So, again, I just want to say welcome to Liquid Margins, and this episode is called Where's Class? Meet your students in the margins. Today's wonderful guest, Carmen Johnston. She's an English professor at Chabot College, and Denise Medulli-Williams. She's associate professor at San Diego Miramar College, and then our wonderful moderator today, Erin Barker, with the virtual background. I'm outing your background there. But this is my real office. I don't know what you're talking about. It's your real office. She doesn't even have to work for a living.  Anyway, and that's it. I'm going to turn it over to you now, Erin, and thank you, everyone, for being here. Today in Liquid Margins, we're talking about how you use social annotation across a variety of contexts. When your students are, they may be in a hybrid learning format. They may be online. They may be in person. They may be a mixture of all of the above, right? But to kick all that off, I want to hear a bit about your teaching background and your specialties. So what do you specialize in? What is your passion? And then the follow-up question is, who are your students? And Carmen, well, I'll tell you what. I'll give you some more think time on this one. And Carmen, we're going to start with you. So go ahead. So I'll start off with my college. I teach at a community college in Hayward, California, which is in the Bay Area. And I've been at Chabot College for 15 years. And I am an English teacher at Chabot. And so in the community college, at least at our college, English teacher means you teach everything. So I teach creative writing. I teach literature. I teach composition. I teach pre-transfer level composition. Our courses are, we do not separate reading and writing. So the courses, we teach reading and writing together. So it's hard to say what a specialty is. I love teaching literature. I really, really enjoy teaching literature. In our courses, our English one, which is a freshman comp, is usually like a non-fiction course. And I enjoy teaching that also. But probably literature is my favorite. And I often get to teach a blacklit course as well. I teach in a program called Change It Now, which is a social justice learning community. So about half of my load of teaching is really focused. I mean, I teach social justice in all my courses. But the Change It Now is more like a cohort of students. So there's students that I usually have for a whole year together. And so we're able to create a lot of community. And Chabot is, I would say, it's predominantly a campus of students of color. So mostly Latino students, Asian, Black, Pacific Islander, and Asian in all the diversity of what Asian means. Arab students, we have white students at our school, but definitely they are the smaller population. So it's a very diverse group of students, mostly working class and low income students. Students who maybe couldn't afford to go after college right away or didn't have the grades or just want to save money. It's community college is such an affordable option. And just brilliant, lovely, wonderful students that I just adore. Yeah. So that's, I forget what your other question. Did I answer all the questions? I think you got most of it. And if you didn't, I promise I'm not integrating you today. At the end of the session, I'm not going to say, Carmen, you get. No, that's perfect. Denise, you want to talk to us about what you teach your specialties and who your students are. Sure. I love that Carmen got to go first so I couldn't listen in and prepare myself. I also am a community college English professor. I love teaching community college. You know that I love this phrase that we accept the top 100% of students. And we're here to support all students reach their goals. I've been a community college educator now for 21 years. And I teach at San Diego Miramar College. I teach English, but I also teach English language learners. In my district, we call that ELAC, English Language Acquisition. And much like Carmen, my student body, the students in my classes are very diverse. So there's not one predominant native language in the courses that I teach. We're focused on getting students prepared for academic English and content courses in our English language acquisition courses, multiple skills, reading, writing, listening, speaking, grammar, vocabulary, American college, culture, all of that kind of mixed in it together. I'd like to say, too, that I just love how the students I have in one class, I have students from 18 years old to 80 all together. New immigrants, refugees, returning students. I don't even international students, just a huge mix.  And we've had some good times working together online, hybrid during the pandemic. And we had been doing that in our program before the pandemic. So we were able to move into that fairly smoothly in terms of the technology. Obviously, during a pandemic, there's so many other issues that make it very, very, very challenging. But our students stayed with us. And I just have really enjoyed working with them. And we're going to get to some of those challenges. Trust me, all my questions are leading somewhere. My next question for the two of you is what are your top three strengths as an educator? So I want you to think on that for a sec. Everyone else who's attending, I also want you to answer that question in the chat. What are your top three strengths as an educator? And if you're a librarian or a teacher or a professor or an administrator, you are still an educator. So I'm curious about your top three strengths. And Denise, guess what? You're going first on this one. Oh, no. All right. So right off the top of my head, I think the first thing that comes to mind is that I am always a learner. I think I just mentioned I'm actually a learner right now in graduate work. But I think that always having a learner's mindset myself, being a student, always trying to improve, be creative, roll with it, understand what it feels like to have to ask for an extension, to do something that I've never done before, to be confused, that I think is very much a strength as a learner, even though I've been in the field and teaching for over two decades now. Knowing that I'm still learning, I think really is a strength of mind when I'm teaching or facilitating the students. I am completely student focused. My whole focus is always providing equitable access for students, for their voices, for their experiences, for their learning, their activities. I'm under evaluation right now. But I always joke that whenever I'm under evaluation, when people come in the room, they can never find me. Where is Denise? And even in the online setting, where is Denise? Because the students are the center. So that's something that I think. So what is that too? I've been talking on the fly here, a learner, student focus. I think that I express empathy for students, and they know that they can come to me, and then I'm here for them. I think it's really, really challenging to be in a new country, to be navigating a college system, to be doing that sometimes alone or with family and supporting children or partners who have come here for work. And I think that students really, really need to know that the relationship with instructor comes before the pedagogy, and that I'm here for them, no matter what. Passing the ball to you, Carmen. I'm taking notes on that one, which is the relationship comes before the pedagogy. Thank you for answering that first. And thank you for having such a great answer. I'll tell you why I asked this question in a minute. Carmen, you're up. Well, I would say that my number one, I don't know, my best attribute as an instructor is my commitment to racial justice and equity, and just how that plays out in everything from the books that I teach, from the way that I teach, to building relationships with students, that that is my primary concern is making sure that my classroom is a safe space for everybody and that we're able to have real talk and challenge oppressive structures and think about institutionalized oppression and give students the language to describe their lives and their experience. So I feel like that is the best thing about me as an instructor is my commitment to racial justice and equity inside the classroom and outside of the classroom as well that I'm very much interested in institutional transformation. And I think having that commitment has allowed me to challenge myself to make sure that I'm always practicing what I preach, that if I believe this, if I believe things to be a certain way, if I have a vision for the world to make sure that that vision is happening inside of my classroom also, right? And giving my students a lot of agency so that we can co-create the classroom space and content and everything together. So really trying to make my classroom like an oasis away from the oppressive structures that our students have to deal with. And I think particularly for community college students the challenges that they're up against are very powerful and varied. I think as you had stated, like being refugees, being current immigrants, often just having to work or take care of family members, often in families, struggles happening. So I really want my classroom to be a place that is just safe and giving and offering some respite from the oppressive things that our students have to face outside the classroom. I also would say that I'm really fun. I'm very funny. I will say that I'm a fun teacher. I like to have fun. I do ice breakers in my class all the time. I want my students to feel like when they come into the classroom that they're walking into a party. So I really try to create an atmosphere of fun and play. And I mean, I think that's one of the things that I like about hypothesis that it really does fit into the play, the playfulness that you can have inside of a classroom. And I believe that I've always believed since I was a student, since a young student that learning should be fun. Like that is a core belief of mine that it should be fun, why not? So that is really important to me. And I try to have a lot of fun in my classroom and also just the ability to build community. I mean, all of my students have always said that my class is the class number one where they know each other, they know each other's names and they feel like they can be themselves. And I just think that that is just such an important aspect that I get to offer them is that this is just a place where they get to be themselves. So they don't have to front, they don't have to pretend, they can make mistakes, they can tell jokes, they can show who they are. And I feel like, yeah, that that is one of my strengths is just being able to build community inside of my classroom. So I, first off, I love the pointing out of knowing students' names and calling them by the correct name. I was a middle school teacher for a long time and that was really important to me as well because our students in community college as well, they move from class to class all the time, right? And it's easy to be seen as just another body in the room or another number or somebody to be graded. And so it starts with something so simple as using the correct name with our students. So I ask that question for two reasons. First off, because I think you need to brag on yourselves more, I think the last year has been really difficult for everyone in education, no matter the context, no matter the way you teach, no matter any of that, right? And so we need to brag on ourselves more, which is also why I asked everyone in the chat to do the same because we need to recognize what we're good at. The second reason I asked that is because I was mining information from you. Every teacher has like what, two objectives, right? The clear objective and the underlying objective. So one of the things that both of you talked about was this idea of relationship before pedagogy. And now we're gonna hop into using hypothesis. You knew it was getting there and social annotation. Talk to me about how you've used hypothesis and social annotation and then how that helps build relationships in your classrooms or in your courses. So I'm gonna add that question in the chat while you think about it. And Denise or Carmen, one of you can go first if you want to volunteer. Okay, well, now I know. I can go. I'm still thinking, go ahead, Carmen. Yeah, I can go. Well, I gather my thoughts. Yeah. Well, I first just have to say that I was introduced to hypothesis by my colleague, Monique Williams, who is like a total, she's just very tech savvy and she always knows like all the cool apps to try on Canvas. And so she had explored hypothesis and she was using it and she kind of did like a little workshop with our department. And I like learning apps and things like that too. So I was very intrigued by this. And I think particularly as English instructors, annotation is just so important. I feel like it's the number one skill that we can teach our students. And it's the skill that's gonna help them in all of their classes. So I feel like in the past, when we were pre-pandemic and face-to-face, I would always come by my students when we'd reading a book and like check their annotations. And we'd spend a lot of time working on annotation and how important it is and checking it. And I feel like one of the cool things about hypothesis is that it kind of does a lot of the work for you. So it's in Canvas, so I can just look through it and then just kind of grade it from there. But to your question in regards to like how it helps build relationships. So often, as I was talking about earlier, like just my pedagogical stance around racial justice and equity. So I am 90% of all the readings that I use are by people of color and the context, right? The issues are so important to our students. And so when they're reading and annotating, they're reading about things that impact their lives and that are really important to them. And so often, I might ask them to identify three golden lines from a poem or something like that, right? Like three lines that stand out to you and they get to highlight and then also to respond to two other people, right? So that's one of the ways that the relationship building happens. And then when we're in class, we'll pull those golden lines especially on Zoom. We might put them on a padlet and people can comment or they might go into a breakout room and share their golden lines from the hypothesis activity and come up with one that they think is the most powerful. So they're having these opportunities to talk to each other about these lines from the literature that really speak to them and how it connects to their own lives. And I think that naturally, builds relationship and community because they're so great at when we have that larger discussion, they'll say, oh, well, so-and-so, yeah, well, you say what you said in the room about that because that was really cool or, oh, I really liked what Marissa said. Marissa, can you speak to this? And so it really helps build that community and have them see each other as scholars because that's also a really big piece of my class is I want them to identify as scholars, right? As readers, writers, and thinkers. And so when they're in there with hypothesis, pulling out these golden lines, talking to each other and recognizing each other as scholars, I think it really helps them strengthen their relationships and build our community of learners together. And Carmen, just to follow up, are you providing, when you're giving that, it sounds like you are, but just to clarify, when you're giving them say a poem and you're asking them to annotate this poem, are you doing that online or in class? So the annotations are usually online, right? So we upload it into Canvas with hypothesis and they'll go in there and they will annotate it as homework, right? So they're kind of doing that work before they come to class. And so then when we come to class, we can look at it together. And then there is the classes in person, is that correct? Right now my classes are all on Zoom because of the pandemic, yeah. So I have one class that's asynchronous so we don't see each other at all. And so it's a little bit trickier, having them figure out how to take those, what they've reviewed on annotations. Sometimes I might put them in like a group discussion so that they can talk about it and work from it there. But on Zoom, we'll do it together in my other class. Got it. Thanks for clarifying. I was trying to picture what was happening. Yeah, I'm just gonna say part of my campus is on, part of my college is on campus right now but I just chose this semester to stay online. Didn't you sort about you? Sorry, Carmen. Sure, I'm in the same position, Carmen. We're kind of, it's like that middle road, right? Where in person kind of happened, also then remote for those people that were in person for two weeks and blah, blah, blah. So I'm still online as well by choice. And my classes are all online asynchronous and have been. And I love using collaborative annotation for this reason because in an online async class, you have to have student interaction and instructor presence, right? They have to feel that everyone is there, that they're not moving through this class alone in a dark, in a self-paced way individually. They need to feel part of the community in order to be successful. And what Carmen just mentioned is very complimentary to what I do as well in my English courses but also I'll speak specifically to my English language acquisition courses. What I love about using any type of collaborative annotation is that really, I believe, equitizes the student voice. So whether we are in person in the classroom or on Zoom live, you know, there's always gonna be the three loudest students and we have all been teaching a very long time and we know all of the pedagogical moves to make sure that we have equitable discussions and we have wait time and we do small groups. But the truth of the matter is, and I was like this growing up, it can be very hard for students, especially learning another language to speak up in person or on Zoom on the spot when you ask them something about a reading. It can also with language learning, a long time ago I learned German. So I just really remember this. What we think is enough wait time is never enough wait time. So when you ask a question, what do you think about this reading or what's your golden line? I do that as well. And then the three, you know, quickest students are ready and then the other ones are like still trying to figure out exactly what is the question, right? And processing that. So on hypothesis or on any collaborative annotation tool online, students have the time and the space to read carefully, to prepare what they want to say. And sometimes the quietest voice in the classroom is the loudest online and you get to hear everybody's voice. Everyone has the space to do it in an equitable way. And I feel like that's the best way for student interaction. I also just know from surveying students and from interviewing that they are done with discussion boards, at least in my experience, it is like the new death by PowerPoint, death by discussion board posts once reply twice, right?  What do you think? What questions do you have? And then they're like, oh, a lot of people have the same question.  And so it does allow for students to build that community in a way that is not like punitive or on the spot. They can take that time to respond and they can see each other and interact kind of in a more lively fashion depending on how you set it up. I don't like police the language or the quality of their responses. The same way I wouldn't in a classroom ask people to speak only incomplete sentences with correct standardized English. Like a GIF or GIF, whatever team you're on how you pronounce it can be just as powerful of a response to a line than a paragraph written in standard English with topic sentences. So being able to respond in ways that is comfortable for them and that they think is fun and lively really gets people into understanding, I think the reading or the document or the chart or whatever the image even more than you would in a discussion board. In my experience. Choosing mothers, choose Jeff. Thank you, Nate. No, it's GIF. I can't decide. I just like say both ways, whatever I have to say it. I really like that both of you are talking about this idea of hypothesis as a safe space to express yourself. And I have to agree with you, Denise like it's death by discussion board. I myself am a doctorate student and every week when I have to do discussion boards in campus, I want to bang my head against the wall and wonder if it's actually beneficial to me and I'm actually learning or getting anything out of it. And I just really wish that my school used hypothesis. They're gonna remain unnamed for right now. But yeah, and so this idea of hypothesis as a safe space especially in an online learning environment especially in this past year or two years or maybe coming up three years is intriguing to me and I think really gets at where we want our students to be, right? Like they can't come to the table and learn academic material unless they feel safe. Both emotionally and socially and academically. And so I'm curious you guys kind of touched on this a bit if you could give some specific examples of maybe students or assignments that you've given where hypothesis has provided a safe space for them to express themselves or maybe they have not expressed themselves before if you have one. And speaking of think time, I've been terrible about it. I say 30 seconds with them, like 10 seconds later you have to say something. Just brief, this popped into my head because we had just been talking about like icebreakers and names and things. And in one of my courses, the first thing that we annotate is the chapter called the F word by Farooza Dumaa from her book Funny and Farsi have a lot of Iranian students as well. But it's all about how her name Farooza was the F word and how no one could say it right. And all these things she changed her name. Like a lot of my students will say, my name is this in their first language but just call me Jane. And I'm like, no, no, I'm not calling you Jane. We're gonna learn to pronounce your name correctly and we're all gonna call each other by unless you really want, don't change it for me, right? So this reading is all about how Farooza changed her name to Julie and then she got married and then her name was Julie Dumaa and then it was like nothing, it didn't match her, right? And then she tried to go back but it was this knot of her professional life and then her family called her one name and then she had kids and was trying to figure this all out. So this space for students to engage with like, what do you think about how she changed her name? And then also reflect on, oh, should I change my name? Or did someone in a previous class change my name for me? Did someone tell me your name's too hard? So let's just shorten it, which is terrifying that this is happening but it does happen to my students sometimes. So it provided that kind of safe space for students to engage with the topic that's highly interesting names, right? And a chance to introduce themselves in this interactive way and learn how to use hypothesis or how to use the collaborative annotation tool because it's a whole cognitive overload if you're learning the technology tool and you're learning a really hard, or you're annotating a text that's like pretty a lot of content right off and you're learning new, for my students, new grammar and vocabulary and sentence structure, right? So trying to step into it so that we just do it in a fun way and a topic that makes sense, get through the tech issues and then as we move throughout the semester then we can focus on topics and readings and charts and graphs and things that are deeper knowledge or that could be more advanced from them but we're no longer worried about the technology of how to use that, right? And then the last thing I would say about just all of that is that it's a lot, a lot of just the tools are sometimes presented as things for students to consume passively. Like you're just gonna watch this or you're gonna listen to this lecture or you're gonna read this and then take a quiz but it's just like all passive, right? And so what I love about collaborative annotation is that they're actively involved and the discussion takes somewhere they wanna go. I love that comparison between passive learning and active learning using social annotation on hypothesis. And it's funny, Denise, because now I'm like considering all my assignments that I do for my doctorate program. I'm like, passive, passive, anyway. That's a whole nother conversation for that to me. I mean, doctorate program too and same, just didn't want that. Carmen, what about you? Well, you know, I was thinking a lot about a couple of things. I mean, one is I'm doing in my literature class right now, we're doing the theme of the class is called resist the canon, right? And so we're talking a lot about the literary canon and about students' experiences in high school and the books that they've read. And we started the course off by reading a short article called mirror windows and sliding doors. And it's actually about children's literature and the importance of having diverse authors and that each book could be a mirror or window or a sliding door. And so, you know, it was the first kind of hypothesis assignment that we did in the class. And I really liked it because it was very introductory, right? So I think very similar to what you're talking about, Denise, like, and it's a very simple article to read, but powerful. And so as they're learning hypothesis, right? They're engaging in something that is, and also just really speaks to them because they get an opportunity to talk about, you know, the books that they read and what books were mirror windows and sliding doors and the books that weren't, right? And so on the annotated side, you can see them having a conversation about, oh, I read that book and I hated the great Gatsby or, you know, Catcher and the Ryan, like I'm having those conversations too. So I think, you know, it's, I feel like part of it is hypothesis and part of it is the text itself, that the text itself provides. And I think this is similar to what you're talking about, that, you know, when you choose these texts that really speak to our students and that's where that discussion can come alive, right? And it becomes a safe space for them to have conversations that they've never really had an opportunity to talk about. Like I could imagine for many students that there isn't really a lot of space for them to talk about their names and the oppression that they face. I mean, I know so many students that have had, you know, maybe they say their name in their home language and then the teacher says, well, I'm just gonna call you Charlie, right? And so there often isn't a lot of spaces for them to talk about that. So I can imagine Denise with an assignment like that, that it would just be super vibrant and an opportunity for students to share these hurts actually that they've experienced in education. And a lot of my students, when we were talking about the mirror windows and sliding doors, they started to become very upset because they realized that there was so much knowledge that had been held from them, you know, so many books that they could have read that the teachers in their K through 12 just didn't choose to share with them. And so I think it can also build, there's that safety, but it can also be build a lot of camaraderie amongst the students. I like this idea of like flipping the script on academics to some degree, right? We've talked about like passive learning and students not being able to access academics or learning and that not to sound like a marketing professional because I'm not in marketing, but that hypothesis can help with that script so that students can then access the academics, can then discuss the academics and then feel safe discussing it together, whether they are asynchronous or synchronous or hybrid or in person, pick your option of the week. So my next question for you is Azure thinking about the rest of the term or the next year is how do you plan to use social annotation differently or similarly looking ahead? This is kind of correlated to that but I'm just going to address some things in the chat about discussion board related to collaborative annotation because I think that's part of it. So I guess I should, I said by discussion board, I still believe that there are good ways to use discussion boards. I love doing small groups. I love doing peer review, but I think that whole group discussions, that post once, reply twice every week for every type of reading is too much. And I think from my interviews with students, I remember that they're not just usually taking one class. So I was talking to students who have four classes or three classes and that they were doing a discussion board in every class every week. That is definitely death by discussion. It's just too much, right? So for me, moving forward, I like it's another activity, right? It's like we have this toolbox of activities that we use at the appropriate times for the type of content or our goals for the course or where our students are thriving, right? Or where we want to bring them. So sometimes I'll do some readings that are collaborative annotations. Sometimes we'll do a small group discussion board instead. Sometimes we'll do a flip grid. Sometimes we'll post the golden line on a padlet along with an image. So like using it, not like I only use hypothesis, but like using it in ways throughout the semester. And I have also felt that I think we learned a lot of tools during the pandemic because everyone went remote. And now we want to leverage, continually leverage those tools moving forward no matter what type of modality we're in. So it's not like, oh, we're in-person now we'll never use this, right? Just like Carmen is saying this is a great way to use it for a prep for the in-person, for homework. So everyone reads it, everyone's discussion. As an instructor, we know the common themes or questions and then we come to the class so we can have a more fruitful discussion. So I think leaving it in no matter the modality and with the other more traditional things is the way that I'll continue to use it. What about you, Carmen? Yeah, I was just gonna say ditto. I mean, I don't know if I have a much more to add but I really like what you're saying Denise in regards to it being a tool, right? And you use it amongst the other tools that you use. And I don't, I mean, I have to say I don't actually use the discussion board that much. So it's interesting to hear people just to hear, you know the death by discussion board. So it's really got me thinking a lot about how I use it and when I use it. I saw on one of my colleagues, Canvas site they actually break students up into small groups and use the discussion board that way. So they're just having a discussion amongst like five people and I thought that was a real intriguing way to use the discussion board because I think it makes it less overwhelming for students. You know, if you're just kind of building with five people and having that conversation. So I think trying to use the annotations in that way. You know, one thing that my mentor Monique who I mentioned earlier, show me was to like just on the document itself kind of doing your own annotations and saying like oh, well pulling out a quote what do you think about this particular quote and having the students respond on hypothesis or you know having little pointers and questions. So I'd like to do more of that kind of putting questions on the text itself and then having them use hypothesis to respond to the things that I want them to think about in the text in addition to the things that they're highlighting. And I think always just trying to figure out, you know creative ways and to how to use it in a playful way like you were mentioning. I love Flipgrid, Padlet, maybe making collages, doing wordles. You know, I just feel like trying to make it as fun and creative for the students as possible. I think what you're talking about too, Carmen in terms of putting the questions in almost like pre annotating. Yeah. Before the students access the text. It's almost a way to think about guiding students through the reading as well and helping them access the text.  Like I need to read this eight different times. Yeah, so I like that a lot. I have a lot of professors who actually do something very similar. So I know that we are over time. There are some questions in the chat, Franny. Do you want to help me grab those? Yeah. And also, Erin, our guests have agreed to stay a bit longer. And I'm not sure what your schedule is if you have to leave, but maybe you can go till around 10 as well. Yeah, so let's, first off, I want to like, I'm inspired by both Denise and Carmen today. This is why I love my job and getting to work and talk with educators across the country because I learned so much. And also, I just continue to think that we have so many inspiring educators and we need to continue to recognize all of you and the work that you're doing every day. So let's take a look at some of the questions in the chat. This is, I think, a follow-up to what we have just talked about. Denise and Carmen, there's a question from, and I'm going to mispronounce this. And so Isaira, if I'm saying that incorrectly, please let me know. Do you require students to make a specific number of annotations and do you think it matters? I tend to ask for a specific amount of annotations. Sometimes it's, I mean, I think it really depends. Like we were just looking at, what were we just looking at? Oh, we were just looking at excerpts from a novel called Brown Girls and we were talking about language and style. So I asked them to like pick their five top words from the piece in two golden lines, right? And so I do, I think it's just really important to be specific with students and it is graded. And it's mostly like you did it or you didn't do it. It's not like, I'm not commenting on the annotations but just making sure they did it because we're going to use it in class. When we get back together, we're going to talk about it. And I feel like for English teachers, one of the hardest things is getting our students to read and be accountable for the reading, you know? And so I feel like hypothesis for me really helps with that because it's, they can do it right on the page. I can see that they've done it and I know then that we're going to have a really fruitful and productive discussion in class. And it's kind of one of the things for me as an instructor that I tell them like, basically, there's only a couple of things that you have to do in the English class. And one of them is read.   Like you're not going to be able to do your job.  So I feel like hypothesis is really helpful for me as an English instructor, just keeping them accountable for the reading. Yeah, very similarly to you, Carmen. I love that carpenter analogy as well. You know, I do, I think that being very specific on the expectations is super important, right? So similarly, depending on what the topic is or what we're doing, I often have them annotate mentor texts or types of writing that we're going to work on. So like, what do you notice about this section? How do they incorporate this quote? How do you, what do you think about this last line? You know, so being very specific of what I want them to do in each one. But I do just give completion points. I do not grade for quality of responses. What I do instead of like, instead of reading their comments to look for quality, I just engage during, in hypothesis with them. So I will give certain questions and then if someone has a short answer or something funny, I'll ask like for further thoughts or I'll add on another question. And so I'm modeling that interaction and that's where my, that's where my time is spent is interacting with them, not judging them. Brandy, you wanted to say something, I can see it. Everyone can always tell by my face and I want to say something. There was a question from Casey in the chat. We might have already kind of covered this, but she wants to know like along with safe space, how can hypothesis help build community and connection through interactions? I haven't used it that way before, please provide any suggestions. And I'm thinking maybe she is, that what comes to mind in that question is this idea of requiring students to reply to each other or back at each other's annotations, possibly. And I think maybe she's asking Denise and Carmen if you require that, what that would look like. I mean, yeah, I do require that on some of them, not all the time, but sometimes I do require them to speak back to each other. I mean, often, especially in my class where we have our Zoom meetings, we're gonna use the annotations. And so that's the spot where they'll go back to their hypothesis to find the quota, the golden line and they'll have a discussion with each other when we're in our breakout rooms. But I would say to me, the thing that's gonna, hypothesis is the tool, it's the content that's gonna really spark the discussion and spark the community and connection. So I think it's really about being very thoughtful about the texts that you choose and how is it gonna speak to the students? Is it exciting? Is it something that matters to them? Is it something they can relate to? Is it something that's, I don't know, not controversial but that's just powerful. I think it really starts with the texts that you use and then we were talking about the hypothesis is the tool. So it's hypothesis isn't gonna do it on its own. You definitely have to make sure that you're picking the right text. Yeah, I definitely agree with that. And I also think that when you let go of requiring, I mean, there is expectations, we're going to all answer these questions and comment and all of this and I expect you to do a couple to your classmates but students will do way more when they're invested in it. So you have an amazing text that speaks to them and they understand how to use the tool and they see me in there, they're chatting with each other all open it and be like, what just happened overnight? All these interactions because they're invested in the community that they built, they built not me and they're invested in the conversation that's happening around a text that speaks to them. And then you can, then you're not worried about did everyone do it three times because everyone's done more than that. Or anyone wants to say something? I have no quicker face. Yeah, I actually had a question I had a question that I've been wondering for a long time. It's pretty general. So, we talked about building community and that seems to be successful with this. And so what happens to competition? Does that go away? Because when you're in college, when I was in college, it seemed to be very competitive. And there was always that person in class, never me, who was like the most competitive and those people were kind of intimidating, I think, but I think competition can be healthy and unhealthy. And so how can, if you could just talk about that, if that question is clear? I mean, I don't know if it's because I'm at a community college, but competition isn't a thing at our level. I think students are more in competition with themselves because they're trying to transfer. I don't think they're trying to get a better, they're trying to get the A for themselves so they can go to Cal. They're not like, I need to be the top, whatever in the class. So there's not a lot, I mean, I haven't seen students be competitive with each other or more with themselves and trying to get the grades they need to get to their next goal. I don't know what that means. I feel the same way, I feel like Carmen and I faces like looked the same. We saw that we're both like, hmm, I mean, I think it starts from the beginning of the student body, but also the class, right? Like we're not grading on curves, you're not competing. Like this class is not built on competition. I want everyone to get an A. I want everyone to succeed. I'm helping everyone reach their goals. We are absolutely not in competition with each other and I don't often feel that for my students either. It's not a thing. I mean, just to add to that, I mean, I think there may be, I mean, there might be other spaces on campus. Like I could see maybe in STEM or maybe in courses where the instructor doesn't have an equity stance. I know there are instructors that may say something like, look around, you know, everyone's not going to be here by the end of the semester, you know, and that creates a sense of competition and a sense of urgency. So I don't want to misspeak and say that it just doesn't happen at the community college level. I would say it's similar to Denise. It doesn't happen in my classroom because that's not what I'm about and that's not the space that I want to create for students and it really is about, I mean, I tell them all the time that, you know, in my opinion, college is about jumping through hoops and I'm not trying to set the hoop on fire. I'm not trying to make my class, you know, have spikes through the hoop. I want it to be as comfy and not easy because it needs to have rigor, but I want them to succeed. I'm not trying to be an obstacle. Yeah, that's awesome. And I think, you know, and my question was, yeah, maybe irrelevant to this discussion, but it's just something I've been wondering about. And also I went to college a long time ago and probably it was a different situation. I think the world has gotten slightly nicer maybe in some ways, slightly. We can, I hope that we're more aware of how we can be nicer. How about that? That's what I think about. I think we're out of time, Franny. So I'm not sure if you want to wrap this up. Yeah, I think we better wrap it up. First of all, thank you for being here to our wonderful guests and thanks for staying a little bit over. And everybody in the chat, also thanks for your great comments and questions. And again, apologies to everyone about the closed captioning. That's completely our mistake and we're going to correct that. So the next liquid margins will be sometime in March and we'll let you all know. And it's just been a really wonderful and fruitful conversation. And thank you, Erin, for moderating from your beautiful home. Okay, great. So again, there'll be a recording of this, hopefully by next week and we'll send that out to everyone who came here today. So again, thank you, Denise and Carmen, this was so wonderful. And we will see you next time on Liquid Margins.


Data rooms, data rooms are spaces used for housing data, usually of a secured or privileged nature. They can be physical data rooms, virtual data rooms, or data centers. They are used for a variety of purposes, including data storage, document exchange, file sharing, financial transactions, legal transactions, and more. In mergers and acquisitions, the traditional data room will literally be a physically secure continually monitored room, normally in the vendor's offices or those of their lawyers which the bidders and their advisors will visit in order to inspect and report on the various documents and other data made available. Often only one bidder at a time will be allowed to enter and if new documents or new versions of documents are required these will have to be brought in by courier as hard copy. Teams involved in large due diligence processes will typically have to be flown in from many regions or countries and remain available throughout the process. Such teams often comprise a number of experts in different fields and so the overall cost of keeping such groups on call near to the data room is often extremely high. Combating the significant cost of physical data rooms is the virtual data room, which provides for the secured, online dissemination of confidential information. The virtual data room DDR is essentially a website with limited controlled access using a secure log unsupplied by the vendor slash authority which can be disabled at any time by the vendor slash authority if a bidder withdraws to which the bidders and their advisors are given access. Much of the information released will be confidential and restrictions should be applied to the viewer's ability to release this to third parties by forwarding, copying or printing. Digital rights management is sometimes supplied to control information. Detailed auditing must be provided for legal reasons so that a record is kept of who has seen which version of each document. Data rooms are commonly used by legal, accounting, investment banking and private equity companies performing mergers and acquisitions, fundraising, insolvency, corporate restructuring, and joint ventures including biotechnology and tender processes.


reserve units while they complete their officer training. Today, we're going to orient you to the facilities that we use. On la fin de faune, where soldiers are tested both mentally and physically, ou en le test mentalement et physiquement, before participating in a soldier ceremony called the, called Turning Green. I'm not gonna, okay. So I'll put myself here. That's perfect. Je vais me mettre ici pour les francophones qui veulent écouter et qui n'ont pas encore reçu de l'hospitalité. Got the CTA? I am the Alpha Company First Sergeant. In our CTA, we have enough room to conduct weapons familiarization, marksmanship, medical training, land navigation and physical fitness. Layed out in front of you is the equipment that each soldier receives when they get here. Un de très important documents qu'on a ici, c'est se fichier avec tout ces informations. Identical. This is so that we can help achieve that uniformity and try and strip that individuality away so that we can build a more cohesive and well-trained and certified instructors. Et des instructeurs qui sont bien traînés et certifiés is what allows our soldiers to be successful in becoming with additional rank on the test. Et il y a plusieurs raisons qui signifient beaucoup. Health and fitness training program. For the physical fitness side of the house, it is a very progressive model for running. There are five domains to the U.S. Army's holistic health and fitness approach. Enjoy what they're doing. What Solina speak about was that transformational leadership process. Although we've had a medical clinic that was centralized for all battalions to use, it could take a very long time for a soldier to seek medical treatment there. So as part of our holistic health and fitness approach, we have addressed the medical aspect by building this troop clinic to allow for the triage of illness in our footprint. It is important to reduce the time of absence of training. Drill Sergeant Ralph has exceeded at every training task all his meals during his training. There are eight warrior restaurants on Sand Hill and they have four sides. For physical readiness, we have that deliberate 22-week approach that is now standardized across all 10 training. Thank you. Thank you for the explanation. Thank you so much. Yes, sir. When soldiers arrive here for their 22 weeks of training, we have an end state. We have a civilian and we've kind of looked at what our current civilian population is, very digitally oriented, not quite as physically oriented, and we have to turn them into capable infantry soldiers. To do that, we have some amazing non-commission officers that facilitate 22 weeks of infantry one station unit training. They start out with the same drill sergeants they graduate with six months later. Other jobs in the Army will only have their drill sergeants for the first 10 weeks, which is the same as our first 10 weeks, but then they will move on to a technical training for their specific job skill. Our focus here is to help an individual better understand themselves, their capabilities and limitations, the group dynamics, building a team, the culture of our Army, how we treat one another, and then the technical and tactical skills they need to know not just to be a soldier, but to be an infantry soldier. Another unique


How can total darkness be what helps us see typically hidden structures in our brightest star? We talk with NCAR scientists, Dr. Paul Bryant, to learn more about total solar eclipses. I try to understand why the Sun behaves the way it does, and in particular how it affects life on Earth. Can you tell us a little bit about the structure of the Sun? Unlike the Earth, the interior of the Sun is not solid, and then there's a fight between gravity, holding everything together, and pressure pushing things out. That energy that is generated in the center of the Sun does eventually make it to the surface and then reaches what we call the photosphere. That's what you'll see with your eyes if you look at the Sun, which you shouldn't do. Then we transition into a region that we call the chromosphere, and finally the corona, which is the outer nebulous part of the Sun's atmosphere. Because we can't look at the Sun directly, and the corona is so dim. How do scientists study the Sun? Well, the corona is not actually that dim, it's about as bright as a full moon. The problem is that the surface of the Sun is about a million times brighter than the corona. There are several ways we can observe the corona. In addition to being much dimmer than the surface of the Sun, the corona is also hotter. And that means that it emits strongly in ultraviolet wavelengths. The problem from a scientist's point of view is that we can't see those wavelengths from the Earth. We need to go to space. If we want to observe the Sun from the ground, the way we usually do that is to employ something called a coronagraph. The Sun is still bright, so that light always gets into your telescope somehow. But a solar eclipse allows us a chance to do a natural coronagraph, where you now have the moon to just cover the Sun. So then, the very bright surface of the Sun is blocked out, and we can now see the corona. Can you share with us some of the photos you have taken of the solar corona? Yes, that's what my office. Let's go. Here at NCAR, we've been observing eclipses for decades. You can see over different years the structure of the corona. It looks very different, right? Sometimes it can be kind of simple. Other times there can be a lot going on. That can tell us about what's going on in the corona and what eventually leads to eruptions that we're trying to predict. What type of data processing do you have to do? That depends on the exact experiment we're running. In 2017, for instance, we deployed some instrumentation on an aircraft that chased the path of the eclipse. Because that camera was on an aircraft, it wasn't steady, right? So you can see the movie on the left here shows the jitter from the aircraft. So we do data processing to get as steady as the image. And why is it important to study the corona? Flares, coronal mass ejections, other explosive events from the Sun affect the Earth. The majority of the dynamics that happens is higher in the atmosphere in the corona. So to be able to understand why these events happen and to predict them, we need to observe that region and that's the corona. Total solar eclipses are a de-class natural phenomena that we can't experience. But what is your experience with total solar eclipses? There is a difference between a partial eclipse and a total solar eclipse that is literally night and day. There is something about that moment when the Moon completely covers the Sun, the temperature drops, it gets dark, animals start behaving strangely and it feels kind of otherworldly.


Let's do one of these determining a reactant concentration at a given time reaction. So it says at 1,000 degrees Celsius, cyclobutane, which is C4HA decomposes in a first order reaction, which we should have already known by looking at the units of K here, okay? So that, since it's seconds to the negative one, we should realize that it's a first order reaction already, with a very high rate constant of 87 per second to two molecules available. If the initial cyclobutane concentration is 2 molar, what is the concentration after 10 seconds? So if you remember the rate law equations that we just went over, okay, if you don't, just look back in your notes, okay? The first order rate law was ln of A, or in this case C4HA, the original time divided by cyclobutane, or the concentration is C4HA at time t. That equals Kt like that. So we have concentration original, we have K, we have t. So we're trying to find what is this concentration at that time. Does everybody understand what we're looking for? So how do we get rid of ln? You guys remember? E to the ln, right? So what we do to one side, we've got to do the other side. So this is going to be E to the Kt. Is everybody okay with me just erasing? So that cancels with that like that, and all of this comes down here, right? So what are we going to get? We're going to get C4HA like that, and what are we looking for? C4HAt, right? So let's rearrange this equation to get that. So we get C4H8t well, C4H8O divided by EKt, like that. Is everybody okay with me? So let's go over here with it. And just plug in Chubb now, so it's 2.00 polar divided by, so the K is 87 per second times 0.00, like that. Cancel, cancel there. What should our unit, what would you think our units would be for the concentration at time t? Mole, or moles per liter, right? Are they going to be? Yes, okay? So if you're not getting good concentration units, then you've probably done something very correct. Okay, so let's go ahead and do this. Fraction has decomposed in this time. Should we do that part too while we're doing this video? I'll let you guys write down what we have here. Can I erase at least this part up here? And we know also C4H8T is what we say. So, fraction decomposed, that's going to be what you have over what was, okay, what was the total, okay? So you had this to begin with, and this is what you have left, okay? So let's say C4H8O minus C4H8T divided by C4H8O. Does that make sense? If it doesn't make sense, maybe it'll make sense when we plug the numbers, okay? So when we got first, 2.0 molar minus 0.84 molar divided by 2.002, okay? So what we have here is C4H8T divided by C4H8O. Is that makes sense? If it doesn't make sense, maybe it'll make sense when we plug the numbers. Okay? So when we got first, 2.00 molar minus 0.84 molar divided by 2.002, okay? So what are my units? Because it's a fraction. Fractions don't have units. That's the fraction decomposed. What if it asks me, what percentage of decomposed? What do I do then? Multiply. Multiply divided by 100%. So let's say the percent decomp. Do I need to show that now? So the percentage that we have left would be 100 minus that. The fraction that we have left would be 1 minus that, okay? But are you okay with doing something like that? So again, in order to do these, you're going to have to memorize those rate laws, okay? Any questions on something like this? If you memorize the rate laws, you should be fine.


Thank you very much for having me. It's a delight to be here. I'm computer phobic, so that explains why people are helping me. I'm in private practice in New Jersey. To me, I try to always be the advocate for the patients for whatever disease they may have. I have the privilege to be in a large group that affords me the time to be taking care of patients with the GU. It is an evolving disease over the last few years that we've been blessed as medical oncologists to be able to offer patients treatments where we did not have that opportunity ten years ago. And kidney cancer is the prime example about how the evolution of science and research has allowed us to offer patients therapy in a disease as you heard before that offered limited amounts of options. So I'm going to give you a brief overview. I try to make it brief because to get into formal detail it becomes very, I guess, boring. But more importantly, I think it's going to lead to a lot of opportunity to ask a lot of questions which I think may be applicable to some people. So this is meant to be a small overview and hopefully you can stimulate more questions afterwards. Broadly put, there are two main opportunities to treat patients with kidney cancer. You've heard Dr. Wang speak about surgery and I think that is the integral part about when one has a malignancy that could be protected, but that is the ideal therapy that one should try. But when it comes down to systemic therapy, when the cancer has traveled outside of the kidney and requires therapy for disease that traveled to other regions like lymph nodes, lungs, even other organs, we do have therapies. So dating back to before 1992, there was really no FDA approved drug. Immunotherapy appeared to be the therapy that was studied most. Dr. Dutcher is one of the leaders when it came down to the data that was published early. And I think the immunotherapy science really is that it's able to attack cancer cells systemically throughout the body. It's an intravenous therapy. Sometimes it's subcutaneous, but it does train the immune system to recognize and target only the cancer cells. So it has this ability of really being primed that it's going to probably help kill the cancer cells. It does have some effect on other parts of the body. We'll talk about that shortly. But the main launch category in the therapies that we've evolved over the last nine years has been the targeted therapy. And these therapies actually target and interfere with the growth of cancer cells at a molecular level. It focuses on specific pathways to inhibit cell growth, replication, and ready to disrupt the blood flow supply to the cells. And when you look at the main categories that's listed, you have immunotherapies. There are two drugs. There's interferon alpha, and then there's IL-2 or Intiolucan-2. And then there's the targeted therapies, and we're going to break them down a little bit. And again, I don't want to get into details about each one specifically. And we're going to not talk about the data, how it got its FDA approval. We're going to sort of leave it very broad. But these are how, when you see a medical oncologist, this is how we think. We think about opportunities we have. What therapies are best to be used first? We try to think about the sequences of therapy, and there is sciences behind it. And there's many different conflicts, how one should think. And I think it's important to definitely hear the conversations that you hear from the physician. But this is all stemmed from a multitude of conversations and data that's been published over the course of the last eight years. When we assess patients, Dr. Wong spoke about the surgical approach about how patients are evaluated. We have two prognostic risk models that we've utilized over the course of the last few years. The second one being the one on the right by Dan Heng. The one that's been used over the last 15 years was based upon the, let's call it the MSKCC or Bob Motzer. They actually utilize this data based upon use of interferon and surgery. And they came up with how we should assess how patients should predictively be doing from when we start seeing the patients upon disease progression. So looking at Dr. Moters, I'm going to start on the bottom of Dr. Moters criteria. There actually is two parts to it. The early 1999 analysis actually looked at patients who had prior refractories, presection of their cancers. And then what we use as Karnofsky performance status is really the patient's functional performance status. And there are criteria by that. Looking at the hemoglobin, the calcium level and the LGH is a blood test. So in essence, every time we see patients and medical oncologists, we should have the category pretty much in our head by the first visit. Because a lot of these blood tests have already been done, we've assessed the patient. The Dr. Moters criteria did change a few years later and they took out the first prior nephrectomy and they actually used the criteria of the interval of time between when the patient had their surgery to when they presented to you as a need to start therapy. The difference between Dan Heng and Dr. Moters criteria is really on the last bullet point. There are times of LGH, which could be a marker for the burden of cancer. Sometimes it's normal and therefore it's sometimes an inconsistent study. So they utilize the neutrophil count, which is a white blood cell count and a platelet count, which sometimes can be elevated with inflammatory processes. Sometimes that number can reflect a true volume of cancer predictor. So you'll see a shift every time you read these articles. They talk about usually it still goes back to how we've always dealt with the MSKCC criteria. That's Bob Moter, but Dan Heng's now the criteria is being utilized a little bit more. So when we look at these risk factors, it's not just one of those. We just see the patient's data and we just see where their survival is going to be. It does actually allow us to see which therapies may be best. A lot of times if someone has a favorable risk factor, it actually would be an excellent candidate to go for surgery for cytotidinefractomy that Dr. Wayne pronounced, actually discussed. And then sometimes even for the intermediate risk, it may be a benefit to have these patients undergo cytotidinefractomy as well. But based upon these risk categorizations, we're able to sort of feel which therapies may be better for patients. We'll talk about how poor risk did come about based upon that categorization about the approval of one of the drugs that are used for kidney cancer. But for the most part, every physician should try to believe that their patients should fit a criteria before you come up with a decision about how to take care of these patients. A little broad discussion on immunotherapy. Immunotherapy really just boosts one patient's own immune system to sort of recognize and attack cancer cells. It activates and increases the number of immune cells. It activates these immune cells again to recognize and kill cancer cells. The death of the cancer cells slows or halts the tumor growth, possibly leading to tumor destruction. For the most part, for kidney cancer, we try to slow down and stop growth of disease that are times we are able to be successful that we can actually reduce them, the tumors that is, and they can go away completely. But for the most part, our goal when it comes to patient care and survival is actually slowing down this disease and sort of halting the growth. Kidney cancer as well as melanoma are one of the two therapies that actually respond quite well to immunotherapy. Specifically for interferon alpha, this interferes with the life processes within the cancer cell and it prevents the growth and making it more susceptible by other elements to be destroyed by the immune system. Typically, this is medication that's given subcutaneously. It's given several days a week. It depends on how it's administered. It's got a lot more headlines since 2009 when Vastin got FDA approved. The Vastin was FDA approved with its usage with interferon. But because of its benefit with the Vastin, the use of interferon as a single agent has gone down in regards to its usage. The over-response rates, it looks small. The problem when it was actually analyzed interferon, the criteria about how to analyze the data was different back then. The use of response criteria was a little bit different, so the rates may be smaller than actually what we see. But again, the best candidates are patients who have good performance statuses prior to nephrectomy. Dr. Wang showed the data that was published in 2001, as well as disease that's primarily in the lungs. And again, the response rates talked about not just how patients do, but just the reduction of the cancer by 50% or more. So the stability of the disease is not reflected by the data that's resented. Again, these therapies usually work by regressing the tumor slowly. It's not a therapy that's going to be initiated and start reduction of cancer within the course of weeks. Usually it's several months before the disease actually responds. There is a multitude of side effects. I always tell the patients it's like having the bad flu. A lot of times these therapies are given three days a week. So sometimes by the time you buy it gets better from the symptoms of the toxicity of the therapy, you get an injection all over again. And based upon the dose, you can actually predict the side effects. Of course, every patient for every disease, for every therapy are different. So a lot of times you have to unfortunately administer a therapy at a dose that offers a higher risk of toxicity before you find a dose that actually can be utilized and adjusted to the patient's success of tolerability as well as efficacy or efficient ways of treating the disease. Another form of immunotherapy, IL-2, proloquine, is a therapy that's been FDA approved since 1992. It's genetically engineered to a product that once body open makes, everyone has IL-2 within their own self. It does allow the stimulation of T cells and natural killer cells. This is a therapy that can be given subcutaneous as well, has a lot more success being given intravenously. There are, I think, between 50 and 70 centers in the United States that actively utilize this agent in the way of using it as a high-dose therapy. There have been studies comparing high-dose to low-dose or subcutaneous doses. Still, I believe most patients are receiving this therapy in a high-dose setting. Before these high-dose centers became more comfortable with this usage, it was just given with a low-dose in the office. It was sometimes combined with interferon, but the toxicities were vast. The most success is actually given as a high-dose. When you are in the hospital for five days of IL-2 therapy, given a dose every eight hours for 14 doses, you have a five-day rest. I'm sorry, you have around anywhere between a five to ten-day rest and then five days again back in the hospital. I learned over the course of several meetings that there must be 50 different ways how to give high-dose IL-2 as a high-dose. You find that there is a lot of variability in how people are administering it these days, but still a very successful therapy. It is the only data I think that the doctor is going to show you a slide that actually has therapies that are given to patients that can put these patients into not only complete remissions but durable remissions. These are therapies that, if given and if it works, you don't always have to have a complete remission to have a cure. You can always have a therapy that can be working partially, can stabilize the disease. The benefit of these therapies can actually be where you are postponing the inevitable next dose of therapy. If one can actually be on this therapy and being able to possibly slow down the disease that you don't need to get any further therapy, I think that's the ultimate goal when it comes down to trying to treat patients and the fact that one's able to believe that over the course of a lifetime if one's going to be exposed to many medications, then limiting the amount of therapies to patients is going to be probably the most beneficial for patients' quality of life. The side effects for high-dose IL-2, unfortunately, are difficult. I think that, again, in the trained center, and as much as I think that we know how to do it, I have to value my nurses and the nurses to have on the hospital floors, because they pretty much are beyond diligent, how to monitor these patients and avoid any worsening of the toxicities. But there is a phenomenon called capillary week syndrome with the capillary week in essence. If you remember, good old-fashioned biology between your arteries and your veins, every capillary fluid drifts out.  The patients go through bad rigors, I describe as good old-fashioned earthquakes from California, but they're very terrible. The great thing about this therapy, the adverse effects are predictable, they're manageable, and they completely resolve upon completion of the therapy. So, best spoken to by a person who got IL-2, but I can tell you that these therapies not only offer a therapy of benefit for the immediacy, but also possibly long-term. And then we talk on the targeted therapies. So, there are three different categories. One's called TKIs, tyrosine kinase inhibitors, and these are anti-angiogenesis agents. They inhibit vascular endothelial growth factors and platelet-derived growth factors to block the growth of new blood vessel formations in tumors. Simply put, cancers need blood supply, and so it built its own blood supply to sort of build a bridge between the tumor and an existing blood vessel. So, these therapies actually have the ability of not only inhibiting the growth of these blood vessels, but also having the ability of disrupting the blood vessels that are already formed. They do work in different pathways that were multi-kinase. It just reads that different pathways that these work by will bring them down a little bit, but they really, as I said, designed to slow down the tumor growth, possibly even shrink to the existing tumor. I do set goals with my patients when we start our discussions with therapy, is that my goal is for them to tolerate the therapy and live as long as possible. We as medical oncologists, of course, like to believe that we understand what it's like to be a patient, that we want the cancer to go away. There are times if we stop the growth of cancer, we are very happy with it. Shrinking it is a blessing, and going away completely is sometimes great hope. But we always believe in everything we do, so a lot of times when we talk to patients about that the tumors are not growing anymore, that is a success. The common side effects with tyrosine kinase inhibitors, they put them up here because we can talk about them individually with each drug, and they have some variability amongst all of them. But for the greater good fatigue type of rash, we'll talk about that. Diarrhea and high blood pressure seem to be the most. There are some that have different within each other, and we'll talk about it. Bleeding, clotting, and wound healing is part of the VEGF pathway, and I think when you have all these drugs that have part of the VEGF pathway, they're all going to have issues that way. Nexivar was the first FDA approved drug. I can't tell you why I know, but December 20th, 2005, nothing else is during the day. So with that, again, that was the first drug, and literally five weeks later, January 26th, 2006, Sutin gets FDA approved, and I think within the course of five weeks to have two drugs that worked very well was really beyond the blessing. I know we've seen articles that talks about the embarrassment of rishes, and I think that's something that applies. Nexivar got its FDA approval based upon its patients who received the prior therapy, then received this as a second option of therapy, and this did improve the median time for the tumor to grow by double, and I think that sort of got the foot in the door, and Sutin got its FDA approval based upon two phase two studies. Shortly after, they did release data on a phase three study, and Sutin pretty much became the drug of choice for kidney cancer. It definitely had the best favorable response. It reduced the disease in a third of the patients by more than 30%, and for some time, that became the go-to drug for patients who had metastatic kidney cancer. Three years later, similar pathway, Voltrient or Pizzatinib gets FDA approved, given once a day its side effect profile a little bit different, and you have to watch the web of function tests almost every two weeks for the first three months, it can affect your electrolytes. So again, monitoring with that seems to be very important. Again, something we instill into our patients, we do ask patients to sort of follow through with the way the protocols were done, and I think it's sometimes we do see patients that we have to adjust the therapies because of these side effects. In LIDA, or I said it was the one that's most recent FDA approved two and a half years ago, it too has its own set of side effects. Horseness seems to be something that we see, and actually they started utilizing, can we start predicting who should be doing well, and they started to use sort of a biomarker, even just using high blood pressure, sometimes within LIDA, and now with Sutin we're going back and sometimes recognizing that patients who have started these therapies and have high blood pressure, they sometimes can predict that they may started having a better response than others. The other target therapies, the M-tor inhibitors, these inhibit the M-tor stands for mammalian target of Rappermycin. It's a protein that controls cell division and survival. Taurus cell and Affinitor are the two drugs that fit this category back in the day, and even now if you look at the M-tor and Taurus cell and Affinitor, they actually incorporate the mechanism into the name of the product. Taurus cell is an FDA approved drug in 2007, it's an IV formulation, and it actually got its FDA approval based upon the poor risk categorization. Some patients who have Sutin and Nexobar, its first FDA approval, these were for clear cell, renal cell cancers. Taurus cell sort of fit the need of what wasn't being covered, so patients were not eligible for those studies because of their poor risk categorization if they had looking at the MSKCC criteria, or if they actually had non-clear cell patients were getting Taurus cell at that point, and its FDA approval was based upon those categories. So its FDA approval is not based upon the fact that it can be taken care of patients who have clear cell, but actually non-clear cell or patients who have clear cell at poor risk. So it gave us an opportunity to treat these patients where data was not offering us that knowledge when it came to Nexobar or Sutin. It blocks the M-tor pathway, interferes again with cell replication, angiogenesis, and Affinitor has a similar mechanism, the side effects appear to be similar. It happens to be an oral drug taken once a day, has a little bit more pathway inhibition, even angiogenesis, or again the same pathways that the VEGF incorporates. It's there again, the side effects between both agents are relatively similar. I'm not going to go through each one of them. You do find with Affinitor you do have more of a mouth infection risk and sometimes you can actually develop an inflammatory condition in the lungs that are readily reversible in steroids. Again, two agents that have actually fitted quite well to our armamentarium. The last one is the pure VEGF inhibitor, that thing, Avastin. It got its FDA approval for kidney cancer in 2009. Avastin is FDA approved in other malignancies, given intravenously once every two weeks. Again, its FDA approval is with interferon, but there are times where it actually can give Avastin by itself and it too has the common side effects of the high blood pressure that headache and the fatigue. I think it was Mike Actins back in 2009. Actually, you came up with this first roster about how we should be thinking that when it comes down to patients, and this list has grown over the course of the last five years, and when we go through experience, when we go through the NCCN guidelines, when it comes down to data, this is how medical oncologists should be thinking. This is kind of the playbook we have in our head when we see our patients. It's relatively easy and it really is important to try to incorporate our therapeutic interventions when it comes to patients, because it's not just about what the doctor feels. This is gut feeling. There's a lot of data that supports that hopefully they're gut feelings. Now, first line and second line is really the first agent they receive. Again, I still think surgery in my ideal scenario is the best thing. And sometimes, as Dr. Wang was saying, you can actually go for surgery and actually do absolutely nothing afterwards. And there's a period of time where you can just keep valuing the patients doing CAT scans or MRIs ever so often to feel that the disease is truly almost a typical kidney cancer where it is a slow-growing process. You can actually be living with cancer and do nothing for it and actually not have to be involved in any of these therapies. But when these therapies are important to be utilized, we do have pathways to think in our heads about based upon the data how we should be thinking it. And again, I'm not going to go through the list on each individual one because this also is a subject for discussion. Just because when it comes down to our oncology meetings, everyone has a reason why they use one drug for the other. The future is going to be discussed probably in the next nine minutes, but more for how the data is going to evolve over the next two years. The science has now evolved to a new pathway. The new pathway is PD-L1, which is program death of Lycan 1. These are expressed on tumor cells and tumor infiltrating immune cells where these are normal pathways that suppress the T cells. So these are inhibitors of those suppressors of the T cells. So our T cells that are normally used to incorporate to help boost our immune system, these are therapies that are now able to sort of inhibit the blockage of our normal immune system to fight cancers. These Ketruda and Urvay are FDA-approved drugs as these types of therapies for melanoma that are being studied extensively. Again, those three bold points at the bottom are active studies that are in a lot of centers across the United States, even in this region. And I'm going to leave that part of the discussion up to Dr. Dutcher. So to sum up, immunotherapy is still the mainstay of therapy for advanced kidney cancer. The FDA-approved drug Progokin or IL-2 appears to be the best drug if one wants to sort of over, I guess, to undertake a therapy that can be toxic temporarily but reversible with its toxicities but possibly be able to be on a therapy and then have a long, durable response, remission for the therapy possibly postponing inevitably maybe having to get another therapy but possibly postponing any other therapy that you may require for advanced kidney cancer. Targeted therapies for the last nine years have been a breath of fresh air for our patients in regards to options of therapy. They do have its set of toxicities and I think that when I talk to patients about therapies, it's about the tolerability of the therapy as well as the efficacy but in that order and that applies for the TKIs as well as mentors as well. As to how one approaches therapy, it really comes down to the patient's presentation, their quality of life, their extent of disease, their goals, our goals and really one always tries to apply the risk categorizations of prognosis to find out how the patients should be able to be given their therapy form. Again, the checkpoint inhibitors, again, is going to be a new science that's going to be incorporated into our practices definitely within the next five years. A new way of taking care of kidney cancer patients allowing us to do what we've done over the last nine years is give them therapies that we were not able to give them in the past. So with that in mind, I think I have five minutes. We should just go into the next one because we're going to have a question and answer period after the break and get to ask questions at that time. So I thank you for your time.