Right now we're facing a crisis of international proportion. It's a healthcare crisis, but it's also an economic crisis. It's going to have long-term impact for us. And we're going to see that the biggest impact is actually going to be acceleration of inequality. The systematic way that we have been built is not holding up. The foundation is cracking. Our duties remain the same. The fact that we should not leave anybody behind again. Many organizations have seen what the impact is of a sudden crisis and how we're able to better navigate this crisis today with the help of technology. And that means the reskilling and upskilling of your own workforce. Jobs of tomorrow are technologically enabled, but also extremely inhuman-centered. It's in the ability to work with technology easily. On the other hand, with this new way of working and especially remote work, we see that there is a huge need of emotional intelligence. We have really to invest a lot in people to guarantee their jobs, but also to allow them the mobility they need on an ever-changing labor market. 8 out of 10 of the young people who are in low- and middle-income countries are going to have to be entrepreneurs. They're going to have to make jobs for themselves. Having creative curriculums and teaching creativity is enabling your learners to have transferable skills, resilience, mastery, collaboration, asking questions, why, how, when. This is what they need in order to thrive in any profession which they choose. The moment you incorporate marginalized segments of society, it changes the product offering. It changes the way that we think about supply chains. When you cater to the margins, the positive externalities in economic terms are pretty enormous. It is critical that leadership understand that the burden of responsibility of driving change starts at the top of the organization so that corporations can give back to the communities, make them more resilient as we deal with these issues around both economic and racial inequality. We need men and women giving the recovery because there is no way we can ever think that a wealth that is lived by men is a wealth that is good for everybody. Now is the moment that we can think about how we use that possibility, the new ideas, the new technology, the new wealth to really create social systems in which we can all flourish. We have the greatest brains, talent, resources in the world. There's no reason that we can't and no excuses that it's too hard or too complicated. Thank you so much for joining us here today. I'm Heather Landy. I'm the editor of Quartz at Work, which is Quartz's edition about the modern workplace. So I feel fairly well situated to join you all here today for this important discussion about jobs and wages and work coming on the heels of day one of our program here, which will look more at economic growth. Today we're going to be focusing more on what's happening in workplaces and with wages and employees. So we have a fabulous panel to help us get through this topic. I'd like to briefly introduce them. Dr. Hans Paul Berkner is the chairman of Boston Consulting Group in Frankfurt. Sharon Burrow is general secretary of the ITUC in Belgium. Geraldine Matchett is CEO and chief financial officer of Royal DSM in the Netherlands. And Guy Ryder is director general of the ILO in Geneva. And lastly, we have C Vijay Akumar, the president and CEO of HCL Technologies. Thank you all for being here today. We'll just dive in because we have a large panel and not very much time and so many important topics to get through. Sharon, if I could, I would like to start with you to ask, what should be the responsibilities of employers toward workers in this new world of work? So I heard yesterday, in fact, Alan Joke from Unilever say that one of the central ambitions ought to be for employers to have zero jobs policy. So for every job lost or displaced, there ought to be another one created. That would be the ultimate. But we need a new social contract for recovery and resilience. And it must be negotiated with employers, with workers, and of course, with governments. We have that the ILO and Guy has talked about this many times, a system of tripartitism that if ever it was needed, it was now. So we have a recipe for the way we actually transition with the justice, just transition through both the climate and the technological challenges, but now the challenges of investing in jobs and decent work, goal eight of the SDGs. So we need investment in jobs in this new social contract. That's the centerpiece. Every working person and their families want to know that there's the security of jobs and a just wage. But they also want to know that they've got universal social protection. So we must work together across employers and ourselves and governments to make this magic recipe work. And for investment in jobs, can I say, sustainable infrastructure, care, mass transit, manufacturing with industry policy to see that we're meeting the technological challenges but building robust, decent manufacturing jobs, repair of our ecosystem and so much more. We know that 1% invested in infrastructure and there are so many employers who want to actually be part of the infrastructure boom. That can get you 33 million jobs. We can get at least double that by investing in care. These sectors and many others have to in fact be financed and the third arm is financing the recovery. Now some of that will come from employers rebuilding their own companies and indeed their supply chains. But it must also come from a renewed financing that has a tax base that actually finances the recovery. It can't come from the previous burden that's been put on people. We need hope and that means that if we work together with jobs as a centrepiece, then we know that we can actually construct a better future. But my last point is we need to support both workers and their rights but also employers, good employers. And so impunity must end. And that means we may mandate a due diligence or risk analysis around finance and investment but around workers and their rights with grievance procedures and remedy. So we build that trust. But investment, investment, investment. It's absolutely critical. Yeah, the World Economic Forum is out just yesterday with its Future of Jobs report. It finds that the workforce is automating even faster than previously anticipated with 85 million jobs expected to be displaced in the next five years. But they're also finding that the robot revolution will create 97 million new jobs. But even still, if those numbers pan out, that's still a huge amount of disruption and a need for reskilling that we're going to see that arguably needs support, not just from business and the private sector but also from governments. And so I'd like to ask Guy, what are the opportunities that you see for new policy initiatives so that we can achieve better outcomes for jobs, wages, and work beyond what the private sector is prepared to do voluntarily? Yeah, thanks very much for the question. What I think is undeniable, however optimistic or pessimistic one might be about the impact of technology, COVID or anything else is that massive changes already taking place are going to accelerate in the future. And here's the bad news. A lot of people have become very reticent in the face of change, not because they're necessarily irrational or ignorant, but because change has been bad for too many people. It's not been managed in a manner which shares the benefits in a fair way. And we've got to overcome that and how can we do that and take advantage of the real opportunities which are ahead? Well, I'm going to follow Sharon in talking about investment in this regard. I put it under three headings, really. We've got to invest in people themselves and that means the skilling, the re-skilling, the upskilling agenda, which I think is a very familiar and central part of this dialogue. We have to invest in social protection. It's the most effective lubricant of change. People can change if they're not going to fall through the cracks whilst they're in the process of change. Secondly, we have to invest in the institutions of work. We're talking, in many cases, of a real rethinking, a re-engineering of workplaces and work organization. And if we're going to make that work in the way that we wish it to, then we simply have to put in place the types of institutions that correspond, the regulation, the laws, the practices, the collective agreements that protect people in these new environments. And lastly, the third area of investment, of course, and Sharon's covered them, are those particular areas where we know there is enormous employment potential in the future, the care economy, the green economy, infrastructure. I'd add the rural economy, which remains fundamental in so many countries as well. And two thoughts just underlying all of that. The first is this notion of a social contract. It's out there. Everybody talks about the need for a new social contract or a renewed social contract. We've got to give some meaning to that phrase. It speaks to everybody. It responds to a perceived need. Now we have to start putting together the components of such a contract. And the last thing I want to add to the conversation is, you know, each country can have a go at all of this, this enormous agenda on its own. Good luck to them. Some will do better than others. But if we really want to move on a common front and move as far and as quickly as we need to, we need very much greater common international purpose, particularly in the face of this global challenge of the pandemic. Thanks. Thank you very much. Geraldine, Guy talked about the new social contract. As you think about that from an executive perspective, what are the things that CEOs and their teams can do to create sustainable working practices as part of that new social contract for workers and whatever this next normal turns out to be? Yeah, thanks, Heather. Now, the way that we look at it and think about it as an employer is that the challenge really has been that over time there has been an increasing separation between the value of work and the value of everything else that we do in our lives. And if you think about it, it's been very much that either you're in or you're out. You know, either you're completely focused on work, but then you normally have issues taking care of the family of society, of communities, et cetera, or you're out of work. And it's been extremely polarized. Now, if we think of a change of mindset in what is work actually about, it's also about valuing the contribution that humans bring not only when they work, but the family contribution, the community contribution, even the environmental contribution.  Now, this is going to be even more true and you refer to it with technology because technology is going to start making it's more efficient and faster to do some of the repetitive rule-based work actually via computer technology. So the value of the human part of what we're doing, which is all about ingenuity, creativity, innovation, empathy needs to start being included in what do we consider work? Now, the way I see hope is that with COVID, it's opened our eyes in my view to two things. One is how quickly things can change when it's needed. And also the fact that we notice that contributing to a goal can be done in very different ways from very many different places and in different form. And I think it's opened up a different mindset of what is work, how do we remunerate it, how do you bring value? And I think the social contract is effectively reintegrating work with the broader societal development and that's how we look at the direction of the next normal. That's really fascinating. And in many ways, we've been forced into that, that bleeding of work and everything else in our lives in a way that we haven't had to handle before. Maybe in the abstract, we were thinking about the barriers and the boundaries between those things. But now when you're working in the same place that you're living and perhaps you have children running around and other distractions, we're all the more sort of appreciative of how these things intersect. You also mentioned technology and so I think that's a really good place to bring in CBK from HCL Technologies. Tell us a bit about technology CBK and the role that you see it in shaping this future of work. Technology has a major role, if not the most important role in shaping the future of work. Technology can create more diverse, more equitable, more inclusive workplaces as well as create new jobs and also modern management practices. The way I see the future of work will be about six things, working from anywhere, work for all, work by choice, smarter work, newer work, and modernized management. Let me take a few seconds to explain each one of them. Starting from work from anywhere, all of us have seen work from anywhere has become the de facto in the current pandemic situation, modern tools, collaboration technologies, the telecom network, all of them have provided the ability for workers to work remotely. And Gartner predicts that 30% of employees will work from home permanently by 2024. I personally believe the future of work is going to be more heterogeneous. It's a combination of home, hybrid, and on location working. And the reason is two-fold. There is a lot of roles that will still require physical presence due to the nature of interface required or due to the compliance and privacy requirements in some segments. And more importantly, the social and the emotional health and the motivational aspects of employees in the long term can be better ensured in the hybrid formats. Talking about work for all with greater number of roles enabled for remote delivery, a large section of the population can have access to newer job opportunities, not necessarily in the economic hubs, which was the old normal, here people can live anywhere in the world. They can choose jobs, choose projects, and employers have a wider access to employees. For example, getting, today we have to take work to people rather than bring people to work, right? This is going to be the real change. And working at will would mean some of the digital technology platforms like Upwork or TaskRabbit or Kaleido, which allows individuals to take on short-term and on-demand positions or freelance work. And it is believed 40 by 20 end of this year, 40% of American workers will be independent contractors. And the reason is quite simple. The new Jenga generation, the millennials, like having the flexibility of choosing when to work and where to work. And they also enjoy the freedom of improving work-life balance by having more control on their schedules. The work will get more smarter, artificial intelligence, machine learning will continue to become more prevalent, both in our personal lives and professional lives. These technologies, while they take over some of the manual tasks, they also free employees to focus on more meaningful work and open doors to a lot of new opportunities. I believe we will see more augmented collaboration with humans and robots increasingly working together side by side. There will be a number of new roles. I think we should not underestimate the potential of new roles that can get created. The jobs that drive sustainable living will be at the center of the 21st century. I do believe this segment will grow enormously. Like 19th century was marked by the industrial economy. 20th century is marked by the knowledge economy. And I firmly believe the 21st century will be marked by what I call as a sustainable economy. And technology and tech companies have a huge role to play to create these new jobs in the intersection of climate change and public services, as well as in consumer products. Lastly, there is going to be a new management methodologies. As these disruptions really take shape and become firmer, technology will play a crucial role in supporting and modernizing management. Using new tools, new applications, new platforms, reconstructing workplace processes, redefining productivity. Some of these are today a little more kind of in the favor of more on-site teams, but in the hybrid model. Some of this will change significantly. So I do believe this is an opportunity to transition from workplaces for efficiency to designing workplaces for effectiveness, resilience and sustainability. And the best part is we don't need to wait for this crisis to be over. All of this can start now. Thank you very much, CVK. A quick note to our audience. If you have a question for any of our speakers, we welcome you to drop that into the Zoom Q&A function. And we will do our very best to get through those. But Guy or Sharon, CVK talked about flexibility and freelance. And we know that there's evidence that those kinds of jobs become part of the safety net for at least in some countries when people are furloughed, laid off, outmoded. How do you feel when you hear about the forecast for that to become a bigger part of the workplace situation? Does it make you nervous? Is it our governments and employers reacting or responding quickly enough to those kinds of changes? It makes me want to say it's a bit more complicated than that. Undoubtedly, technology is a driver if not the principal driver of change in work. That's quite clear. It's always been true. It's always been true. It's always been true. But we have to, of course, take the benefits that it brings. But let's be a little bit careful. Let me sort of say it in a very simple way. The fact that technology is potentially allow us to work anywhere, anytime sounds extraordinarily attractive in many regards. But if it similarly would allow someone to tell me that I must work anywhere, anytime, regardless of my own choice, it's somewhat less attractive. So I think we have a sea change move towards independent contracting as a way work is to be done in the future. Should make us pause for thought. The gig economy, and this is something COVID-19 has shown us, has created extraordinary precarity and vulnerability in the world of work. I'm not just talking about the developing world. I'm talking about people in attics in Manhattan. Their employment status is entirely unclear. They fall down the gaps of social protection systems, and they end up really in a very difficult place. And you see, when we see this as the 21st century employment model, it looks a lot like the 19th century. It looks a lot like the 19th century. The old putting out system where everybody's an independent contractor, it took us a century to build the institutions to put some sort of decency into that business model. So proceed with caution would be my reaction to that. And I would add to that. Guy's absolutely right. But I would add to it by saying it's not the technology. You know, unions working people, they know that they have to work with technology. Although there are technologies that should be very clearly scrutinized because of the dangers of the surveillance economy, and of course the privacy for the public. But it's the capacity, as Guy says, for exploitation through the technology. And if you think that those jobs, internet mediated platform jobs are absolutely breaking down wages and conditions. And they are effectively informal jobs. When unions went to work at the beginning of the COVID to make advances in protecting jobs, incomes, keeping business continuity, advancing the social protection floor, what they found is already those excluded had no access to any of that. And so while some countries put special measures in place, very many didn't. So when 60% of the global economy is in informal work, because we're seeing a breakdown, and even a third of those formal jobs are precarious, you add to that the growth in the informal internet-based jobs. And you ask why? Why don't business want a social license to operate? Now last year at the ILO Centenary Declaration debate, indeed this was dealt with very clearly. It said, irregardless of the employment contract, every worker should have a labour protection floor. It should in fact be fundamental rights. It should be occupational health and safety. And we must now see that as a fundamental right. And indeed adequate or evidence-based minimum wages and maximum hours of work. And I'll leave you with this thought. Even as people see the opportunity for mixing, you know, home-based virtual and physical work, it's women who are telling us overwhelmingly that the stress of working from home with family is causing them in droves to leave the workforce. That's not a consequence of that choice. That sounds good when young people say it. But when they move into a more responsible environment with family and indeed with partners, that's got to be considered, as Guy said, in a more holistic way. And what are the labour institutions we invest in to make sure exploitation is not the jobs model? Absolutely. Hans-Paul, I'd like to bring you into the discussion. You were talking all the time to people in boardrooms. What are you hearing them saying? And what do you think the role of corporate boards should be in planning out this workforce of the future? Well, you know, let me go back to what CBK has started and also what I think the other panelists now have taken up. I think we are talking about a very heterogeneous workforce around the world. And of course, at the one end, you know, in Europe and in Japan, where we run out of people before we run out of jobs because of the demographics, you know, of course, companies and including boards are really pushing hard to invest in people. And very much as Geraldine has said, you know, we need to invest in work-life balance, inclusion, contract for lifelong learning. But that's the one end. The other extreme is, and it already came up a bit, is that, you know, in South Asia, in Africa, in Latin America, 70%, 80%, 90% of the jobs are informal, you know, and even more than are in small and mid-sized companies. And so I think, you know, we have on the one hand, you know, a very, very extreme effort in investing in people and investing in security and learning and so forth. And the other hand, we have enormous amount of insecurity. And I think, unfortunately, you know, in our discussion about, you know, home offers and, you know, how things going to be different after the pandemic, we focus too much on the developed world and on the top companies and what they can offer to top talent. But we need to really see how we can really help. And that's also a job, of course, of the larger companies in the developing countries in South Asia, in Africa, Latin America, and so forth, to really create more jobs to make sure that more people are getting training and that more people are really getting into formal jobs that allow them also step-by-step to build, you know, a good living and more security. And clearly, their technology plays a very important role. Technology is not about replacing people, but really increasing productivity and helping to improve standards of living. And companies, you know, the big companies from the Northern Hemisphere, but also all the other companies need to embrace this and need to change the business model in order to stay competitive and thus to create also jobs and growth that allow us to really make sure that more and more people are gainfully employed. But I would really worry if we focus too much on a very narrow band of talent that we are employing in certain sectors of the world and forget about 90% of those people who really, you know, need to become really a more stable participant in the global economic development. Thank you. We have a question from our audience asking that Internet-mediated platform jobs are often the only source of income for many workers in developing countries, which Hans-Paul just alluded to, and particularly for youth and women. Rather than vilifying the gig economy, should we be working on better regulating and improving it? I wonder if any of our panelists would like to hear. I will take that, Heather. I would absolutely agree with that, right? I mean, gig economy, it is today called gig economy, but if you really reflect on what Hans said, even today in most of the, most countries, there is a significant part of the labor force who are in the informal sectors. It is more pronounced in some of the developing countries than developed countries. So even today there is a need to get better social contracts and better regulations on how we handle that. And whatever we do there is only going to help the whole gig economy model. And while we are talking about the, some of the issues related to gig economy and flexible workforce, we should also keep in mind there is a generation shift. Millennials are different. It does not matter whether they are from well-developed nations or from developing nations. It is just a psychological thing. They need more flexibility. They like more freedom. So we should not ignore those aspects as we develop frameworks and support mechanisms to really strengthen this informal or the contingent or gig economy kind of solutions that are evolving. Flexibility doesn't mean exploitative work. And I don't think you're saying that for a minute. But we can put a flaw under all workers.  We try not to use that because it's not very much fun. But it's not just Deliveroo and Uber and others. This is now underpinning a whole range of professional and technical roles. And when you think about a profession like journalism, even in Europe, you can earn as little as 15 euro a day the price of a going article. Because collective bargaining around fair contract price flaws is almost non-existent. So when guys say we need to invest in the institutions, we do. And can I say, this is on wages. So let me just say one thing on wages. 75% of people say that their income is stagnated or fallen behind. And indeed, we know that the labor income shares been like a roller coaster since the late 80s. In that context, when 76% tell you that the minimum wage is not enough to live on, and we see collective bargaining collapsing, there's no way unless we rebuild those commitments. We will share prosperity and build the basis of a genuine economy where people can actually live independently within an economy where they make choices. So I would just say, flexibility is not the problem as long as it's chosen. And there are two pieces of legislation already, and there'll be more, one in Argentina, one in Spain on digital work. And they actually start to preserve that flaw we're talking about. I wish we had more time to unpack this issue, but I feel that our panelists have left the audience with plenty to chew over as they go about their day and hopefully listen to more of these sessions. Thank you so much to our panelists and to the World Economic Forum for putting this together. And thank you to all of you for joining us today.


All right, we have about 30 minutes for discussion Q&A. What I thought I would do is maybe try to use a system where if you put your card like that, it means that you want to speak. And I'll try my best to try to get you in the order in which you did that. Since my card is up first, I'm going to take the opportunity maybe to pose questions and are well done in putting our three speakers together as a mini panel in the U. So thanks to NHGRI, we have a really prolific ecosystem of genomic medicine implementers with Ignite, Merge, Insight, Caesar. And at least in Ignite, I know we have 17 affiliate groups. And I'm sure there are many others across the other networks. And then there is implementation going on that we simply don't know about. And there's a global community that's implementing genomic medicine. So I guess my question is really, how do we harness the knowledge that's being gained across those communities in a way that allows for us to be more effective going forward? And I'd like to also just pose the question of what action can we take coming out of this meeting that will give us something tangible that we can begin doing to harness that wealth of knowledge? I don't know if David, Laurie, or Alana, you want to respond to that. So I think often getting folks together to talk about what are common measures that we can identify that we could potentially use across different observations, across different studies would be a great thing. So we've talked at the NCI, one of the things that the Cancer Moonshot gave to us was the impetus for thinking about big data and thinking about what a cancer data ecosystem would look like. And the broad discussion has been primarily around the individual sort of biologic level as opposed to the system level. I would love to see getting folks around the table and in the broader community together to say, what would that ecosystem look like that enables us to capture similar data across different health settings, across different populations, et cetera? I'm not sure the degree to which that's happened to this point. I mean, folks around the table might be able to tell me, but I would say that that's a logical starting point because I think until we get there, we're all measuring different things at different times and we can't pool it together as well. So I know a number of the networks that I mentioned are also developing standards. I'm not completely convinced that they're working across one another to your point. So thanks for that. Any other comments from Lori or Alana on that? We've got a lot of other questions around the table, if not. Yeah, I think I completely agree with David's comment. That was the whole point of kind of what we were doing with the IgniteWet network is, are there things that are common to genetic medicine implementations regardless of what the specific intervention is that we could measure? And I showed you the list of constructs and we were actually able to get a lot of those from our sites once we were able to sit down and talk about what they meant and why they were important and how we would collect them. We were actually able to do that, which I think was a remarkable achievement given, we didn't go into that grant with that idea, but it evolved over time. And I think that that could happen at the broader community level as well for sure. Yeah, so again, the same thing holds true as we've started looking at putting a framework around the Emerge network as well because everybody is implementing the return of results, but using slightly different processes, adapting it to their own setting and putting a framework around it allows us to look at that across the sites instead of looking like everybody's doing something totally different. Thanks. Okay, so I've got Rex, Bob, Howard, Bob, these two guys over here with his names I can't read and then Stephen, so let's start with Rex. So one of the things that, I mean, we've heard several times in the presentations that you talked about was you've seen one thing, you've seen one thing. And we're talking about really implementation of genomic medicine, which often occurs with an N of one situation. So I'm struggling as how do you match the N of one environment and you've seen one thing, you've seen one thing paradigm and then how do you go about implementing? And maybe the answer is these common measures that you've just been talking about, but it still seems to me that's one of the biggest challenges that we face is how do we match this N of one world with a paradigm that allows you to make cross system comparisons? My first thought would be contextualizing it, right? So your N of one is probably pretty similar to somebody else's N of one, is similar to somebody else's N of one and if you were to put the framework around it, so you say you measure these things so that I understand what's going on with that particular patient and how that pathway happened. Other people who are in a similar situation would be able to take advantage of that and now the adaptations might be slightly different from individual to individual. The idea that there's some common understanding of what's happening, they will converge over time. Yeah, and I think there's also a lot to be gained for people trying in different settings some quite similar strategies. And so I think there's both the potential, there's sort of common ingredients of context that can be measured. There's also common ingredients of the approach that individuals are taking to trying to get this taken up setting by setting by setting. And so I think there is convergence in the same way that these 61 are now 70, 80, 90 different models started from different places but are often saying the same things based on observations of a variety of different settings of illnesses of clinicians, et cetera. Just to follow up on that, do you have any sense of what N is needed for this convergence to actually occur? So I think it's always gonna depend on what's the question that we're asking. What's up? I suppose. But I think, again, in the same way as we're used to powering trials that are focusing on individuals, we have trials that are powered focusing on other individuals, providers we have trials that are powered on at the clinic setting. The challenge, of course, is at some point our one becomes the universe and it's hard to randomize the universe. Maybe people will try. I would just expand on that a little bit in saying it's sort of a different way of thinking so that the, yes, the N of one, rather than discounting that N of one is by using standard frameworks and reporting structures and outcomes and comparing those N of ones, as David just said, until you get your bigger universe, that's the point of looking at it this way is so that that N of one doesn't become just to oh, that N of one, we can't use your data. That data is just as important as this other N of one data and this other N of one data and that's what's gonna move the field forward faster and help us implement genomic medicine or anything more efficiently and effectively. Let's move on to Bob Nussbaum. Those were wonderful talks, I learned a lot, thank you. I was struck, David, by the comment you made about who is it that coordinates all this care and what I was struck by in all of your presentations was they were very dispassionate but I think the patients were all passive receivers of interventions and I didn't see how the patients were actually being factored in as active movers because they are. Yeah, I think it's a wonderful point and again I think one of the challenges is sometimes we have days and weeks to talk about these things and so in the 20 minutes one is selective but other ways in which that point exactly has been front and center, I've used this cartoon that has this person who's selling snow cones in a very cold place and someone else sort of taps them on the shoulder and says it's not or demand, it's supply and demand and it's exactly to make the point that too often we make that assumption that we know exactly what's needed as opposed to starting with the person who presumably all this is intended to benefit and saying what is it that would be most helpful. So, but yeah, it's a great point to say that it was an end around, I guess, but yeah. And I would also say too that while I think a lot of our talks did focus on the more organizational and setting level, some of the point of these models and frameworks is to remind us to move beyond that focus on just the intervention being effective to improve a health outcome for an individual patient and look at is it also feasible in the context of your healthcare setting? So it's not an either or it's all of it, patient and the setting and the providers and the staff and the broader environment. So again, and PCORI is doing a lot with that, making sure that the patients are engaged in this process. And so there are another place that we can look to. Thanks, Howard. Thanks, Jeff. Thanks for making me hungry for a Brazilian steak by you when you tilt, when you put it up, it means you want another portion. Oh my God, I'm sure, I was wondering where that was coming from. I know we have a break coming up anyway. Yeah, you can have chicken or you can skip the chicken hearts though. One of the things in oncology that we've had a problem with is rapid adoption is usually more driven by economics and champions than it is by process. And we suffer from that in terms of almost everything we have now in terms of the therapeutic side. But how do we drive away from a semi-panic implementation, which is let's get something going, which is why we have so much disparity even within an institution, towards something that's more process oriented. And I think the frameworks are nice if you have the time to sit there and talk them through. But typically a study comes out, KRAS is now mandatory if you want to prescribe a Tuximab and get it paid for, and therefore it is done. And certainly precision medicine is just full of that sort of thing. I'd love to get your thoughts on how do we practically move away from this lack of strategy? That's an easy, no, incredibly challenging question. So I mean a couple of things come to mind. So one of which is to what degree can we at least be able to use these rapid experiments to learn from? So how can we by studying the ways in which we are doing the best that we possibly can given these external influences and learn from them in terms of what's going well? Usually it's a longer process than that initial step. So I think that we can use those natural experiments to try and learn from. But the other thing I think is a broader way in which, and that was that very quick shot of the learning healthcare system and precision medicine and implementation science coming together, is to think about, again it may not be the latest crisis or the latest thing, but to think about over time how are our systems built to take on these things which I don't think we've always done such a great job of. And so to some degree expecting that the next thing that we have to deal with is gonna pop up in the next couple of months pushes us away from at least saying oh this is a crisis that's already on us. So again I think there have been other industries that have said how do we re-engineer our system so that it is able to account for the uncertainty that's coming in the future and I don't know that we've done that as well. So that was just too quick. Actually your second point was exactly what I was gonna say is if you put in place your infrastructure so you know you're gonna need the ability to do specific genetic tests in order to drive the chemo therapy for your patients. If you put into place the framework and we know that champions are great but they are definitely not sufficient. It just makes things very scattered and dysfunctional. So if you have an entire, you understand the ecosystem, you understand what does it take when you need to add a new genetic test? Who in the lab needs to be involved? How does that process happen? Who needs to have the buy-in? So if you have that whole process thought through each time they come out with some new paper that says you need to by the way add this you already have an implementation infrastructure in place and the buy-in from the health system that you're gonna be able to adapt more quickly. I'm not saying it's gonna be easy but you have a process for adaptation that's at least controlled. It's great for the places that are in this room. I'm thinking of, at our place we have an implementation department and it doesn't matter if it's a new scan or new test but most care for everything, not just cancer, is out in the community and there just is not the time to think much less do. Yes but they're also not doing K-Rest testing for most of the time. No they are because they don't get paid otherwise. Precision medicine has been adopted in the community way faster than in the academic setting and so because of these other drivers, so that's some of the challenges that are there. So I would add on that too and my question to you would be then, do you have the infrastructure in place that there's at least some of that data you know which, because you have to know which patients got the K-Rest testing so you can get paid for that, do you have the ability to pull that and say then yes, we know that all of our patients are getting K-Rest testing or that they're not so you know that there are some providers who still aren't doing it, don't want to get, apparently don't want to get paid for it. But again, using the other half of this is the evaluation. Using that data that you're already looking at because you're already saying, okay if I have to use this to get paid, I have to know that my patients are getting it so that my community setting is getting paid. You can report on that and what's happening and that helps the broader community with the one thing that David touched on too which is the de-implementation. What isn't working? Thanks for that. Just one take home message I got out of that discussion was that how much financial pressures and are really what may be driving a significant driver of implementation, particularly not outside of the non-academic community. Next is Bob Olden. Thanks also for all those wonderful talks. I'm really interested in digging into this deeper and so glad to see that the links and so forth on the slides. I recently was reading a paper where implementation framework was used and it seemed very complicated and challenging for me because I'm not used to it and began to think about what is the evidence that a framework like this actually helps things move forward as opposed to, say, guided chaos. And I think if I was trying to do something in my own institution and went to a clinician and said I need you to participate with this because it's a systems thing, they would say the same as they would say if when I go them and say let's do pharmacogenomics they say what's the clinical utility? So that's my question. What's the evidence? One of the things I wanted to say to your question is not, there's a lot of evidence that the frameworks and the constructs within those frameworks are you work and are useful for implementing evidence into practice or implementing things into any change. But one of the other things that you brought up was this you go to a clinician and they're gonna tell you I don't do research, I don't wanna do this. But and I think that's why there's been so much work into the pragmatic use of re-aim and what full disclosure re-aim is my first implementation science language. I worked with Russ Glasgow so I've sort of ingrained it into my being. But it's very simple, it's very approachable and they've used over time this more pragmatic structure to facilitate that conversation rather than going to a clinician and saying hey we need to use this framework and look at specifically these outcomes. Just questions, who are you trying to reach? What is the benefit you're trying to create and you can show then how this once, that everything that they wanna do fits in this framework and here's how we can then turn around and present it so that it's useful information not only for you clinically but for the researchers and the broader generalizability of it. I would just say, I mean there are over 100 studies that have shown that using an implementation framework is very heavily used in mental health. But the ICU infections is sort of the perfect example of how that's useful. Also there've been a number of studies in cost effectiveness for blood transfusions where they use an implementation framework and greatly decrease the cost for the health system. So I'm happy to give you a whole bunch of them but there are a lot out there. They just aren't always sort of tagged as this is an implementation science study and so you don't always know that the benefits were due to that. Okay, I've got Peter, Lincoln, Steven, Dan, Bruce, Terry and then Casey. So Peter. Thank you, so great to start with implementation science and this stuff tales a little bit with Howard's comments that a lot of this is happening at the community level and that's included in our organization. We've been trying as we try to implement different pathways to bring more rigor to that both internally with implementation science and it's interesting too with this concept of de-implementation because we try some things and realize, hey that didn't work the way we thought and we need to pivot a little bit. My challenge is we do have some internal funding and we're looking for external sources but the typical NIH cycle for funding these types of projects or just projects in general really isn't realistic for an organization like ours that needs to make a decision. Hey, we need to shift gears because of other pressures as Howard mentions. Is there a novel way or a thought process to this roadmap where there may be other sort of callous funding in this space to help us bring this information to the sort of the general academic knowledge as well? So great question and I think no matter even when some of our institutes and centers at NIH have done these sort of rapid mechanisms, it's no not as rapid as we would really like. One of the concepts that we presented publicly so that we can talk about it as part of this moonshot effort is to create these broader sort of implementation science centers and I mentioned on one of those slides that precision medicine might be this really lovely example of how this could be particularly useful because it's evolving so rapidly. Part of that is this idea of setting up these natural laboratories to study implementation and it would be thinking about what kinds of community or clinical sites might be willing to partner together and with researchers and have much more fluidity in terms of being able to identify as a center pilot studies and moving things forward. So that's along those lines and I think it's an ongoing challenge for all of our agency folks to say how do we balance between the work that needs a little bit more time to be fully fleshed out and the emergent need that comes in community and clinical settings and probably useful to any of our strategic planning efforts over these days. Just along those lines I know that Muin is not here today but he published a few years ago a data that suggested that the funding of T2, 3, 3 and beyond research was the NIH was 2% or less maybe even at NCI. How has that changed maybe from your perspective or perhaps Eric's in terms, has there been a shift to the right in a sense of the funding along the translational pathway? So I guess the quick answer is we have seen increases broadly in terms of funding. I don't have, we do our portfolio analyses that look at the trajectory over time and certainly we've seen increases as well as more people who maybe their primary question is around the effectiveness of an intervention including questions about implementation so it's both sort of expanding those solely focus on implementation and expanding implementation focus within other parts but it's still gonna be relatively small and the biggest driver from my experience has always been what's the denominator of studies that are coming in that we can fund? So across NIH we have typically a success rate and typically percentiles. The higher the denominator is in a given area it seems like the more ability there is to fund studies but if we have too few studies or if people say I'm not sure this would get funded and don't apply then there's no way they can be funded. We also do have a standing study section that specifically focuses on implementation and so that's been an effort to try and drive more but I don't know if others wanna make comments but typically it operates the larger the size of the community, the larger work we can get done. Yeah, I think to date much of this has been institute initiated rather than invested initiated for many of the reasons that David elucidates and that the peer review system sort of isn't ready for this or isn't seeing it as being ready for prime time and that's a real challenge but the only way to get it there is to keep knocking on the door. Right. Lincoln. So there's been this ongoing debate and we even talked about it this morning about how much evidence is needed to really justify implementation of genomic medicine in various verticals and I'm increasingly suspicious I think others are that there isn't a single randomized phase three study we can conduct that will convincingly result in the data we need to implement genomic medicine. I think increasingly it's just becoming, I think it almost has to be something of an executive strategy at some of these institutions where they decide we think that the metadata is sufficient that we're gonna do this for patients. And so I'm really intrigued Elana by what you had to say about the experience at Geisinger and using the 59 ACMG genes and you're gonna be sequencing patients and that you're gonna be targeting just the GHP patients initially. And so did you go and have a conversation with the GHP leadership or how did you decide, I'm guessing that GHP is gonna pay for that and what was that conversation like and how did you decide on that strategy to target those patients first? So this was a strategy. It was decided by the group that decided they wanted to implement this program and try it and see what we could if it could be done. And the health plan had said, well, we need to take on that risk because we can't ask other health plans to pay for this if it doesn't work. I don't know if there's a better way to say that. Yeah, it's actually beyond health plan. It's Geisinger employees who are covered under Geisinger health plan. And I think the piece that we forget about is that most of the insurance decisions made in this country are made by employers. Employers are like Geisinger that are large employers are self-insured. So they're actually their own insurer. And so when we think about this, we think about what is, where's the biggest return? What we call the sweet spot. And so if we have issues where a health related issue might impact a person's ability to be at work or be effective when they're at work, the presenteeism, absenteeism, that's a cost to the system. There's the actual medical cost, the insurance cost to the system. And then there's the personal cost to the individual, into that individual's family. And so we think if we can operate in that sweet spot, that's where we can have, show the biggest return on the investment. And so that's why the decision was made when we wanted to launch this critically to go to the health plan. And the health plan has something called a quality initiative. So they recognize that when the system provides better care, they actually run a higher margin. And so part of their contribution back to the system is to say, we want you to do more of this. We think that this is a virtuous cycle, so they invest in it. And this gets to Peter's point too, which is we don't look to the NIH to do this sort of rapid cycle because they're not set up to do that. If we have an interesting research question, then we'll go to NIH. But this is an institutional commitment, which I think, Lincoln, you were also alluding to. We have to invest in this, but the payoff is that if we actually invest in this, we do it better, and we can actually measure the return to the system. And piecemeal implementation always costs more than thoughtful implementation from the system perspective. So in some ways it's a cultural change that we've been through and Intermountain has been through and that other systems haven't quite gotten to yet, but that's the way we approach it, and that's the reason why we have willing partners to say, we want to go ahead and move forward with this because the research project that you'll hear more about this afternoon has convinced us that there's real value here. And so I actually think this is a huge key to how a genomic medicine can be implemented at scale. And there isn't a single research study that any of us can publish. It is going to convince everyone to go and now implement this. The barriers are really significant. And so it becomes a question of, can you present sufficient data to your partners on the payer side that this is worth implementing with the promise that you will measure outcomes and return those outcomes back to the payer. And it does become that virtuous cycle. And then you gain enormous credibility and you can begin to argue for additional implementations. I think also patient demand is gonna be a driver in this space too, because we see it certainly. And eventually if enough patients are demanding this, right or wrong, we have to guide them, but that's gonna be a significant factor. So how do we educate the patient on the promises versus the hype? That's right. And that's part of where the executive strategy comes in is executive level decisions can be made based on consumer demand, right? And they're responsive to that. Yeah, actually in a first genomic medicine meeting, GM1, one of the key drivers that we found across the communities that were already beginning to implement genomic medicine, more the fact that the C-suite, the CEOs or CSOs of those organizations had embraced it and said we're gonna take the risk. So I've been told by the boss that I can go over time a little bit since there's some changes in the schedule a little later today that will not make us late for anything. So I'd like to see if I can get as many of the additional questions in as possible. So next I think is Steven or David. I can't remember, didn't see who's sign was up. Thanks, Jeff. Really awesome stuff and I look forward to getting those slides. It really strikes me that this field of implementation science is ripe for NHGRI engagement. As I've listened and looked through some of the URLs that you suggested, it does seem to me that there's a lack of interoperability amongst these various frameworks. And at least for genomic medicine, it does seem to me under this NHGRI remit that there ought to be certain characteristics that define optimal framework choices and something that maybe would be a helpful offshoot of this conference would be just a gathering to actually determine what are the critical components of a framework for genomic medicine implementation. It strikes to me that we need both cost and outcomes that those are really critical. We need both dissemination and implementation and we need to stretch from individual benefits all the way up to policies. And as I look at the choices that there are, I'm not sure there's something that's really tailor made. So I guess I'm supposed to ask a question. And so my practical question would be given all of that. You've given us two examples of genomic medicine initiatives in Ignite and Geisinger where you did choose a singular framework with CIFER and REIM. Could you explain how you made those choices and to what extent you would agree with me that we need maybe a custom interoperable set of guidance in terms of as a community where we should go with this as opposed to selecting one off the shelf. So I will say, I completely agree with you, right? So that's what we kind of did when we went through CIFER and we said, oh, look, the patient's really missing from this part and, sorry, I can't look. I know I'm speaking to the microphone. That's really awkward, I'm sorry. But so, yes, we completely agree that there needs to be some customization and so we kind of tried to start that process. And then I should have said that CSER also is in the process of doing this and they were kind enough to want to learn from the work that we did in Ignite and so we've kind of incorporated the things that we were doing in Ignite with the things that they're doing there to try to come up with a new sort of updated genomic medicine model. And I know Carol's working on a paper that I'm supposed to be writing, so. Anyway, I think that bringing the communities together to continue to build this knowledge would be, I think, ideal way to go and I'm not sure we picked CIFER just because it was very broad and didn't define limit the constructs that we could look at. And so, to answer the last part of the question first is how did we choose ReAIM? For both eMERGE and the, sorry, I can't turn the speaker in the microphone either. For both eMERGE and the, for eMERGE it was because it was an, it was helped to answer the question of everybody's doing something different, how do we look at those adaptations and measure them across the sites? And so it was a framework that helps us do that. Same thing with the clinical sequencing is it was a way to show how ReAIM fit to show how we can take the questions that they're already asking and the outcomes that they want to use and put them into a framework that is then reportable and with the guidance to say here's the things that you need to report that you're already collecting data on how you can report them in a way that makes sense to you. So it was really giving a framework so that instead of it looking like the Wild West that you were just throwing it out there that here's a framework that helps you really put some structure around it. And that also what I will say with the, you know, with what's going on with the other networks using CIFER, all of this. There are lots of models out there and I don't know that it's a matter of finding the one model. It's the more like Lori's checklist idea. The point isn't the checklist, the point isn't the model. The point is putting the structure around it and one of those things we want to make sure that are measured and reported upon, the framework or the structure that you use to do that may vary based on or the framework that fits may vary based on your question or your study or your project that you're implementing. I just have one other thing. Based on the conversations that we were having earlier, I think one of the challenges that Genomic Medicine has is very different from anything else. Most of these implementation studies are things that are not expensive to do. Handwashing in the ICU is not an expensive intervention or are things that will decrease the cost to the health system and there's no reason for a payer to be involved in the decisions around these implementations. I think it's very rare that in Genomic Medicine where you're so beholden to the payer because it's so expensive and there's such a large infrastructure that needs to go around it and because of that uniqueness to Genomic Medicine, I think it really does take something at a higher level than the individual. So in your case, thinking about the community of people, if there was some sort of broader network or infrastructure that was available to them at a higher level so that when these things came out, they could just tap into and say, okay, now I've got my built-in pathway to do what I need to do. But that's a different level of commitment. But I think based on what people are saying is that's what you really need to make this work. That's just my thoughts. Thanks, so we've got Dan, Bruce, Terry and Casey and then I think we'll be at the end. So Dan? So I've been listening to the back and forth and I'm not sure what my question is. I couldn't resist the opportunity to say something. So one thought was my initial question was gonna be to Elana and that is sort of the mechanics of implementing the ACMG-59 in the Geisinger Health system. So how many people, who pays for it? How do you return, what do you return, those kinds of? I'll be going through that in a second. Okay, so I would echo what I think Laurie just said and that is that this appears to only happen in institutions where the leadership has drunk this Kool-Aid along with us and each one of us has sort of a different twist on that. So you have your ACMG-59 and we have predict but I mean the idea is that we're all sort of learning these lessons in a different way as opposed to the cancer space where there's this tight link to therapeutics. You can't prescribe expensive drug X without doing genetic test Y. So the problem I think that we have in implementing genomic medicine from cradle to grave is that we don't have a single payer system, we don't have a person who's gonna be a steward of that genetic information across the span of a lifetime and we don't know exactly what to use when. So this is a problem in pharmacogenomics, it's a problem in the rare variant genomic stuff and so I think that we're ending up being a fragmented community and maybe one way forward is to sort of have meetings like this where we decide as a community where do we put our oomph and I'm not sure how to do that but that's the sort of fundamental problem that I see right now and I wish more people would drink that Kool-Aid. Yeah and we might also learn from other systems outside the United States that are. Again who have the sort of, I hate to sort of be a complete pessimist but who do have single payer systems for better or worse and who do have mechanisms to aggregate these very, very large data sets. I mean that's the other part of the cancer business that by making people contribute data to very large common data sets everybody gets smarter about what variants do what and we're not quite there yet even in the pharmacogenomics space. Dan I just jump in here though and say I agree with you completely but the problem is those people are not in the room today and we need to figure out how to address that I think. I mean we can all go back and be as persuasive as we're capable of to our guys but yeah. Okay Bruce I think was, yes Bruce you're next. Yeah thanks. It was wonderful. So I think the discussion has focused on implementation into the existing sort of paradigm of medical care and maybe that's the scope of this meeting but I'm wondering where disruptive innovation fits into the picture and I guess that could be things like direct to consumer testing or app based medicine or social media and I suppose we could let natural selection take its course for those things realizing it's possible that will be the victims of it or is there a way to harness the implementation sort of science approach into this larger sphere than just existing medical care systems? I think so. I think that in all across medicine most of the NIH institutes have the studies that are looking at this particular app or this newer approach or direct to consumer advertising in some limited scope and we haven't necessarily thought about how to put those together. It's such a rapidly evolving and expanding base. The idea and that was that thing starting from if anyone still has that mindset that the best way to inform a population is through that initial peer review obviously were a few years past that. So I think it fits entirely into the space. I mean broadly I think implementation is really trying to understand what is able to be supplied, what is demanded and how do we try to use all of the knowledge that we have to try and drive toward better health and better health care. And so I think it is fragmented. There's so many different ways in which we can approach this. It's also understudied. So I think we don't do nearly enough in our NIH portfolio to focus on dissemination and how information is transmitted through a whole range of different technologies as we should. In cancer we have a health communications branch. Most of NIH doesn't really think about at least in as vibrant a portfolio about the ways in which communication is changing, the need for care, the request for care, et cetera. So yeah to me that's all part of this space. Okay Terry. So I wanna agree with what David said and sort of maybe build on it a bit. We ought to think a little bit about what we're asking for because it seems like early this morning we all sort of decried the fact that payers aren't paying for this and so we need to do research to show them that they should pay for that. Is that really the NIH's role? And then we heard from Howard what happens when a payer mandates something that then there's this whole infrastructure need that needs to be had. And so if the holy grail is actually getting people to pay for it, do we need to also to think about what happens once we have the grail and how we drink from it in order to be able to get this to actually work for patients' benefits? On that David or others or Howard, but it seems sort of the first time I ever thought about that was oh my goodness once they're paid for it then we have a whole nother set of problems to deal with. Yeah I mean I think again from our observations across a whole range of different health topics we have a lot of things that are paid for and people don't get it. So it is and people there have been tables that we've sat around where the issue has been all we need to drive for is that payment decision. But because particularly as we cascade outward and say well what is it that we actually need to provide in order to make this information used to the benefit of people and it's far more than what we often start with right? And so yes I think we see the economic aspects as necessary but insufficient and that if we assume that that's our one audience then we miss all of the other ways in which care is suboptimal and health is suboptimal. And I think also we can use this to our advantage. One of the, there's been a massive improvement in our region for lynch screening and the improvement is not implementing of lynch screening. Improvement is MSI testing allows you to get immunotherapy. And so now everybody is getting lynch screening not to find lynch but to find eligibility for immunotherapy which finds a bunch of lynch patients. And so can we harness the evil for good if you wanna call it that in terms of trying to make sure that we can get a lot of these things for and it's you know if I knew how to do it we'd already be doing it but you know there are some opportunities emerging to kind of use maybe inadvertently achieve our goals through a process that we didn't expect. If I can just add to that though I think one of the things that we consistently encounter and maybe it's an oddity of an academic health system but is you know we're all the true believers right but then you try to go to the primary care providers and it's really hard for them to even think about how to do this. You know we've all done experiments in our health systems where we try to implement pharmacogenomics for example. You're biasing the 430 debate. Isn't part of the fundamental problem and I'm looking at Eric now because this is sort of part of the fundamental problem of genome science is that we're looking at large populations and trying to find small subsets of those populations that because of their genetics deserve different treatments deserved a different approach to care and that's gonna be the fundamental problem with the payers because the payers want a population approach payers not interested in doing a thousand genetic tests to find one person who is different or a million genetic tests to find one person who's different. So that's the problem that we should have end up grappling with and need to think about in terms of a strategy for going forward. Although I think the OM in our name answers the question so yeah so you do a thousand genetic tests and you find people who are at risk a thousand different ways but then you have to have a thousand different implementations I know you know this I'm speaking to the camera. So guys I just wanna let's we just need to get to the some closure on this session so I wanna Robert do you have a quick follow up to that really quick. Just a quick thing I mean the challenge also I love the theme of fragmentation and the challenge is how do we take a public health perspective when this is fragmented across specialties so OBGYN, cardiology, pharmacogenomics all of that and across time because there's so much about genomic medicine that will land across the decades of a person's life rather than in some narrow window like a treatment perspective. So I just wanna keep those fragmentations in mind and I'm curious whether implementation science has precedence for looking across specialties and across decades in the way that I think some of us believe genomic medicine will really find its true value. Yeah so you were not allowed to ask a question just kidding but if you wanna respond to that that's fine. So yes I think there has been limited within and again I think all the caveat is within some of the stuff that we've done at NIH because we end up being siloed into different mandates different institutes but there is precedence for it and I would say that the best example is looking at all of the efforts to try and manage care for various chronic illnesses and in some cases multiple chronic conditions which requires thinking about some of the Ed Wagner's chronic care model thinking about broader across different systems primary care specialty care, allied health professionals, care managers, et cetera. So I think there is but I think it's how broad and how complex are a piece are we willing to take on, we need to but it's a question of are there manageable components of that so that the study doesn't have to be the universe. So I think that's where our challenge has been. And the last question of the session we'll go to Casey. Keep it short since we have a session tomorrow where we get to talk a little bit more. Let's get closer to the mic please. So my question is around health care technology fits with the framework. So I often do start with these different frameworks and models when I'm thinking about technology interventions and I run into the challenge of figuring out, okay, if it's not a perfect fit can I make an adjustment? And so I thought it was great that the paper that Lori brought up they actually proposed additions to those models and so I'm just curious how that went over and what's that process when you have to kind of make those adjustments? Well first, one of the studies that came out while we were working on the CIFER draft model was the ERIK where they looked at all the different implementation strategies that are possible and then they categorized them. And so technology is very heavily used as a implementation strategy. Clinical decision support they claim as a implementation strategy if you want to spread the awareness about how to respond to a particular patient and you get a pop-up alert in the EMR that's actually a way of implementing that change in care for the patient. So we strongly believe that implementation and technology go hand in hand, particularly around genomics, but in terms of actually adapting the model that's just a, I get people emailing me still all the time saying I'm interested in using this, this and this and what do you think and then we take that information and at some point like we are now with CESAR sort of publishing an updated version of what does this look like now that people have used some pieces of it and have feedback for us. Excellent, so in 30 seconds I'm just gonna summarize what I heard in the last 50 minutes. Headlines being standards, we started off with standard measures across various implementing groups including the patient voice, generalizability and dissemination, the need for infrastructure for implementation science, the need for funding for implementation science, having an executive strategy that engages the payer community, providing guidance to our community in terms of which implementation frameworks might be optimal for genomic medicine, encouraging disruptive innovation outside of more inertia-based healthcare systems and probably most importantly is the alignment of the economic incentives to implement. So I think that was kind of some of the gestalt for today and I wanna thank our panelists and also the engagement of all of you for a terrific first session of this meeting. Thanks. And now we're gonna take a break but I don't know when it ends. Yes, thanks very much Jeff. I will tell you when it's gonna end. So we're gonna take a break and we'll come back at 11.15 to reconvene. But thanks everybody, this was fabulous.


In the previous segment we talked about software components. In this segment we are going to talk about constructors. So as motivation for this let us examine the queue struct in TaxiDispatch. So this is the definition of the queue, the queue struct and if you remember there was an array of elements storing the weighting drivers IDs, then a few variables, then an initialize member function and insert and reboot member functions. The main program looks something like this, so we started off by declaring, by defining the queue, creating the queue and then we called queue.initialize. And then there was a fairly long, well there was a loop which I have not put up over here. I want to look at these two statements. There is a simple problem over here which is that a programmer may forget to call initialize. People forget. What do you do? It turns out that the designer can ensure that n weighting and queue front will become zero which was the job of initialize if you remember even if the programmer forgets to write this. How that happens we are going to see in a minute but that is the idea that somehow when we create the queue we will execute something automatically which will cause n weighting and front to become zero. So this special code that we execute at the time of the construction of an object is called the constructor code. So basically the constructor is called whenever an instance of a struct or a variable of a struct type is created. Now inside the body of the structure definition, the structure type definition, a constructor has the same name as the struct and it does not have a return type. So we will see that. For struct queue these were the members and here is the constructor. So queue there could be parameters but this particular constructor does not have a parameter and then we are going to give the code that is to be executed. That is it. So this is what the constructor is. And in main the moment I define queue, I define small queue as an object of type, structure type queue, this code is automatically going to be called. So the variables will be created and then this code will be called. So the code inside the constructor is expected to perform initialization of the members. But of course it is any code so you can make it do whatever you want but that is why, but its purpose really is it was intended, the notion of a constructor was created so as to enable initializations and enable initialization. So it is really the designer who is keeping track and saying that oh look when you create you need to initialize and therefore I will give you a way of making that happen automatically. And then the user just writes this and the initialization happens. So the constructor is called automatically. So in general we can have constructors in any struct. So here is a struct x which is being defined and here is a constructor. So this is the body of the constructor. And in main I can have, I am declaring little x to be an object of type capital X and I am supplying these arguments and this will cause this constructor to be called. So the constructor can take arguments and the creation of an object x in the main can be thought of as happening in two steps. First the memory is allocated for x in the activation frame of main and then the constructor is called on x with the given arguments. So this code executes but with respect to these arguments and if you have members referenced over here they are considered to be the members of this structure, of the constructed structure. You can have many constructors provided they have different signatures and we are going to see examples of this as well. So here is an example of constructors for v3. So this first constructor does not take any arguments and it just sets all the members to 0. This constructor takes a single argument and it sets all the members to that single argument. Are these useful? Well if they are not useful you can define your own but I am just showing this just to show you what the possibilities are. So how does the main program work? Well when the main program works when defining v1 here an argument has been given. So the constructor which takes a single argument so since a single argument is given the constructor taking the single argument is called. So this is the constructor which takes a single argument. So thus it means that v1.x, v1.y, v1.z are set to the value 5, set to value a which in this case is 5. When defining v2 no arguments have been given. Well note that we are not putting parenthesis either. So this is kind of a non-uniformity but that is what it is. We are not putting parenthesis. So we are defining, we are just giving the name of the variable which is being defined and since no parenthesis argument, no arguments are given we look in the definition of v3 and see if there is a constructor without arguments. So this is the one. So this constructor will get called v2.x, v2.y, v2.z will be set to zeros. So that is how constructors work. So these constructors work. So now you might have wondered we have been creating all these structures without even knowing about constructors. So what was going on then? Well it turns out that C++ defines a constructor for which takes no arguments and does nothing. So if and only if you do not define a constructor. So in the earliest examples we did not define any constructor but you could think of it this way that C++ supplied a constructor which was really doing nothing. So you could say that look there always is a constructor either something provided by C++ or something that you provide. Now there is a technical term which is very commonly used which is the notion of a default constructor, a constructor that does not take arguments and this constructor might be defined by you or by C++ is called a default constructor. If you define an array of struct each element is initialized using the default constructor. So if you want to construct an array of a certain kind of struct then you had better have a default constructor. So now look at this line. So if you define a constructor then C++ does not define a constructor. So if you define a two argument constructor then C++ will not even define a zero argument constructor but if you want an array of struct then that is not a satisfactory state. So if you define a two argument constructor and you want to define arrays then you had better also define a zero argument constructor and it could do nothing but that is fine. That is what C++ would define on its own anyway. One more remark. So if a member itself is a struct then its constructor is called first and even this is the default constructor. So or however that constructor is used. So for example struct point XXI I have struct disk point center so when constructing disk center will be constructed according to the constructor of point. So what have we discussed in this segment? So we have said that constructors can be defined so that variables get initialized in the initialized the moment they are created automatically. There can be many constructors with different signatures. Next we are going to talk about something called operator overloading but before that we will take a quick break.


WJC-T Public Media and the Florida Theatre presents Spyrogyra performing live at the WJC-T sound stage on Friday, July 1st, 2022 at 7.30 p.m. Visit jacksmusic.org slash events for tickets.


My fellow Americans throughout the history of our Republic many a candidate has promised that if elected he would clean up the mess in Washington. Well when I got to Washington six and a half years ago I found the mess still here. Our federal government was weighted down with waste victimized by fraud and out of step with modern management techniques. We started on day one to set things right. To begin with we brought in top-notch inspectors general for federal departments and agencies who were instructed not only to be tough on waste fraud and abuse but as my press secretary Jim Brady put it to be as mean as junkyard dogs. In March of 1981 a council on integrity and efficiency composed of these inspectors general was established to ensure that our cleanup operation left no stone unturned. Over the years you've probably heard snippets on the news about outrageously expensive wrenches purchased with the military and other stories concerning government waste. More often than not what you've been hearing are success stories stories of waste or fraud uncovered and corrected. In the last few years we've made enormous strides in our efforts to ensure that you get the maximum benefit out of every tax dollar you send to Washington. Already over 90 billion dollars have been put to better use since we took office and I fully expect this trend to continue. Just this week I signed HR 1444 which will improve the government's tools for weeding out fraud and abuse in the Medicare and Medicaid programs. Furthermore through Reform 88 my government-wide management improvement program efficient new business techniques have been put in place. This includes a new comprehensive cash management system that now oversees the federal government's 1.8 trillion dollar annual cash flow. By relying on the existing private sector banking structure the new system has reduced cost from 1983 through 1986 by 2.3 billion dollars. We've also reduced the federal publication inventory by one-fourth at a savings of 35 million dollars and by using private travel companies the federal government has saved 762 million dollars in its annual travel budget and the list goes on.  Over at the Department of Education for example we found that many individuals some in high paying jobs simply ignored pleas that they repay their long overdue student loans. Our efforts to crack down have paid off. Collections of loans have almost quadrupled since 1981 from 80 million dollars to over 300 million dollars last year. Last month budget director Jim Miller announced that the entire federal government will be accelerating the drive to collect the delinquent 68.3 billion dollars it's owed but peace by peace change is not enough. In 1982 we established a commission headed by Peter Grace one of the country's most prominent businessmen to set down a long term strategy for streamlining our government. Mr. Grace put together a team of experts and went through our federal government from top to bottom. Their report is now the basis for ongoing reform that should save tens of billions of dollars over the next decade. The recommendations include everything from stepped up privatization of federal services to the reform of our budget system. Building on this success Peter Grace and a group of dedicated business leaders are now forming the United States Tax Payers Commission to keep the focus on reducing costs rather than raising taxes. I expect they'll bring renewed interest to streamline federal operations and to ensure that you the American people are getting all the government you're paying for. Getting the waste out of government of course requires not just a commitment from the executive branch but also from Congress. Unfortunately expensive special interest provisions are often added to needed legislation. We can no longer afford this costly all or nothing way of doing business. The president should be able to cut the fat yet keep the meat of spending bills that reaches desk.  Congress has the power to enact this needed reform right now. I hope you agree with me it's time every elected official be part of our effort to protect the take-home pay of the American people by getting waste out of government. Until next week thanks for listening God bless you.


So we're here at the Yulei phone. Hi. Hi. So who are you? We are a Chinese company we focus on the rocket smartphone. And what is this? Our latest model is a walkie-talkie phone. As you can see it comes with a walkie-talkie fish antenna here and also it can be detachable and take it to your pocket. Nice. So it's very can you hold it like this? So it's very rugged. It will not break. Yeah it will not break. This blade is strong. Yeah this blade is strong and the shield is strong. Waterproof IP68 waterproof also sharp proof. It's ideal for the outdoor use. It's bulletproof. Yeah sometimes kind of and maybe. And what other phones you're showing here? There's a lot of phones around the table here. They all the same or different? Different. We have different models. Let me show you. How much do you want? The phone is the last bigger. Wow. Okay be lower. Okay okay. I don't have a contract with Michael Jackson. Okay because it's very loud and it comes with a ring light on the back. When you go outdoors you can have a party overnight. That's cool. That's awesome. I'm afraid of music. Okay. Okay. Let's play it down. Okay. That's awesome. Big speaker. Which other phone do you have? We also come with the phone with a magnetic feature. With the Apple like MagSafe. MagSafe. Yeah with the Apple like MagSafe it's compatible with the Apple's MagSafe gadgets. This phone also come with lucky features. And I came and 1.0.a make a piece of camera. 1.0.a make a piece of camera here. Nice. And all these phones you have they're all drop test. You test them. They fall they never break. We want to see the test. You sure it's okay? Okay it's okay. I'm afraid a little bit. It's okay? It's okay. Okay let's try it. Oh my god. Oh no. Oh no you have to buy a new one. No. The back is okay. Oh my god. Really? Nothing wrong. Nothing wrong. This was a it's not concrete floor but if people climb people work if people are tooling and biking this is the phone to get. Yeah the phone to get very useful. If they live in a van amazing van with a conversion and everything they can get one of these phones and climb and stuff during the afternoon. It's a uniform make phone for many years no. Yeah why don't you work in the ice. Well we focus on Rocket Phone for many years around 10 years. Well the oldest one. But you focus on many different phones before. Yes only Rocket. Yes now we focus on Rocket Phone. We made the back to Rocket Phone for our customers and our partners. Is this a case? Yeah it's a case. It has a dedicated design for our phones not for other phones just for our phones. If the case can be detachable we can hand up. Cut to your belt. Cool. All right. And what do we have here? Do we have even We also have many accessories for our phones. You make tablets? Yeah we also make tablets. Common tablets. Our Chrome? Tablets. This is the thermal imaging. Can you show what is that? Just an example here to showcase the thermal imaging camera. So it's what's inside the phone and the thermal imaging with NFC. Yeah to see inside. This phone comes with the thermal image camera from Flia. The most professional thermal image camera provider from Flia. You can you can see of the environment market with different colors to help you to. So that you're healthy. Yeah to to to see the temperature difference around the environment. I could see your bones. You can see. It's scary. Because it comes with the different temperature. Our bones, my skin and also when you maybe you can again it's where the buildings maybe some water leak it can tell you where the leak it is. Can you see with this if people are carrying a gun? If the gun has some kind of temperature, if the gun is hot enough it can tell you. Ah if it was used recently. Yes. Yeah. All right. There you have all the tablets and it's interesting to see how it is inside reliable. How long is your warranty? Oh we have one year warranty. One year? Yeah one year for all our lucky phones. Is that a chainsaw? What is this? How is the engine to show you? Uh that's just this to showcase the endoscope. Oh this endoscope has two cameras. And there you can film in the end of something. Yeah you can see the thing inside. You can see the screen here. Oh there it is. Oh you help you see the thing inside. Oh endoscope. That's deep inside the you can change the camera you can see different angle of the of the engine inside. Cool. Wow that's cool. Okay we also have um microscope expansion as you can see you can see the thing very close. How is connect here? Uh we made a dedicated external expansion part. It's not just a type C? Not a type C. Type C is most stable enough. We made a use not expansion part.  Cool. That's fantastic. How many different adapters you have? So you have the microscope. Endoscope. Endoscope. This is microscope right? Yeah this is microscope. And endoscope. And there's the more advanced microscope. You can change the angle by this controller. That's crazy. You can move the angle. Oh you can move the angle camera. You can see all the thing inside is two. Oh that's cool. And that's the same connector? Yeah same connector. So this connector is only for you the phone? Yeah only for you the phone. It's safe and stable. And what is the name of this phone that support this every you the phone or only some? Uh country only some but in the future we may as more more models support this part. This one is the you the phone power armor 18T come with the 18th come with the temperature sensor. So the temperature sensor next to the camera there? Yeah mixed camera. Nice. You can sense any temperature of people or things? Well any temperature. The temperature of the phone? The case external camera? This is the external vibration camera. The phone we already out of power for this. Out of power you can say. You can also can this one come with a night vision camera. When you come to the normal camera you can see the thing inside. What is the night vision camera? You can see the same things even with no light at all. That's a very special camera. It's not like night mode on the one way. It's different. It's different. You can see the things clearly. Even there's no light at all. That's amazing. And there's more and more things. What is this thing? It's the internal external imaging camera. But now it's just a prototype. You can see the thermal imaging in this phone. We integrated into this phone. But for some of our models it doesn't come with the thermal imaging camera like this phone. So you can also use this port to connect to our other phones. What does it do? Thermal imaging camera. External imaging. Same like the FLIR. Same like the FLIR. Come from the FLIR like this. It's kind of like a thermal selfie camera. Uh, maybe just like you can be selfie. Selfie camera. All right. That's crazy. Somebody's posting a, somebody's saying in the chat, you like the James Bond toolkit. You like Mr. Q. You are giving all the gadgets to James Bond. Yeah, we are giving all the gadgets to James Bond. Maybe he's one of his best friends. Where's my Aston Martin? Where's my car? Where's my car? The special car with the rockets. Maybe it's just on the on the strong floor. Okay. Cool. Is it little speakers here? Hi, speaker. This phone has a featured, uh, magnetic feature like Apple's mega face. So it's just a magnet. Magnet. Which is not every phone have this. More every phone. Just this model. Come with the magnetic feature. It compatible with, uh, Apple's mega safe gadgets. That's so cool. Uh, here you have just a very normal, nothing special. Oh yeah, they have something special. Yes, our customers sometimes ask, ah, do you have some Bluetooth Bluetooth? It doesn't include a thermal imaging or microscope in your ear or something. No, no, no, no, no, no. Just a normal, normal earbuds for our customers. They usually ask, ah, do you have the earbuds? Okay. We also provide the earbuds for you of quality. And here you can have, on your mountain bike, you can have two rugged phones at the same time. It depends. You have two models of what okay. It's just different stands. Hey, Deepen, Deepen, you can. What's the problem with this? Is that a dock charger? Yeah, it's a dock charger or this phone. This phone comes with a live speaker. If you use the dock charger, you can turn into a Bluetooth speaker. That's a Bluetooth speaker. Okay. It looks like this one has one. A phone with a live speaker. All right. But this is just a dock for charge. They all use this little pins for charge? Yeah, the little pins. All the other ones also? No, just this model. This model. The big speaker model. Nice. There's a lot of stuff happening here. You have many fans.  Yes, always. I have many customers. All the ones that are to produce the cool, rugged phone, the true, like outdoor device for them. So. Is that a rocket? Ulefone tablet? Or is it only the case? Just a model. Okay. Let's wait here for a second. Already in production. They're already? Yeah, already in mass production. This one. So there you put on your hand the tablet? Yeah. With this gadget you can easily hold the tablet. Nice. This way you can show people, if you don't understand what you're saying, you show them the presentation. Yeah, presentation or when you walk, you hold this tablet like this way. It's more convenient to walk. That's awesome. This is built into the tablet or adapter? Adapter. Adapter. If you don't need just get out. Okay. Cool. I've spent like a whole conference or two with a tablet strapped to my hand. I was 2012 with a smart glass. So you can use that as your little dashboard. Cool. If you want. Is that your smartwatch? Rugged smartwatch? Our Rugged smartwatch. But still in... Runny Android? Not Android, yeah? Not Android. Just other platforms. And this is a different platform or similar? Similar one. That's the square one, the circle one. All right. Any other things you didn't show? We also produced normal phones for our customers like this. Who don't want to be rugged? Yeah, who don't want to be rugged and slim. It's better than an iPhone, right? I don't. I'm at a better price. Better price, of course. How much is the price? Maybe around $100. $100? I don't want $100. Yeah. Why do you need to pay $1,000 for Apple when you can have a ULIFONE for $100? But that's the distributor price. What is MOQ? How many minimum order they need to do like the customer to get this price? Just for one. For every customer, you don't need to buy it in a large quality. You don't need to buy $10,000. What's the CPU here? This one comes with the UNISOX T606. UNISOX T606. Who's the UNISOX? Chinese? How many chipset? Chinese? Yes, Chinese chipset. A good one. It's as powerful as the MediaTag, MediaTag chipset. Qualcomm? MediaTag. As powerful as the MediaTag, MediaTag chipset. Is the ARM Cortex something? Is it the ARM Cortex? I see. But here you also have some MediaTags. MediaTag 6.7, 3.0, and you have the MediaTag Helio. All right. And this is also a good price? Yeah, also a good price. Around $100, a lot $100. Okay, that's a good price. Thanks. You don't do a rugged foldable phone? Rugged foldable phone. Foldable phone is very hard to do the rugged thing now. The foldable thing is because it's very easy to break, so it's very hard to know. And here's your phone. It's been underwater for 20 days. Oh, what is this? This is ours. What is that? 18 days? 18 days. 18 days? That's longer than... Did you bring this water tank all the way from China? Oh no, I don't know. How many days is that? I'm not sure. It's a lot of days. About 800 hours. About how many days? There you go, 44. Yeah, many days. We break here. And it's waterproof, dustproof, IP69K, military standard, 810G. And when I look over here, one more thing. This one. Here you're showing dustproof. Cool. All right. That's cool. Thank you very much. Okay, thank you. Thank you for your video.


You know, I believe that when people think about Navy energy, they have certain preconceptions. They think it's just about alternative fuels, but in reality it's a lot more. Most of the energy program that we build here on the Navy staff is about efficiencies. Not efficiencies in terms of just saving money. They may, but what the technological or operational changes really do is give us more combat capability. They help the warfighter be more agile and capable, more spartan. Let me give you a couple of examples. The efficiencies that we're working on for the surface ships help a destroyer be able to steam 10 more days if it has hyperelectric drive or stern flaps. The things that we're doing on F414 engines for F-18s, they're going to mean more F-18s, not just burning fuel to deliver fuel, but more that can carry weapons and be a part of the fight or the flight of the sortie that can do operational business for the Navy. Now, what we're trying to do are changes that can do exactly what Doolittle did at the beginning of World War II when he used B-25s off the end of a carrier to fly further than anyone ever expected and accomplish a mission no one thought possible. The changes we're talking about are ones that can make us more resilient, agile, and capable. And we just completed a conference down in Norfolk with the fleet sailors and commanders to discuss these very issues. And what we're doing both down there and here at Sea Airspace are going to capture the innovation between industry, academia, and the uniformed and civilian sea service members. In essence to capture the fearless ideas, the fearless ideas that will ignite bold invention. And these energy ideas that we're coming up with are ones that will allow us to be where it matters and when it matters in theaters like the Pacific that are defined by a tyranny of distance.


ārrela ʻun i beti waita koketheriai manifestua i mana koo kambis planes ni omoko mell걸o kotouu syatura. Shiff lu, pār dingесon喜欢 We all know them, they know us. I'm surprised when I walk in the office and they call me by name because I think there must be so many other students but they know us all individually and they're there to help. There were mentoring sessions as well where the year ahead of us would help us with any assignments that were coming up. Tutorials are quite intimate so we actually get quite involved with what we're doing. It's interactive. Our cohort was very supportive of each other to this day. We still have our Facebook page where we contact each other and ask each other questions about anything in regards to teaching. When I finish my lectures, I'm pretty much straight away driving across town to go get my kids which makes this campus so convenient. It takes me about ten minutes. My routine when I get home is pretty much my kids. It's getting them ready, getting their homework done, giving them dinner. If it's a nice day and we have a bit of time, I might take you to the playground. My study itself doesn't really start until they go to bed. Down a normal week, I might stay up to about ten or eleven o'clock at night just getting in a few readings and what they need to do. When I was on my first youth camp, we all had to sit around in a circle and tell everybody what we wanted to be when we grow up.  I do want to be a teacher so it's taken me a good ten, fifteen years to really decide but this is what I want to do so this is why I'm here now.