Welcome, everyone. Welcome to the Center for Strategic and International Studies. My name is Seth Jones, Vice President here. And welcome, more importantly, to a conversation with the AUKUS Army Chiefs on land powers contribution to AUKUS Pillar 2. AUKUS, which was first announced in September of 2021, is a trilateral U.S.-UK-Australia Defense Partnership, which includes two pillars, Pillar 1 and Pillar 2. I'll let Dr. Charles E. Dell talk more about that. But last year, the Australian, British, and U.S. Army Chiefs signed a statement of intent identifying capabilities of priority for cooperation across the three countries. This effort is intended to contribute to the broader work under AUKUS Pillar 2. So in this panel discussion, which I'll hand off to Charlie, U.S. General Randy George, U.S. General, U.K. General Sir Patrick Sanders and Australian Lieutenant General Simon Stewart, will discuss AUKUS Pillar 2 from a land domain perspective and how the three armies can work together to enhance collaborative efforts in capability developments. Charlie, over to you. Great. Well, thank you very much, Seth. Thanks, everyone, for joining us here today. All our distinguished guests that we have, and for those of you who are tuning in online for this discussion about AUKUS and how it intersects with land power. I'm thrilled to have the three AUKUS Army Chiefs from Australia, from the United Kingdom, and from the United States here with us today. When AUKUS came out, as Seth just described, in September of 2021, everyone immediately fastened on Pillar 1. That is, the nuclear-powered, conventionally armed submarines. That was what AUKUS looked like. So naturally, it had a maritime dimension and focus to it. But AUKUS, of course, is broader than that, and it's evolved over the past two-plus years. In fact, it continues to evolve about both what it is and what it might become. And that really brings us to our conversation here today. Now, Seth had mentioned Pillar 2. Pillar 2 is an initiative to really hone, push, and forge collaboration between the three nations in advanced technologies, whether we're talking about hypersonic missiles, quantum, artificial intelligence, unmanned vehicles, or a range of other options. Really, that is what AUKUS is, but understanding that has been a bit of a challenge thus far. And to really discuss what opportunities Pillar 2 might bring to discuss the emerging challenges in the Indo-Pacific theater and how land power is situated to meet those challenges and really hone in on this particular configuration, Australia, the United Kingdom, and the United States, and why it's so critical in this theater, I'm beyond honored to have the three Army Chiefs here. Lieutenant General Simon Stewart has been the Australian Chief of Army since July of 2022, bringing 35 years of experience and command at every level, from the company to the Joint Task Force to the Brigade to the Force level, and having served in East Timor, Afghanistan, Egypt, and Israel. And most recently, before this role, he served as the lead of land capabilities in Army headquarters. Next to him, I have General Sir Patrick Sanders, who has been the Chief of the British Army since June of 2022 and is over 38 years of service and command experience in Northern Ireland, in Kosovo, in Bosnia, in Iraq, and in Afghanistan. Finally, last but certainly not least, General Randy George, who assumed duties as the 41st Chief of Staff of the Army in September of 2023 prior to that serving as the Vice Chief of Staff of the Army. He was commissioned as an infantry officer in 1988 from West Point and has previously served in Italy, in Iraq, and Afghanistan. We're going to hear some initial thoughts. I'll run the conversation for a little while, but very eager to make sure that we go out to the audience for questions. That means both people who are online, you can register questions directly through our portal, but also for those of you in the room too. Let me turn to you first, General Stewart. And I'm hoping that you can begin this conversation by telling us how the Australian Army is really thinking about the transformation that it needs to undergo to meet the new types of challenges that we're seeing in the Indo-Pacific region. Thanks, Charlie. If I might just begin by thanking CSIS for boasting this today and to Seth for the introduction to you, Charlie, and also to my friends and counterparts and everybody that's turned out today. Just last year, the Australian Government commissioned a very detailed review called the Defence Strategic Review and then issued very clear direction to the Department of Defence and the ADF. And it's probably worth just taking a moment to sketch out the context. It, as would be familiar to my counterparts, recognise that in an era of great power competition, defence and security is once again a whole-of-nation endeavour. But even more so, it requires us to work even more closely and in a more integrated fashion with allies and with partners. As military professionals, our greatest challenge is balancing the enduring human nature of warfare with its ever-changing character. And that ever-changing character is absolutely dominated by technological advancement at pace. And so really the challenge for us is how do we adapt at a speed that is relevant and very clearly by working together we can achieve the sort of tempo, the sort of speed and the sort of outcomes that we all need. My job of course as the Chief of Army is to maximise the value proposition of land power and the contribution that armies and land power make to the combined multi-domain force or the integrated force as we describe it. And if I can just quickly sketch out what that value proposition looks like. Five key elements, we'll go into them in a bit more detail later. But presence, land forces are present among populations. They can understand the environment. They are persistent. They can consolidate gains across the integrated force. They can provide reassurance for partners and they can contribute to deterrence through their persistent effect. Symmetry, in the Indo-Pacific region the A2AD complexes are optimised to defeat air and maritime forces. So how do we leverage the asymmetric effect of standing land forces that are distributed, that are survivable, that are sustainable. And of course the ability to support our navy and maritime forces in their manoeuvre by applying maritime fires from the land and expand the options there. The fourth is versatility. You can take almost any army unit or formation and it can perform a very broad range of tasks from humanitarian assistance and disaster relief through to combat operations. And fifthly, and I think particularly importantly in today's climate, we are really good value for money. You get a lot of bang for buck out of armies and out of land forces. So relatively inexpensive way of generating that value proposition. From an Australian army perspective I'm part of an ADF that has been directed to move from being a joint force to an integrated force. Quite simply that means a joint force converges in effect. An integrated force is something you do to very deliberately and consciously design an integrated force so that's more than the sum of its parts. We've been directed to move from a balanced to a focused force and that means prioritising and very clearly focus pillar one is a great example of that prioritisation. And the army, the army I'm privileged to lead has been directed to optimise for lateral manoeuvre operations and if I may just finish on that, whenever you mention lateral people will immediately think of ships, boats, watercraft. They are absolutely central and important and vital but it's actually about manoeuvre and advantage for the multi-domain force. The latorals are a couple of hundred kilometres either side of the beach, the air above that space, the electromagnetic spectrum that operates within it and the space capabilities that can be applied within it. So it's how do you better leverage positional advantage for that integrated or combined multi-domain force. And so our adaptation, our transformation is all about very quickly filling the gap between where we are today and our capabilities, where we need to be in the future, long range precision fires, the ability to draw on a persistent sensor network, to decide at machine speed and to be able to manoeuvre in those latorals but also to maintain the capability for the close fight, the combined arms fight which is often the decisive phase in any battle and campaign. Thanks very much. One of the things that you had said which I hope maybe we can dry out a little bit more is the shift as you rightly noted, highlighted in the defence strategic review about different suite of challenges than we had previously so therefore a different type of force and no longer balanced across everything but focused against a particular type of challenge. So hopefully we can pull that thread a little bit more but things look similar but not the same in a different part of the world. General Sanders really with the army fully invested in European security quite obviously. I wonder if you could talk a little bit about how you see the British army evolving against the backdrop of what's happening in Europe and then on top of that, because it is on top of that what is the role for the British army in the Indo-Pacific? Well, thanks Charles. And it's, I mean as Simon said, it's a huge honour to be here sharing a platform with British armies, two closest partner armies and two close personal friends and Randy and Simon as well. And like many, I have spent much of my operational career serving alongside US and Australian soldiers. It's also a signal honour to be here. You're described as the finest defence and national security think tank in the world.  And this feels timely. We can see threats proliferating at a scale at a pace and a vector that we probably haven't seen for 80 years or more. It's not beyond the realms of possibility that these threats begin to metastasise together. And it's timely in the sense that time is surely the most critical strategic resource that we have in the face of these threats. And so it is so important to begin to restore deterrence and that's about magazine depth. It's about more fighting competitive edge and it's about partners. And that is what is at the heart of AUKUS and for us AUKUS Pillar 2. So I thought I'd just talk a little bit about strategy about Ukraine, about land power and what we're doing about it. On strategy, I always tend to go back to George Kennon. I think that it's hugely resonant with the Euro-Atlantic era at the moment but more widely as well. And from that we need to relearn the nuances of the strategies of containment of deterrence and coercion. But it's also clear that we no longer have the luxury of treating means as something that's discretionary because a lack of strategic means will ruthlessly undermine the ends that we're pursuing. And we need in that context, just to remind ourselves that Russia is currently spending 40% of public expenditure on defence and security. So that draws us to Ukraine. And Ukraine, and I'll say this unashamedly, Ukraine really matters. This is the greatest geostrategic catastrophe for the free world arguably since World War II. It is the principal pressure point on a really fragile world order. And it is about a few thousand hectares of fertile land in eastern Ukraine. But it's about much more than that too. This is a concerted attempt to defeat our system, our way of life politically, psychologically and symbolically. And I think Ukraine is the test for our generation. And how we respond to that test is going to reverberate through history because Russian aggression cannot stand. Because if we fail, if you contemplate what failure looks like, we end up with a world that we've agreed to our children and our grandchildren that is infinitely more unstable, infinitely more perilous, where autocracies have been emboldened and our collective deterrence and security has been weakened. So for now, Ukrainian blood, and we should be clear about that, and bravery is buying time. But they need our support. And it's not just morally right to do that. It is in our own self-interest because preserving our future security by supporting Ukraine is much better value than fighting a war. And then thirdly, just turning to land power. I mean, I'm an army chief, so I'm going to advocate for my domain, not in zero-sum terms, but it is an inescapable fact that land is where people live. It's where human affairs are settled. It took a great naval strategist, Union Corp, to remind us that, except in the rarest of cases, the great affairs of state are settled on land, and its war wars are concluded. And I think, as Simon was saying, that it is growing in relative value as a domain because as we see projectile ranges and precision increasing, the large capital platforms in the other domains are at risk. And you can mitigate this by thinking cross-domain because cross-domain effects are more deliverable ever. And as Simon said, land platforms are disposable, disposable, survivable, and they're cheap. They're really good value. And they allow you to unlock challenges in much more constrained and contested maritime and air domains. And that's as applicable to the Euro-Atlantic area as it is to the Indo-Pacific. So what is all this being for us? Well, I'm frequently guided by Dr. Jack Wattling. I'll give him a chuck up because I think he's becoming a national treasure. Works at IUSI if you haven't been there. And he writes that if the fundamental elements of the character of war are changing, as Simon was saying, transform and not just optimize. And we are going through as an army the most profound transformation of my career. It's guided, our North Star, if you like, is an operating concept, a land operating concept that is the most significant, tested, and peer reviewed of any concept that we've produced in more than a generation. The context this describes is happening right now and the principal deductions and recommendations that you draw from that will be applied to the force right now. But the processes that we have for design, for acquisition are based on an orderly measured cascade of ideas and then very stately approvals processes. And we're operating in series rather than parallel. And we have to transform that and it can be the only approach. And that transformation demands a leap of faith. It demands ruthless prioritization, a willingness to discard old structures and old ideas and a tolerance of risk, including financial risk that feels counterintuitive when you are husband and taxpayer's resource. What does all that mean for us? As you said, NATO is our North Star, but it is not exclusive in the way that you implied. Indeed, the UK's largest and most persistent presence to use two of the characteristics that Simon described in the Indo-Pacific are land. We have a joint task force alongside the US, the Australians and other partners across the Indo-Pacific. And the Indo-Pacific, a free and open Indo-Pacific is in the UK's strategic long-term interests. And pillar two of AUKUS allows us to develop high-end capabilities that will enhance deterrence, yes, in the Indo-Pacific, but it's applicable across school theatres. And the way we think about how we design that force is really guided by four values. Height, breadth, depth and edge. So height is about our convening power as a multi-domain integrator as Simon was describing and as a leader across NATO. So if you like, that's about growing core-level capabilities. breadth is about broadening our strategic utility and therefore offering greater choice, more options for government. And that's generally growing capabilities at the formation level, including a global persistent presence in the Indo-Pacific. Depth is about magazine depth. It's our ability to endure through conflict, particularly through people and stockpiles. And edge are those things that contribute most to war-fighting competitiveness. So for us, AUKUS pillar two is predominantly about edge, because it's the cutting edge joint cross-domain technologies, and it's about breadth, probably best represented by the multi-domain task force that Simon and I have been invited to contribute to, and we will. So those are the things that we're wrestling with. How do we balance those four values? And I'm happy to unpack them further in questions, but I'll stop there. Terrific, thank you. I was really struck by your comment about what Ukrainian blood has purchased for everyone else, which is time. And so the question obviously becomes time to do what and acquire what and set ourselves up for what. We'll pull on that a little bit too. General George, this past week you've been hosting two of our closest allies. I'm really curious if you might kick us off with your thoughts about how the U.S. Army is thinking about collaborating with two of its closest allies in order to drive some of this future collaboration that we just heard described. Sure. And first, it's great to be up here with my teammates. We've had a really good couple of days of conversation. So I could repeat a lot of the things I think that Simon and Patrick both said about the environment. And just when I'm out talking to our commanders, I mean, for 36 years in the Army, I don't think I've seen the change that I've seen that's happening in our world over just the last couple of years. And we always say that the world is complex. We've been saying that, I think, forever. And I think the difference is, as Patrick suggested, is it's also very volatile. I mean, any regional, I don't think anything now is regional anymore. It could be a spark that could set things off. So a lot of the discussions that we've been having are a big focus area for us inside the Army, and that's how we transform and how do we change. And we have four big focus areas in the Army that we're fighting to make sure that we're always focused on building lethality and building cohesive teams and we want our formation to know that up and down. Delivering ready combat formations are important for the Army because for the U.S. Army or a global Army, we just this last weekend, we sent Seventh Transportation Brigade over to the Middle East to help set up the port there in Gaza. So we've got to be able to ready to do anything. And Army is a big part for us, for Army material command and everything we do for the organic industrial base. Patrick mentioned magazine depth, and that's critically important. We had a lot of discussions on that. I think the big thing that we all three of us realize is that the old model of where you would put something out and say you had to change and maybe look at a system coming online in three, four, or five years, I think that we have to be quicker than that. And so what we talk about in the U.S. Army is continuous transformation. And what we're seeing all the lessons that we're learning from the Ukraine or the Middle East, you really can't hide anymore. With all the sensors that you have out there, the UAS that's out there, everybody in here is in probably a million cell phone photos. I mean, there's really no hiding that's out there right now. And that has implications for what we're, how we're going to have to transform. Commercial tech is moving much quicker than military tech in a lot of areas. And so we had a lot of conversations about that. I think people are moving to cities, combat's moving to cities. And that will have implications on what your capabilities are and how you're going to do those things. So we've really been focused on that. And it's a lesson observed, I think, until you actually make changes inside your service to whatever you're doing with changing how you operate. And this is what we're talking about. We have to change how we operate on the battlefield. We know that, for example, you can't have these big C2 nodes, command and control nodes that we've had.  And we have to transform how that looks. We talked a lot about unmanned systems and what we can do to partner in that area. And that's also tech that is moving really fast. And we have to figure that out. Same with countering unmanned systems or counter UAS. And I think we've also seen just what missile technology, and I think this gets to the cost effective of what we can do with Prism, for example, one of our systems that can, you know, how far that can reach. It's very, very difficult to target land-based fires. And I think we've seen that over in Ukraine. They can hide, they can move, and they're very effective in just what that will do to contribute to the joint force. So we're busy in the Army, but we have to continuously transform and what we're doing is undertaking, is using every advantage that we have together as AUKUS nations to use exercises for us to transform. We were just out at project convergence. All three of us working together and making advancements. And, you know, what we're calling it in the U.S. Army is transforming in contact. We're going to have to transform in Europe. We're going to have to transform formations that are in the Middle East, and we're going to have to transform units that are out in the Pacific. And so we just have to have that culture, that innovation mindset. And we spent a lot of time talking about what we can do together to get momentum in those areas. Perfect. Thanks very much.  It's something that all of you have touched upon. General George just gave us an example that it's very hard to find distributed land forces. And so one of the things that I'd really like to draw out on this conversation is how do you think about, how should we think about how land power contributes both to a combined fight, a joint fight in a theater that is predominantly water-based? General George, would you start us off on that? Yeah, I think you're not going to win a war, you know, from the sea. I don't think you're going to win a war from the air. I'm certainly not saying that you would just from the land. I mean, I think that there's no such thing as a, you know, a maritime theater, for example, I think these are joint theaters and it's going to take everybody's capability to do that. We certainly appreciate, and we absolutely, you know, it's going to have to be a joint team and the Navy for the global commons. But what, I think you just said it, what you can do with long-range fires and, you know, distributed forces that are out there in whatever environment, whether it's the Pacific or anywhere else, I think is going to be the difference. Same with, it's going to come down to, I think, it typically does, to a close fight in the streets, to, you know, people are living, and I think Patrick or Simon said that, people are living on the land. Command and control nodes are on the land and in cities, and so I think it's going to be the whole joint team that's going to have to be successful out there. I'm trying to think too about this, about more capabilities, more attributes that we're looking for, particularly that we've learned over the last couple of years. I mean, this is a question that I got from several folks incoming that all three of you have talked about transformation, but we've had transformation shoved in our face with not one but two wars that we're watching play out now. Things that we didn't think were possible. For instance, the Ukrainians who have no navy, sinking and destroying the Russian navy, are transforming how we think about not only war, but about power and the capabilities that we need to acquire. So, General Senators, if I can ask you about this, can I ask you to pull a little bit about both innovation and technology that we've seen flowing out of Ukraine and the conflicts in the Middle East? Particularly, you know, one example of this is kind of increased ways, as you were talking about, our phones, but how it is that we detect and target forces. How does that apply to a much larger theater across a maritime realm, but that will come in the form of land power? So, Ukraine points to a combination of regression and progression. A lot of the lessons that you see come out of Ukraine is what some are saying about this simply being the nature of war. We are, you could see the same things, scenes that could have been in Antietam, could have been from the First World War.  And those facets of war, I don't think will change. But we're also seeing, as you're hinting at, extraordinary, progressive, almost revolutionary change in some of the character of war. And perhaps the most revolutionary aspect to this is what you could almost describe as a Cambrian explosion of autonomous systems. Now, not all of them are working effectively, so up to 80% of the drones during one period recently simply were not getting through because of an extraordinarily contested electromagnetic spectrum and effective Russian use of electronic warfare. But I think this does point to a very, very significant change and that of course is enabled by data and by being able to freely flow data from sensors through to deciders, through to effectors and across all domains. And just last week in Camp Pendleton you saw a perfect example of that where we were able to take data from an air force sensor which we previously wouldn't have been able to do, not least because of levels of classification and exchange it and pass it through a decider and then to an effector, both a British effector and an Australian effector, and the Australian effector was actually located in Australia and that was done at machine speeds. So you can see how the range, you combine that with the sort of precision and the ability to use ubiquitous sensors and the ranges and the precision that we can achieve with multi-domain effectors. So a land-based missile, Prism, being fired out of a 30,000, not 100 million, $30,000 platform, which is hard to find, can reach out to previously unthinkable distances and target a maritime platform. So that gives you a sense of how I think the innovation that we're seeing feeding, being developed in places like Ukraine, has got direct transfer and applicability into the Indo-Pacific. I really like these concrete examples that you've offered up for us that we can see bespoke capabilities in the EW domain, in the fires, in the data sharing and transfer that we have. Is there a relative kind of pecking order for which types of capabilities we want to go after first, or is it all the above? How do you think about this in Canberra? Well, I don't think we can afford, nor do we have the time to be, as Patrick said, operating in series rather than parallel. So we're certainly starting from, I think it was the 26th President of the United States that said, do what you can with what you have where you are. And that's a good starting point because we can actually do quite a lot more than this exists already today. But I do think it's fair to say, and a lot of our conversations over the last sort of couple of days have come back to our ability to share data at machine speed. So, you know, how do we communicate and share data? Because to actually deliver on the theory of any, on every sensor, any decider and the best effector and then the optimal sustainer, you need to be able to operate at machine speed and you need to get the right data in the right place, at the right classification. So that, you know, if we were to look at what some of the central priorities are, I think, what we would previously have called the network is really at the heart of digital age warfare in all domains, but particularly in the land domain. Then I'd say, and both Randy and Patrick have mentioned this, long range precision fires. Now, a little bit like Littoral Maneuver, when you say long range precision fires, everyone thinks of a missile. That's the penultimate step in that kill web. So it's ensuring that when you strike, you can also shield. So what does our own protection look like in terms of integrated air and missile defence? But the game changer from a land domain contribution to that combined multi-domain force is the ability to apply it fires at strategic and operationally relevant ranges. And that, I think, as an addition to that joint force is particularly powerful. So I'd say that those two things, I think are probably central to the value proposition of land power. But the other things we've been talking about, the ability to sustain contested logistics, the ability to apply autonomy, resilient autonomy at scale, both on the ground and in the air, to achieve human machine teaming. They give us scaling and mass advantages. But also, because our people are our most valuable asset, how do we move them away from the point of contact? I do not want to be putting our soldiers into a fair fight. I don't want to be trading blood in the encounter at all if we can put machines out front to do that. Yeah, but it's more than machines, right? Because we said we don't want a fair fight. We want a manifestly unfair fight that tilts in our favor. And so the question is, and I think you've underscored this really well, is how does AUKUS, how do these three nations working together become more than some of its parts? Right, what the UK learns all of a sudden is pushed out to US operators. What Australia can see all of a sudden gets integrated into a larger system here. I'm not sure, General Senators, if this aligns with the first of the pillars that you were talking about, about height, that we stack on top of each other and we have more breath than we might otherwise here. But I do really want to drill down if I might for the challenges that we're facing. In the Washington games we play here, which is at what date precisely are we most concerned? It doesn't matter because we are concerned. I think that's the point that we underscore. But when we look about the decade of challenge, critical challenge that we find ourselves facing and emanating from Beijing as they go through a rapid military modernization, I guess the question that I have here is, how do we feel not we, how do all of you feel about the speed with which you see AUKUS coming online and bringing combat capability to bear. Is it delivering deterrence fast enough, given the scope of the challenge that we're facing and what can we do to help accelerate this further? All three of you talked about timing and speed and the timeline that we face the challenge. General George. I know I would say we want to go faster. That would be my answer. And we have given very specific examples to give another example. I think a lot of this with this partnership is that we get the ingenuity from three great countries and all that industry together coming forward. As a specific example we were talking about UAS unmanned systems that we could have a common controller and we could exchange systems and do things. So I think that there's ways that we're figuring that out. Specific to where I'm at and one of the things that I think we need to do better is consolidate some of our funding lines. It's something we're going to have to do inside the Army but also with a little bit of help. And I've talked to folks on the hill about this is that I think we need to be a little bit more flexible with how we buy things so we can do things very quickly. The unmanned systems what's happening in the electronic warfare EMS is changing every three weeks or three months and have the ability to update systems to update software and to do things more rapidly. I think we need to be able to move from research and development to procurement very rapidly. And that's been very hard for us to do right now for example with a continuing evolution as far as moving things around. So I think that we have to speed our buying models a little bit to get after that. General Sanders, how are we doing on a timeline here? So I think it's probably if you take an optimistic spin to begin with and a pillar one is not going to deliver for decades. This is a very, very long time frame. The full suite of pillar one won't deliver for decades. We know that's supposed to start up in two years though in Australia. But pillar two you will deliver from the land contribution, the land of opportunities that we can exploit in pillar two you can be delivering next year. So when it comes to pace this is the best opportunity you have to inject pace into AUKUS and critically to begin to restore that commitment to Terrence that we've been talking about. When I pick up on I don't want to describe all of the impediments because we face many. But I think the one I would pick up on most is the ability to share data. It's the single most important enabler to allow us to co-develop co-produce and co-sustain the sort of capabilities that we're talking about because if you can free the data around and then also do it in a way that allows you in a more limited way to bring in other partners as well then that's where the pace will come from. These inhibitors to our collaborating are closer than they have. General Sanders described this as the need for all of our countries to assume more risk than we have before. That's true at every level. But if we assume more risk here we get more things more quickly. Again, I know I've asked this before but I'm keying off something that General Sanders just said about AUKUSPORT 2 has the ability to potentially start delivering immediately. I think you said last year. There's a range of things that constitute Pillar 2. It's both fraud and somewhat hard to hang your hat on. I guess I would ask if we want to start delivering deterrence effects immediately do you agree with this that it's data sharing as priority number one what should we be acquiring now or in the next 12 months that kind of add to the deterrence equation that we don't have right now? If I can answer in two parts and go back to your original question at the outside I said in an era of great power competition defence and security are a whole of nation endeavour whole of government endeavour and so it's going to require us to change our systems and processes and I certainly know that in Canberra colleagues across government and indeed across industry are working on their part of the equation for me I have an obligation to make sure that we're good students of taxpayers money and also to change what we can within our army and so instead of starting the process of delivering a capability with the platform let's take watercraft for example that's the last thing that I'll be able to deliver to our soldiers they're already training we've already written the concepts we're already working with our joint partners and indeed our combined partners with the Defence Force in Darwin the composite watercraft company out of USARPAC for the last three years to demonstrate operational manoeuvre across the north of Australia we're re-skilling our people the first seven skippers of those first watercraft are being trained by our Navy today in that partnership so that capability is using you know Submission lease hire watercraft to emulate and simulate and provide some capability so the last thing we'll deliver will be the major platform which is completely the opposite of how we've previously done things where you start with that and then you develop the capability so it's going to be a team effort but we have responsibilities and we take them seriously and we're moving out you know again I think all of our discussions have come back to our ability to share data and to be able to do that at machine speed when you talk of inhibitors obviously there are different systems there are different caveats on information in terms of security and and access and then there are different data standards so I think right there you've got the aspects and they're all things that we are getting after and I know that from an AUKUS perspective the theory of course is that if we can share the secrets associated with nuclear power submarines then everything else ought to be a little easier for us I'd like to go to the audience but I'm just going to underscore something that came to me recently about what is AUKUS and we were kind of kicking this idea around and I said well it strikes me that it's at least two parts it's the very visible things that you see like this it's the signal that we send of enhanced collaboration the additive portions about this what this means for all three countries but it's also the less visible parts that not only the end part but also the metric edge capabilities are we not only thinking about collaborating on but bringing to the field quicker than we might otherwise have the ability to both the invisible and the visible parts that actually feed into that deterrence equation let me turn to the audience here see what questions you have I'd like to ask our audience both online but really for those of you in the room to please identify yourself and also keep your question concise Dmitry please wait for the microphone Thank you Dmitry with Financial Times Charlie this is going to seem like you read my mind but we did not coordinate in the context of a Taiwan contingency if you had a magic wand for a day what are some things that you're not thinking about right now in the armies that you should be thinking about and are you facing any resistance from other services or parts of the joint force that you tried to propose things that are not on the table at the moment General George do you want to start with that question I will answer your second part first Dmitry I'm not sure I'm getting any pushback from anybody across from my joint teammates I really have not seen that we're exercising together out in the Pacific we're doing war games together I'm good friends with all the other chiefs and when we talk about this I think that there is a clear recognition that it's going to take everybody across the joint force with whatever we're doing to be successful out there so I haven't and if I'm if I'm forgetting to think about something you know I forgot what it is we spend a lot of time actually trying to pour over this I think if anything what we're learning is that we're you know again we have to figure out where I think our challenge is is that we may observe something it's actually drilling it into our formation and actually making the change it's one thing to talk about a lesson that maybe you've seen from Ukraine but if you don't actually change you know what you're buying how you're buying things if you don't actually change how you're operating and how you're training and how you're training your people then you're not really preparing your formation and so that's I think that's our big you know that's certainly my big focus can I just shift that question a little bit General Senators when you think about this I mean all the lessons that we're pulling out of Ukraine transformation of war also landlocked country does this apply when we're thinking about you know contested logistics when we're thinking about a maritime theater when we're thinking about Taiwan contingency which thing should we have front of mind for this so first of all I should clearly say to the financial times that any decision to be involved in a conflict in the Indo-Pacific will be a government one so I'm not going to put that out there but so one of the things I think we have learnt from Ukraine and I don't know if this extends to the scenario you describe is that at the start of a conflict you see actually a dislocation of domains so mines and land-based coastal artillery if you like pushes maritime forces away from the land I'm not sure that you can draw all the right lessons from Ukraine but certainly you know the air domain has not played a significant role and ground-based air defence has kept the Russian Air Force for the most part at range and so you need to be able to think through how initially you can either unlock that problem or you have got sufficient organic resilience and capability to be able to cope with that initial phase of dislocation of domains because you may not be able to rely on the assumptions but in the same way that if you want to go fast you go alone you want to go far you go together in any way that we unlock some of these very very complex operational challenges that we're going to face is to do it A, by integrating all the domains I think that is our superpower as armed forces we do it arguably better than anyone else in the world and secondly to be able to do it with partners and that comes down to what we've been banging on about enabling the data sharing and the interoperability Final kind of ping off of Dimitri's question noting that I'm changing the question as we go here General Stewart you've mentioned several times about the transformation from a land base towards a lateral force for the army why the logic of that change how does this apply to this specific region that we're talking about how does it make the army more useful Sure Can I just directly answer the first part Or you can answer his question that also works No I'll come back but just to say that in the same way as our the work we're doing with allies and a growing number of partners has increased exponentially in just the last few years the same applies internally so with the other service and domain chiefs in the Australian context we're all rowing in the same direction there's I think better cooperation and genuine teamwork than there's ever been and I think our circumstances demand nothing less and that's certainly the approach that you would expect from military professionals to the point about why lateral manoeuvre its physics and its geography and it is a response to how can we best optimise our army our land forces to do their principal job which is to win the battle on the land but how can we be more useful how do you leverage the versatility of land forces in ways that better support the multi-domain combined fight so if you look at as you've mentioned the map there's a lot of blue but that blue extends inland as well so how do we best take advantage of a much greater surface area by leveraging the land the sea, the air above and the EMS for positional advantage so that we can apply effects from whichever domain is best place to take advantage of the window of convergence to apply an effect Let me see go out to the audience for questions Sir, please wait for the microphone it's coming right your way I'm going to stand up here Hi, my name is Nishank I'm with the Australian Strategic Policy Institute we've talked about asymmetric capabilities and the gray zone so my question to each of you is what is your conception of the gray zone in the Indo-Pacific visibly China and what is the role of land power particularly in exploiting that gray zone I'm wondering if you could draw on any lessons from Afghanistan and Iraq knowing of course that we don't really talk about that much anymore, we're looking at Ukraine specifically but certainly China and other actors are looking at the performance towards the end state in both Afghanistan and Iraq so what if any are some of the lessons that can be drawn on from those conflicts to develop our understanding of the gray zone and perhaps how can be exploited in the Indo-Pacific, thank you Great, thank you for the really simple question How do you define the gray zone challenge and what are we doing to go after it Let's start actually right in the region How do you think about that? I actually don't subscribe to the theory of a gray zone I tend to say that it I think the term emerges from the gaps in our capabilities to respond to the challenges of the 21st century and that's what we've been working for the last sort of half decade in the sort of post Iraq-Afghanistan era to understand and understand how we need to firstly modernise then it was transformed and now adapt and adapt means continual process to the changes in our operating environment so I think gray zone sort of really is a term that describes a set of challenges that we didn't really have good answers for and so the areas that we've just been talking about those areas of endeavour and in particular being able to share data and information at machine speed and in an environment of trust is central to that to the question of you know what are some of the lessons that we've learned in places like Afghanistan that we need to bring with us into the future I think the integration of effects but we need to do that exponentially quicker and at scale but also the relationship between special operations and conventional operations I think needs to be a lot tighter and for example we've just completely transformed our special operations capability along functional lines, special warfare strategic reconnaissance technical enablement and those kinds of functions to best meet the demands of the theatre and of the support for that combined and multi domain fight See if we can gather maybe one or two more questions let me one quick comment that I was going to add on that we are working on for us and I agree with Simon as far as understand the environment so we are actually one of the things that we talked about over the last couple of days is we have a multi domain task force is actually doing that together so again part of this we're looking at having a joint team it'll be out at the multi domain task force and again I think that's what's important is understanding your environment and that's what that organization is out there is built to do I'm going to go out but okay let me gather actually two questions at the time that means you get to pick which question you actually want to answer but let me go Sir right here and then we'll go to the back please sorry right up here thank you Thanks we have a team at the Arborites Stonebridge Group of Dentons Global Advisors Generals thank you all we have a team sort of activated to try to help clients companies to meet the needs and the opportunities of AUKUS just very briefly I'd toss out there what would your messages be to the private sector that they should be doing thinking about focusing to meet some of the needs you've described and help our militaries in that sense and then there's a question right here go ahead the microphone's coming your way Hi I'm Kate Kiddell from The Washington Post I just wanted to ask about your perceptions of Beijing's land forces how they're changing and whether you think Ukraine has really impacted their thinking in terms of how they're thinking regionally as well and how they're growing their partnerships in the region great let me throw it back to the three of you we have one question about how you'd like the private sector to be thinking about some of the opportunities that we've scoped here and then two how is Beijing viewing this particularly some of the transformations that we've been talking about here General George do you mind kicking off yeah so the big things that we've been talking about unmanned systems and countering unmanned systems the big challenges that we're seeing and how fast that that's spinning and how quickly that we need to be able to react to that we talk a lot about the network and what we need to do to simplify our network and a lot of that is the kind of commercial off the shelf tech that I think is out there and that's an example of something that is moving very rapidly I think a lot in the contested logistics that we can that we're talking about additive manufacturing tele maintenance and all the things again that we're learning and then obviously spent a lot of time on long range fires so those are kind of the big areas that we are really focused on and I think we could bring things very quickly to AUKUS so in the spirit of rugby I'm going to leave the hospital pass on the Chinese army to my good friend Simon to pick up on and just to acknowledge Philip who is not only a great servant of the United States but a great friend of the UK as well so it's good to see you again I think I would I would focus on responsibility and what I mean by that is we know that some of the most important foundational technologies we're going to be employing over the next few decades are in cyber and particularly disinformation and misinformation and artificial intelligence and because we are well leading as nations in these spheres and we are the standards that we set, the approach that we take will kind of set the standard for the rest of the world as well so responsible use of artificial intelligence and the ethical considerations would be well near the top of my list so you've it's been punted over to you think about the lessons that others might be drawing out of contemporary conflict which may or may not be the same as the ones that were drawn let me answer your question by saying a few things the first is deterrence is ultimately decided in the mind of its objective and our nations all seek to ensure that we live in a world we call it the rules based order that is there are road rules and that we can all nations can live in a way that satisfies their national interest the way of life, their quality of life and not be dictated to and that's the world we've been for about the last 80 years that's worth preserving and that's worth working together to preserve as I said at the outset a whole of nations and a combined effort and capability or collective capability is at the heart of supporting collective will and it's our job as military professionals as leaders of our respective armies to ensure that we are doing our part to generate collective capability as part of that combined multi-domain force to provide the governments and the communities that we serve with options to demonstrate collective capability that gives effect gives expression to collective will it is not specifically directed at anyone it is directed at everyone who might seek to challenge that global rules based order I'd like to wrap here by thanking all three of you for coming here to have this conversation because this is I'd say an underappreciate but it's really an underdeveloped part of how we think about this domain this is a conversation about not only this partnership but about how these nations work together to generate as you just said collective capacity collective capabilities and one thing that really struck me in our conversation is if it hasn't hit you in the face already the fact that we're moving into a new and much more contested it's very clear that the risks that we are assuming are greater and so the risks that we need to take from how we do business as usual to potentially what our budgets look like to the amount of friction we're willing to stand as we push back against coercive attempts to undermine this rules based order is growing but thank you very much for coming out for this very public conversation that is the start of a conversation about where we go next thank you all very much


All hands up date was recently given the opportunity to sit down with the chief of naval personnel Vice Admiral Scott Van Buskert to discuss numerous topics of concern to the fleet. One of the topics discussed was the status of the Navy's workforce. What we're really talking about is in this time frame of stabilizing the workforce is getting that workforce to the right numbers to match the fleet needs, the force structure of the fleet. And I think we're doing a very good job of that. Right now we're stabilizing the workforce at about just over 320,000 active duty component in there and about 60,000 reserve component. And we're doing a pretty good job of doing that. I think we've invested well in all of the programs to help us do that and we've put a lot of initiatives in place to stabilize the workforce. Van Buskert said that stabilizing the workforce has been a challenge because it hasn't been done in more than 20 years. He added that the Navy has been in a downward trend for personnel, bringing numbers down for more than 560,000 in 1992 to where it is now. He also said stabilizing the workforce isn't the only goal. The focus is also on balancing and distributing the workforce properly. As we stabilize, it's about getting that balance right. And what you'll find is that we lag a little bit as we get that balance right. As we adjust our sessions to now man up where we've had under man ratings and where we balance and bring down our over man ratings and that's what we've done over the last couple of years is getting that balance right. Still working very hard at the balance and then it's about distributing that workforce to get the right sailor out there to the right job and where they're needed. From the Defense Media Activity, I'm Petty Officer Matthew Halls.


Texas Heart Institute educational programs on innovative technologies and techniques. The purpose of this presentation is to inform and educate the general public as well as the physicians and allied medical personnel on the latest advances in cardiovascular medicine. I'm your host. My name is Juan Mircresa. I'm an international cardiologist at Texas Heart Institute and Baylor College of Medicine. The topic today is incidents, causes, and treatment of pelvic congestion syndrome. Our special guest today is Dr. Breanna Costello, our international fellow at Texas Heart Institute and Baylor St. Luke's Medical Center. Thank you for having me, Dr. Crazier. It's a pleasure to be here and to talk about pelvic congestion syndromes. So as we start off, can you just maybe describe, give us a brief description of what pelvic congestion syndrome is and maybe how patients with this present? Very well. Pelvic congestion syndrome is commonly recognized as a persistence of chronic pelvic pain for longer than six months of duration in the absence of a known pelvic pathology. Now we all know that the venous system functions in the way that the blood is carried to the heart. So it means from the legs, from the abdomen, the blood should flow in the venous system towards the heart. What happens with pelvic congestion syndrome, this blood flow is reversed in the venous system. And as a matter of fact, the blood flows downward towards pelvis. This is very commonly seen whenever this particular syndrome exists in ovarian vein, this function where ovarian vein, typically left-sided ovarian vein, dilates or develops a valvular incompetence and then you get a varices in the abdomen and particularly in the pelvis that causes congestion and discomfort in the pelvic region. This condition is not very rare. As a matter of fact, up to 15% of women between the ages of 20 and 50 years of age will have varicose veins in the pelvis and up to 60% of those will experience some symptoms. Now it's interesting that over 10% of gynecological referrals are due to pelvic congestion syndrome and over 30% of pelvic pain is caused by pelvic congestion syndrome. So this entity is very common. Unfortunately it is not frequently diagnosed in early stages of this particular condition. So you said pelvic symptoms or pelvic pain. What are some other symptoms of pelvic congestion syndrome or what should we look out for our patients who have this type of you know issue? Well typically it's a chronic pelvic pain. Very frequently it's misdiagnosed as endometriosis and it can be accentuated before men's and also the patients experience dysmenorrhea. Frequently they also have this perunia, typically postcoital aching and discomfort or pain. Not infrequently they experience dysuria and worsening of stress incontinence in certain scenarios when the patients have well advanced pelvic congestion syndrome. This comfort also occurs with prolonged sitting or standing which is typically in a lot of professions like medical professions, surgeries or nurses and many other professions. Pain is also very commonly experienced in lower abdomen but also there is discomfort in the back in the large number of patients and hips as well. There are frequently encountered varicose veins in the vulva and vagina and also left lateral vaginal tendon is due to varicositis in that region and this is obviously related to malfunction and the valvular insufficiency of the left ovarian vein. Not infrequently also the patients will have hemorrhoids and symptoms related to hemorrhoids and also irritable bowel syndrome can be accentuated or caused by pelvic congestion syndrome. And then finally the patients will experience varicose veins and chronic venous insufficiency in the lower extremities, obviously more commonly in the left lower extremity because of the left sided predominance of this particular condition. Now what is not really well known, this particular entity or pelvic congestion syndrome also occurs in men and this is probably in most of the instances misdiagnosed or underdiagnosed but men will also experience chronic pelvic pain, pain in the lower abdomen or back or hips. They will also develop left sided varicose, frequently it is called the bag of worms and there will be scrotal varices, hemorrhoids are not uncommon, irritable bowel syndrome as well as dysuria and worsening of stress incontinence and in certain scenarios even erectile dysfunction and impotence in general but also other symptoms such as leg varicose veins and chronic venous insufficiency again more frequently present in the left lower extremity. You know it's interesting I wonder this is a touchy subject probably for both men and women so I wonder if that number you know the prevalence or the incidence is maybe even higher but a lot of patients are you know a little skittish about going to their doctor to address it because it's uncomfortable to talk about so it's very interesting. So why we talked a little bit about having pelvic congestion in men and women but why more in women than men, why you know is there an anatomic reason or what is what's the reason for that? Well this is not clearly understood but there are certainly some factors that are clearly explained it is not infrequently genetically transmitted type of entity or condition it is probably related more to pregnancy and issues related to pregnancy such as compression of the pelvic veins during pregnancy. There is also in women as you know we did present and discuss this in the previous presentation. May turn a syndrome or iliac vein compression syndrome is more commonly seen in women than men so this is another potential reasons. So as far as the causes of pelvic congestion syndrome is concerned we have two prominent factors that are playing a role. One is as we mentioned may turn a syndrome that's compressing either the left common iliac vein or iliac vein on the left or right side at any location and then another one is so called nutcracker syndrome which is a compression of the left renal vein by superior mesenteric artery and actually the left renal vein is being compressed between the superior mesenteric artery as we can see here and the abdominal aorta. So what is typically seen is with invasive or noninvasive evaluation enlarged left ovarian vein due to that compression and valvular incompetence of the left ovarian vein and then large varices as we can see here in the pelvis particularly around the uterus and urinary bladder. On the other hand may turn a syndrome is only related to compression of the iliac veins as we can see here on the bottom right image with the CT there is a severe compression of the left common iliac vein by the right common iliac artery that's crossing from the left side to the right side. Now as far as certain facts related to the pelvic congestion syndrome and the magnitude of this problem in my opinion this condition is the most under diagnosed and the most ignored and the most misdiagnosed and the most under treated medical condition to the best of my knowledge. And you touched on a few of these reasons but what do you think the biggest reason is for that? Well there are several factors that are playing a significant role but the most important one is delayed diagnosis obviously by patients and physicians lack of knowledge poor understanding of pelvic veins by clinicians. The average number of diagnostic tests prior to proper diagnosis is at least four and it takes on an average four years to establish the diagnosis that information is available in the literature. And several patients wait for over twenty years with symptoms to develop proper diagnosis and treatment of this condition. And you can imagine like you said a lot of these women have been pregnant or have gone through pregnancy so a lot of their symptoms could be just pushed aside as postpartum changes and uterus changes after delivering a baby but in fact maybe they could have this as the real etiology of their pain or discomfort so it's good to keep in mind. So what are the best tests in your opinion or in general to diagnose or work up this type of pelvic pain and diagnose the issue? You know it's sad to say and it's so disappointing that this condition is so poorly understood and misdiagnosed because we have simple tests that can clearly establish the diagnosis. Just a simple abdominal and pelvic duplex or ultrasound scan can reliably establish the diagnosis. Transvaginal duplex is also very useful to look at the varicose veins related to the post-pelic congestion syndrome and this can be done on outpatient basis in physician's office. It's painless, inexpensive and very reliable. But once we establish the diagnosis with ultrasound or duplex scan, additional tests might be of benefit. Unfortunately they're not frequently ordered and interpreted properly but for instance CT of the abdomen and pelvis and magnetic resonance particularly MRV of the venous system is very useful and clearly diagnostic of this condition and it can help us in differentiating the nutcracker syndrome or compression of the left iliac vein versus may turn a syndrome that also is commonly seen and a lot of patients actually will have both conditions at the same time. Can imagine the symptoms that you can have if you have both that would be pretty you know uncomfortable. Right. Alright so what is in your differential when you see a patient in the clinic with pelvic pain and you're maybe wondering if it could be pelvic congestion syndrome. One of the most common conditions is problems with some kind of arthritis or inflammatory process like lumbosacral spine degenerative arthritis, low back pain sciatica again due to this compression. Sacral iliac joint inflammatory arthritis and there are several conditions like that and several other ones that are maybe not clearly understood but inflammatory process of any kind including gastrointestinal type of chronic inflammatory disease would be very commonly be included in the differential diagnosis. Very good so when you've identified your patients of having pelvic condition syndrome what's the treatment options what do you talk with them about as possibilities to help with their symptoms. I usually use an algorithm in explaining to my patients and also to referring physicians how to evaluate and how to treat this condition and I certainly hope that this approach will help in establishing a diagnosis in great majority of patients without significant delay. So in my consideration any patient with chronic pelvic pain that cannot be explained with any other condition should be evaluated with abdominal and pelvic duplex scan and in women with transvaginal duplex scan and if there is evidence of compression either due to May Turner or the nutcracker and presence of varicositis then I would suggest to order either MRV or CTA. I prefer MRV because there is no radiation and it's as sensitive and diagnostic as CTA which obviously includes radiation. Especially in this young female population avoiding radiation would be ideal. So then once we establish the diagnosis that there is pelvic and left a renal vein abnormality from the MRV or CTA or noninvasive elevation then we have to establish the diagnosis is it related to May Turner or is it related to nutcracker or is it both conditions that are causing the problems. If we have a reflux typically like in a varian vein left a varian vein the treatment is simple and straightforward it's embolization of that insufficient and competent enlarged vein that has a lot of varicositis. So all of those conditions whether it's May Turner or nutcracker can be treated via endovascular interventions it is extremely rare that you need to resort to surgical treatment of this condition. That's great. So if there is compression obviously stenting is the treatment of choice. For May Turner. For May Turner obviously that's a must because you have to overcome that compression from the artery that has systemic pressure and venous pressure is very low. And also in certain scenarios when we have a nutcracker syndrome you have to stand the left renal vein and the indication for that would be only when a patient has symptoms related to that compression and the compression is putting a patient at risk of developing left renal vein thrombosis. So typically a patient will have dysuria they will have hematuria and left flank pain that will be persistent and in that kind of a situation stenting would be indicated.  Obviously this depends on the patient and patient symptoms and if there is any evidence of progression of disease and progression of symptoms but I would say that the great majority of patients will require treatment because this condition is progressive it gets worse over a period of time and in a lot of instances can be debilitating. So here we have actually the images of MRV and the treatment for the nutcracker syndrome in particular and what we can see here on the right hand side this patient already had coils in enlarged incompetent left ovarian vein and that usually should give alleviation of symptoms and improvement in a very short period of time in great majority of patients. All right so can you share with us maybe an experience or two with your treatment of pelvic congestion syndrome. Well as you know you are involved in several cases as a matter of fact one just yesterday so it's not uncommon to see this type of patients. I would like to share with the participants of this presentation one of the patients that we treated relatively recently and this patient was a 33 year old female with the history of two previous pregnancies complaining of abdominal lower back and left leg pain also she experienced dysparunia and had vaginal and vulvar varices which have been bothering her for a very long period of time since actually her teenage years. So she was quite incapacitated with her symptoms and was referred to us for further evaluation without proper diagnosis being established. She saw numerous practitioners including an orthopedic surgeon for evaluation of her lumbosacral spine several gynecologists and they did not establish proper diagnosis. So what we did is we evaluated her at our office obtained abdominal pelvic and vaginal ultrasound and then proceeded with MRV and we established a diagnosis that she had pelvic congestion syndrome. Now what was very interesting that she had a more advanced and more complex pelvic congestion syndrome because she had incompetent enlarged left ovarian vein with huge varices and also she had a late turner syndrome. Wow it's no wonder her symptoms were present for so long 20 years. So here we have the images of her CT angiogram of the abdomen and pelvis and we can see that her left ovarian vein was close to 11 millimeters in diameter which is probably three times larger than normal and also on the right hand side in the section right at the superior mesenteric and left renal vein we can see that the left renal vein is compressed to close to 90 percent with enlargement of the left renal vein post compression which had significant dilatation and also looking at her pelvic images we can see on this CT that she had large varicositis around her uterus and also urinally bladder not only on the left side but also on the right side and obviously the reason that the right side was enlarged as well with varicositis because the venous blood had to drain through the right side because there was severe compression of the left renal vein by the superior mesenteric artery. So here we can see the treatment. The treatment is pretty straightforward it's done on outpatient basis under local anesthesia. Typically we use five French catheters here we use the renal double curve diagnostic catheter we entered into the left renal vein and obtained an angiogram and we can see in the middle panel dilated the left ovarian vein that's also incompetent as we can see also on the right hand side. On the left hand side we can see a diagrammatic representation of what needs to be done basically placing coils and occasionally using sclerotherapy to thrombose that disease the incompetent ovarian vein. Now here we can see that the catheter is advanced distally to the distal part of the left ovarian vein and it's a showed with a red arrow and we can clearly see now on the middle panel that we have a huge varices in the pelvis around the uterus going from the left to the right and then we can see in the still image on the right hand side several actually varicositis that need to be addressed at the same time. So we proceeded with coil embolization of the left ovarian vein as we can see typically we start very distally to address all the varicositis that are clearly seen and gradually build up this endovascular coil occlusion all the way to a few centimeters from the origin of the left ovarian vein and then we can see on the completion angiogram that there is no longer flow in the left ovarian vein so that indicates a successful treatment of this particular condition in this particular patient. On the left hand side we can actually see on the still image evidence of compression of the left renal vein which we didn't stent at that time because the patient did not have any urinary symptoms such as left flank pain or hematuria and we typically like to reserve stenting only for patients that have obvious signs that the left renal vein is in jeopardy and at risk of thrombosis. Very good so for this patient did she improve or her symptoms better after this? Well she improved to a certain degree she had less back pain she had less ovarian left sided pelvic pain but she still had some symptoms and so she felt like she needed to have some other procedure done to address and correct this problem. Now what we decided to do is to wait for a few months because this condition requires a little bit longer treatment and follow up until you see significant improvements because there are numerous varicositis and they have to shrink over a period of time and typically the symptoms do not disappear within a few days or a month. So after two months she still had some symptoms that were obviously related to pelvic congestion syndrome and also iliac vein compression as you know as I mentioned previously she has or had a May Turner syndrome. So we proceeded with venogram and intra vascular ultrasound of the left iliac vein and on the left hand side we can see a still image where we can at least have a suspicion that there is compression of the left common iliac vein because of certain haziness or what we call pancaking of that vein that is being compressed by the right common iliac artery. We can see also endovascular coils in the left ovarian vein and we don't see any flow in it which is a good sign that we have at least achieved that successful treatment for the pelvic congestion syndrome. Now we also interrogated the left renal vein and we performed IVAS and we saw that there was no severe obstruction of the left renal vein. The flow was adequate but left ovarian vein was occluded as we can see it does not fill through that flow. We performed an intra vascular ultrasound of the left common iliac vein and we can see on the left hand panel there is severe compression of that vein shown by the arrow and where the catheter is. Yeah that's highly compressed wow. Right and then we measured it and actually the opening was somewhere in the range of two to three millimeters. Wow so what did you do next? Well obviously we had to address and correct this problem balloon angioplasty does not work for this condition. And that has to do with the systemic pressure of the artery. So we placed 18 millimeters in diameter stent as you can see here. There are several of them now available on the market that are dedicated for this particular application. We can see on the right hand side the completion angiogram showing excellent flow and on repeat IVAS there was no evidence of compression. And on the left hand side we can see balloon angioplasty being performed after the stent was deployed and using the intra vascular ultrasound now we can see that the left common iliac vein is fully open. There is no evidence of compression. On the right hand side we can see the glimpses of the stent in there and no evidence of compression. So this certainly had to help her so did you feel better after this? She felt better. Good. I was also encouraged. You felt better too. And I saw her about two months after the treatment and she said to me, which was relatively recently that she's totally symptom free. That's wonderful. Totally symptom free. Not only related to her back pain or pelvic pain or any pelvic discomfort but also total disappearance or left leg discomfort as well. That's great. That's a great end to that story. Well, thank you very much. This was great to be here with you today and learn about something that most of us don't think about on a daily basis. Well, thank you very much for being with me discussing this and I appreciate all of your questions. Great. Look forward to the next one.


I have a bit of a confession for you. I love those nature documentary TV shows movies and things anything to do with nature, especially Africa. I'm fascinated with Africa. I just love all those nature documentaries and and one of the things I'm especially interested in is the what's called symbiosis that exists between some of these animals like you have these big hippos and and these birds that live basically on top the hippos and around the hippos and they have this mutually beneficial relationship that the birds help take care of bugs and other things that would bother the hippo otherwise and the The hippo provides protection and things for the birds. It's just this wonderful relationship between the hippo and the birds is again symbiotic relationship that benefits both parties in the you know course of nature and in truth organizations really aren't that different there exists a symbiosis between an organization and a community and it resides in which it serves and and so public relations then has an important role to play in the role of Corporate communication to help develop and maintain and You know ensure the smoothness of that symbiotic relationship between the organization and the community and the public's that it serves So in this video, we're going to talk a little bit about corporate Communication and we're going to focus primarily on external communication It will touch on internal, but we have a separate video for employee relations and you can check it out but so this is going to focus primarily on External communications, but how this corporation or organization works with the community around it how we communicate that the importance of that and and the role that public relations plays in that function so in truth Corporate communication comes down to a really a very simple equation sort of that or this is the sort of balancing act If you want to think of it that way that Basically, you know trust is important for that organization It's important that the public be able to trust them your customers trust you your employees trust you that that there exists a level of Trust between an organization and the various publics that it serves And so it's a really simple equation to get to that that sort of positive balance of trust You need more positive news stories and more positive impact than you have negative You want the positive to outweigh the negative in other words and that will then cause the trust to slide now Toward where you want it to be and and you know these publics will have more trust in your organization So we want to then both create circumstances where that's the case and then also publicize those circumstances that would that would kind of you know Provide that positive impact in the community and provide that positive sense of Trust and in gender trust through that those positive news mentions and positive relationship-building Elements that exist between the organization and the community So if we look at the specific functions then of corporate public relations And we think of corporate communication or corporate public relations Whatever it might be called at the organization where you're working and it could be different if you're in a non-profit or in a government agency Maybe a public information officer or or whatever it is but you know basically we're talking about any function of public relations that where you're you're you are The middle person between the organization and the public and really publicizing what that Organization is doing so some of the different functions though may involve Identifying and engaging key stakeholders. This could be employees. It could be Investors it could be customers. It could be just people who live nearby physically live nearby wherever your organization is at There are lots of different stakeholders as we've talked about before In public relations that we have to be concerned with so we want to identify those stakeholders first and then engage them in a positive way So that's a that's a function of corporate PRs to both Identify and then engage in some way those key stakeholders so that we develop those and cultivate those positive relationships We also want to secure effective media coverage and ideally effective positive media coverage obviously We want to we want to develop relationships with people in the media and the different media outlets and so we can get our news out there when it's appropriate and And so that we can kind of shape the story and shape the narrative around our organization and they can cultivate those positive feelings as Positive relationships within the community through the kind of gatekeepers of the media. So we need to secure effective media coverage We also want to be developing thought leadership opportunities. So Thought leadership is basically Anytime you can put somebody from an organization who's an expert in something in front of a public crowd That's thought leadership in essence or you can publicize some research that you're doing that's going to benefit the community or benefit You know your customers or whoever. It's it's those types of things, but so giving a speech having your CEO or somebody Significant the organization give a speech on the area of expertise To a community group would be an example of thought leadership or publicizing some research that you know that can be publicized That's happening within your organization and the imp positive impact that it's going to have on the community and on the world If if that's the case so but we want to develop these thought leadership opportunities to not only put our people out in front of the world but also to develop their Their world the world of the people who Have relationships with our organization, you know with our customers with our clients with our Community with our peers. We want to develop those thought leadership extra opportunities so that we can Demonstrate that the quality of our organization and the positive impact that our organization has And then in general we've talked about corporate social responsibility in other videos, but we need to develop and promote Corporate brand what we call corporate brand through corporate and social responsibility. All right, so We want people to when they think of the brand of our organization or our company We want them to have positive thoughts. We want to develop that positive Brand right that that says that to you know, for example, when you think of whole foods Just you know the first thing that comes to mind from most people would be our many people would be okay. It's nutritious It's good for the environment. It's good for it's good for us as people. They're looking out for us And so they have a sort of that that's their brand that they are sort of health conscious and and Concerned with the environment and things like that As opposed to you know, Amazon in some ways has a corporate brand that says you can get what you want and you Can get it quickly But their corporate brand has also taken a hit in recent years in terms of they don't necessarily treat their employees the way Some people think they ought to Maybe their packaging is not so great for the environment And so when you're ordering multiple things and they come in six different boxes Gosh that what what impact can that really have when you have millions of people doing that? Around you know around the country around the world or whatever So their corporate brand has taken a hit in recent years in terms of yes They're efficient and they're they're large and they're cheaper But are they really good for the community or they good for the environment they good for their employees and so forth? So so we need to focus on our corporate brand and develop that corporate ran through corporate social responsibility So whether that's through your organization what we're doing in our company with we don't we're making donations We're we're being responsible in terms of the environment and things like that or whether it's through our employees supporting our employees volunteer Efforts and and and supporting them in their own organizations their pursuits and supporting their development or whatever it is However, we're doing that when we want to develop our corporate brand and promote that corporate brand through corporate social responsibility And finally the the sort of the last category we're going to look at here is the Public relations in in the corporate world oftentimes involves managing issues and crises This is something we'll get into in a in a later video here, but the difference between these really is that managing issues is proactive trying to you know anticipate things that might be coming down the pike ways that things might be affected and So we're trying to manage those issues Proactively and get in front of them head them off if we can but if not then get in front of them and determine How we're going to deal with those things or crises which are more reactive? They're not proactive with crises or things We don't see coming and there are issues that we have to respond to on the fly a lot of times And we have to respond quickly in order to be effective So in both of those areas though public relations is involved in managing both the issues and Crises within an organization. That's another function of corporate PR. So so as you can see public Relations in the corporate world takes on a lot of different Focuses it's a lot of different areas. There's a lot of different Your hands and a lot of different cookie jars here when we're dealing with that which some people find really exciting other people find not as Engaging they like to focus more on one thing or another And the larger the organization the more likely you're gonna have the people that somebody's gonna focus on each one of these things Specifically if you're a smaller organization, you might be responsible for all these things But if you're in a larger organization, you'll probably have more of a division of labor And you may be focusing more on one of these things than the others or a couple of these things Just depending on the size of the organization and the structure of that organization, but But public relations could theoretically Be involved in in any of these tasks One of the things we mentioned was corporate branding so I want to take a minute to look at corporate branding and And take a look what that looks like so and some key elements for corporate branding You know branding is just as we've as I mentioned before branding is just establishing You know the essentially the identity of your organization What are you gonna be known for when people hear the name of your organization? What's sort of the first thing that comes to mind or the or the thing that they attach with your organization or attached to your organization? most readily So when we think about corporate branding, it's a cup. It's important to keep a few things in mind first of all You want to pick a lane you want to decide you want it You want to shape that narrative of what your organization is going to be known for What is your brand and they'd be very specific in picking a lane with you know? How are you going to approach that are you going to for social media? Let's just take social media for example Are you gonna be the really engaging social media brand where where you're kind of you know You're are you gonna try and be funny?    But but otherwise we want to stay in our lane and make sure that everything we're doing is really pointing back to that specific brand You also need to know your audience You need to know whether or not your audience has a sense of humor or whether or not they're more serious or you know Whether they're gonna be on social media or whether they like something a little more traditional So we need to when we're trying to establish our brand and promote that brand We need to know where our audience is gonna be where we're going to find our audience And when we're thinking about audiences, don't forget about your internal audience Be sure that your employees understand what your brand is as an organization that they're in line with that that they support that and And and so so we want to make sure that internally We have all of our ducks in a row in terms of branding as well that that our employees are aware of our brand and conscientious of that and Following following that the policies and principles that we have in place in order to maintain that brand I don't be afraid to lean into whatever it is.  Don't don't take half measures here when it comes to branding You really have to be all in on whatever your brand is going to be and finally be consistent again That's sort of the touching on what we've been talking about here, but be consistent Don't try and constantly jump back and forth between funny and serious and and all these other Areas decide who you are as an organization I really lean into that and then be consistent with that Have that follow through with all of your different methods of communicating with your audiences and with your public's right Be consistent in who you establish that you are and who you communicate to your public's that you are What kind of last aspect of public relations in a corporate world I wanted to look at real quick was just a financial Communication and sometimes as public relations people we are specifically tasks tasks with communicating something related to Finances regarding that organizations. That's not uncommon at all. Whether it's internal or external So financial communications can be a little different So a couple tips or points that I wanted to throw out there for financial communications First of all a public company means public relations if you work for a and you're representing a publicly traded organization publicly traded company or Organization that the claims to serve the public good then you need some public relations You have a community that you're serving and so you need to be aware of that And so public relations are important anytime when you have a public company who's Either traded publicly or doing business publicly and engaging with customers publicly So if that's the case you need to be aware of and consider the public relations aspect of things for your organization Also need to remember coming back to this that media matters media are the gatekeepers They they share a lot of information they control a lot of the narrative and and help you develop that narrative and and Get the word spread. So media matters. It's important to develop relationships people in the media and have clarity in What that relationship is okay, don't let those lines get blurry, but but keep up very clear But but but vibrant relationship active with the different media outlets that might Affect your organization Also need to be focused with investors of this is a publicly traded company. You're gonna have investors You have to have a plan for How am I going to communicate with investors about money? What money are they? Sorry, what information are they? Entitled to what information would be good for them to know and support our case and those types of things and and what's the best way for me to communicate that to them so Lots of things to think about one more dealing with investors as well And then finally not to keep you know beating a dead horse here, but but corporate social responsibility People want to know that we're good stewards with the money and not just using it wisely within the organization But we're using it in a way that benefits the community. That's very important so anyway engaging in corporate and social responsibility, it's an important aspect of Financial communications for a public relations person as well In the end we can see that this all really comes back to relationships in developing relationships building relationships cultivating relationships and maintaining relationships and and utilizing those relationships to the best interest of the other party and and yourself but People really make up these chains and this this chain that leads you from Effects of public relations to you know to Engagement with your communities and your publics and things so the people Aspect is very very important whether those people are internal employees or whether they are People in the public's that you're serving. We need to remember that these relationships depend on people Organizations don't build relationships with one another that then we've not the buildings and things It's it's the people within those organizations that really develop those relationships If you have questions about corporate communication or about anything else related to public relations, please feel free to email me I'd enjoy communicating with you there in the meantime. I hope that you have Enjoy this overview of corporate communication and have a better understanding of the different functions that are served in that particular field or vein of public relations You


If you accidentally delete a Strava activity you can always re-upload it from Garmin Connect using the web browser on your phone rather than the app. Log in and go to Activities. Click All Activities and then choose the activity you need. Click on the cog and then click Export Original. Then click to download and open it in Downloads. Tap on the file to unzip it so you've got a fit file. Then open up a new browser tab and log in to Strava. Once logged in click on the hamburger menu at the top and scroll down to the bottom and click on where it says Upload Activity. Click File and choose Files. You may need to search for it but choose the correct fit file and it will upload to Strava automatically. You can give it a name and then click Save and View. And there's your activity back up on Strava.


Hi, this is Dave Vellante, the Wikibon Project here with Silicon Angles coverage of the EMC Megalodge. This is day minus one, this is the day before the event, and there's a big analyst meeting here today, there must be, I don't know, 60 analysts or so, and I'm here right now with Chuck Hollis. Hey Chuck, how you doing? Good to see you. It's great to see you. Always good to see you at EMC. I didn't know you were going to be here. I understand you're going to be in London too, so all good. We've got the entourage, and we're following this like a blanket as we usually do, in Silicon Angles as you know, so a lot of analysts in there, I don't know, like I say, 60 or 70. Big room full. We heard Tucci this morning, we heard Gelsinger, and we're going to hear a bunch of customers this afternoon. Sujal, we heard Sujal on the Cube, so I want to talk about big data. So do I. All right, great. So tell us in your excellent style, boil it down for us, simplify us. What does big data mean for customers? Big data is a change of perspective, at least in my mind, from lots of data is a problem to lots of data is an opportunity. As costs go down, as capacities go up, we're finding that more and more people realize, hey, I can take enormous amounts of information, either create value, cure cancer, something I couldn't do before. At its essence, it's looking like a different style of IT about creating value from information as opposed to just keeping it around and trying to reduce costs. Yes, the problem meaning it's always about, oh, I've got so much data up and to the right, I can't manage this stuff. And you're saying there's going to be a bit flip here when we start to look at data as an opportunity. We're trying to meet people who see a petabyte of data as a good thing, not as a problem to be overcome. Traditional IT is all about using resources more efficiently, less storage, less compute, kind of rationing things. We're seeing these enormous projects, whether it be in media, genomics, pick your favorite vertical where how much data can I collect, process and create new value from becomes kind of the new mandate rather than just making a standard IT type. So EMC has some pieces of the puzzle, right?  So talk about how the pieces fit together, maybe what you have, what's missing, who are you going to buy next to fill in that gap? I think it all starts for us with the information itself and in a very traditional sense, that storage. So when you look at how Icelon is built, it's a very different kind of scale out NAS than anything that we've had in our portfolio. When you look at how Atmos is built with object storage, very different architectural concepts than anything we've ever seen in the rest of our portfolio. On top of that, what do you do with the data? Green Plum for analytics, parts of our IIG portfolio and document them around creating richness out of it. We have a lot of opportunity to think of, we get into these customer engagements, building fuller and fuller stacks from everything from the information management layer to the applications and the use cases, which typically are on mobile devices these days. So what's the fit between big data and cloud? It's kind of funny, big data usually requires big compute and the two tend to go together. When you have on these large repositories of information, you can't predict all the time how it's going to be used on any given day. So not always, but a lot of the time, people who are interested in big data also want to have a cloud consumption model to go with it, whether that be a private cloud, a public cloud or some combination of both. All right, we're here with Chuck Hollis at the EMC Analyst event. We'll be covering this throughout the week and beyond. This is Dave Vellante. Thanks for watching.