that subscribe button so you'll be make make sure that you know when all these videos are coming out in the future if you've got a photographer who'd like to see featured here on this channel please drop me a line below and I look forward to hearing your input thanks again and I'll see you all again soon


not want to develop that more because it's not not not about closing gaps in your competency profile we're moving away from closing gaps in competency profiles okay this is for the old world the old traditional HR that's why you used to have the perfect profile for this job or this role it looks exactly like that but we cannot squeeze people into those limited roles putting labels on people you should be like this but I'm not okay I'm good at that and that and that but I'm I really I'm not good at these things and I don't want to learn these things then you should we should not force people to do it because they will never do it well I think this provocation that I brought was interesting every time you have an experience in the business because what is missing is always what is missing but I'm so good at so many other things I really have in my life to worry about what is missing or will I be able to contribute to all that I want to do better and the truth is that what is missing really makes it difficult to focus on what is always missing is a perspective you know I want to continue focus on the other thing and pick a little stronger in the things that you do good or that you like doing this is to coach people to be their best cells inside the organization so it's about finding that best cell for everybody and then you find a spot where you can use that and that's what it is because sometimes the company really wants to be it has to be like this and sometimes it's like she said you can collaborate in so many other ways and also what is the role of the company in this process of protagonism because a lot of people talk about protagonism but how do we also come from these scenes when we are living here in practice but we bring it to the institution and especially those institutions that look really for that you are failing not for what is good because everyone is good in something and sometimes he doesn't want to be good in that so we will be there in that game exactly and it's about the garden again being the gardener right planting the plants in the place where they grow the best and treating them in a way so that they grow the best so giving enough sunshine and water and all the things that the plant need being aware that different plants have different needs that's the leader that's leaders job to understand that different people have different needs and they are doing differently in different positions so talking to or understanding the needs of the plant and then helping the plant to get to the place in the garden where it can grow the best maybe together with other plants or more alone maybe because it needs a lot of space around itself or maybe it needs some shadow or maybe it needs you know some some different plants sometimes grow very well together so it's all about finding that the specific circumstances in the system where this person can grow and contribute then you actually and now I'm going to to say it in a very rude way do you utilize your resources in the best possible way right but at the same time it's a win-win solution for the person at the company because you're finding the best way for that particular person to contribute to the organization's goals and then we get the most out of people and the people get the most out of the company also so it's a win-win solution to work with the people in the center and shaping work around the person instead of closing people into job descriptions and labels and putting them in boxes


I came from a rural area to pursue my dreams in film. It was hard to be separated from my family and my home and all that I knew. Receiving the scholarship really helped reduce the financial pressure that my family and I felt. It gave me the freedom to focus on my studies without worrying about finances so much. Today I work in the film industry, predominantly in post-production. I've like an editing before to putting together a jigsaw puzzle. You've got to condense it down into a little 10 minute story or sometimes even less. So it's just a matter of finding the story within that.  It's allowed me to go on and tell other people's stories and I'm really grateful.