My name is Quadi. I'm excited here to introduce this next panel. And the topic of which you might think is a little bit of a mystery because not much on the website. Who here has any idea what this panel is about? Great. And yet you still came. So that's awesome. That is amazing. I can't tell if you just need a place to sit or what but we will proceed with some very interesting content primarily because this topic is very interesting, right? We're talking about hacking medical devices, hacking critical hospital infrastructure. As you can see all the great work that's being done in this village next door about keeping patients safe. And that's really the key thing we're going to talk about today. And when we say simulation, simulation comes in a lot of different flavors. There's a lot of different definitions. But if we think about it, we're really talking about what could happen to patients that are connected to these devices that are vulnerable. How can we study that ahead of time? Because we don't want to be discovering it after the fact, right? So we have to use the critical tool of simulation whether or not that be high fidelity simulation when we train doctors or whether or not it's going to be simulating attacks in different environments so we can better understand and learn them. So that's enough of my introduction for the topic today. I'm going to go ahead and start introducing some of our panelists. Dr. Saxon who is listed to be on this panel had a family emergency this morning and actually has flown out of the state. So I apologize to anyone who wanted to come for Dr. Saxon but she sends her regards. We're going to go ahead and start off. We have Dr. Julian Goldman at the end. They're each going to give their own introductions. We have Dr. Suzanne Schwartz. Yeah, Suzanne Schwartz. And we have Mr. David Guffrey. I'm excited. They'll now proceed with their own introductions. I'm so sorry. Listen, I went to public school and I can't spell anything. So please forgive me. Yes, yeah. It's the anesthetic. Please. Of course. Thank you. Okay, so it's been given away. The secret is out. I'm an anesthesiologist. I work at Mass General Hospital and I'm also the medical director of biomedical engineering for the partner's healthcare system. In 2004 I started a lab working on medical device interoperability and a few years ago added cybersecurity to our portfolio. And we have a lab which we have no patients of either kind. And so we have a simulation environment. We have a sandbox in which we can look at the different scenarios and what the clinical impact might be if either a device or part of a system is affected. Our work has been supported mostly through federal grants including work supported by the FDA. So when Dr. Schwartz is passed on, the mic is passed on to her. We've been collaborating closely on medical device cybersecurity and also with other agencies. In order to provide information and resources, education, knowledge, and work together as a community to address what we know is a serious threat and to avoid any negative effect to patients. And that could happen if a device is affected. It could happen if a device isn't available. It also could happen if incorrect information is disseminated to clinicians and it overwhelms them. So like any complex ecosystem, it's really difficult to address all the issues. But we're working with a lot of collaborators and trying to do that. And we're looking forward to the conversation today. Thank you, Julian. So I'm Suzanne Schwartz and I'm at FDA Center for Devices and Radiological Health. I work as the director of a new office as a result of a reorganization, the Office of Strategic Partnerships and Technology Innovation at CDRH. And it is a pretty expansive portfolio that we have within this office. All extremely exciting leading edge work which makes every day an extraordinary challenging but again intellectually, scientifically stimulating and exciting portfolio. Included within that portfolio is medical device cybersecurity. Interestingly enough, my background, I'm a clinician as well. I'm a physician. My training has nothing to do with cybersecurity. I'm a burn surgeon actually. And prior to coming to the FDA what will be nine years ago in October, I worked both within the clinical and academic sphere as well as sometimes spent in the private sector as well working within the medical device space for a start-up technology company. But when I came to the FDA as a medical officer, I was placed within CDRH and was involved really in the pre-market side of review and consultation on submissions of new technologies that has to do with my field, burn injuries and wound repair. Really exciting. As a result of long story short, as a result of the work that I was doing, I was introduced to the field of what's called emergency operations and medical countermeasures at FDA and was assigned to really represent efforts on behalf of the center for public health related emergencies. And when we were struck several years ago, this goes back to 2013, with the presentation of vulnerabilities of medical devices to the agency and really we're not sure what we were supposed to do with that information. Especially when it comes in as a huge package of information through the researcher and through the Department of Homeland Security. The agency had made a decision at the leadership level that it's within this public health response role that we would undertake efforts for medical device cybersecurity. So what started out, the point here is what started out as purely reactive and response subsequently evolved and morphed into a much more proactive forward leaning stance. And it took really putting together a team across the center of experts that really represent the entire product life cycle. But beyond that, it was really about recognizing what we lacked. And that's a really important point for our discussion here because it's recognizing that there is a lot of expertise, knowledge, resources that the agency did not have and still does not have with respect to medical device cybersecurity. So what do you do in that set of circumstances? You reach out. You collaborate. You look for partners. You look to understand exactly what it is that we need to be working on together as a community in order to address some of these really complex challenges and this evolving space. And it's really as a result of that over the past several years that we've come a significant distance. We still don't make any mistakes. We have a long, long way to go as an agency and as a community. But it is an arduous journey. But it's through the types of collaborations and partnerships that we've had through your community, through the hacker community, with industry, with healthcare delivery organizations, with patients, with others that has brought us to where we are right now in articulating policy guidance, in defining collaborations and understanding what are ongoing challenges and we'll continue to do that as time goes on. Thank you. Hi, I'm Dave Guthrie. I'm the biomedical cybersecurity specialist for Partners Healthcare. I lead the medical device cybersecurity program for operations and research across the healthcare enterprise. Background is kind of winding and varied. So I started out doing electrical stimulation feedback systems and signal processing nonlinear and linear systems. Transitioned into doing virtual reality as well as brain computer interfacing and other kinds of sensory motor integration. Came to Partners Healthcare a number of years ago, was on the medical device integration team leading architecture development, medical device integration across the enterprise with our health record system and overseeing cybersecurity as well as monitoring systems pieces for the medical device integration. And a few years ago, transitioned to this current role, leading the medical device cybersecurity program across the enterprise. So I work organizationally across all of our sites, all the different information systems groups as well as our clinical groups, biomedical groups and conduct research in the medical device interoperability cybersecurity program lab that is co-run with Julian Goldman over here, who is our medical director of biomedical engineering and in conjunction with our chief information security officer, we do a lot of work across the organization for both operations and research within the lab and we'll talk about some of those activities here today. Give it up.  I'll just keep it for a minute and pass it around. All right. I'm waking up. I think we're going to talk about a lot of serious problems today, right? We're going to be talking about some of the big difficulties that still remain in the space, issues of patient safety, et cetera. But before we do that, I think it's important for us all to take a little history lesson, if you will, and look back at how far we've actually come. So being involved in this space for several years now, I remember first coming to this and thinking, wow, everything is broken. It's a giant dumpster fire, right? How many people have heard that? Like healthcare cybersecurity, medical device is a giant dumpster fire.  I mean, there's probably some varying opinions. Could you roast some marshmallows? Probably. But I think it's important for us to take a little bit of a trip down memory lane. I'm going to ask each of these panelists to just reflect briefly on how far we've come. Please, if we can start. And just talk about how far the space has come. What have you seen in the last 10 years or so that gives you some hope about what we've accomplished before we just tear it all down with the negative stuff? Sure. I think, you know, regarding how big the fire is, is it only sufficient for roasting marshmallows or what, I think put into perspective that when we talk about medical device cybersecurity, we have to kind of think about which part of the system we're talking about. Are we talking about a device itself and devices being affected? Are we talking about men in the middle attacks of data that might flow within a health system? Are we talking about, for example, ransomware of health records? And probably the answer in where we are with that differ depending upon which part of the system that we're talking about. But I think, you know, just even before digging deeper into that and we'll all do that, I think everyone should have a small sense of comfort knowing that medical devices have always been imperfect and they've always have the potential for failing. I mean, that's what equipment does. And so the basic part of medical training, of clinical training, nursing training, biomedical engineering training is to deal with equipment that isn't performing correctly. Things break, they don't work. And so depending upon the criticality of a medical procedure, there are backup systems in place and always have been. And as an anesthesiologist, for example, we've always expected that the anesthesia machine and ventilator will fail during an anesthetic. We always expect that our other equipment will fail. We've always thought that way ever since these things were developed and when they used to fail a lot more frequently than they do today. So the reasons for failure are different. They used to simply be mechanical failures, pneumatic failures. And now that everything is microprocessor based, we have to be more concerned about cybersecurity. But at least so people don't cancel the surgery that's scheduled for tomorrow or next week, be aware that failures happen. Now, we're not used to seeing large fleet failures of entire products across the whole hospital, for example, which of course is the big fear with cybersecurity. However, those things have happened also completely unrelated to cybersecurity. For example, if there's a defect in the plastic tubing that's used for infusions of medication and all that truckload of that defective tubing arrives, it's all distributed throughout the hospital. The next thing you know, all the pumps are affected. There have been software upgrades over the years that have caused problems with medical devices, critical devices. So even that is not entirely new. But in a sense, the vector and the nefarious nature is what's changed probably the most. And so I think the end result of this is we're talking about it now, we didn't ten years ago. We're thinking about it now. And what we have yet to do is start to ensure that everyone has a higher level of vigilance for cybersecurity related device failures. And we need new ways of being able to address those when they occur. So instead of going on for an hour, I'm just going to stop right there. Julian, I'm going to pull on one thread that you mentioned because I think when I reflect on the past several years, I think a lot of it comes down to a significant change in culture, a significant change in mindset and how we think about cybersecurity. And what I mean by that as an example or illustrative of where we are now versus where we were several years ago is that in many of the conversations that we would have, FDA, whether it's with industry, whether it is with healthcare delivery organizations, whether it's with just general public, it was kind of that can never happen. That's just purely hypothetical, theoretical. I don't need to be worrying about that. And how that would translate with respect to how even industry would view an issue that we'd bring up. It was like, well, you know, but we don't design our devices to be thinking about the potential mal intent or nefarious intent. We're designing for intended use. So think about the shift in mindset that we've asked of industry in the design of new devices to be putting on the hat of the adversary to be thinking about it from the standpoint of threat modeling. It's like, no, we need to consider other potential mechanisms by which a device could be used other than what it was, perhaps, you know, in the most beneficent sense intended for. The same mindset shift was required of healthcare organizations and of providers, because all of us who work within this field, it's hard for us to wrap our brains around the idea that anybody would want to do anything bad. That why would you look to disrupt operations within a hospital, the most vulnerable of individuals there? Why would you do such a thing? Nobody would ever do such a thing.  And they therefore have to be thought of as kind of a hostile environment in terms of attempts at attacks on the systems. And CISOs of hospitals will tell you that that happens, and that's been happening day in, day out, all the time that they're constantly trying to defend from attacks, attempts at intrusions. So when you think about the requirement of taking on a very different posture here, that means really moving to a different place with regard to what, first of all, FDA would expect of manufacturers in the design of devices, as well as in the ongoing vigilance and management and monitoring of these devices throughout their lifetime, and what the expectations are in not only in the monitoring, but then therefore in attending to vulnerabilities that do get identified through the lifetime of that device. And we cannot just ignore those or leave those, but they really do need to be looked at, assessed, validated, assessed and determined in terms of what the potential is for patient harm, for a safety concern coming out of that vulnerability word to be exploited. So those are, you know, some prime examples of what, you know, at the very core, the very foundation is required in order to move the ecosystem. There needs to be an acceptance of changing that culture, changing that mindset. It is an ongoing process. I think that we've certainly seen a lot of understanding of this and buy-in from industry, as well as from the hospital healthcare side, particularly, again, from CISOs that are on that front line, where there's a lot of work that's yet to be done, and I think that this will be a good also segue as we talk about today's discussion in medical simulation, where there's a lot of work that has to be done, is with the clinician community, clinicians and patients as well, but clinicians who are, again, focused on treating patients and giving care and thinking about things in the most kind of beneficent manner. The notion that something can, something, someone can impact on a device's safe performance, and therefore considering the benefit risk calculus, understanding what that is, and how to have dialogue with patients, and how to also be on the lookout for that, that is a whole new world. And that's a world that, you know, Christian and I have, we've talked a lot about, and that is where we need to be thinking about as we go forward. Medical simulation offers a real, you know, extraordinarily, really excellent tool in terms of being able to do that, particularly because it's something that resonates with the clinician community, and we'll talk about that as we go forward. I would say where in my tenure, my tenure hasn't been as long in the field as the other two well-respected people next to me. However, what I have seen in this timeframe has been a rapid increase in connectivity. So medical devices now are not functioning as an island. We don't even have vendor systems individually functioning as an island. You have a system of systems that are connected together with, you have imaging, you have clinical monitoring, you have electronic health record systems, you have laboratory systems, we have even R and D systems. They're all tied together in some manner, all on our networks. And because of this rapid connectivity increase over the last number of years, as a result of several governmental initiatives, as well as other aspects that have gone into this, this threat surface is increasing with that and the awareness of cybersecurity and the need for cybersecurity is increasing in the medical community. We have individuals such as myself now popping up at other health institutions across the country where you're having medical device specific experts devoted to securing their systems within the healthcare organizations. We have procurement aspects that are going into your, you're considering cybersecurity now as part of your procurement process. You're assessing your medical infrastructure intake into the company prior to deployment and you're making recommendations and mitigations as a result of that. You're reassessing your existing inventory that may have been, your medical device systems may have been in operation for decades potentially and you're looking at it with a new lens to see where are your potential weaknesses, how can you fill them and where do we go for the future so that we can make better decisions. Awesome. So of course we picked the best of the best, right? The people most aware of this representing institutions that are very savvy when it comes to medical device, critical hospital infrastructure security, right? So the best of the best, right? I'm going to ask a provocative question to the panelists here. Put on the hat of a middle tier, somewhat rural hospital that takes care of 100,000 patients a year. So it still takes care of a lot of patients but isn't connected to a big hospital network, doesn't have tremendous amounts of resources, etc. And take what you know about how hard it is to secure these systems, how vulnerable it perhaps could be and answer the question, do you think that if a patient was harmed by a device that was compromised by a piece of malware or some other thing that we would, that hospital would be sophisticated enough to detect it? I think that's a very tough question to answer. Where I would start with it is it depends on, A, the monitoring infrastructure that they have, B, the relationships that they have with the medical device manufacturers themselves and C, the technical personnel that they have on staff. This is a mid-sized hospital, not a small rural community hospital. So you can suppose that they are going to have some technical resources, you are going to have some form of network monitoring, you are going to have clinicians that are going to be able to see changes in behavior of your medical infrastructure. And we have many manufacturers in the field that are on top of their game and they are act, they will actively work directly with the hospital to help remediate and mitigate their risk. So as long as those relationships exist, I would think that you can, it's going to minimize the potential impact. I can't, I can't directly answer it fully. No, it's hypothetical. It's my favorite one because you can't answer them. I would be pessimistic about the ability of such a hospital being able to recognize a cybersecurity related incident as being just that. And I think it has a lot to do with the fact that the hospital is not well resourced. It is in perhaps an environment or a location that is geographically well, well removed from some of the, you know, bigger academic or bigger, you know, clinical centers where there is a lot more likely exchange and dialogue happening across the C-Suite's and the operational folks within those organizations. And we've heard that, you know, we've, there's been an analysis, it's really done of that several years ago through the healthcare cybersecurity task force actually that kind of surveyed what does the nation look like with respect to its current state of preparedness and capability. And there's a very wide spectrum across the United States for hospitals and healthcare facilities, which leaves us certainly very concerned about those types of facilities and how we, as a collective, as a community can bet not just government, but really everyone, the private sector as well, think about the notion of partnerships and other efforts creatively that can help those types of institutions that may be, again, more remote, more siloed, less resourced to assist when these types of incidents do occur. Thank you. Well, I think we should consider what kind of issue we're dealing with, what kind of attack it is. Is it something that's intentionally in stealth mode or is it something that's intentionally not? So if the Windows desktop screens pop up or ransomware notice with a very long, hard to remember Bitcoin, you know, information, I think he's sure the hospital is going to know that's been attacked. If, on the other hand, someone is performing a man-in-the-middle attack to modify lab values and other data with an intent to assassinate someone or cause harm or disrupt operations, I imagine it would be very difficult for anyone to detect. If a medical device is bricked, if the medical device obviously isn't functioning correctly, what people will do is grab another medical device, call their bio-med department, clinical engineering department, call the manufacturer and say, hey, you know, this thing's a piece of junk, please fix it. Manufacturer might examine it and hopefully would identify that it was a malware-related issue. If it happens to many devices as soon as they're connected to the network, I think the light bulb will come on pretty quickly that something isn't right. And probably most hospitals would, you know, one of the things they would do, of course, call the manufacturer and hopefully the manufacturer would know. And a lot of small medical device manufacturers aren't resourced. You know, probably to sort this out easily. There are a lot of mom and pop operations. Others that are larger are well resourced, but they'll often call up the FDA and they'll call Dr. Schwartz and say, we got a problem. Could you help us out? What do you know? What does the intel look like? So I really think it could cover the whole spectrum and to some extent depends upon how stealthily they're intending to be. I'm not looking forward to that day. There's a lot of talk about how we need to do a lot of technical work and process improvement from when a security researcher finds a vulnerability in a device to when they interact with the medical device manufacturer interact with the regulators to perhaps when they put in mitigating controls, perhaps patches. I mean, we spent a huge amount of the last 10 years talking about that process. We're going to transition a little bit into talking about this unknown part. Just to put a little bit background out there. Imagine an implantable medical device needs a patch. This patch doesn't go over the air, like your phone, right? It's not a very easy thing to deploy. In fact, it almost always has to be deployed by a doctor in a doctor's office. Why, you ask? If it should fail, then the device won't work and you'll need a doctor or nurse nearby to make sure you survive without the function of the device. Does that make sense? Well, you can many people out there who are probably new to this space in the medical device patching world can already understand how hard it must be to patch these things. If every time a device has to get patched, you have to go see your doctor, it's a big deal, right? Now, the question to the panelists are, how equipped do you think doctors and nurses, nurse practitioners, the clinical staff is today at A, understanding this and B, being willing to deploy something like a patch, knowing nothing about cybersecurity or patient care implications. So the question again, how well do you think doctors are prepared now? And then we'll get to in the future how we can maybe change that. That's a good question, an interesting one. These things are happening already. We're receiving notifications that devices might be affected and we contact specialty groups. For example, if a device, you mentioned specifically an implantable device, but it could be something that's connected and not physically implanted like an insulin pump, right, which is similar in some regard, although it's not life sustaining, the pump itself isn't because someone could use an injection instead. When we contact our different physician groups and others, there's really no pushback. They think they're used to being advised by other experts when it comes to technology, and they ask what is the risk, you know, they rush to find out if the devices they have are affected or if their patients are affected, and then they ask for guidance on what to do. Now, I don't think we've hit times yet where it looks like something has a very high risk if not addressed and a very high risk to the patient if addressed for the reasons you mentioned.  If you have a device that's working and let's say is a very low risk that it will be affected as long as let's say it isn't not connected to something if that's the case, then the, you know, the best course could be transparency, advise everyone, and then make sure that you monitor the situation. And, you know, based on the experience to date, I'm finding very receptive groups of clinicians. I'm an anesthesiologist, as I said, but I work in my role in biomedical engineering, work with all the other groups, you know, across the hospital. And there's really been no pushback, but sometimes what the guidance is not necessarily very clear when we're in a stage of uncertainty, which is usually that first stage. So I have a slightly different perspective, having to deal with the responsibility from the FDA of putting forward recommendations through communication to providers, to clinicians, and dealing with what one could consider a much more high stakes or a high consequence type of situation where, as an example that Christian provided, it would be necessary for the physician to bring a patient back in and have a discussion with the patient over what it is that's about to happen and why, you know, the physician feels that it is a prudent step to take. And we have seen a lot of reluctance, a lot of hesitancy within certain clinical groups, within certain clinician communities. The one that is most prominent, I think it's because also it's the first one that we've really had to deal with has been within the cardiac space, specifically with electrophysiologists. And I think that it's a demonstration of really where we are in, you know, the nascent scene and what will be growing pains here as far as better arming clinicians with what we can anticipate in the future with respect to these types of devices, definitely needing to be updated over their lifetime. And taking that from the standpoint of, oh my God, this is, you know, this is going to create a lot of anxiety and concern and fear for the patient as well as for the physician to something that becomes more of the norm that a physician, you know, can expect that over the lifetime of a device, the device just like a phone or any other technology, will need to receive updates in order to address the vulnerabilities that get identified later on that are not, you know, known or have not been discovered earlier on, that becomes, again, this comes back to the shift in mindset and culture, like that this becomes, yeah, part of what the practitioner can expect and therefore how do we ease that level of comfort for the practitioner so that they also know how to have a discussion around that with a patient. So I think that there's a lot of opportunity for us to talk about approaches that we can take to better educate clinicians, to better inform, to arm them for these situations that we would expect are going to become more normal and that we're not dealing with a kind of crisis every time a vulnerability is discovered within a device that is going to necessitate the physician to take a specific kind of action. And I'll take it just a step back as well. I don't think that at this stage for different clinician groups there's sufficient enough even understanding of cybersecurity to recognize with whom, with which patients they may feel the action or recommendation is appropriate and where they may feel, nope, it's not necessary for this particular patient and how to have that kind of benefit risk related decision, benefit risk excuse me discussion in order to come to an informed decision. One has to have ample background and understanding of what the risk is and what the consequences are in order to be able to render that kind of a decision together with a patient, but we're not even at that stage yet. So simply handing over a set of recommendations or next steps to a physician without having more contextual understanding I think is right now a gap area that needs to be addressed. I'm in full agreement with the other two panelists. I think that there is definite room for improvement regarding the educational process and communication process. So over time there is going to need to be a shift that medical devices will need to be patched just part of normal course. Eventually we're going to find vulnerabilities in almost everything. That's just how it's going to happen. Everybody in this room knows that. So those kind of conversations need to be starting to happen with the clinical staff. Now that kind of piece can go into well how do you develop an educational structure within your organization as well as how do we develop a national educational structure? And those two pieces all three of us on the panel are actively working on and there's a number of people in the room that are working on how do you put out information in a digestible manner without increasing the anxiety while improving the context and awareness of your device and its potential impacts and situations. Awesome. So we're going to go a little bit faster through some of the next topics. Who here in the room would like to fly in a plane with a pilot who has never actually flown a real plane and let them take off and land? Please raise your hand. What's your sense of excitement? Yeah, how much to take it? We could discuss that. Let's see how much you would pay. Are we willing? Maybe $50 is not enough. Anyways, we're going to talk about simulation next. So we're going to have two different types of simulation. One is simulating attacks on medical devices. Probably best exemplified for their work at the partners lab, right? So how do we simulate these types of attacks? How do we put clinical risk in the criticality of these types of things and see how they translate to impacting patients? That's one type of simulation we're going to talk about. There's also this other simulation which falls into the pilot part of it. So aviation figured this out decades ago that they didn't want pilots flying in planes the first time while learning to fly planes. So they put them in these high fidelity simulators, right? Like basically video games to teach them how to take off, land, push all the buttons the right way, et cetera. We stole that in medicine and we teach doctors how to take care of really sick patients using simulation. So who here wants a doctor who looks like they're 25 taking care of them when they have their first heart attack? Anyone? Never having taken care of a heart attack before? You probably don't, right? So we teach those doctors how to take care of those sick patients using mannequins and dummies in fake emergency departments so that when they give the wrong drug or give too much of a drug or too little, we can correct them before they do it on a real patient. That sounds great, right? We did this for medical devices, right? So we took some real research out of this security researcher space and we wrote clinical simulations based on if this pacemaker vulnerability is real and it impacted the patients, this is how it would look. The patient would come in complaining that their pacemaker kept shocking them and perhaps they'd even go into a deadly heart rhythm as a result. Or maybe if the infusion pump they were hooked up to was compromised, it would give too much or too little medication and we let these doctors go through these cases not knowing what was going to happen. It's kind of like Dr. Dungeons and Dragons, right? They unroll this scenario. I bring all that up to say Dr. Schwartz, you saw some of these simulations in a couple of these conferences in the past. And what were some of the insights you saw? Did you see anything? Was it magical? Was it boring? What were some of the real importance to this that you saw that we could leverage to address the very issues this panel is talking about, which are generally clinicians and clinical staff don't know much about this and need to be better informed? Yeah, I have had now the opportunity, really the privilege to attend and to observe to such types of summits that went through these types of simulations and for each of the scenarios observing the clinicians kind of go through step by step their interventions they're kind of watching them think through and act at the same time and then do a debrief afterwards and listen to their aha moments was just extraordinarily insightful and impactful because each of them had said, you know, again, going into such a simulation not knowing what the scenario was going to be that the consideration of a exploit of an attack never would have entered their mind and it brings the understanding that this can occur into a frame of reference that resonates for the clinician, you know, in terms of what it is that they need to be thinking about in dealing with a emergency or scenario that's unfolding right before their eyes. And I think it was in some ways an awakening and an enlightenment for each of the clinicians that were involved in those scenarios and for me very much validating that in order to bring better awareness to cybersecurity for clinicians placing a clinician in an immersive type of learning environment in the way that we do teach and train medical students and house staff and so forth is one is a very, very effective method of doing so because the intent is not again to turn clinicians into cybersecurity subject matter experts but rather to give them the tools to be recognizing and to therefore be doing what they do best as a situation is presented to them. And it was again a very, very enlightening and informative exercise. So if may I add, so what is called high fidelity simulation is what this is usually called in the medical education world and a number of specialties now use these environments. I go through simulation training every few years as well and you know, boy it makes you sweat. And you know, so what's special about simulation? Well, you can simulate things that someone may never see clinically and you can control and contrive whatever you want so that it becomes not only that educational opportunity but it also becomes seared in your memory and then when there is an event there's a problem, people usually fall back on, you know, their most memorable events of, oh yes, there was a simulation on this and maybe this issue is related to cybersecurity, you know, would be the outcome of that. Also a big part of simulation is the team training aspect. It's learning what to do when devices fail, things fall apart and it's learning how to recognize that something is actually much worse than it first appeared to be because we've all had bad things happen. Could it be a fire in the kitchen or it could be a car accident and at some point things look okay and then they suddenly become terrible and we train clinicians to recognize that tipping point which is, you know, hard to do. You have to kind of step out of the experience and know how to bring in other help. So there's a lot of value at multiple levels for simulation and I think it's been really great to, you know, go down that pathway because of the potential for all sorts of good things to come out of it. And you're of course welcome, Dave, to comment on that. Or if you'd like to talk more about your simulating of hacking these devices because the last topic I'd like to hit after you talk about that is really how do we involve this community in here because they're hackers out there, right? We care about being involved in this. That's why they're out here. They are patients themselves or their parents or their kids are patients and they want to help but they don't fall under the traditional categories, right? They're not in academia. They don't care about writing papers. They want to hack. And there are a lot of barriers to hackers out there getting involved in this space. So please talk about your work in the lab and then also let's start talking about how we can broaden inclusion into this space which is really hard.  They don't know who to talk to. There's a lot of problems and pushback and even threats from certain organizations being involved in that. So if we can move on to that for the last topic. All right, well I'll say one comment on the previous topic of when an area in these various simulations that has been very enlightening is learning who needs to be at the table. So when you're doing emergency preparedness and response activities and you're working through emergency situations it's important to figure out what your communication paths are. Who needs to be in what particular role? How do you all work together? You need to have people from the federal regulation level. You need to have people from your various groups within your hospital organization. You need to have medical device manufacturer groups. You have to have researchers at the table. And you have so all of these various pieces have come out in some of our simulation activities working through these kind of emergency disaster situations within our laboratory. As far as other kinds of more hacking oriented research and activities that we've done in the lab. So we use the medical device cybersecurity lab for a number of different pieces both on the operation side and the research side. Operationally we do penetration testing of our systems prior to deployment, prior to procurement. You work through your various systems and figure out how you can work then with your organization and with your medical device manufacturers to fill any potential gaps or figure out how can you have mitigated controls. As far as we also have work under a project with the Department of Homeland Security and this is an aspect where all of you in the room I highly encourage you to join us in this effort. So this is under the DHS impact program and if you Google impact it'll pop up and we have a project for a generation of medical device network traffic. And the reason for this is because as you have all experienced in this research community you can't get a hold of easily of medical devices. You may not be clinical experts and know the clinical workflows and there may be other legal barriers to be able to do research on these medical devices and because of that there's a lack in our field of networking systems and understanding of the medical network traffic in order to develop tools that we have tools in our regular IT networks. We have visibility. We have detection systems. We have artificial intelligence. All these different pieces on our IT networks we don't necessarily have access to that on our medical networks due to a number of different hurdles. We are doing under this grant generating medical network traffic under normal state scenarios, failure mode scenarios, attack scenarios. We're bringing this to the research community so that you can then get access to this traffic and be able to start developing tools to help improve the ecosystem as a whole. Yeah, that deserves a clap. Yeah, get the data. That's awesome. Build the tools. I just want to clarify when Dave said we don't we don't have we don't have those tools on medical networks. The we in this case he meant was the health care sector. Not we in our hospitals. Not partners. Yeah. So, right. So the very nature of how medical devices are connected in hospitals is they're typically on separate and proprietary networks for a host of things that relate to the fact that they were not necessarily designed to plug in to your backbone. They don't go into the technical details. But the bottom line is that they're typically isolated and separate. And that's why this is a data set that's been hard to get access to. Another reason is that medical devices are expensive and one needs a license to buy them unless you buy the money bay in which case you just need money. So and then as Dave said setting them up requires a certain level of clinical engineering knowledge. Part of the reason we set up the lab the way we did that's allowing us to share the data through the DHS impact program part of the way we set it up was to answer a question of what does a laboratory sandbox need to be prepared for a cybersecurity event a significant one hopefully not cyber Armageddon or whatever it's called. But you know these things could happen and we as a nation and as a community have to be prepared. So part of that work over the last year and a half or so has been a project sponsored by the FDA in partnership with MITRE to build a medical device cybersecurity sandbox to understand what do we need what kind of tools how do we simulate different hospital environments and different network architectures different implementations and configurations of equipment manufacturers may dictate that for a device to work correctly or a hospital may have to dictate a configuration requirement based upon their available technology or clinical workflow physical layout they may have antiquated equipment networking equipment they may have state-of-the-art equipment and so we've been studying that for some time and built out the cybersecurity sandbox as part of this cybersecurity preparedness initiative and you can see how there's really good synergy between these initiatives whether it's DHS science and technology S&T program wanting to share more core data with the with the cybersecurity community whether it's the FDA in Suzanne's office thinking about how do we prepare as a healthcare sector so that the community could rapidly engage hopefully ahead of time not in response but proactively to these events do you have anything Suzanne? I would just simply add that I think that both types of scenarios that we were talking about whether it is the clinical simulation for providers or whether we're talking about again the test bed or sandbox they both demonstrate the power of simulation for preparedness and we always talk about the importance of you know preparing exercising exercising exercising exercise to failure not to futility it's the idea of before something bad happens let's play this out and understand exactly what our weaknesses are what are the things that we need to sure up and then reiterate on that and continue to learn through that process simulation is a really powerful tool to do that. Phenomenal. Alright so we're approaching the end here I just wanted to again thank our team panelists and leave perhaps a challenge to the audience and everyone here we've talked a lot about simulation as a powerful tool let's practice let's tabletop these things both to educate the doctors and nurses to in-care patients to talk about involving hackers into this space but really I feel like simulation is a tool that can be applied across this community right and that's really something I'd love to see go in a different direction we'll continue to do clinical simulations we'll continue to do the technical simulations but what we really need is involving more of the community outside the walls of a hospital you know tapping into the tremendous resources of all the hackers here and allowing them to experience what this would actually be like because what we want to do is leverage the expertise out in the room all those hackers to do meaningful work to help secure patients and we talked about all the difficulties of how to do that and all the intricacies and how much you have to know to do that let's reduce those barriers if you will to allow more hackers into the community and I guess I want to say thank you as well to everyone that's involved in the We Heart Hackers Initiative the Biohacking Village next door please sit down and take a stab at the CTF, check out the vulnerable devices and also join the community this is something that's really important medical devices take care of our brothers our sisters our moms our friends there are a lot of nuances in this community we should be banning together to solve a lot of these challenges and avoid the pitfalls that have happened in other industries that result in either outcomes we don't like delays to fixing this issue and then also it's just a cool space to be in who here is having fun here at DEF CON you came to the simulation panel didn't even know what it was we had some fun can we give it up for our panelists please


No, no, no, no, no Damn you, Saf Yeah, yeah, I took that trip to Leicester strictly to get my revenge on Saf I mean I lost to him on the OnePlus Nord 2 Pac-Man edition. Oh Man, seriously, so I had to train I train hard I trained as much as possible with the best equipment and that was the one plus 12 hour now This device packs in tons of features and shout out to OnePlus for this because it's it's stacked You've got a fifty five hundred milliamp battery, which means I can train practice train Train some more and just get it right sharpen those skills And then of course you do have a superbook charging up to a hundred watts Which means even if for whatever reason my device dies. It only takes 26 minutes to go from zero to a hundred percent Yeah, I was training a lot getting ready to just Decimate him, but of course they also have some great cameras two megapixel macro eight megapixel ultra wide 50 megapixel main sensor Hmm. Yeah, I can imagine now taking photos of Saf crying as he's losing with that great 50 megapixel sensor But you know what forget that forget that let's go ahead Let's put our phone on silent with a slider and get ready for that first round now for the challenge We have three games to really see how the one plus 12 hour handles them and to see which one of us will be victorious I will be victorious. It's gonna be me. Yeah, obviously. Of course. It's me. It's me Like you lost already. So this is this is already the second video I mean you're playing the game for an old guy like you so you're older than me anyway, but let's go So the first game we're gonna play of course is all of duty.  No, it does not ah Got sniped. I got sniped. It's double kill. Oh god another UAV. Thanks. Thanks to me. Okay. I'm in the zone I'm in the zone. What zone losing zone Fred, it's a missile kill. Okay. We're done. Okay. Let's see. Let's see. Oh Oh That was intense MVP. Oh, no That was all thanks to my UAVs helped you out. I should not have helped you out All right, let's let's see how close the kills were. Okay 18 kills 20 All right, it was close. It was close. All right 18 and 20 kills. So I mean All right, I was thanks to my UAVs obviously I mean thank you you easy. You still couldn't kill the guys anyway I was giving you the support that you needed see that's what I wish you would not have I would not have those two extra kills, but it was close. It's not over. It's not over. Okay, it's over All right, I didn't hear no bell. So we've got two more rounds. All right, let's do this. Let's do this That was pretty close. Nah, I'm just kidding. I had it on the control. I mean come on I'm like I was slipping and sliding left and right I mean, I got a device that has your 6.7 inch display 120 Hertz refresh rate Super smooth for all my gaming needs plus maximum neat brightness of 4600 nits LTP of 4.0. I mean come on plus it packs a lot of power So playing games like card, PUBG, whatever you're playing you're getting in the best performance of the snapdragon 8 gen 2 And you can also get either 8 or 16 gigabytes of RAM 128 gigabytes of storage 256 now and I'm gonna get ahead of myself because I've got a second round now and Let's get this close. Let's just finish this off because I went to he's done. Oh, the second game. We have is Shadowfight for arena. Okay. Okay. Let's see. Let's see who is victorious Okay, it's gonna be a second beat down guys. Okay round one. Okay. Okay double kick one two Let's take him out. Oh, man. He's coming back though. I've got like a slither of life left. Oh shoot. She's actually One that was that was that was very close though. That was very close. Yeah, we've got we've got two we've got two rounds That's right critical counter. There we go come critical hit Today out of that. Come on. It's close. It's close. No, okay. No, no, you look like don't don't don't kick kick kick Oh, oh self-destruct. Yes. Yes. All right. Okay final round I'm still hanging on. I'm still hanging on. I need to win this a final round so we can get on to the third round Take him out. Take it. Take it. There we go to combo. Yes. No, they're actually you hang that You know what we should have done different characters because right now I can't tell who's who I'm gonna do the same move over and over again Nice just spamming just spamming.  Yes Okay, okay a draw What was I thinking? I mean I lost my cool there. I didn't stick at the game plan. I didn't focus I should have been more like the one plus 12 are I mean it's got the cryo velocity cooling system That keeps the device really cool while we're doing this whole gaming session and I'm trying to beat staff I should have also used the gaming toolkit It has that allows me to optimize my system effectively when I'm increasing the clock speed Looking at my FPS readouts or even just optimizing Specifically for the game. I want now. I gotta win. I gotta win I mean I let him back in with that draw So let's see if we can close this out and get the dog now that this is a draw It's one to e the second game has been a draw so the final one will be the deciding now So for the final game, we have real racing three. Yeah, do we do this?  I'm ready to take home the glory. All right real racing three. Okay, two one go I don't even know what track this is. I'm bleeding. I have to win. I says I'm first though Oh, no, you're not I'm not seeing any but like right now I'm just racing on my own am I sure I'm in the right place. Oh, he just he just went past me. Oh, there Is he's lagging? I could see a ghost. I could see a ghost. Oh my ghost is just killing it. Oh, yes That's right. That's right. That's right. I'm channeling my inner, you know, sir Hamilton right now. I think I've got an electric vehicle Actually, that's what I need. I need an electric vehicle. Oh, look at this lap time. Oh, okay Look, maybe I shouldn't talk too much. I was lost it there That was that was a close one. I could have got past you there, but in your dreams Where's where's my turbo? I need my turbo. Why did my tail light? Oh, this is all corner cutting penalty. I got a penalty. Oh, that's not fair. Try to cheat to win and guess who's about to No, not yet. I thought I was gonna finish mine. Yes Ah Her race complete. Oh beautiful Beautiful. It wasn't by much. It was by about few seconds. Wait, wait, wait. What was your time 2 2 2? Yeah, 2 19 Yeah, so that is that is huge in the racing world guys. No, it's this. No, look, I let him win this time He was he's been training hard as you saw earlier in the video He's been training very very hard and I felt bad for him Maybe I should have worked a bit more on my training But regardless guys the one plus 12 are has handled all of these games absolutely perfectly. Yes Not even not even one to the touch. No, we've also been screen recording But it's it's been nice and smooth, hasn't it? It has been I gotta give shout out to one plus for helping me train To get myself in gear because the 12 are is really solid, you know performance smooth and great Great touch sensitivity on the controls Especially playing, you know call of duty and making sure I could beat saff It was very close. It was very close. Two kills nothing much in it But anyway guys if you guys want to find out more about the one plus 12 are then there's going to be a link down in the description below now remember I've won one game and Ennebong has won the other so I Call it a draw so far, please. So I think we're gonna have to do a part three at some time What do you think possibly so I can take him down forever? We can just put up on the wall there in my office. He's gonna put up in his bedroom. That's how But anyway guys, hope you enjoyed this video I found you so if you did then do smash that like button for us and do consider subscribing to my channel not his It's it's not that great to be honest Wow Don't listen to him guys always as I always say it's okay very much like and subscribe Average always enjoy just like his gameplay.  His wife is having me saff you beat him He's not slept since we married in three losses.   See what happens when three losses. That's all I have to say Just remember guys just go online and mention it. He lost over all two two Out of the two we both won one each We need the best out of three. So we'll see you back in a couple of years Enjoy guys It doesn't even let me hang in there almost Oh


All right, it's time to talk about what happened in January. January of 2016, that is. Ah, I can't believe it's already 2016 and that January is already over. It's amazing. Before I talk about the books that I've been reading this month, let me do a little bit of an update about the YouTube channel. I passed 400 subscribers a couple of weeks ago. My little video about the Space 1999 technical manual is what put me over. The Tumblr has not grown. The Twitter is not growing and neither is the Facebook. There is a Pinterest and an Instagram. I don't update them very much. There's no Follow Ship there at all. Is Follow Ship a word? The YouTube channel is the only part of this project that is getting any attention and that is actually growing and I'm getting comments on every video now and interacting with people who are leaving comments. There are no new patrons this month. Just like in December there are three patrons, I think $24 a month. Anyway, let's talk about the books that I've been reading just today. Earlier this afternoon I finished reading an e-book of Man in the High Castle by Philip K. Dick. It's an unusual book for Philip K. Dick. It's short like most of his books are. I'll review that in March. For February each week I'm going to review a book series that is novels that compose a series, not collections of anthology stories, but novel series. What else did I read in January? I read Radiance which I reviewed last week and as far as new reading projects that I finished, there's not, I don't think there's anything else to tell you. I started reading Across the Wall by Garth Nix. I'm not impressed so far. I finally got around to Memoirs of a Space Woman by Naomi Michison. I've had this for a while and been looking forward to it and again I'm not very impressed. And The Best of Pamela Sargent. This is a book I had years ago. I remembered it but I didn't have a copy of it. I acquired this sometime last year and I'll finish it and let you know. Other than that, as far as books go, I checked out two books from the library Shards of Honor by Lois McMaster Bujold. I've never read Bujold before. I hear about her all the time, especially this series, The Borkosigan Saga. My YouTube friend Catherine at Maybe in Android talks about this all the time so I'm sure she'll be pleased to hear about this. And Something Called A Darkling Sea by James A. Cambius. That's it as far as books. I did have one other idea that I wanted to talk to my YouTube subscribers about. There's quite a few of the people that I follow on YouTube who open up these delivery boxes they get every month. They call them, what do they call them? Lootcrate is one of them. I can't really tell you why I enjoy watching people open those boxes. I'm not interested in the boxes or their contents myself. I guess I follow these people because I like them and their personality to begin with. So watching them, just watching them do stuff is why I follow them in the first place.  Anyway, I always find myself wondering what would a science fiction crate be like? What would you get in a box for science fiction? And it's science fiction, specifically science fiction reading that we do here. So I'm thinking, what would you all think of a science fiction book crate every month? Every month you get a book. I would go to the used bookstores, I would buy books, books that I've either read or authors that I know are good or authors that I know you probably haven't seen before, buy stacks of books and send a book out to every subscriber every month. I guess call it sci-fi crate. The monthly fee would have to be something like $20 a month because in addition to shopping for the books and paying for postage and paying for shipping supplies, because envelopes and bubble wrap do cost money, I would also be spending time shopping and that takes time and time is money. So it would have to be something like $20 a month and you would get one used book. If you like that idea, leave a comment below right now. If I can get four or five people interested in that, I'll start it immediately. It should be easy to get up and going. Also, when you follow my patronage link in the description below, you're sent to my Tumblr. In the future, I'm going to start sending you to 50th street. That's 50th.st where 30 second sci-fi and my projects in general are going to be housed. And there will be other people with their own projects under the umbrella of 50th street as the year goes on. It's going to be a subscribership crowdfunding site for artists and creators. We've seen that kind of thing online before and this is another one and I'm happy to be participating in starting this one up. Okay, so let me know what you think and I'll see you with the next review. You can support 30 second sci-fi and my other projects by becoming a patron. There's a link in the description below. And visit the 30 second sci-fi Tumblr. That's my headquarters. In addition to my videos, I publish links and updates there every day.


What's going on everyone? Sam here with late in sports car dripping 23 Bowman baseball jumbo 8 box case break number 14 Random team style. There's a look again at your random results as always you can find those on the website under the results tab As well as a Lincoln chat. So good luck here everybody. Let's do some more Bowman Got one more case to go after this. That's gonna do it on the night I'm just gonna do it on the night Kyle is still over on drip rip in personals.  There's a huge bowman bounty over on drip If you buy a personal box on drip and pull a super fracter auto of first bowman player $5,000 drip credit if you pull a red $500 drip credit first pack of the first box of case 14 It's like all paper chrome base You know your chrome will ship. We'll stop on all the colored stuff stopping all the autos and such There's dn. Jorge on the Invicta gold auto 250. There you go. Rockies. Nice way to start there Anton Grats, buddy Invicta the D on Jorge. Oh, just when I just when I thought I said his name too many times I'm sitting there Who's that? Didn't see him sitting there and Kevin ferrata Gold shimmer gold shimmer auto coming up.  That is Jayce Jung nice for the Tigers 8 of 50 Jayce young on the gold shimmer not a first he was a first in Bowman Draft It's still a very nice card regardless gold shimmer Jayce young that is blaze Jordan to 250 Britt baby the 125 For the Mets said your name too many times gave her a marina last really close it in boys. Close it in. Yeah I'm like dog the bounty hunter man. I'm going to I'm going around to the friends houses 175 I'm figuring out where they hang out doing the recon. We're doing it. We're gonna find Yeah Absolutely, I pulled uh The guy with the Chinese auto too. Oh, yeah, uh, how young Lee? Yeah, yeah, dude. He's his his auto sweet lunar crater Same actually let's go dude Yeah, honestly, honestly, all right now pull a super and I'll pull one too.  That's interesting. Yeah, maybe they do if they run a little bit Michael Harris rookie Rise and shine Christian Hernandez Uh, that is white speckle ariel monte to 2 2 99 Let's go That is on hell janeo On the base auto for the guardians Uh, I don't maybe I'd be kind of surprised but they looked good last night, but it also took a buzzer beater to win You know what I mean? Like if trade misses that shot the hawks are out at this point, you know what I mean? So I don't love like it's great to win it. You know, I got to mess with all the Celtics like Vaughn and my friend Mike and Blake I got to mess with all the Celtics fans for a couple days But uh, no, I don't think I I think the series is over now. I think they'll they'll lose in Atlanta But I don't know they won without Murray. That's pretty impressive Corbin Carroll rookie Helly day luckers. I hope they I hope they just make it go to seven Make the Celtics sweat it out a little bit. Uh, Vincent Peruzo on the lunar Lunar glow No, they wouldn't they would not win game seven if they push it to seven they won't win game seven Riley green. I don't think they're gonna win game six, but I think so So I think they're they're still up three two Barry face There's a Oh drew Jones again this time Refracted a 499 back to back cases with a drew Jones Carla W 18 out of 499 on that one. We'll get that magged up for you. Congrats Carla Nice drew Jones Josh jump Five full potential drew Jones Here's Oswald Paraza and uh, Jackson chariot. Did you see the one on that too? Not set dude. Out of freaking nowhere. Yeah. How was that? Uh, yellow crater 275 Simon one That was freaking out dude Yeah, it's pretty funny Uh future paper Garrett Mitchell rookie to 2.99 for the brew crew There's Jackson Ferris base auto for the cubs first Then the of tani super from gilded came out like two breaks later. I'm like good lord, dude. What's going on? It's awesome Sweet man There's purple Tommy speck to 250 for the rangers nice one there Tommy speck specked Uh Garrett Mitchell rookie does he He's all the makers right now Salty. Oh, yeah True blue Kyle Harrison 150 Salty's a good five star guy Loves his five star There's Adley rookie There's Ruben Santana to 499 sky blue paper And peace Box number three Mark Johnson Mark Johnson There's uh Dylan Auto parts Lunar grow Lunar, uh low 399 christian hernandez Jackson holiday happy holidays That one's kind of just low hanging for me pushing the leather here's me I think Sam needs some sleep. Oh jacob barry Refractored 499 for the marlins. There we go. Chris G I just won there buddy and grats on that Dude when I was working for the minor league hockey team in upstate new york Leandro rice the 499. I was I was like a sales like It's up Joshua and um Shea Langler's and uh We had like the we had like an ox like so the radio would like play overhead and stuff And that o'reilly commercial would come on like a once an hour.  Oh my lord bass Good god man. Good god still one of the best movies that has a great movie Brett Beatty rookie future paper trace weenie for the inks to 299 Dude when he gets his chest wax, it's the best so far So funny because Steve girl actually yeah, yeah, it actually happened. Yeah. Oh my god. Yeah, that was so funny Uh See we can get out of this too. Well here everybody Bunch of spots coming in again guys, uh Kyle is live over on drip ripping some ripping a lot of bowman today And there is a uh bounty For a super fractor uh first auto or a red first auto Jack's holiday in there Lunar glow on heligenaio For the guardians there's christian vicaro Joshua bios Jordan walker bass There's hector rodríguez for the Reds to 299 nice one there hector rodríguez Very nice grads on that sincey bass rookie Miguel Vargas So then i raffael there's Joshua bios on the uh aqua crater to 125 or aqua lunar pretty house Steve perles best movie That one's good. I would say for your virgin. That's one of the best Pedro Ramirez bass auto for the cubbies so funny Yeah, it's a good one lake Invicta jarlin susana for the nationals. We've got a It's a 199 mark vientos on the purple pattern paper Eight nights are going to get smarts a good one Yeah That is cam collier On the true blue to 150. Let's go reds. Congrats on that sincey That will be going out to Ralph Ralph f Ralph f green paper Is myrosendic martinas for the Dodgers to 399. Yes, 399 And bass all right. I'll do it for box four round to box five Good guys bunch of teams coming in Yeah, no, you know, it's way to follow either No jones plus two drew jones's Like four cam colliers now or three or four cam colliers Uh, Lazaro Montez was in like every case One jr. Kaminaria a couple of Justin Crawford's Is Jorge Ruiz bass auto first for the angels zack giloft to 199 on the pink lunar Don't understand it man. I know I do not understand it Dude Yankeel Fernandez and bowman's best signs it like at the bottom of the wild like dude People don't explain it to us Oscar Gonzalez to 499 sky blue paper. Maybe there's Colton causes So then a Raphael That is uh Dylan, let's go So 150 for the Padres on the atomic Number 99 on the top 100 just snuck in there That was somebody in bowman chrome did that yasser mercedes to 499 What'd you say That changed that is brandon walter on the yellow to 75 first for the red socks Casas jaco berry I think 22 chrome. I want to say it was somebody on the royals daniel vasquez. I think did that I think it was daniel vasquez signed or are vertically uh, drew jones Elijah green i'm pretty sure he was 22 chrome remember him and like choice and stuff pulling like a green To 99 of him and it's like vertical and it's like really To 99 Looks there's uh jackson chariot Honey nut chariot lunar glow wanilanzo for the uh dodgers short to print Doiers Refractor auto in here that is going to be a dominick canzone Refractor to 499 nice one there for the diamond backs to go with your drew jones We've got a valera and curdsmeade got the need for me Marco Luciano the giants Yeah, sure it is better than just a scribble or a letter or something Adley rushman rookie Yes, they're strange Strange in general. I only have one redemption so far too today. It was kind of wild Which I am not complaining, but I feel like there'd be more Garrett Mitchell rookie Because last year in bowman it was like Two of like the big guys triantos and colas were both both redemptions and uh 22 bowman Regular which kind of sucked, but Corbin carol I'll hear it for mr.  Yeah here Let's have him You can see him snagging orange Uh blue pattern is trey turner to 125 uh daemon keith base auto the dodgers He you It smells like that light goes green He's like your job That is cole young to 250 purple ray wave robber himself Cheerio There's riley green rookie a brilliant bishop sky blue paper 499. There's uh, gabriel martinez to 299 White speckle dover piguero nice rookie of the year autograph to 150 for the pirates second one of these we pulled in Eight cases now not bad Oswald parraza more spots coming in again. Everybody. Thank you. Thank you. Thank you. Appreciate that very much Good much Brett baity rookie Jackson cheerio is uh lozaro montez nice one there for the um Uh mariners on the lunar glow kind of a color match there. It's cool rookie of josh jung Coleman irons prospects uh jason cheerio to 499 i know i know honestly wahoo they look good They look good And i think i think they could beat the heat in a series too nice roman anthony nice one They refractor auto to 499 congrats red sox To 499 roman anthony li dela cruise Yeah, i think it was a good trade for the jets the jets really didn't give that much up Corbin carol we're kind of talking through it a little bit earlier today, but Packers gave like nothing up, dude I mean the the jets the jets didn't Dillon let's go Don't look over here when you do that close please Brett baity you look crazy Jeff van Gundy had a lot of morning's leg Yeah, it's a it was official a couple days ago illegal. Yeah I think it's half listening to all this nonsense about it g rod There's uh zander boogers lime green paper to 399 uh bell bastidas base auto for the tigers Bastidas now it's all shifting to lemar now though. That's the only thing ESPN's got a scramble for something to talk about.  Who do you guys want your teams to take? I don't have a paper I'm ready to do that to us jackson chariot and jackson drill And i'll buy the i'm hoping the ravens go corner wide receiver But it depends i i mean there's rumblings on draft they might go out make a move try to get de-hop Matthew wood true blue for the um Brewers to 150 Gabriel morano First take vijon at 31. I don't think he's gonna be available at 31 to be honest Leandro arise to 399 Yeah, no, no for sure. I'm not saying that like the packers did well for the situation. Don't get me wrong But everyone was like freaking out that the jets were gonna give up this king's ransom to get Um rogers, but it really wasn't shelling lears, which understandably so That is leandro arise purple pattern to 199 first for the uh orials And No, I don't think he's gonna Yeah, I don't think he'll make it out of the top 15 What was that? Uh, pijon robinson the running back in texas That is stud Probably be the highest drafted running backs into what zeke or for net Now someone like some team and like like the eagles is like the perfect spot for robinson That's not like a like a team with a not a lot like Not a ton of needs It's like if you have other needs and you take a running back at like 11, that's ridiculous But tosses le de la cruise, but if you're a team that's like like like I said like the eagles that doesn't have any glaring needs Like that's not bad. It's just like firepower Juan burrito Nice one there for uh the lunar Lunar glow for the Rockies Ross bags luller if you do yeah, exactly like if you just need another offensive weapon Take will Anderson that'd be kind of crazy Uh, so we if they traded up and took will Anderson and put them out to the hutch dude on the other side of hutch that'd be scary That is William bergoia to 125 for the fillies on the teal shimmer get rid of kyler. Hmm That is uh, cate and Dana For the angels wait speckle to 2.99 first So they're trying to swap the lines to get cargo that'd be pretty cool Gunner Henderson Prospects jackson holiday happy holidays That is no one gorman rookie Uh green grass still uh d.n. Jorge 15 of 99 nice one there for the Rockies Yeah, true. It's like a quarterback needy team that wants to jump up Uh, Matthew wood again on the base auto for the brew crew. Nice one there milwaukee Matthew would Woulda coulda shoulda matt mclean Christian Hernandez and base Three you go. Yeah, joy porter jr. What's banks his first name? He's a stud too Brandon Brandon banks is it? Colson Montgomery, uh Simon one I don't I don't think I don't think porter's gonna be on the board when the jacks pick because they're what mid 20s I don't think porter's gonna be around still. Thanks, mate And Troy Johnson for the marlins on the purple two 250 There you go. Congrats, uh, Miami Vaughn grissom deante. Thanks. That's right. I couldn't think of it. I was reading a scouting uproar on him earlier I just forgot his first name base Skransky would be be awesome if the eagles can land him I got a jammy if they get jailing carter at 10 that's terrifying Uh, blue pattern similes avala to 125 for the potteries and base still a quick recap here everyone Thanks again for getting this filled on up. Do appreciate it Then We've got Matthew wood Uh, about the steed us Damon Keith Jorge Ruiz Pedro Ramirez Jackson ferris jackson ferris uh, on hell janea Dominic canzone cate and dana Hector Rodriguez, Troy Johnson Tommy specked Matthew wood leover piguero Troy johnson, yoan hella paunt Brandon walter jace jung diana Jorge We had a Refractor jacob berry to 499 We had drew jones refractor to 499 as well And a true blue to 150 cam collier Nice one there that will do it for the break guys. Thanks again for the fill next up 15th and final key


Hello friends. I'm Sanjay Gupta. I welcome you on Sanjay Gupta Tech School. In this video, I'm going to demo how you can send email alerts using workflow rules. If you want to watch more Salesforce training videos, you can search my name Sanjay Gupta on YouTube and you can follow my YouTube channel. So if you want to create any workflow rule, then quick find you need to search for workflow rules. So this option will be available. You can select this option. Then it will show an introduction page showing what we can do with workflow rules along with examples. So if you click on continue, you will see this screen. So it is showing all existing workflow rules. So if you want to create new one, click on new rule, select object and selecting contact object. Clicking on next. So now here we need to mention three things, a rule name, evaluation criteria and rule criteria. So send email alerts. So it is name of rule. So this is demo workflow rule for email alerts and description you can fill as per the requirement. Then for evaluation criteria and choosing created and every time it's edited as of now. So this workflow rule will work while creating a record or editing any record. Right. And here we can put criteria. So I'm putting the criteria that email should not be blank. So I'm searching for the email field. Yeah, here it is operator and it is I'm leaving it as blank. So email not equal to blank. So if email is not blank, then this will be fired. If you want to add more rule criteria so you can choose any other field and then you can set operator and values accordingly. You can also mention filter logic that will be for and or or. So here is the example you can choose accordingly. So right now we have only one field so and then or are not required here. Now I'm clicking on saving next. So I mentioned evaluation criteria as well as rule criteria. So email should not be equal to null. Then it will be fired. So here I need to choose new email right so I'm clicking on it. So whenever you want to send any email alert so you need to choose this option. So here you need to put description unique name object is by default selected then email template. So first you need to create emails template also if you want to choose email alert option right. So now I'm opening one more tab. So I'm going I'm going to create email template and then I will link that email template. With that email alert right so I'm selecting text. So this is a demo email template. So in my another videos those are related to Salesforce admin lightning experience. You can see how we can create email templates. So here we need to choose a folder. So I'm choosing test email templates available for use. Then for contact alerts it is the name then subject congratulations registered. So this way this is the demo subject then email body high congratulations. Thanks. So this is demo email body. Now I just want to add name of the contact also so here you can see much fields are available. So contact is by default selected then I'm selecting name field. So this is the merge feeling value that I can copy and I can paste it here. So this merge field will be replaced as per the record that you will be creating or updating and attaching this email template with email alert so it will automatically be updated. Right. So this way we created this email template that is for contact email. So now I'm moving to email alert. Right.  So let me first refresh it so that that will be available. So I'm refreshing this window so that that email template will be available in this email alert. So now if I click on this look up in words for contact email alerts I'm typing that clicking on go. Yes. I selected wrong folder. So now you can see it is available here and selecting it. So this way I selected email template now send emails to contact. And here you need to choose the recipient type. So you can choose any of this option that is suitable. So on contact we have email so I want to send email to that email ID that is available on contact email field. If you want to send emails to additional emails like in CC so you can choose five email address and you can type them here. And from email address so that will be current users email address so that will be my email address. So I'm clicking on save. So this way you can see I created email alert. And now I'm clicking on done. So what the rule is created. Now I'm activating it so that it will be fired whenever I will be creating any contact or editing or updating any content. So now I'm going to open this my university app. And this is my mailbox. So right now it is not having any early emails. So now I'm going to create one contact record. So this time. Put in last name. First name is my so full name will be my test email. So you will see my test email name in the email that will be sent out because we choose merge field. Then email should not be blank.  And I'm clicking on save. So record is created. These are the details. Right. And let's check the mailbox where the email is available or not. So it is refreshing. Yeah, here you can see this is a congratulation email. And these are old emails. Yeah, this is a congratulation email. So I'm opening this. So because my email ID for both contact and user is same. So that's why it's sent to me. And here you can see name is my test email and that message that we typed in email template. So this way it is working fine on creation of the contact. Right. Let's create one more. So my test. And this time I'm leaving this email as blank and clicking on save. So let's see what happens whether it triggers email or not. So I'm doing a refresh. So you can see it is not triggering any email because email field is blank.  So now I'm going to modify this record so that I can provide an email. Again, I'm putting my email address and clicking on save. So now you will see while editing and if we provide email that is not blank. So it will trigger email automatically. So you can see it is triggering a email. So now I test email to this is the name and rest of the message is same because that is a static or plain text must fields are replaced automatically. So this way you saw on creation and on updation on both scenarios. This workflow is working and finding a email alert. So I hope you understood how we can send email alerts by record creation and updation using buffer rules. I hope you understood whatever I demonstrated in this video. If you want to watch more Salesforce training videos, you can search my name Sanjay Gupta on YouTube and you can follow my YouTube channel. Thank you for watching this video.


malaria has many signs and symptoms that are similar to those of other fever-causing illnesses. It is essential to test for the presence of plasmodium parasites in order to guide appropriate case management. New diagnostic tools are needed to detect infected individuals and to monitor transmission reduction efforts. Additionally, improved diagnostic tools for mass screening and surveillance are necessary to detect asymptomatic infections of very low parasite densities. Furthermore, antibody-based tests, biomarker-based tests, and novel methods for the detection and treatment of plasmodium vivax are needed. Rapid diagnostic tests for P. Vivax are not as effective as those for plasmodium falciparum. Drugs for radical cures may cause serious side effects in people with G6PD deficiency, so it is important to know the prevalence of this condition and develop tests to identify at-risk individuals. Research is also needed into the context in which malaria diagnostic tests are used, into diagnostics for other febrile diseases, and into the integration of these tests into health systems. This article was authored by Maliara Consultative Group on Diagnoses and Diagnostics. We are article.tv, links in the description below.


Welcome to Spotlight. I'm Liz Wade. And I'm Adam Navas. Spotlight uses a special English method of broadcasting. It is easier for people to understand, no matter where in the world they live.  It is pizza. Very simply, pizza is a food made by putting meat and vegetables, called toppings, on top of bread. But pizza is not the same everywhere. All around the world, people enjoy different toppings on their pizzas. In Brazil, green peas are popular on pizza. In Japan, food from the sea, like eel and squid, are popular. In Costa Rica, people enjoy the coconut fruit on top of their pizzas. In Italy, the bread or crust of the pizza may be the most important part. It can be more important than anything that goes on it. But in the Netherlands, toppings are very important. A popular pizza in the Netherlands is called the Double Dutch. It has two times the cheese, two times the onions, and two times the beef. It has two times the toppings. As you can see, there are many different ways to eat pizza. And each way is correct. The simple design of pizza is the same all over the world. But everyone likes something different on top of it. It is common for different cultures to have their own kinds of food. Food that is popular in one culture will not always be popular in another culture. But pizza seems to cross all these barriers. Pizza is popular in almost every part of the world. So why is pizza so popular? Where did it even come from? No one really knows where the idea for modern pizza started. But experts do agree that the design or recipe for modern pizza was probably put together using different ideas from different cultures. A few cultures already had a simple, common recipe for pizza almost 2,000 years ago. Even before that, Middle Eastern cultures had something similar to pizza. Babylonians, Israelites, and Egyptians liked to eat flat, cooked bread. They would add olive oil and good tasting spices to the bread. Then they cooked this flat, spiced bread in hot ovens made of earth or on top of hot, flat stones. It was a small food that people ate between meals or they added it to a meal. Another version of this flat, round bread was also popular in Greece. The Greeks called it plankountous. They put vegetables and meat on top of the flat bread. But many experts believe that the version of pizza that people know best today started in the city of Naples in Italy. It was a street food. Poor people there spent a lot of time outside of their very small homes. They could buy this food and eat it easily as they walked outside. One more thing added to the creation of the modern pizza. They put tomatoes on their pizza street food. Today this soft, red fruit is the most popular fruit in the world. But back in the 1700s people thought it was poisonous. But that did not stop them from eating it. Finally the popularity of pizza began to grow. Shops opened where people could buy pizza. In 1830 the first pizzeria opened in Naples, Italy. This restaurant only sold pizza. But the pizza of that time still looked a little different from the modern pizza we know today. However in 1889 Dan Raffaele Esposito created the first modern pizza. Katie Blake tells the story. Queen Margarita Teresa was visiting Naples. She had heard of pizza. But she had never tried it. During her visit to Naples she finally decided to try it. Don Raffaele was a famous pizza maker. She asked him to make a special pizza for her. So Don Raffaele created three pizzas. But he designed one pizza especially for the queen. He added three toppings to the pizza. The first topping was mozzarella cheese. Mozzarella cheese was made from the milk of a water buffalo. A kind of local cow. It is a white cheese. The next topping was red tomatoes. Finally Don Raffaele added basil leaves. Basil is a green plant with a mild spicy taste. These three toppings were white, red and green. The colours of the Italian flag. He called this pizza the Margarita pizza. The queen was very happy. She loved the pizza. And the Margarita pizza is still a very popular kind of pizza today. After this event people no longer considered pizza a poor person's food.  As people began to travel more often, they began sharing the news about pizza. Today people all over the world eat more than five billion pizzas every year. The recipe for pizza has changed over the years. Today people usually make pizza by putting sauce, a kind of thick liquid over the crust. The most popular kind of sauce is made from tomatoes. Then cheese and toppings of all kinds go on top of the sauce. But pizza makers have tried to put almost any kind of food you can imagine on top of a pizza. People all over the world have helped to create the recipe for pizza. It is a food that combines different foods from different countries. And it is probably one of the oldest foods you can think of. But one of the best things about pizza is this. You can create your own special kind of pizza. You can put anything you like on it. You can mix different foods from different cultures and create something wonderful. Who would have expected that such an ancient and simple food would be popular today? Pizza is just one example of how great things can happen when cultures come together. Do you enjoy pizza?  Tell us about your experiences. You can leave a comment on our website or email us at radio at radioenglish.net. You can also comment on Facebook at facebook.com slash spotlight radio. Visit us on YouTube at youtube.com slash spotlight English one. The writer of this program was Liz Wade. The producer was Michio Ozaki. The voices you heard were from the United States and the United Kingdom. All quotes were adapted and voiced by spotlight. You can listen to this program again and read it on our website at www.radioenglish.net. This program is called Pizza, the world's food. Visit our website to download our free official app for Android and Apple devices. We hope you can join us again for the next Spotlight program. Goodbye.


The Santorini Cataclysm is related to biblical accounts. Geologists believe that the explosion on Santorini was the single most powerful explosive event ever witnessed, and that this single event is widely overlooked in the historical context of the effects it had on society at the time. Minoan culture crumbled as a result of the eruption, historians believe, changing the political landscape of the ancient world indefinitely. Environmental effects were felt across the globe, as far away as China, and perhaps even North America, and Antarctica. The legend of Atlantis and the story of the biblical plagues and subsequent exodus from Egypt have also been connected to the epic catastrophe, which exploded with the force of 100 atomic bombs, instantly killing many thousands of people as the blast of Santorini was heard over 3,000 miles away. One of the most epic stories in the Bible is the story of Moses parting the Red Sea as the Israelites fled to safety under the protection of God through the guidance of Moses. It strikes us immediately as a miracle, but one group of researchers disagree. They say the parting of the Red Sea was a natural event, and it's linked to the tsunamis that were triggered as the volcano on Santorini erupted, engulfing the kingdoms of the Mediterranean and cataclysmic occurrences. The eruption on Santorini is one of the biggest eruptions in the past 10,000 years, and only now are we beginning to understand that this is widely connected to other narratives that were described by other cultures at the time, often simply describing an act of God because they simply didn't know what was going on, so the connections can only now be realized. When the waters drew back in preparation for the surge, the Israelites hurried across. The waves roared back in before the Egyptians, whose chariots were trapped and slowed by the wet sand and mud. This is the result of the tsunamis triggered by the Santorini eruption, according to researchers in Spain. Now, we're not saying what we're about to tell you guys is 100% accurate, but what we are saying is that we should be attempting to piece together an accurate overview of the history that's been lost in an effort to properly understand the timeline of the past. Not everything said here is going to be accurate, but only during the process of research are we going to find this understanding. And that's going to involve making some mistakes, and through this process of elimination, we'll hopefully arrive at the truth. So wait till you hear this. Scientists studying the biblical narrative in the Spanish city of Sevel have come up with an alternative answer to the apparent act of God at the parting of the Red Sea. When the eruption happened on Santorini, roughly around 1650 BC, it destabilized the entire region. Scientists in Egypt described structural damage followed by a darkness that could not be lit by a flame, and the follow from this brought temporary climate change that probably had adverse effects on the entire world one way or another. Lava flowing into the sea, land slips, and the subsequent collapse of the caldera generated huge tsunamis that swept the Aegean Sea with waves of 15 meters high sweeping the entire region, leaving sedimentary deposits in many parts of the coast. Even at the far away coast of Israel, there have been found similar marks of the remnants of a tsunami, which have been dated approximately the same period of the eruption on Santorini. The path of the Israelites guided by Moses is described in the biblical story of Exodus in the Old Testament. As written, And the Lord spoke unto Moses, saying, Speak unto the children of Israel, that they turn and encamp before Paihahiroth between Migdal and the sea, over against Baal Zaffan, before Chalye and camp by the sea. Following this text, the separation of the water should have happened in the vicinity of Migdal, a location that's been identified thanks to various archaeological studies developed in the area with the military fortress of the way of Oris. This is on the banks of the Shior Lagoon, which opened into the Mediterranean, to the northwest of Sinai. It could be the Sea of Reeds in the Bible. It is for these reasons that researchers at the School of Agricultural Engineering at the University of Seville believe that the reference to the Red Sea Prating appears to have just been a reoccurring translation error. There are simulations that recreate the old waterfronts of the area around Migdal support this theory. The reliability of the narrative of the biblical Exodus has been subject to heated debate for decades. Recent archaeological studies seem to provide new insight of the Exodus path, and although with a still controversial chronology, the effects of the Minoan-Santorini eruption have been proposed as a likely explanation of the biblical plagues. Particularly, it's been suggested that the flooding by the associated tsunamis could explain the first plague and the seaparting. Recent modeling studies have shown that Santorini tsunami effects were negligible in the eastern Nile Delta. Historians and archaeologists had trouble deciding on the year they were erupted, with dates ranging anywhere from 1645 BC to 1500 BC. Studies of ash deposits on the ocean floor have revealed, however, that when the volcano did blow, it did so with a force-dwarving anything humans had ever seen or have ever seen since. The temp is steely, being a possible description of the effects of the event in Egypt. This would have carried the volcanic ash to Egypt at some point over the summer, and the toxic acids in the volcanic ash would have included the mineral cinnabar, which could have been capable of turning a river a blood-red-like color. The accumulated acidity in the water would have caused frogs to leap out in search for clean water. Insects would have burrowed eggs in the bodies of dead animals and human survivors, which generated larvae and then adult insects. Then the volcanic ash in the atmosphere would have affected the weather, with acid rain landing on people's skin, which in turn caused boils. The grass would have been contaminated, poisoning the animals that ate it. The humidity from the rain and subsequent hail would have created optimal conditions for locusts to thrive. Volcanic eruptions could also explain several days of darkness, which means nine plagues are accounted for. Amid all this destruction, firstborn children could have been sacrificed out of sheer desperation in hopes that such a meaningful sacrifice would lead their gods to stop punishing them. The plagues occurred due to the volcanic eruption and attracted hordes of locusts, and there was evidence of erratic animal activity due largely to the alteration of air pressure and water conditions. After the complete devastation of Egypt, the Jews were able to get away in spite of the pharaoh's soldiers in hot pursuit. In the Exodus, there's a quotation which goes like this. By day in a pillar of cloud, to lead them the way, and by night a pillar of fire to give them the light, Exodus 1321. This state of biblical affairs can easily be related to the volcanic eruption at Santorini. The Exodus dates back to 1447 BC, but this is by no means an exact date due to the fact that it's an anthology of stories. Historians have said that they have no clue to the pharaoh who ruled during the era of Moses which in itself is regarded as the most authentic timing of the story. If the tempestile is to be considered, then a more accurate dating of the event can be related to the pharaoh Amos I, which by the way Amos incredibly translates as the brother of Moses. Yet in Egyptian, Moses, Moses, Mez, etc. means son of, and Ah is a common part of Egyptian royal names referring to the Mungad Aya. The examination of the mummy of Amos' son appears to have died at the age of 12. In the Bible, the pharaoh loses a son to the plague of the firstborn. We'll of course link the findings below for you to go have a look for yourself guys. We're not saying that this is the case, and that all the things said here are the truth, but at least keep an open mind of the study of the past. These things, after all, were told after events that happened and the written accounts could be glorified as origin stories. Bits lost here, bits added there, it all makes for interpretation. In any event, we wanted to make you guys aware of the fact that the eruption on Santorini may have been a driving force for many ancient accounts that were associated with godlike activity. We recommend you check out our video on the tempestile of Amos I, and we would love to hear from you, so sign in to the comment section so we can gather your thoughts on the matter. As always, thanks for watching.