So, again, for today's webinar, a silent epidemic of mental health among prostate cancer survivors, a secondary analysis of the Canadian longitudinal study on aging. Let me please introduce our panelists Louise Moody and Dr. Gabriela, Ilya, or Ilya. I knew I was going to get that wrong. Louise Moody is a recent master of science graduate of community health and epidemiology from Dalhousie University. She is now a 2nd year medical student at Dalhousie. So, welcome to Louise and Dr. Gabriela Ilya is an endowed chair in prostate cancer quality of life research in the faculty of medicine at Dalhousie. Her research examines the needs and challenges of men diagnosed with prostate cancer and prostate cancer survivors. Inactions this evidence based information into tangible education and empowerment programs aimed at improving the lives of cancer survivors. So, with that, and I'm ready for my water now, I will turn it over to Louise and Gabrielle. Alright, so, hello everyone, thank you Jennifer for the introductions. So, again, my name is Louise Moody and I'm a 2nd year medical student at Dalhousie and my thesis supervisor Gabriella is here today. And so, she'll be answering any questions at the end during the Q and A. So, I just want to start off the presentation. Second, let me see if I can flip through there we go. Okay, so I just want to start off by giving you guys a bit of background about our story of how we got here. So, basically, our story of how and why we decided to do this research. So, this research began 5 years ago and we started with identifying mental health issues in a survey of maritime population of men diagnosed with prostate cancer and the survey started in March 2017. And by the end of 2018 there were about 200 men who had responded to this survey and at this time we acknowledged that this sample was quite small and also it was quite heterogeneous in the sense that we had both patients and survivors. Some of which who had been treated more than 8 years ago, but nonetheless at the time they took the survey 1 in 3 and a half men screened positive for clinical depression and anxiety. And at the same time we uncovered that survivors of prostate cancer have the lowest so less than 20% attendance to cancer support groups compared to 60 to 90% of in other forms of cancer. And these men feel lonely and isolated. They experienced challenges and satisfying their emotional needs and most rate sexual dysfunction as their major concern. So, this raised red flags for us and the immediate question that arose was how does this compare to men in the general population who have never had a cancer diagnosis. At the same time that year, the European Neurological Association conference had a presentation that showed that prostate cancer survivors up to 18 years later had severe anxiety and depression. So this prompted us to look at the Atlantic path data as well as to put in a request for the CLSA data. So the Atlantic path data had a population that included men who had never had cancer and men who had other forms of cancer as well as prostate cancer. And so in 2020, Drs. Ali Rutledge and Sweeney published the results of their population based study of 6,685 men residing in Atlantic Canada. And they found that survivors of prostate cancer had more than double the odds of screening positive for clinical depression and anxiety compared to men who had no history of cancer, which was the control group. They also found that while men with a history of other forms of cancer had comparable outcomes with this control group. So basically two questions emerged from these investigations. And the first one was, is this an issue that pertains to Atlantic Canada only given that we have the highest rates of cancer, including prostate cancer in the country. And this is what prompted our CLSA investigation. And the second question was, how do men with the prostate cancer diagnosis compared to men with other forms of cancer when it comes to their mental health. And is this situation that affects men with prostate cancer more than any other form of cancer, perhaps due to their low attendance to support groups as well as their unmet psychosocial needs, such as feeling lonely and disconnected. So, as I said, this second question was addressed in a study that was published at the end of last year by doctors, the Lee Rutledge and Sweeney showing that rates showing rates twice higher for anxiety and depression for prostate cancer survivors compared to any other form of cancer, especially among men with low socioeconomic status. So today I will be presenting on my paper that was recently published in the mood and anxiety disorder section of the frontier psychiatry journal. Which addresses this first question as to whether this is an issue across Canada for the prostate cancer population. This research was completed under the guidance of my thesis supervisor, Dr. Gabriella Ilya was here today with me. So I'm just going to jump in right now. So in the background section, so prostate cancer is the most commonly diagnosed cancer among men in Canada and the USA. Currently research indicates that 1 in 7 Canadian men will develop prostate cancer during their lifetime. Although the incidence rate of prostate cancer increases faster with age than any other cancer, about 81% of prostate cancer diagnosed cases are diagnosed in the early stages of development when patients can receive effective curative treatment. Prostate cancer treatments have improved considerably over the decades and are providing very good curative results. However, patients are still at risk of complications and side effects, especially urinary incontinence and erectile dysfunction. These side effects often negatively impact the cycle, the psychological well being of these patients. What is most important to note is that the majority of prostate cancer patients become long term survivors, so living greater than 5 years with over 70% of patients expected to live 10 years or more from the time of their diagnosis. So any unaddressed mental health disorders can negatively impact their health long term. So according to a literature review conducted in 2019 by Forveha A. All, 1 in 6 men with a prostate cancer diagnosis will experience clinically significant depression, which was shown to contribute to poorer oncological outcomes. However, this paper was a review of the literature at the time and it was based on small scale studies. So the rise in prostate cancer incidents with increased age combined with low prostate cancer mortality have important implications for the Canadian health care system. Men with co-occurring depression and prostate cancer are more likely to have worse quality of life, both short and long term, increased risk of multi morbidity, increased mortality and higher health care utilization than men in the general population. So existing studies examining the relationship between prostate cancer survivorship and mental health have not controlled for substance use. And this is important given the established relationship between mental health and substance use in the literature. Specifically, research shows that mental health disorders have long been associated with multi morbidity and unhealthy lifestyle coping mechanisms such as alcohol use and smoking. As 99% of patients diagnosed with prostate cancer are over the age of 50 and about 65% are over the age of 65, they are more likely to experience the sequel of cancer treatment in the context of co-existing medical conditions. Studies show that individuals with multi morbidity have worse physical, social and psychological quality of life. Reed et al. found that depression is two to three times more likely to be experienced by people with multi morbidity than those who have no chronic physical conditions. Alcohol use and smoking are known unhealthy coping mechanisms and risk factors associated with prostate cancer. Continued alcohol use and smoking after diagnosis can complicate treatment, increase risk for further malignancy and contribute to secondary health problems such as cardiovascular disease and diabetes for prostate cancer survivors. Therefore, we chose to examine the prevalence of prostate cancer and examine the relationship between status of lifetime history of prostate cancer diagnosis and current mental health status while controlling for the contribution of multi morbidity, alcohol use and smoking status. In a large population based sample of adult Canadian men who participated in the baseline data collection cycle of the CLSA between 2010 and 2015. Alright, so as I'm sure many of you already know, the CLSA is a national longitudinal research platform that collects comprehensive data and biological samples, which support a wide variety of age related research. So our data was based on a sample of 25,183 men between the ages of 45 to 85 years of age, and this was from the slightly more than 50,000 men and women across Canada's 10 provinces who participated in either the tracking or comprehensive cohorts of the baseline cycle. So all the variables in the analyses were assessed in both cohorts with the exception of psychological distress or the K10 variable, which was only assessed in. And I'll talk about that a bit more when I'm talking with the results. Okay, so in terms of our methods, so mental health was our main outcome variable of interest. So we used 3 indicators of current mental health that were available in the CLSA data set and these measure different dimensions of the mental health construct. So the first one was the Center for Epidemiological Studies Short Depression Scale or the CESD 10. And the CESD 10 asks individuals about their depressive symptoms and the week. Therefore, it is a measure of current depression screening. So the CESD includes 10 items comprising six scales reflecting major facets of depression. So those included depressed mood, feelings of guilt and worthlessness, feelings of helplessness and hopelessness, psychomotor retardation, loss of appetite and sleep disturbance. So our second mental health measure was the Kessler Psychological Distress Scale or the K10. So the K10 is a measure of clinical screening for current symptoms of psychological distress such as depression and anxiety within the past month. And lastly, we use the self rated mental health. So this is a measure of one's perception of their overall mental health. Individuals that participate in the CLSA were asked in general, would you say your mental health is excellent, very good, good, fair or poor. And we included this measure to see if it would align with the objective measures such as the CESD 10 and the K10. So for our exposure variables as you can guess our main predictor was lifetime history of prostate cancer diagnosis. So in the CLSA participants were asked, has a doctor ever told you that you had cancer? And if the participants answered yes, then they were prompted with a further question, what type or types of cancer were you diagnosed with? For our multi morbidity variable, we included 26 chronic conditions as they either met the definition of a chronic condition or have been included in previous multi morbidity studies such as diabetes, heart disease, thyroid conditions, osteoporosis, arthritis, etc. And then our final exposure variable was substance use and this had two facets. So the first was alcohol use and item we used from the CLSA was frequency of alcohol consumption in the past 12 months. And then for smoking or tobacco use, we use the item frequency of smoking in the last 30 days. So for covariates, we selected these based on previous literature indicating that these variables are associated with mental health. So we use six covariates, age, province, education, household income, marital status and ethnicity, and the categorizations that we used are on this slide here. So for all analyses, complex sample analysis using IBM SPSS version 25 was employed with geo strata and entity ID variables used a strata variable and cluster variable respectively in the design module. And to make the estimates generalizable to the Canadian population and to address the complexity of the CLSA survey design, we use trimmed or inflation weights in the descriptive analysis and analytic weights in the regression analysis as recommended by the CLSA protocol and which were available to us in the data set provided. So for analyses with the outcome measure psychological distress or K-10, we use the comprehensive cohort as the K-10 questionnaire was only available in that survey. So our sample size was smaller for this, so it was 14,777 and we used multiple imputation and that was performed based on 5.5% of the outcome variable missing. And so all our analyses that include psychological distress were reported for both the original end to the multiple imputation pool data, and you can find those tables in our paper. And when I'm discussing the results, I'll let you know when am I multiple imputation results were comparable with the original data. So just one sec. All right, so now we'll get into the results. All right, so for results in estimated 4% of adult men reported a lifetime history of prostate cancer diagnosis. So this corroborated the prevalence of prostate cancer in the Atlantic Path data. Of the Canadian men who reported a lifetime history of prostate cancer diagnosis, 72.8% were over the age of 65. The majority of men who reported a lifetime history of prostate cancer diagnosis were married or common law, so 83.7%. And over 70% of men who reported a history of prostate cancer had a household income of less than $100,000 per year. And of those 29% reported a household income of less than $50,000 per year. So in these descriptive analyses, increased household income and education were protective factors for lifetime history of prostate cancer. All right, so I know this table is a little small, but I highlighted the, the two most important results and I'll verbalize them now so in the logistic regression analysis, which were adjusted for covariates and the complexity of the design I revealed that men with a lifetime history of prostate cancer diagnosis has statistically significantly higher adjusted odds of screening positive for psychological distress and depression, but not for self rated mental health compared to men who had received a lifetime history of prostate cancer diagnosis. So the top blue box up there that's for psychological distress. And so men with a lifetime history of prostate cancer diagnosis had higher adjusted odds and so it was 1.52 times higher of screen and positive for psychological distress. And in this case, the multiple imputation data set was comparable with this result. And so for depression, it revealed that men with a lifetime history of prostate cancer diagnosis has statistically significantly higher adjusted odds so 1.24 times higher of screening positive for depression and that's the bottom blue box there that circled. And then as I said, it was there was no statistically significant relationship between lifetime history of prostate cancer and then the poor self rated mental health variable. So getting into the multiple logistic regression analysis. These were adjusted for the covariates as well as the complexity of the design, and we examined the contribution of lifetime history of prostate cancer diagnosis, multimorbidity, smoking and alcohol use on each of the three mental health outcomes and revealed a statistically significant contribution of all four predictors to depression, but not to psychological distress or self rated mental health. So first I'm going to be talking about the relationship with depression or the CESD questionnaire and so that's the middle column with the sky blue boxes. So the odds were so the top box there, the odds were 1.32 times higher for screening positive for depressive symptoms among men with a lifetime history of prostate cancer, compared to men without a lifetime history of prostate cancer. And then when you move down the box to look at multimorbidity, the odds were 1.62 times higher for screening positive for depression among men with multimorbidity, compared to those without multimorbidity. And then when we look at alcohol use men who were weekly drinkers or daily drinkers had odds 1.18 and 1.47 times significantly higher for screening positive for depression respectively. And then finally that last sky blue box is looking at tobacco use or smoking. And so daily smokers also had a 1.57 times higher odds of screening positive for depression at the time they were being surveyed compared to the to non smokers. And then if we go over to the left column so that's the dark blue, that's psychological distress. And so lifetime history of prostate cancer was not a statistical significant contributor of screening positive for psychological distress. But when we in the original data set, but when we did the multiple imputation analyses it showed that among men with a lifetime history of prostate cancer odds were 1.62 times significantly higher for screening positive for psychological distress compared to men without a history of prostate cancer. And so again that multiple imputation data is available in a table that's in our published paper. So, then if we look at the dark blue boxes so that first one there that's looking at multimorbidity so the odds were 1.64 higher for screening positive for psychological distress and the multimorbidity controlled analysis. So, and the results there were comparable with the multiple imputation data. And then men who identified themselves as weekly drinkers had 1.52 times higher odds and those who identified themselves as daily drinkers had 1.59 greater odds of screening positive for psychological distress than non drinkers and again that was comparable in the multiple imputation data. And then finally that last dark blue box on the left that is men who identified themselves as daily smokers and they had 1.84 times higher odds for screening positive for psychological distress compared to men who identified as non smokers. And then finally we'll look at the last column there on the on the far right.  But then if you look at the multimorbidity so that that top blue box on the right hand side, odds were 1.97 times higher for poor self rated mental health among men with multimorbidity than those without. And if you look down at alcohol use so the next box odds were 1.58 times higher for self rated poor mental health among daily alcohol drinkers compared to men who identified themselves as non drinkers. And lastly, men who identified as daily cigarette smokers had 1.45 times higher odds for poor self rated mental health compared to non smokers. So, our covariate results which I don't have in the table in this presentation but again are available in our published paper but I'm just going to summarize some of it so the covariate results from our final analysis also indicated that younger age not being in currently in a relationship, lower household income and residing in Atlanta, Canada may be placing men at higher odds of mental health disorders than being of older age being currently in a relationship, having over $150,000 total household income and residing in Alberta. Okay, so to get into the discussion. So, to our knowledge, this is the first study to assess the prevalence of prostate cancer survivorship in Canada. And results indicate that 4% of adult men in this Canadian population based sample reported having had a lifetime history of prostate cancer diagnosis between 2010 and 2015 when the baseline cycle of CLSA was collected. So, as I said, this estimate is comparable to the 3.9% prevalence estimate of lifetime history of prostate cancer in Atlantic Canada between 2009 and 2015. That was characterized by similar demographic characteristics through the Atlantic path data and those results are available in the paper by Dr. Ilya Rutledge and Sweeney. So, our results indicate greater psychological distress and depressive symptoms among Canadian men who reported a lifetime history of prostate cancer diagnosis compared to men who had no history of prostate cancer diagnosis in these demographic controlled analyses. And so, to our knowledge, this is the largest population based study examining these associations. So, results corroborate findings from previous smaller sample size investigations and indicate that mental health disorders are significantly prevalent among prostate cancer survivors compared to men who have never had a prostate cancer diagnosis. And support evidence that mental health care should be part of the prostate cancer survivorship plans. While a statistically significant association between lifetime history of prostate cancer diagnosis and validated mental health outcomes, so psychological distress and depression was observed and the status of lifetime history of prostate cancer was not associated with self reported mental health. So, a scoping review of the relationship between self rated mental health and validated measures of mental health show that these measures, though related, should not be considered equivalent or interchangeable because self rated mental health may be measuring people's commonly held perception of mental health and may reflect equating the question to mean whether or not the individual looked for mental health health or resources available to them in their communities. Evidence shows that men tend to report less self perceived disorders, although the rates of social isolation and suicide are higher among men compared to women. These differences may point to the possibility of less communication or verbalization of mental health problems among men and or more issues of shame or guilt around acknowledging these problems among men. Alright, so our results were not without limitations. So, first and foremost, the nature of the data is retrospective and self reported. Thus, it is subject to the challenges of accurate recall and also survivor bias. Since the CLSA data does not capture the date of prostate cancer diagnosis, survivorship time could not be controlled for in these analyses and may have bias the results. The overall response proportion in the CLSA data was around 10%, which although was adjusted for by the use of the population based weights may have introduced a non response bias. And finally, since multi morbidity and substance use increased the risk of mortality. The proportion of cases with high multi morbidity and heavy substance use may be lower in our data and could have led to an underestimate of the odds ratios observed. So, despite these limitations this project offers important contributions by providing evidence of poor mental health outcomes among Canadian men with the history of prostate cancer diagnosis by examining data from a large scale national population based survey that used it a standardized protocol. So, to reiterate the use of the CLSA data set was the main strength of our project and all the following strengths are related to the information that was available to us in this robust survey. So, the use of 3 validated mental health measures the CSD 10, K10 and self-rated mental health is a strength. Additionally, the breadth of information collected allows for several potential confounders to be controlled for in our analyses. And another important consideration is that we were able to capture 26 chronic conditions for inclusion into our multi morbidity variable. Alright, so just to conclude, I'm going to talk about implications of this research, both for researchers and clinicians. So, our present findings caution us to be particularly attentive to symptoms of mental health among men when they are observed. Our results also further emphasize the importance of including validated questionnaires and prostate cancer survivorship plans to assess mental health disorders among prostate cancer patients during their survivorship journey. And also the implementation of innovative and integrative patient education and empowerment plans through holistic interventions that aim to ease the psychosocial and physical needs of these survivors is warranted. So, some of those psychosocial and physical needs include loss of sexual function urinary leakage feeling disconnected from their intimate partners and close family members and friends lack of sleep and fatigue. So, currently, our lab is in the middle of a phase 3 RCT that helps address loneliness, disconnect and prehabilitation in this population to help alleviate some of this mental health distress. So, just in conclusion, I just want to acknowledge again the CLSA for providing this data set that we use for all our analyses. As well as the solstice lab supporters and members so Frank and Debbie so be as well as the Dalhousie medical research foundation. And again, this research was based off of the work I did for my masters and the community health and epidemiology program here at Dalhousie. And so I had two supervisors, Dr. Gabriella Ilya, as well as Dr. Susan Kirkland, who is a co principal investigator for the CLSA. And then Dr. Pan Andreu and Dr. Rob Rutledge, who are on my thesis committee as well. And then I have to acknowledge my parents marine and death for all their support. Over the last few years. So, yeah, those are just some references from the slides today. And again, those can all be found in our paper. And I just want to thank you guys all for listening and Gabriella and myself are here to field any questions that you may have. Thank you. Well, thank you so much for the presentation. And, you know, I think it was definitely. A very important topic, especially for men clearly. I'd like to open it up to questions sort of formally, even though questions could have been coming in throughout. So just a reminder, your muting will remain on and you can enter your questions into the chat box, which is in the bottom right of your corner. But first, I just wanted to touch base on one of your last points about the RCT. You're you're currently conducting. Can you tell us a little bit more about that? Yes, yes, yes. So it became very apparent right about 5 years ago that we're dealing with a silent epidemic of unmet needs and men needs at all stages of the prostate cancer diagnosis.  What sort of active treatments are there? What are the implications associated with them? And now that you got a cancer diagnosis, are there some ways in which you can control the direction of the diagnosis? Could you change, could you improve your lifestyle? Could you change your diet and eat better? And if so, what should you eat? What should you avoid? Could you control the amount of exercise? Should you maybe start exercising or if you're exercising only once a month, could you bring a little bit of routine into that to help you along? Are there any things that are pre-habilitating, meaning the sooner you do them, the better it's going to be. So for instance, we know that having a high BMI and going into surgery is not a good thing because that surgeon is going to have to navigate through that fat. So, so getting rid of it before your surgery is a good thing. And of course, you know, healthy manner. So we basically went to the literature with the help of patients. So we had patients involved in this research from day one. And now we have almost an army of research citizens that are cheering us along the way and being involved in every aspect of our research. We don't make any decisions without patients' involvement. And because they give us a reality check, including this intervention that we developed, they said, well, let's, let's talk about us and what happens here. Because we don't want to end up with yet another intervention on which billions of dollars are being spent and it sits there on an internet site and nobody's using it. So very important to bring the voice of the patient back into the medical system, see whatever size is there to support patients and empower them from day one. Really, oncological outcomes can be improved by working with a patient, by informing them rather than leaving them in a black hole. You don't know what's going to happen. You don't know what side effects, you don't know how to navigate your way through appointments. There's a lot, there's a lot of unknown there. And that plus the big cancer diagnosis creates a lot of anxiety. And especially in a time like this one, on top of it, you have a world pandemic. So it is so important to start looking at what we have and do better. Yes. Yeah. I can talk about this. We're so passionate about it. You're definitely clearly passionate about it. So just in terms of the RCT, what were the interventions that were part of the RCT? I'm just curious about that. Yeah, we do have some questions that are coming up as well. So, so the intervention has an exercise component, which includes also pelvic floor exercises, which are very important for men who have been diagnosed with a prostate cancer diagnosis because they have potentially they could have a red file dysfunction or urinary dysfunction. So it's important to engage in pelvic floor exercises that are rehabilitating and we know that they work well when they're started before the actual active form of active treatment. So there is an exercise component. There's a diet component. There is a social connection component. There is an intimate intimacy education and sexuality education.  So we did a proof of concept at the beginning of 2019. That worked very well. We published the results of the study. We showed that not only is it feasible and it's working and men will engage in that routine, but that actually there are results that were noticing even after 28 days. Now, we're in the middle of an RCT that goes on for six months as soon as you get diagnosed. So the RCT either assigns you to the intervention or the standard of care. Six months, the program gets evaluated. We have weekly compliance surveys. We also have daily videos that are sent to people. So it's very engaging. We get together with everybody in the team once a month, all the patients in the trial. It's very supportive from, from a social point of view and social interaction and social connection. And then we evaluate again patients at a year later. So patients in the late group get to get the program six months later. So nobody's left out. So it's a wonderful design and we have already run a few preliminary analysis and the results are looking amazing so far. But we only have about 50 men that have completed the trial. So we're in the middle of it. Thank you. So 1 question we had is whether you controlled for physical activity. I presume this isn't from your original the main study that you're talking about today and not the RCT. Oh, you mean in the analysis? No, we did it. Okay. No, no, we control for this particular lifestyle. What else do we have here in terms of there's also a very positive comment from Valentina just emphasizing the fact that you're addressing the psychosocial determinants of health and. That this is a very important to patients with prostate cancer. So that's just a kudos to you. Next question, which I usually also ask because my background is a knowledge translation is how to envision the study may change policy.  Yeah, yes, we've done quite a bit of work in terms of implantation. In fact, we're in the middle of planning for phase 4. RCT. It's an implementation study that we're going to run throughout Canada, New Zealand and Australia. We have received some money for funding and we're waiting results of yet another funding opportunity for which we applied. But we are talking with a lot of state. There are a lot of stakeholders in this. So, yeah, and including, including here in Nova Scotia. So we're already rolling the ball to make the standard of care within our own province. And so, yeah, many from prostate cancer Canada to November to which are the typical organizations that support this kind of research. Incredible research citizen support patient support. Not just here but throughout Canada and in New Zealand and Australia we have established groups of research citizens in New Zealand and Australia that are so excited to help along. We have a group of mentors, people that have gone through the program that don't want to say goodbye. They want to remain involved and they want to make sure that they help along. So lots of ideas on the table. But most importantly, this phase 4 randomized clinical trial, which is going to start this year. So exciting. Great. There's a mess. There's a chat from Prakash here. Oh, I just lost it there. I think Prakash, I think you were more asking something more general. So, I might encourage you to send me a message or send the team a message about. Access to CLSA data more generally. Okay, so, in terms of the current presentation, do you know if any of the men with prostate cancer in the study attended support group meetings? And also, second part to the questions did attending the meetings result in reduction in any depression or anxiety. So, yeah, so from this study that I presented on today, we didn't have access to that variable in the CLSA data set. We didn't know if they had attended cancer support groups as well as I mentioned that we also didn't have a date of diagnosis. So we didn't know their survivorship time. So all of those things would have really aided in our analysis. But I, and then to answer the second part, we know from other research that we've done that attending these meetings can really drastically help reduce anxiety and depression as well as distress for these men. We didn't have access to that in this study. And just going back to the RCT, which you talked about, what was the control arm for the study? The control arm is currently standard of care. So men go through the normal standard of care. So they would have their appointment with their neurologist or radiation oncologist and have their form of active treatment and just follow along. I'm not seeing. I hope I got everybody's questions. There's also another sending kudos and congratulations on an excellent presentation. From Louise and her master's work. I'm so proud of her. It's a great work. It's such an amazing student. I'm working part at work of the Solace lab and Gabrielle's larger prostate cancer research portfolio. So I think that's just a testament of the great work that that you're doing. Louise is phenomenal. We have, I mean, we're so proud of her.  She said access to this type of research talking to patients directly from the start of her master's program, even before, even before. And it's yeah, one of the things I think that stood out to me the most do doing like the preliminary RCT stuff was like this age group and this, this group of men that come to these like interventions. They are so dedicated and they want, they want it to work and they, they come to everything and put 120% effort in and like that is phenomenal to see. And I think that really shows like, you know, that there is a need for this, like they, they want this kind of intervention. They want this holistic approach and they have the time and the dedication to, to put the work in. And the results have been quite amazing so far. And I know that they will be even more in the future. And I think it's just a true testament to like the patients like want and need to do. Yeah, it's really important to get them involved. Exactly. Bring the voice of the patient back into the medical system. There's a lot of wisdom there and practicality and with something as, you know, inexpensive of this is the program that we're working on. And it's easy to be sustainable clinicians love it nurses love it why because they don't have to do as much maintenance on those patients, you know, so, and it's easy to be implemented. At the end of the day, this is a good program for all of us.  And again, nobody's forcing you to do anything, but you might want to try to just want to try it. And what we're seeing from our patients is that they are eager. They want to try. You know, they want to change something and they want to do it as soon as they get their diagnosis.  I went through, you know, bad things before I'm just going to go through this on my own, because look that that erodes your soul and doesn't help anybody doesn't help the medical system was going to now end up having to spend money and find resources to treat them doesn't help the patient doesn't have the family doesn't anybody at the end. Definitely an upstream approach, which we need more of in the healthcare system. I think we had a, I don't let you determine if you want to answer this, but I guess there's a question of why you became interested in this topic. And so, I don't know if this is directed towards. We either Gabriel, but you're both interested in it, which, you know, if you want to feel free to comment or not, or I can tell, yeah, I can comment on it a bit and then I Gabrielle can go into more detail about prostate cancer and particularly, but what was interesting for me is I decided to pursue my master's degree and I reached out to the department and I by like honestly a stroke of luck somebody put me in contact with Gabrielle because we have similar background so I had just completed my undergraduate degree in neuroscience and religious studies and had always been interested in kind of the psychosocial, you know, part of patient care and so and Gabrielle was just beginning her she had just moved to Halifax. And so we got connected that way because of our shared backgrounds. And then Gabrielle had the solstice chair position in prostate cancer research. And so kind of the combination of the prostate cancer research and then our both are collective. Like appreciation for just mental health care. We kind of went down this path. And I'll just tell you very briefly my story. So I came from University of Toronto where I did research on quality of life and cash and brain tumor. Completely. I mean, going from brain to. Okay, so so I started my research. So I got a position a chair in in prostate cancer quality of life research here at the House University. And what attracted me because at that time I had three offers I could have gone in three different directions, well, two of them, much more similar to what I was doing before and then there was this House University position. But what really got me was that the actual there was there was a Frank so be donated money for an endowed fund to support research that sheds a light on the issues that men with this condition have to go through. And I talked to him and I remember being, I mean, when I started the position I never thought this is going to be so focused on mental health, which I had such extensive background on, because prior to that I had over 50 publications in mental health and substance use and how adverse health correlates influence the quality of life of people that have had a big question or brain tumor and so on. I thought that this is going to be very good as prostate cancer I've heard about sexuality being, you know, affected by the disease I didn't know almost anything about prostate cancer. I went the first thing I did I remember I picked up the phone I called David Bell who's a urologist here in in Holly Fox and I said, I want to learn I want to go everywhere I want to go to every support group I want to see patients I want to hear what's happening.  And they said, you know, we love them so much we do our best but you know I'm focusing on the surgery or I'm focusing on radiation or I'm focusing on chemotherapy and why don't you ask the patient. Honestly, honestly, and I started going to support groups and I was very open I said I want to know everything. Tell me what's going on. So I can start pulling together go go out there and find out the golden standard questionnaires, put them together and survey. I didn't tell them what I'm going to survey them on of course with my background I just went up you know psychosocial from left 180 degrees the whole board. But I wanted to know from them directly and they started talking. And then this is what I did, my, even to now, I'm still attending support groups I dedicate in my free time my holidays I spend going to prostate cancer support groups or cancer support to give them everything I've got, all the knowledge, all the papers that I read everything that I have goes right back to them, and it's empowering. It's empowering to me and makes my life purposeful, because here we are, we're a community we're so much more like than different. Those are issues that can affect all of us. And so low and behold through the survey, we find out that there is an epidemic of mental health issues. It's quite interesting and then you start to scratch your head but why is that. And so we're still doing so many investigations we're looking at sexuality urinary function we're looking at relationships, we're looking at this idea of meeting emotional needs, social support what does that even mean. And what role do they play so this RCT that we put together and the intervention which is called prostate cancer patient empowerment program, which is a trademark now. Yes, it's something that took years to develop. It took science, it was top down meaning scientific evidence into the intervention but also the wisdom of the patients going back to bottom up. And I think there has to be a marriage of the two of them. Mike Strong, who's the president of CHR I think we have some amazing people in leadership today that really get it that you can't do research without involving the patient if you're going to say something or do something about the patient that affects the patient. Yeah, very important. Yeah, I think we all think we've most people would would agree on that. I don't see any more questions coming in and I, you know, thank you again. Very passionate presentation. I think one of the more passionate presentations or webinars that we've had. So, thank you again for your participation in these webinar series. I'd like to remind everyone that the CLA data access request applications are ongoing. The next deadline is April 14th of next month. Please visit the CLA website under data access to review available data, including the COVID-19 questionnaire study data as well as additional details about the application process. I'd also like to remind everyone to complete their survey, which is located under the polling option. Option. If you didn't see it beside the chat button, please click the drop down arrow and it will come up. So, our next webinar sadly today's webinar does need to come to an end is entitled the impact of COVID-19 of the COVID-19 pandemic on the mental health of older adults. Longitudinal analysis from the Canadian longitudinal study on aging, and we will have Dr. Perminder Reina, who's the lead principal investigator of the CLA lead that webinar. The webinar will present findings on mental health outcomes from the COVID from the CLA COVID-19 questionnaire study. So, actually, it'll be a nice follow up from the webinar focused on mental health this month to talking about COVID next month. And remember, the CLSA does promote this webinar series using the hashtag CLSA webinar and we invite you to follow us on Twitter at CLSA underscore ELCV. And finally, just thank you once again for everybody attending and to our presenters and we will see you next month.


At the Hawaii Natural Energy Institute's GridStart laboratory in Honolulu, variable renewable energy resources, storage and smart grid applications that promise a viable clean energy future are developed and evaluated. Leon Roos, GridStart team leader, describes their work. GridStart is a practice group and our focus is on looking at and bringing into the power grid renewable energy technologies and integrating that into the system at very high levels and doing that effectively and efficiently. The world is changing rapidly and we need these solutions now and our team is focused on delivering that. What's exciting about what's happening here is the integration of a lot of these resources at the home. So we have batteries and the PVs and vehicle charging that are all controlled at a local level then integrated in with another control scheme that's aggregating all of these end uses to create a reliable as well as economical power system. The other part we're starting to look at is the consumer part where you have the conversions from AC to DC. Can we build systems that just use DC from the DC source like PV all the way down to serving the DC load? The other component is that transportation piece. We have a two-way charger outside where you can charge your electric vehicle but you can actually draw power out of that car battery and utilize it in your home and maybe even to the larger power grid. It's about a solution that fundamentally changes the way things happen in the world, right? I mean, it's just a regular part of everybody's life, right?  Leon's team is taking a major step towards that goal by studying a pilot integrated energy system that they have implemented on the island of Maui. Here in a neighborhood of roughly 800 residents, more than a third of them draw power partially from the grid and partially from rooftop PV and the rest rely entirely on mainline electricity supply. This kind of situation is beginning to create some issues in managing and operating the power grid with so much renewables and so we deploy a lot of data monitoring devices and we deploy them strategically across the neighborhood to collect not only what the PV panels are doing but also how is the power grid reacting to that.  That's a key part of the work we do. We iterate between this modeled environment and the real-world environment and our fundamental mission and vision is to expand that knowledge and know-how and bring it into the markets in the Asia-Pacific region. It's going to be built on a fundamentally different foundation of technology and capabilities that we've lived with for the last 100 years. Energy and these issues are a global issue. It's not a Hawaii-specific issue or a US-specific issue. It is a mankind issue.


Bemidji State University has upgraded its on-campus weapon storage facility at Walnut Hall for resident students. Haiti Clotter shows us how BSU is providing a convenient and safe service for students who take advantage of the outdoors. Having an on-campus weapon storage facility may not be common at other institutions, but when you're located in Minnesota's Northwoods, it's fitting. Bemidji State University expanded its facilities for resident students to store their weapons. Many of our students participate in the outdoor activities that are in the area. We recognize that that includes hunting and shooting sports. We wanted to accommodate students' needs there. School policy prohibits weapons anywhere else on campus. The new facility is twice the size of the previous weapon storage. There are 126 lockers and 77 are currently in use. Students can store long guns, bows and arrows, fishing spears, any other type of knife or blade. Even Garrett Ober stands at 6 feet 8 inches tall in the lockers' tower over him. Gun clean kit, gun ammunition, and then a gun pouch that I have on me with my waiters. Ober says he looks forward to duck hunting season and tells me he was just out there last week in the rain. There's got to be some people that go out here to come up and hunt, especially. He appreciates the convenience of the facility. Your stuff's like room temperature and you just grab it and go. Students use the wild game cleaning room to process what they harvest. The freezers keep remain so they don't cause problems with odors and cleanliness.  Safety is a priority. Students have 24-hour access to the room and the public safety office monitors it. We have added the technology to the facilities to make sure that our students are safe. Our students spend a lot of money on some of this sporting goods equipment and they want to make sure that if we're storing it, that it's safe. By the end of October, gun cleaning stations will be installed in the middle of this room in Bemidji, Haiti, Clowder, and Lakeland News. The lockers are available at no cost for students through housing and residential life office. Students are required to show a student ID and have their photo taken to reserve a locker. If you've enjoyed this segment of Lakeland News, please consider making a tax-deductible contribution to Lakeland Public Television.


And welcome back to Talk Story with John Waihei. We've got a really interesting program for you today. In fact, we've got a program that I've been thinking a lot about lately. And my guest is Gary Hooser, former state senator. And now, I guess you're in charge of Hawaii Pono Initiative or something like that, right? Hapa, Hawaii Progressive Alliance for Progressive Action. I'm the president of the board, volunteer. Yeah, and I receive your emails regularly. And they seem to be regularly talking about the fact that our government is not as open as it used to be. And I have to tell you that you're not the only one sending me messages like that. It's happening all over and from people. And usually, how do I say this without offending anybody? Usually, it's the progressives that talk about the fact that government is not open because it is a progressive issue, open government is. And yet, I'm getting emails and things from the cross-section of people, business people, republicans, believe it or not, have indicated that. So I just wanted to ask you, Gary, what's happening? Why is this crescendo going on? That is a great question, Governor. And it's been a slide in this direction, I think, for many years. When I first went in the state Senate in 2002, there was a lot of votes, discussions behind doors, that kind of thing. But it's gotten worse and worse and worse over the years. And the public is fed up with it, I think. Important issues that can't even get a public discussion.  Things like increasing the minimum wage. Well, the minimum wage, as I understand it, passed the state Senate. It did. It did. The state Senate, and perhaps off the senator, Blayantanaguchi, not a huge raise increase. It was a very modest $12. We're at $10, $10 right now. And he said, let's take it to at least $12 by next year by 2022. And in the House, under the leadership of Speaker Psyche, and the chair of the Labor Committee, Representative Onishi has not even gotten a hearing. I don't understand. This is a very important issue to me. And so I'm going to just get right into it. And we can come back. I don't understand how a labor chair would hold something like this up. I mean, where are the unions on this? In fact, just three days ago, well, Friday, last week, Friday, one of the people who complained to me about the lack of openness was a member of one of our public worker unions. And they're not prone to do that kind of complaint. But anyway, how does it happen that a labor chairman and a speaker who ostensibly is, I guess, labor oriented, would hold up something like the minimum wage? Well, this particular labor chair that the committee is labor and tourism. So I don't know which were the priority lies quite frankly. And I know the big business, certainly the large businesses and the fast food industry has been opposing for a long time. I'm pleased to say that just today, I found out that the iron workers, the teamsters, the ILWU Local 142, Unite Here, United Food and Commercial Workers are all coming out today strongly asking the speaker, Speaker Psyche, to allow a floor vote on this on the 7th. Wow. Committee or no committee, they're saying, we want this voted on, not just the minimum wage issue. That's one. There's two issues. The other one is relieving people on unemployment of the state income tax during the COVID period. Those are the two bills. You mean the House, that's no prayer. Don't you think so? I mean.  What's the justification? Well, the minimum wage, they'll say it's not the right time. The economy is not good, et cetera. But as you know, it's never the right time for some of the folks. And 26 other states are doing it this year. Florida is doing it. Republic of red Florida is increasing their minimum wage and blue Hawaii won't do it. Again, 26 states this year. And the $12 isn't even this year. It wouldn't take effect till next year. But they say it's not a good time. And on the tax forgiveness, if you would, for the people on unemployment, some of those folks have been fighting for a year. And the state has really bungled it. And I'm not blaming anybody in particular. But we have bungled it. We have bungled it badly. And now some of these folks are going to get tax bill. For unemployment, they're standing and lying for food. And the House says, well, we're not sure if the federal government will let us do this or not. And you and I both know if they want to do it, they'll find a way to do it. Absolutely. Absolutely. And so it's disheartening. Again, what could possibly be the justification for taxing unemployment benefits during the pandemic? I'm searching for, I'd like to believe that these things are done for some kind of rational reason. I couldn't tell you that money might be part of it because it's a budget impact, even though the state or the federal government's going to be giving us billions, maybe the powers would be that the legislature would rather spend that money on something else. And I think we should support business, small business. Yes, let's support them. Let's support public working. But let's support low income working people and the unemployed also. Don't leave a segment, an important segment out and hang it. And both of those bills, the unions are coming out in favor of action on it and taking it out for both. These particular unions, the public worker unions, I haven't really heard from them. But these particular unions, they did a strong off-ad piece in Civil Beat a few days ago. And then I just literally five minutes before the show started, I got an email with a copy of the letter they're sending out, asking for a floor vote. Fine, this is how democracy is supposed to work. If you don't like it, say no, vote against it. But don't tell us you support it and don't pass it. Well, let's put it out. So just so people understand our conversation and I am irritated enough to have just spotted with the content. But what we're talking about is basically these things are being held in committee. And which I don't think a chairman could take this kind of a strong stand against two obviously important bills without the support of leadership as well. So my understanding and the complaint that I get is that this actually happens quite often, at least in the house of the legislature. And it happens because a few people make the decisions for the entire house. Is that your feeling? I mean, that's absolutely it. In the Senate, the power, if you would, is dispersed. The president of the Senate is not all powerful because he has to please various factions within there and make everybody happy. It's more of a collaborative kind of environment. In the house, it is very centralized. If you read the House rules, which I just did a couple days ago, the speaker controls the deadlines, the time, and controls the referrals. He doesn't have a committee that helps him refer the bills? He doesn't need a committee, but the rule said he's the one that refers. He refers it. If there's a dispute about whether a referral, he has a committee. But ultimately, he settles. Regardless of what the committee decides, the speaker prevails. And it's just over and over again, the power is centralized in one person. Well, I tell you, that's not the only complaint. So these happen to be two bills that I think are very important and that I would like to see voted on. But the complaints also include the fact that it seems like there is less openness, just period. When I was in office, we passed the open records law, which basically, I think you were in the Senate that time, were you? Or you just came in there? Well, 2002 to 2008, I was in the Senate. OK, so this is before that. We passed the open records law. And it wasn't an easy thing to do. And I mean, in terms of having to put up with it as an elected official. But it seemed to have worked pretty well for, well, with a few hiccups now and then, pretty well for the last 25 years. Now I'm hearing that a lot of that is not even being adhered to. I think it's about a mindset. And the mindset is not, how do we have an open process to the public's benefit? The mindset is, how do we push this through quickly with the least amount of trouble? And the public is seen as a bothersome pain in the ocoly rather than a valuable part of the process. There was a bill just recently that failed in the Senate. And lo and behold, it's stuck into a House bill with no public notice, no public hearing, no public discussion at all. And it's just not right. It's about respect for the public. I'm afraid also that this remote testimony has two sides to it. I'm happy that people that live in rural areas and live on the New York Islands and testify via Zoom. But also I'm concerned that this will separate the public. I've heard that they're going to even allow some commission meetings without even a proper public meeting at all. How do you do that? Did not violate the statute? Well, they're looking at changing the statute. Yeah. And again, if it's a mindset, it's an attitude. And what's happening around the nation and in our state, people don't believe in their government anymore. And we need to reverse that. And so I'm hopeful that if one more people speak out like yourself and like these other union leaders, that people in power will maybe realize that they need to slow down a little bit and look out for the public's interest, not just their own interest. Yeah. And I should confess that I'm not like a rabbit public participation kind of guy. So when I'm having a show like this, I think there have been a lot of lines that got crossed. I believe in the openness in government. And I believe that you should know what your legislators and what your public officials are doing. But to get to the point where such a cross-section of the communities are concerned, something must be really broken. I don't know what it is. I have to, we need to give responsibility also to the majority that allows this conduct. And we both serve legislative bodies. And we know that it's difficult sometimes to challenge leadership because you risk maybe your committee assignment, you risk having a bill, you're afraid of retribution. And just that the fact that there is people afraid of retribution is a bad sign. But we need to ask the rank and file to step up a little bit. And maybe they don't have to do it in public. They can speak to the chair behind closed doors and say, listen, we need to hear this bill. And if the majority did that, I think they would hear the bill. And if I could just add real quickly, because this is particularly what irks me, we live in a state where our government is controlled by Democrats. There's only one Republican senator and only four Republican. So there's no excuse from a party perspective. You'll be watching the DC, they're struggling in both 50-50 and they're still trying to pass this progressive legislation. Well, we're gonna take a short break. But when we come back, I wanna follow up on that thought, that idea of why Democrats are not acting like Democrats. And we'll come right back right after we have a break. Welcome back to Talk Sorry with John Wahe and our guest, Senator Gary Hooser. And who is one of the leading, I guess, mentors for young, for not just young, but for people who want to see progressive government. Now, here we are, we're just talking about that. This is the blue state, as we mentioned earlier, and a red state like Florida, who you can't get much redder than that, but maybe you would name might be with Texas, but you can't get much redder than Florida, just passed some of the bills, like the increase in the minimum wage, which gets held by a democratic, heavily democratic, also representatives. And what's up? I mean, I just don't, I don't know, do we, I think you just hit the nail, why have you?  We really need some, we need more opposition. Give me some of your thoughts on all of this. We do, I think to keep everybody honest, and in a literal and figurative sense, we need competition, we need watchdogs. As a former chair, vice chair of the party, I work closely with a lot of really good Democrats, members of the party, who work hard on putting their, the program together and setting the legislative priorities, and increasing the minimum wage to at least $15 is a number one priority of the party, but yet you can't get democratic leaders in the state house particularly to support that. And so it's frustrating. And I think in other states, they may frankly not be Democrats, but in Hawaii, you pretty much have to have a D or next to your name to run and win. Even Arizona also has a higher minimum wage than Hawaii has. Really? Arizona? Oh, my God. And so I think it's all of us that believe in, and the fundamental values that people that, that work 40 hours a week should be able to have a safe place to live and put the food on the table. You know, these are core values regardless of party. It's certainly the democratic party's values. And it's not happening. The open government, you know, I spend a lot of time, you mentioned that I was a mentor and that, and that really is what I'm doing a lot right now is seeking out people who want to get involved and have a calling or a desire to get more involved. Tell us about that. Tell us about what you're doing. And some of the people who have successfully transitioned through your efforts. We have, it's a program we call the Kuliana Academy, which is a, right now we're doing it online. We have been doing it for about five, five years at least. And we have a lot of people have gone through the program and it teaches people skills training, how to run for public office, how to run a campaign. It teaches them about different issues, progress from a progressive slant, and it exposes them to the world of government and politics. And you've spoken there. I appreciate that. I enjoy speaking there by the way.   We do. We have representative Amy Peruso, who she went through our program. She's serving in the house now, representative Tina Wildberger, representative, they've all gone through the program and they, they get elected on their own. We just expose them and teach them and educate the nuts and bolts of how it works. And then in the Maui County council, we have four sitting members right now that have gone through a program. And I have to say, if anyone is interested, you can find me at Gary Hoosier.com. Gary Hoosier.com. And my contact information is there. As you mentioned, I do an email newsletter. And they can sign up for the newsletter on, on joining the joint page. But what I do also is I try to tell people, our government doesn't work because more of us aren't involved.  And a lot of people, you know, it's sad. We'll say, Gary, I don't think it makes a difference whether I send an email or a call. Or, you know, does it help? So why bother? And so I always try to tell them it does help. But when, when some of the leaders in office play fast and loose with the public interest in the rules and the Sunshine law, it doesn't help at all. It just further creates more cynicism. And people don't want to get involved.  But there's a difference, though, that I see anyway, you know, giving all my years. I don't even want to talk about how many years, but giving my years of involvement. And that is that in those days, they actually went in the room trying to figure out what was best for the public interest. They may have had all kinds of other interests on play, but they came out and they felt somewhat compelled to do something that would be generally good for everybody. And I don't see that happening anymore. I see a lot of tricks being played. I see a lot of things, but there's no good result at the end, you know. And I don't know, there's this cynicism. I don't know how much of it has to do with the last four years with having a president like Donald Trump who could get away with anything and having that infect some of our leaders or what would be, like putting a bill that was clearly turned down by another house for good policy reasons and trying to sneak it back out again in a bill that would sort of ensure passage and no veto. I mean, how is that in the public interest? You know, I think sadly, they still go into the room and talk. It's just the people in the room don't represent all of it. The low income workers are not in the room and their representatives are not in that room, in my opinion. The unemployed obviously aren't in that room and the people that represent them. Access to power is evolved more and more every year.  You know, but what's funny, Gary, is that I can show you some emails from lobbyists complaining about how bad it is.  Otherwise, nothing happened. No, it's probably worse than I think.  And it is, it's this fear-based decision-making. No one wants to irritate or be on the long side of key people because they're not sure what's going to happen. Wow. You know, there's a great song in the play, Hamilton, about being in the room when the decisions are made, you know. You got to be in the room otherwise, you never know what's going on. Well, I tell you, I appreciate the work you're doing. And I do, that was just, we got a couple of minutes left. Tell us just a little bit more about some of your activities. And so that people who are interested might be able to. So the Hawaii Alliance for Progressive Action, HAPA is the acronym, is the main nonprofit organization. I also got Pono Hawaii Initiative up there. Pono on Initiative is a 501C4. The way nonprofits work, the 501C3 HAPA is an educational nonprofit. And the donations are tax-deductible. Someone wants to contribute to that organization. Pono Hawaii Initiative is a stronger advocacy organization and the contributions are not tax-deductible, but you're allowed to do more advocacy. There's both organizations. They're separate in terms of their leadership, their boards, and their budgets kind of thing. So the Pono Hawaii Initiative, we support candidates, we endorse candidates. We're looking right now at 2022. And we're saying if you're not going to act like a Democrat, even though we're not partisan per se, if you aren't going to look after the people's interests and have hearings and vote in public, then perhaps we should find someone to run against you. Well, that's a democratic way. And I got to thank you for joining us today and for your service to the state of Hawaii. But keep up the good work and hopefully we'll have some sunshine. Thank you very much for having me on the show today. Thanks, Senator. I really appreciate your presence. Take care.


Red Lake Middle School celebrated all the progress they've made over the past year with a special awards ceremony and a very special guest. Red Lake Middle School has been on a positive path. They have seen declines in both student referrals and suspensions and increases in enrollment and attendance. To celebrate Grammy award-winning DJ, DJ is paid a visit to the school as part of the Turn Around Arts Program. Turn Around Arts promotes positive progress in schools with the help of art. It's an honor and blessing for me to come out here and visit Red Lake and kind of just see the culture and the arts and how the kids are thriving. One thing that I love about what we do at Turn Around Arts is for me it's not so much about a program but more or less it's about the human element and how we connect to our kids in the classrooms. Through arts, through music, and just through creativity and imagination. Students also competed in a snow state competition after the awards ceremony. If you enjoyed this segment of Lakeland News, please consider making a tax-deductible contribution to Lakeland PBS.


I just, yeah, I wouldn't want to put it out just yet. Do you want something done in here? Yeah. I want to put up in a clip and have the ends curled, the big curling iron, and then a couple pieces. Did you see it? This was in the cake. Because I think it's gonna work better for me than I thought it would. This was in the cake. And does it pull? I probably open up the sides to get it out. Yeah. It's supposed to go like this. Lift it out. Yeah. Careful. Oh, that's really pretty. That topper's gonna look really nice. Where'd you get the cake? Pollock's. Yes. It's where I got Michael's. It's too soft. I need something. Yeah. Yeah. I normally go like this. And then I clip it. Right. Let me show you what I'm looking at. I'm following you where you're talking now. And then have it come down over. Okay. And those curled. And I think that would probably look good. All right. Besides the ponytail. You know what I mean? Yes. All right. And then a couple like here. All right. We'll strand those out first. That looks pretty. That looks really nice. Is that done? Yep. Yep. Mm-hmm. I'm sorry. I put it on the corner. I put it on the corner. Caleb took the paper. Hi. Hi. You're on camera. I'm going to do a video and then I'll take some pictures. Okay. Sweet. One more. One more. Let's take a new one. We are gathered here today to celebrate the loving union between James and Linda on this 13th day of December 2020. Do you, James, take this woman to be your wife to live together in peaceful bliss, to love and honor, and obey. To comfort her and keep her safe. We're saking all others even when she plays sleepless in Summerfield because she cannot sleep at first. For as long as you both shall live. I do.  To live together in peaceful bliss, to love, honor, and cherish. To comfort him and keep him safe. For saking all others. Even when he decides to use his selective hearing when it's good for him. For as long as you both shall live. I do. Right? James, please sit. James, please sit. Linda, take you, James, to be my husband. I love to take you, James, to be my husband. To have and to hold from this day towards. To have and to own from this day forward. For better for worse, for better, for poorer, for richer. And sickness and in health. Sickness and in health. To love and cherish, to this day. To love and cherish, to what is safe. I, James, take you, Linda, to be my wife, to have and to hold from this day forward. Please rest ISIS. for better, for worse for richer or for poorer for richer, richer in sickness and in health in sickness and in health to love and cherish to love and cherish to haveernts by the authority vested in me under the laws of the state of Florida i now pronounce you husband and wife james you name me now kiss Yay! I can't even get around. How many are there? I don't know what's good. So then Marty can drink it. Marty's drinking that. Marty's drinking that. Daddy. I said alright. I'm sorry. Alright, pull it out. Okay, that's a plate. I'll get on the plate. I'll get on the plate. You guys eat. He's first. Hey, he's wearing white. What do you mean, good? Put your feet down. Oh, yeah. Oh, yeah. Just wash it up with nose. Get my brother.