Hello, everyone. My name is Jane Katten, and I'm the CEO at Agewell. I'd like to welcome you to our show, Aging Matters, and I'd like to thank our sponsor, MVP Healthcare, for making our show possible each month. As you may know, Agewell is the largest area agency on aging in the state of Vermont. We serve anyone over the age of 60 or under the age of 60 with a disability on long-term care Medicaid. Our goal is to make sure we provide just the right wraparound services to allow eligible individuals to stay healthy and independent in the setting of their choice. Each month on Aging Matters, we try and find topics of interest for all of us as we age, and those topics may involve subjects that will help us to all age well. Today on our show, we're going to explore a very interesting topic related to long-term care planning, advanced planning, as we think about the future and even end-of-life matters. Today joining me on our show is Cindy Bruzezi, who is the Executive Director for the Vermont Ethics Network, and she's going to help us explore these topics. So Cindy, welcome. Thank you for coming to our show today. Thanks for having me. I have so many questions to ask you this afternoon. But before we dive into those, Cindy, maybe what you could do is tell our viewers a little bit about the Vermont Ethics Network and your role as Executive Director. Sure. So the Vermont Ethics Network is a very small not-for-profit. We're located right in downtown Montpelier, but we serve the entire state. And I'd say a little bit of New Hampshire as well. We certainly get calls from folks in New Hampshire because so many Vermonters get care at Dartmouth and at those border hospitals. And so my work really, or the Ethics Network, really centers in sort of three general categories. We do the bulk of the work around the topic that we're talking about today, planning and medical decision-making and thinking ahead about circumstances in the future and what matters most to people and how do they make that information known to their loved ones and what are the tools that are available for them to document those kinds of decisions. I also do work in Ethics, the middle name of the Vermont Ethics Network. And so I support hospitals and non-hospital healthcare facilities and basically recognizing, managing, and ultimately hoping to prevent ethics conflicts from occurring in those clinical settings. I mean, medicine is very complex. People are living longer, so there's always complexity. So it's kind of inherent in clinical medicine to have some uncertainty about what the right thing to do is. And so that's pretty much what Ethics does. And then I also direct the statewide task force on palliative care. So all of these topics, Ethics, medical decision-making, palliative care, they kind of all intersect around caring for people as they're aging through the lifespan. Oh, wow, sounds fascinating and very complex, as you said. So let's dive into our topic today and jump into a few questions. So, Cindy, as we think about making end-of-life healthcare decisions, could you please describe what advanced healthcare planning means? So advanced, to me, I think the simplest way to put it is exactly what it says. It's planning in advance for future healthcare needs. But I like to think of it as planning for the what-ifs that kind of happen across the lifespan. So there's always chances that something sudden or unexpected can happen. And so ultimately, what advanced care planning is about is making sure that the care and the treatment that people want aligns with what they get. And so thinking about circumstances that could happen in the future and making your wishes known about what's important to you, things that you would find acceptable, things that you wouldn't find acceptable, sharing that information with your loved ones or family or friends, and then ultimately putting it in writing is all part of that advanced care planning process. And it is a process. It's intended to be revisited as we age across the lifespan because we know that people's values change over time. What matters most to them changes over time. Their circle of friends and family changes over time. And so it's important to revisit these things periodically. Mm-hmm, fantastic. Well, I think it gives us a lot to think about because as you say, things change. And we have to do a lot of communicating, I imagine. So let's go a little deeper. Why is it important to think about health care planning, and you alluded to this a little bit, before a medical emergency or serious illness arises? Yeah, so I would say that's the hard one, right? Because who wants to think about things that are unpleasant? Right? I mean, nobody really does. But the fact of the matter is that sudden illness, accidents, these things can happen to anyone at any time, regardless of their age, regardless of their baseline health. And they may find themselves in a situation where they're not able to communicate with their health care team. And it's really difficult if we don't know what matters most to this person and there's decisions to be made. We may not know who the right people are to talk to, and we may not know what are the priorities that we should be focused on as a health care team. And so it's tough to do that kind of critical thinking, big thinking in the midst of a crisis. And so lots of people do kind of manage their health care by crisis. So a crisis happens, we make decisions, we go along for a while, another crisis happens, we make another set of decisions. And so the goal here is really to think about that a little bit in advance when you're feeling well, maybe you've had some experiences, you've formed some opinions about what you like, what you don't like, what would be acceptable, what wouldn't, and then you share that information ahead of time and you identify the people that you want to have speak for you if you can't speak for yourself. And I'd say that's probably one of the single biggest and most important things that people can do in advance. In most states, the law tells us who will make decisions for us if we can't make decisions for ourselves. There is a very prescriptive set of rules and a hierarchy if you will that says, well if you can't make decisions for yourself then the decision-making will default to a spouse if there is one or next of kin in some order of priority. Vermont just has no such framework. It doesn't mean that those people can't make decisions, it just means there's no order of priority, there's no preference given, it's not automatically going to be your next of kin. So this is an opportunity, I think, that people have in advance to think about the people that know them best, to think about the people who can be good advocates for them at a time when they maybe can't advocate for themselves and to make that a legally binding kind of person to do that work in the event that they can't do it. And that's difficult to do in a crisis, especially if your decision-making is impaired and you can't communicate. Right, right. And I think the most important thing that I heard there is take the time before you have a crisis and be thoughtful. It's so much easier to think about big questions and difficult things when you're feeling safe and calm. Right. It's so much harder to do it when the stakes are high and you're scared or frustrated or worried and you're not sure what to do. And a lot of information is coming at you all at once. So this is an opportunity to sort of take a step back, slow down and also get your questions answered. Like if you have questions about your illness or what's coming or what to expect, there's opportunities there to get those questions answered so you can really be informed about what lies ahead. Yeah, great points. So it sounds like a big piece of planning, and now we're going to talk a little bit about advanced healthcare directive. So planning is about thinking what might go into those directives. Can you talk about what the directive or advanced care directive actually is how to get the process started? And do they have to be legal documents or could I write it on the back of this piece of paper? Yeah, so those are great questions because in Vermont, we are very liberal in terms of what people can do to formalize their planning documents. So the Vermont Ethics Network has plenty of forms, and I know they'll put the website up on the screen so your viewers can see it. So you can look at forms that are, questions are prepared in advance and it covers kind of the big things, but you're also free to make your own document, write your own wishes down, a long personal statement. The only thing that's needed is that it's signed by two witnesses, and there's no notary requirement in Vermont, so you don't have to go trekking to find a notary. You just need to have two adult witnesses who are not your immediate family sign that they've witnessed the document and you sign in their presence, either virtually or physically in their presence, and then it's a legal document. So as long as it conforms with Vermont's witnessing and signing requirements, these are legal documents. So people can feel free to customize things. They can use the forms that are provided by the Ethics Network or by their attorney. Attorneys are preparing these. Estate attorneys can prepare these as well, although you don't need an attorney to do this. You can do this sitting around the kitchen table with your family. And having conversations and then have your neighbor's witness kind of a thing. You can keep it informal, but it's a really great way to sort of solidify and make sure everybody knows what the plan is. And so should something happen and where we need to be looking at these documents. And I think it's important for your viewers to know that we're not looking at these documents as long as we can talk to the individual directly. People still get to call the shots on what will and won't be done to their bodies as long as they have the ability to make those decisions. It's only when we can't get that information directly from them that we need to talk to someone else that we're looking at these documents. And these documents and your wishes combined with the person that you just designated to make those decisions, we call that person a healthcare agent. We used to call it a durable power of attorney for healthcare, but it's the same thing. It's the who, who gets to make decisions. They need to work in collaboration with your healthcare team and to promote decisions to be made in accordance with what you've specified as most important. Perfect. So once the document is created, I guess it's really important to find a good place to put it that somebody knows about, right? Yeah, and it used to be that people put these in their safety deposit box and I can strongly discourage people from doing that. These kinds of things, these situations almost never happen when the bank is open. And so then we're in this like pickle. So Vermont very proactively created a registry. It's a secure repository where people can send their documents. They'll be scanned in. So if you're handwriting these, it'll be in your writing. And then they're accessible to healthcare providers and facilities across the state. And they're even accessible because it's online outside of Vermont. So people can get access to this if they're traveling. People will, it's voluntary. You don't have to submit your document to the registry as long as it's assigned in this document. It's legal. And you should give it to the people who are making decisions for you. You should give it to the hospital where you're most likely to receive your care. You should give it to your doctor. Your circle of friends and family. And then the other option is to also give it to the Vermont Advanced Directive Registry so that they can look it up directly into the registry and we don't have to worry about trying to track down someone who has a copy. Oh, that's a great idea. The registry, remember the registry. Perfect. So you were just alluding to another term, a healthcare agent. So let's talk a little bit about the healthcare agent. Is there a difference between a healthcare agent and an advanced directive? It's a type of advanced directive. So there's different kinds of advanced directives that people can complete. And they may have heard terms like living will, durable power of attorney for healthcare, terminal care document. These are all the different kinds of tools that have existed since this whole thing began back in the late 70s, early 80s, where we started thinking about, gee, we should be planning for these kinds of things like we planned for so many things in life. And so a healthcare agent just covers who can make decisions. So it's a type of advanced directive. Sometimes the people call it a proxy directive. Some states call it a healthcare proxy. Vermont calls it a healthcare agent. Again, synonyms for who gets to make decisions, who has the legal authority to make medical decisions. And then there are other types of directives that speak to the what. What's important? What matters? What do we need to know about this person to take good care of them? We used to call that a living will. Okay. But living wills were very narrowly defined around a very specific type of end-of-life scenario and had language that was kind of ambiguous and difficult to implement. The language was, if I have a terminal illness, there's no hope for my recovery. I don't want any extraordinary measures taken. I want care directed at my comfort, that kind of language. Unfortunately, words like hope, recovery, extraordinary, those all mean very different things to different people. So it became very difficult to implement a document when we weren't really sure what the person meant. And so we've now kind of expanded on the concept of a living will to make it broader, not so narrowly confined to just end-of-life to allow people to articulate not just what they don't want, but also what they do want so that we can align, again, as I said earlier, the care and treatment that they get. And so proxy directive or the decision-maker directive, the who, and the plan, the what, what's important. And we have a little campaign that we started years ago at the ethics network called Who's Your Person? What's Your Plan? And really, that's really just a simple way of talking about advanced care planning and thinking about the two areas people need to think about. Who makes decisions if you can't? And what do they need to know about you in order to be able to be a good advocate? Great. I love that campaign. That's fantastic. Cindy, what's the best time for someone to fill out an advanced directive and who can help with that? So you talked a little bit about, well, maybe it's your friends or family, lawyers, but when's the best time to do it? So what I would recommend, which I know is going to be kind of a odd thing to say, but I think anyone from the time someone turns 18 and they're a legal adult, that is when they should start the process of advanced care planning and even the process of completing at least a proxy directive or the naming of a health care agent. Because as we know, things can happen. At young, old, it doesn't make any difference. Unexpected things happen. And so it's really important, I think, for people to think about that in advance and to start the process at 18. When you move from your pediatric physician to your adult family medicine physician, when you're going off to college, that's the best time to start the process. And I think if we have these conversations often and early, it becomes so much easier to have them when the stakes get higher. I think you're right. Communication is really key and not being afraid to talk about these things. Exactly. Yeah, doing it together. Let's see. I have another question and it goes down a little bit more the medical path. Can you tell us and our viewers about the difference between a DNR or do not resuscitate order and an advance directive? That's a great question too. These terms are so often confused, I think, and not just by everyone, but even by healthcare professionals. Sometimes they're using these words interchangeably and I think that also creates confusion. So an advance directive, as we were talking about, it's a document that a person, anyone over the age of 18 can fill out as long as they're their own decision-maker. So if they have a medical guardian as someone else who's making decisions for them that the court's appointed, then you can't complete an advance directive, but as long as you're an adult and you're making your own decisions, you can complete an advance directive and it's really a preference-based document intended to guide future healthcare problems at a time when you couldn't make decisions for yourself. So you can only complete one when you're an adult. You can only complete one for yourself. You can't complete one for someone else. They have to complete their own and they're thinking about a time in the future when they wouldn't be able to make decisions for themselves and trying to make a decision about what would give people information about what would or wouldn't be the right thing to do for them. DNR orders are a type of document that's like an advance directive, but not quite. It's actually a medical order. So it's a different type of document and it only focuses on a very narrow number of treatments, things that we might be considering if someone's very sick and they might even die. So the use of CPR, the use of breathing machines if a person can't breathe for themselves, the use of providing artificial nutrition and hydration if they're not able to take in enough food or liquid on their own. Those kinds of really more technical interventions that are aimed at saving people's lives or prolonging their life and some people may or may not want those things depending on their own values and what's most important to them. And so these are medical orders they're actually completed by your clinician so you don't fill one out for yourself. It's like writing a prescription, right? You can't write your own prescription for medicine. You can't write your own DNR order. You need that healthcare professional to have a conversation with you so that you fully understand what it is you're saying I don't want. So that you fully understand what that means to say no to CPR. So you have a good understanding. And then it's actionable so because they're medical orders they're binding on all healthcare providers including first responders because they're intended to guide the current treatment plan. What are we going to do today if something happens? Very different. Future-oriented advanced directives preference-based thinking about the future DNR orders they guide the here and now very narrowly crafted you can't name a healthcare agent in a DNR order and they're binding on all healthcare providers including first responders. So if someone is certain, let's say, that they don't want CPR that's just not something they want doesn't matter why that's just not an intervention they're interested in. It's great that they might have an advanced directive that says that in it but EMS can't honor that. I see. What EMS needs is they need a medical order signed by a clinician either a physician an advanced practice nurse or a physician's assistant that says I've had a conversation with this person they understand what it means to say no they don't want this and then they sign that order. EMS is looking for that order when they come to someone's place of residence. I see. And if they find that order they're obligated to respect it and to honor it. But if someone's just saying advanced directive somewhere and it says they don't want that that's not good enough because CPR is one of those interventions that we assume people want us to try. And so if you're going to say no we want to make sure people fully understand what that means. Perfect. Well those are great differentiators and it sounds like we have to have all these forms and get them sorted out in advance and make sure that there's somewhere in our residence that our family member could quickly grab if we're incapacitated. Yeah the recommendation for these types of out of hospital medical orders and that's what they're called Vermont calls it DNR Colst so the C-O-L-S-T stands for clinician order for life sustaining treatment so these are medical orders the recommendation is that they be on the fridge or in your refrigerator. If a person lives in like a residential care home they may have within the facility or the home a set place that they've already trained the first responders that come to that facility this is where you look it's in the first cabinet you know some place specific but in general it's on the fridge or in the fridge and local EMS will have something you're in your town called a vial for life or a vial for life and they're like a a red magnetized thing that you can put these orders in and stick it to your fridge or if you want you can put them inside the fridge so you can ask your local EMS what is the thing that they recommend in your community and to follow that great fridges and forms fridges and forms I like that awesome let's see I have another question for you and then it has to do with what you were talking about earlier shifting gears a little bit to palliative care because the Vermont Ethics Network also has their eye on palliative care so Cindy what's the difference between palliative care and hospice care because we know they're too they're similar to the continuum I guess I would say yeah I like to think of palliative care as this sort of big umbrella term that talks about how do we care well for people who have serious illness and palliative care clinicians trained physicians nurse practitioners PAs who have specialized skills in dealing with folks who have serious illness or progressive illness or even life limiting illness where they have a really big toolbox in order to help people manage their symptoms of their illness so they can live well for as long as they can and so that's really similar to hospice but hospice is really a special type of care that's it's all palliative all hospice is palliative care that makes sense hospice is a specialized type of palliative care that happens when someone has is expected to have six months or less to live so it's a very focused type of care at the very end of life and it's typically defined by the Medicare hospice benefit which says that there are certain types of services that people would be would be getting if they're on a hospice program so all hospice is palliative care it's just special palliative care the last chance of life but not all palliative care is hospice because people could be getting palliative care much earlier in their diagnosis to help them live fully and continue to enjoy all the things that they enjoy doing even though they may have a serious illness thank you for describing both of those things because I think there's a lot of confusion at times when we hear palliative care and people are thinking hospice and it may be end of life care and there is a difference definitely I think the important distinction too is that when someone's on hospice they are forgoing sort of disease modifying or curative types of treatment that's sort of a condition of being on hospice they're no longer pursuing sort of treatments aimed at prolonging their life they're going to allow for a natural death and the disease will follow a natural course in palliative care people can absolutely still be pursuing curative or disease modifying treatments but the palliative care may be helping not just to manage the symptoms of the disease itself but maybe the symptoms of the treatment so that people can continue to enjoy the things that they enjoy doing that makes life worth living for them right perfect that makes all the sense Cindy we're coming to the end of our show but we have just another minute or two and I wonder if there's anything you'd like to share with our viewers that you think is the most important takeaway for them this afternoon have conversations with people that they care about I think doing an advanced directive thinking about advanced care planning is actually a gift a gift to your friends and family because it's really tough to never have had this conversation and to be in the position of having to make decisions for someone else when you have no idea what they would have said if they could and it's really a gift to give to your family and friends to say hey this is what's important to me these are the things that matter and it's okay I trust you to make these decisions for me if I can't it's a really nice thing to do for your friends and family or whoever you're choosing to be your decision maker to help them feel comfortable and okay and able to really represent you well if and when the time comes well at my next birthday to get their advanced directives organized is that an idea that's a great idea that's what I did my 50th birthday party I had my family complete their first advanced directive I think my son was 19 my daughter was 21 and my husband who hadn't done one up until that point finally did one so it was a good birthday fantastic well there you go a great gift so Cindy what I've learned today is that advanced care planning is not just for us and planning ahead is important it's really important part of making sure that we receive the medical care or the treatment or the services that we think are most important to us at certain periods of time in our lives and before it becomes critical so did I sort of get that right? I think you did a great job great so Cindy thank you so much for taking time with us today we really appreciate it and to our viewers always remember that if you or someone you know needs assistance please call Agewell and as you're thinking about advanced care planning there's also case managers at our agency who can help with that there's also the Vermont Ethics Network that you can log into online I know that the website will be posted and other than that please take care think about planning and be sure to tune in next time as we explore some very interesting topics on aging matters thank you and we'll see you next time


from San Jose in the heart of Silicon Valley. It's theCUBE covering Big Data SV 2016. Now your host, John Furrier and Jeff Frick. Okay, welcome back everyone. We are here live in Silicon Valley in San Jose at the Fairmont Hotel right across the street from the convention center where Strata Headdubs happening. It's part of our Big Data Week and Big Data SV. I'm John Furrier. This is theCUBE, our flagship program. We go out to the events and extract the signal from the noise. I'm joined by my co-host Jeff Frick and our next guest is Keeble and my Ryan Peterson who is the hot property on the market. Big startup, CTO. Hot startup called Data Republic, formerly with EMC you've been on before. CTO at EMC as EMC and Dell merged in or Dell bought EMC on private. All that stuff's happening. So even the front row of big data now doing the startup. So give us the update. What is Data Republic? Why did you leave EMC? What enticed you to jump ship into a growing startup, a round type funded startup? Well, before we get into that, let me just stop and say something. You guys have been fantastic. Through the entire process of transition, you've kept up with me. You guys are connected to everyone and it's been really, really fantastic and I appreciate everything you guys do. But let me tell you about Data Republic and you know, is that EMC and we talking about data being the most important commodity of the future and thought about how do you value data and how do you use that data for more value? Well, certainly everyone's been talking about the data lake and bringing everything into one place but we talk about everything and everything really is just your data.  You don't know what they're doing with everyone else and so that's what we sought out to change is we can get everybody else's data into your environment where you can start looking at the holistic view of a person. Now you've got real power in the process. So were you guys waffling between Data Republic and Data Empire? I mean bring the whole Star Wars theme. Let's just bring it together. I mean Republic, Empire, I mean, what's going on here? What is it? Republic or an Empire? The Republic's all about. Let's break down the Empire, the empirical control and let businesses get back their data. You know, frankly, we think a lot of data is starting to show up in a couple of really big key companies. It's all keep nameless, but everyone knows.  Well, at least I thought that was silly. If you're able to get your information and bring it into your environment, analyze it the way you want it. You shouldn't have to be giving your information to someone and then having to pay for it. Well, it's always interesting because I think some of these big companies that will go in name to start with G&M and other things like that, they figured out early on kind of the value exchange of service for the value of that data. And the value of that data exceeded, obviously, what it cost them to provide the service. And I don't think a lot of people really understood the value. And maybe the value as a solo person, it's not that much and it's really the value in aggregate. So how are you kind of wrestling that back? I'm sure a lot of people are very interested, A, to get it back, but two, to really start to get compensated or get value that's worth what they're actually providing. So we decided to go closer to the source. So instead of looking at somebody who's observing our behavior, we're looking at what actually happened. So the fact that you searched for an iPhone on the internet, it doesn't mean that you're necessarily gonna buy one. But the fact that you bought one means that you bought one. So I'm going to the actual banking data. I'm getting the transactional information and finding out exactly what people are doing, getting that kind of content. We're going to the merchandisers and saying, hey, I know what you bought because you bought it. And I'm figuring out how to do that in a very secure and private and regulated way. And we believe we've solved that biggest challenge. We spent two years building the company to the point where all it is is a legal framework. And we just launched it about a month ago out of stealth and we're already seeing profitability from it. It's amazing. So talk about the big trends that you guys are riding behind. And a specific question I wanna ask you since you're here and such an expert on the market is, what's the big story here at Strata? We're out hunting, we're fishing for stories. Obviously theCUBE, we're extracting the signal of the noise. There's a lot of noise still in this market. I mean, a lot of people kind of groping for success. We know a lot of companies are going sideways, but yet some are growing exponentially. So there's gonna be the haves and have-nots. And then you get the big guys coming in, the rich are getting richer, as Dave Vellante always says, with this kind of softening of the market. Yet there's underlying technology change. So with that, what's your view on the top story here in this show at Strata Hadoop? It may be a contentious conversation, but I actually feel like there's too many people who are doing the Me Too. And there's gonna be value in that. The Me Too's are gonna get to the point where they can be acquired. I think a lot of consolidation is based with the bigger organizations who start to swallow up the guys that have figured out something interesting. And we'll start seeing this show start to become just about the big guys over time, as well as, of course, the open source community, which will never go away. What I think is interesting is I'm not seeing a lot of very unique differentiated companies come out of the marketplace. I'm not seeing a lot on the floor of, hey, show me something that you're doing that no one else has done. So you think that rich are getting richer? Yeah, rich are getting richer. And I think that the startups are spinning out, and then ultimately they can spin back in.  Not yet public, and you got Hortonworks. All they're all here. So who's gonna break out? Who do you think's gonna be? What's category, I should say. You don't have to name companies.  But you want certain actors to be in the market. Who are they? Certainly, I think that you've seen the majority of the fight be Cloudera and Hortonworks in the marketplace, MapR closely following behind. I think that's gonna shift a lot. There's obviously been a lot of ups and downs in the Hortonworks stock. There's been a lot of big announcements by Cloudera, some good and some bad. I think MapR has actually made quite a lot of push in the recent history from my view, at least. I think that those three are gonna continue to push forward. I think Pivotals, it looks like they've changed a lot of their methodology and direction. At the same time, I think that what they've done with ODPI is incredible. We're gonna see those four players, and as well, of course, IBM just doesn't go away. So data republic, it really implies data working together, data fusion, whatever word you wanna use, essentially an overlay, mix and match, alchemy, whatever the term is, so I wanna get your thoughts on a topic as you're so close to the action. You're really in that first party mode, right on the front lines. So a theme we've been kicking around in the journey of big data, which you're on, continuing on, and now it's a little bit hotter in your kitchen, because you're gonna start up, you know, a lot of pressure in the big company of EMC. But three areas I wanna get your thoughts on, completeness, integration into production, you know, invention, innovation of production, and three hybrid cloud. Those three areas. So about what that means to you in this industry scope of are we complete, what needs to be completed, where's this integration, which now is coming up as a core theme, and ultimately the role of hybrid cloud. So going back to what I was saying earlier, starting off with that completeness, so we believe that the majority of data is what you actually have about your customer, and then survey data that you buy from someone else, and we think that that's pretty thin survey data. So you get deep information on what you know about your customer, and then you get thin information about everything else. We think that filling in those gaps are gonna be with things like banking transactions, merchandise information, all the other collective data about a particular individual, or a particular company, whatever it might be, and that's gonna complete the actual data set. So completeness on the progress bar of completeness halfway there, not complete, we're certainly incomplete, if you think about it. I think that the most successful organizations of building a data lake and have all of their data in there are still only 10% the way they are. They only have a small, very small slice of the data that they need to truly be successful. So that's why I really wanted to dig into data sharing and data exchange, and how do you get information from their companies. It's really, really, so we're incomplete on a road to completion. Okay, now integration. This seems to be the new barriers to entry that some startups can't get out of the hurdle on because this seems to be enterprises saying, okay, we've done some data laking stuff, we've done some to-do, but I gotta integrate in with a lot of other operational systems. Your thoughts on that. Yeah, I think part of the problem is that there's so many different tools to choose from, and there hasn't been a lot of consolidation yet, that'll get better as we start to see tools combined with each other, and so the bigger organizations bringing a higher class of product than the smaller guys can actually create. I think that the idea that governance has been a real problem of data. We're seeing great companies emerge, like Waterline and Zoloni, trying to solve these challenges of governance and cataloging. Part of the problem has been it's just another place to put the data. We've extracted it from the data warehouse, so we've now put it in a data lake. Now what is the same thing I had before, just a bunch of flat files that I have to figure out how to work with. You gotta use those. It's gotta be usable, right? It's gotta be usable, it's gotta be searchable, it's gotta be findable, and I think that the next step is really to integrate truly, you've gotta get to the point where you can find all that data, search through it, and then also find data sources outside. Okay, hybrid cloud. Just the compute engine role of it, is it relevant, irrelevant, non-factor, or just compute or deployment factor? Yeah, I think the companies that push hybrid cloud think that it's very relevant and very important, and I think that to some extent, there's truth to that. There's certain things you don't want to see outside of your organization, physical organization, and there's some cases you want stuff in the cloud and people are saying, well, hey, let's try and keep both because the people who are losing on either side want to say, well, it's better to work together, right? So hybrid cloud, I think, is a word to say, hey, let's try to keep our data where people care. Frankly, it's a bit of a challenge, and it's something I was working on quite heavily at EMC, was how do we make it so that you can analyze data that is geographically disparate? When you have data that's in a cloud and data that's on local, and you know that having that locality is really important to get to the point where you can search through it and run through it, how do you make that happen? Brian, I want to follow up on your point about, you said most of the data that you want is stuff you already have and the stuff that you don't have is thin. The counter would be that there's so much of it, does so much of it make up for the thinness or is your hypothesis that it's just so thin that even though there's so much and it's growing, that kind of this ancillary data, that it's really not as relevant as you're saying, if I understand you, kind of horse trading for the other transactional data with other people that have the richer set. Yeah, I think the challenge is that people are going through and they're looking at their data and the CEO's asking a question and the CEO's have been trained to not ask a question that they don't think could be answered and that's a real problem, I think. The reality is that they're starting to ask harder questions or to quote Cladar or Michelson who said this, ask bigger questions. I think that those bigger, harder questions are things that you have to be able to answer with other people's data. So if you have an airline who says, how much am I making compared to, how much of the spend do I have? Well until you go to other airlines to figure out how much spend they have and you really don't know, you can't just go ask your competitor how much money are you making, but you can certainly find out by looking at the transactions and credit cards, what the percentage of utilization is on a particular place. So getting that information answers that question more specifically more accurately than any other place that's been before. So those are the kinds of harder questions we're trying to get to and we think that we've found that answer for being able to ask for that data quickly, easily, efficiently. Today people do this, happens all the time. You get two partners that work together, they exchange some information, they sometimes do it completely out of compliance. We're trying to solve all those problems and get some please. And is it peer to peer? Is it within a group? Is it buying to the network? Kind of what's the business model or what's kind of the transactional model in terms of the actual sharing of the data? So our business is to take it from being peer to peer which it is now. I imagine somebody working at the legal contract that could take a year for someone to finally get to the point where they work out one deal with one partner to make it a start to apology. Everyone comes into the center environment, they all agree to a standard terms and conditions and that's what makes it available for everyone to use. One of the things that we've been talking about on theCUBE, the great thing about going to theCUBE we all have different events and talk about different topics but we were just at Oracle Cloud World in DC and it was interesting and we're getting geeking out on some product managers about the notion of how the infrastructure certainly changed and we always talk about that but specifically the DMZ. The DMZ was a nice area, the demilitarized zone and IT was the area where you would have extra nets and you would do some of these exchange concepts and we saw B2B exchanges, all kinds of technologies around web services enabled that but with security kind of now perimeter-less, there's no more perimeter, but there's no more DMZ, it's been gone for years now. So you guys are doing something interesting with an exchange of data, so that's cool. How does all this fit in? Is it an enabler for you? Is it a technical challenge? Is it a condition that allows you to get a position in there? Because the notion of a DMZ was to create a safe zone. Yeah, so we are the DMZ to some extent. You're the new DMZ. We're the new DMZ. For data. Yeah, we're the place where data comes in, data flows out and we figure out how to handle all of the process in the middle, so whether it's the financial transaction, which is probably the lowest level component, how much are you going to pay me for the data? Which by the way, and to the ancillary to that, imagine in the future people start seeing the biggest number on their P&L, the biggest number on their balance sheet be data, which I believe is going to be a future for us. But in any case. So it's a capital item, it's going to be a not oil, it's going to be actual. They've been making money on selling data for a long time, right? That was kind of the head of the curve and they didn't have a lot of competition. Data Republic's all about bring that back to the users, bring it back to the people who own that data and can actually make money off of their own content as opposed to companies like that or just like that buying data, reselling it for a profit, they can sell their own profit. All right, so what is, I mean, we've heard these stories in the past. They've been grandiose and a lot of them have flamed out and a lot of it's timing. So what makes you think that the timing now is good for this not to flame up? Because it's very democratizing, oh, we're going to democratize data. You know, you smoke the peace pipe all day long but the reality is what's going to happen with that? I mean, do you think the time is now and why? Well, I think the first problem we had to solve was the data, like getting all the content into a single place, cataloged and find a place where you know what the data looks like. The next challenge becomes, how do you value the data? How do you know what it's worth? And until there's an open marketplace for data exchange where people can start to figure out exactly what the financial value is in economics of supply and demand, you won't know how much data is worth. And so we figured out that if we don't start doing that process in a shared way where we can start to manage and look at that kind of information, we won't ever be able to tell somebody how much their data is really valued at. So is that your goal to help people quantify what the data's worth? Yeah, I think that's one of the goals. For customers or end users. We believe that the biggest goal is to get data, more data into their environment so they can learn more. The ancillary goal to that is of course they'll make money off of that and put it on their P&L. But the long term is we want to be able to tell people how much their companies might be valued at. I mean, look, it's a great example. Caesar's entertainment, bankruptcy, big problems, sold their data set, billion dollars. Had they known that their data was worth over a billion dollars, would they've even had to go to bankruptcy in the first place? Those kinds of issues are the kinds of things we want to extract early before it becomes a problem, right? Where can I find a billion dollars to get the company going? Well, I've got a billion dollars that I can go sell right now. So, Ryan, I want to get your perspective. You're at a big company for a long time. Now you're at a little company, and we see it over and over at all the shows we go to. The big guys are carrying their freight. It's the little guys are really where a lot of the cutting edge innovation happens. From your perspective where you sit now, and you just said a little earlier that you're not seeing a lot of original things here at this particular show, right? What would you tell people that are out there trying to find opportunities to come at this problem, additives to the problem, a slightly different twist on the solution from an entrepreneurial point of view? Are there still a lot of great opportunities out there? How should they look at the problem? And where do you see some of the things that obviously aren't directly competitive to what you guys are trying to do, but really still some greenfield opportunities even though we've been coming to the show since 2009? Yeah, I think you have to, it's hard to quote Steve Jobs, but I think he's got that great quote out there about you have to build what people need, not what they ask for. I think part of the challenge is a lot of companies just look at what are people asking for, what's the market analysis, and they tend to do this superficial view of things. You really have to look at what could completely change the world, and I think I've told you guys in the past, I'm all about let's change the world, let's do something, and change it for good, but how do we make it better, faster, easier, and I think there's so many opportunities out there, and we're seeing some really great innovation. I just don't think we're seeing as much in big data as we're seeing in the rest of the technology world. Apps are coming out every single day with something, and I just saw an app where you can now rent a car by simply walking off the plane, and there's somebody parked their car over there, and you can go, you said, I mean, those are the kinds of things that I think we're just going to change things. It changes the way that the world operates. Well, Ryan, great to see you, great to have you on theCUBE, Greg, thanks for coming in and sharing your insight here on our CUBE Insights segment here, the Ryan Peterson entrepreneur now, CTO of Data Republic, congratulations, good luck with your success, and we'll be following you guys as theCUBE, extracting the signal from the noise from Big Data Week and Big Data SV, and Strata Hadoop, we'll be right back with more after this short break.


Dividend investing is boring. At least that's what I hear from a lot of people. Because nobody cares about a 4 to 5 percent steady growth every single year if you can get a 35 percent increase in a day in the crypto market. And why would you waste your time with the dividend portfolio? Anyways, in this video, I'm going to tell you exactly why I personally think dividend portfolio is going to be a very powerful tool for myself to set myself financially free. There is no doubt about it. We live in a fast world. Get rich fast, lose weight fast, make a thousand percent in the crypto market today, consume content even faster, you get it. There's absolutely nothing wrong with that. To be honest, I actually like it. But at the same time, I think it's important to differentiate between the fast lane and the slower one. Most likely, unless you crash in the fast lane, both lanes will get you to your destination. Just like one is fast and one is slower. So dividend investing for me is basically the safe and slow lane, which will take care of me in the future.  Here we go. A dividend portfolio is like a tree. Yes, I said a tree. Don't click away. Just hear me out. It all starts with a very small seed, which if planted in the right soil will grow to a massive tree one day. As we all know, a healthy tree is very strong and powerful, and it's very hard to shake it out of its roots. When taking care of correctly, this tree can provide you with delicious fruit every single year. And with the fruits that you get, you can either consume them or replant them and grow more trees for yourself. Are you still with me? What I'm trying to say is you have to start somewhere. If you only have $100 right now, don't wait and start investing today. Water and nourish that seed every single day as much as you can, and it will grow into a massive tree one day. And when I say start investing today, I'm not necessarily talking about putting that $100 to work in the stock market. Instead of doing that, I'd rather have you invest $100 into yourself to generate more income, which then you can put into the stock market. Learn a skill that other people pay for so you can generate more income, so you can then plant a seed and nourish that seed so it will grow to a second income stream. And as soon as you plant that seed, just keep watering it, keep nourishing it until it becomes a massive tree, and at one point it will take care of it itself. With that being said, here's an update of my current dividend portfolio. I haven't changed much, but I decided to no longer purchase AT&T on a regular basis. The dividend cut and the sell-off of water media just didn't motivate me to invest more into a telecom company.  I will just hold on to the shares that I've accumulated over the past two years and just use the dividends that it still pays, even though it's like half now, and just reinvest it into companies that I actually want to purchase. As you can see, I also increased my S&P 500 position to a goal of 20% of my portfolio. Also, my smaller positions like 3M, Walmart, and Proctine Gamble will catch up within the next purchases, which will even out my entire portfolio, so I'm not heavily in AT&T right now, so it will just balance each other out. Within the next couple months, I will probably have a better balance within my portfolio, and I'm not heavily invested in AT&T, because right now that's my biggest position. Since I'm not purchasing more AT&T, this position will become smaller and smaller over time, and the other positions or the other shares, the other companies that I have will grow bigger. Last but not least, someone asked, and I'm sorry I didn't take a screenshot and I can't find the comment for the life of it, somebody asked me how do you fund your dividend portfolio? The short answer is with my growth portfolio. The little bit longer answer is I'm selling covered calls on my holdings in my growth portfolio. Selling covered calls means you have 100 shares or a minimum of 100 shares, and then you say you want to sell them at a specific price in the future. For this contract, you receive a premium. I usually go way out of the money which will lower my risk of getting assigned, but at the same time it also reduces my premium by a lot. But I don't care too much about it, because I really want to hold on to my shares, but I also want to put them to work. I just don't want to hope for it to appreciate in value over time. While I'm holding it, I still want to make money with that, and that money that I generate through selling options I use to fund my dividend portfolio. So all the money that you will see coming into my dividend portfolio is generated by my growth portfolio by selling options. If you want to see more of my daily financial moves, feel free to join my Patreon, the link is in the description below, and also don't forget to collect your free money also in the description below. I'll see you next time.


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Hello. Yeah. I'm Abed. I work on accelerator solutions and architecture at Marvel Semiconductors. So we provide the accelerated compute networking storage and security solutions for the data infrastructure. And we've been doing this for quite some time. So major market segments that our solutions find use in is like 5G carrier, enterprise networking, and security, automotive, and data center. So a recent trend is that all our data infrastructure-related market segments have started transitioning and converging with the cloud. So the enterprise has become borderless. Automotive and 5G autonomous driving, they all need a cloud strategy. Carrier infrastructure is going towards virtual ran. And data center, of course, is leading this transition. So we have been addressing this convergence. And we are trying to enable what at Marvel, we call the cloud optimized silicon era. So I'll start with the DPU first. So actually, we are coming from the infrastructure side. Most of the talks here are targeted towards application. So I'll just introduce what we call the DPU. So modern DPUs or data processing units, these are a successor to what we call the SmartNIC. They consist of some general purpose CPUs, usually ARM in most of the DPUs that are available in the market today, as well as a set of workload accelerators. The accelerators are targeted towards accelerating data infrastructure workloads, usually all the packet transformation functions, flow processing, connection tracking. And there are other accelerations for compute intensive tasks like cryptography, EIML inferencing. And these continue to grow. Initially, we used to have just cryptographic accelerators. Now we have AI accelerators. Now we have specialized accelerators for other workloads, for carrier workloads. We have some accelerators that are specialized. So and on the general purpose ARM course, and these are also becoming very powerful. So the oction consists of like around 6 to 36 N2 cores on the chip, on the card itself. And you can use these cores to run general workloads that can run on Linux. So they all boot Linux, so you can run the Linux workloads. And to give an example, we are already able to run CNI and STO on the DPU itself. So that's something that we have been trying out. But that's not the intention. The intention is to use these accelerators, these specialized accelerators. And to give an example of what these accelerators can do today is that even before any packet that comes on the wire, even before it reaches the ARM core, they can be decrypted, detunneled, inner classified, and then they are given to the workloads. So there's already a lot of work that is done in line. And these are very power efficient. So just to give an example that we are able to do 50 gbps of IPsec traffic in less than 15 watts and irrespective of packet size. And we also do L2 to L4 processing in line. And a lot of TLS related workloads, a lot of we already have. So Oction has been used in a lot of enterprise devices for SSL gateways, for intrusion detection systems, for routing solutions, for the 5G solutions. So it's already used in those segments. So why service mesh? Service mesh, one of the definitions that's on the internet is like it's a dedicated infrastructure layer for making service-to-service communication safe, fast, and reliable. And it aligns with Marvel's goal, which is to move, store, process, and secure the world's data faster and more reliably. And ambient mesh is very interesting development for us. So we have been looking at Cloud Native for some time. And what the sidecar was able to do was it was able to isolate the infrastructure workloads as part of the sidecar processing. Ambient mesh has gone one step ahead. And it's able to isolate it per node. So because it's already isolated as part of specific compute paradigm, so it would be very easy to transition it to separate compute element also. In this case, we are talking about DPU. So just to give an example, I picked up this diagram from the Isolven blog and used this to make this. So what we envision is that all the infrastructure common workloads can actually move or transition onto the DPU, which are more specialized to deal with the specialized kind of processing. And the processing can be anything. It can be policy lookups. It can be the cryptographic workloads. All those which the DPU is more geared to more efficiently and more power to handle in a more power-efficient manner, those can be taken up by the DPU. So we have done some experiments in this regard. And Shatakshi here, as well as Garwit and Akhil in India, they have run some experiments with ambient mesh. And we have come up with a prototype. So Shatakshi will go over that prototype for the rest of the talk. Hi, everyone. Good evening. My name is Shatakshi. I'm a part of Marvel's Accelerator solution team. And I'm looking into P4 programmable data planes, Kubernetes-related solutions, CNI, load balancers, and et cetera. So coming to the slide, we know that ambient mesh is a layered architecture where stereo functionalities have been distributed across the layers. And all the data plane functionalities previously were handled by the sidecar deployed per pod. But now they are being shifted to per node and per namespace bases. So the secure overlay layer zeternal is present on every node. And layer 7 has been handled by Waypoint, which can be one or more per namespace and can be scalable according to the traffic demand. So as seen in the Gregory study published on solo.io blog, this architecture has eliminated almost 90% of the service mesh offload. So we also ran some tests. We executed an ambient mesh setup with some basic functionalities and gathered some CPU utilization metrics. So these are our profiling and synthetic test details. So then a virtual cluster, traffic type was HTTP. We took two packet sizes, 1M and 1K. We enabled all the default features with MTLS. And it was a pod-to-pod packet transmission scenario. So now this is the case of when layer 4, only layer 4 is enabled. So this graph is showing us. So actually, this is the case where we have server pod on one node, client pod on another node, and both are in the same cluster. So here we can see that roughly up to the server node zeternal using up to 0.4 CPUs, client node zeternal using 0.35 CPUs. In the second case, when packet size was 1M, we see 0.85 CPU utilized by the server node zeternal and 0.75 by the client node zeternal. This is the case when layer 7 and layer 4 was enabled. So similar case, two pods, two nodes, one cluster, one waypoint proxy on that same cluster. So we saw that waypoint proxies resource utilization was up to 0.74 CPUs. In the first case, when the packet size was 1K, and the second case when the packet size was 1M, it was 0.69. So we have these numbers with the basic functionalities enabled. Now in future, when the functionalities and features of zeternal and waypoint will increase, these numbers may see further growth. So we are looking and exploring multiple architectures and models and ways to migrate these layers and their functionalities to the DPUs because modern DPU supports some functionality which are directly overlapping with the features supported by zeternal. And DPUs have the capabilities to accelerate those functionalities. So our target is to eliminate the resource demand on the server nodes, freeing up them for the, so that they can serve additional application workloads. We started similar kind of study earlier with Selium. And we are using learnings from that model to come up with a similar design for the Istio Ambient Service Mesh. We created a similar off-road architecture for Selium where we were able to shift the CNI, data path, and the proxy totally onto the DPU. So first we'll go with the same architecture. We'll go with the detail of this one. We are able to achieve this with Selium. This is the detailed diagram of the full primary network offload on DPU. We have introduced some plugins to transparently offload the CNI layer and its components onto the DPU. No changes to the Kubernetes N application port spec as soon as the port is being deployed. So let's go through the flow of this diagram. As soon as you deploy a user application port, CRI will call the CNI in the same fashion as it does today to create an interface on the port. Now our CNI offload layer, we're going to intercept that traffic and we're going to allocate an interface to your application port. Now it will going to send details related to that interface to the plugin deployed on the DPU. Now that plugin will going to send the data to the CNI plugin in the exact way CRI does. And then CNI plugin will going to allocate the other side of the connection. We're going to attach it to the EBPF data path. And this connection is via virtual function pair. And this model is POC ready. We came up with a similar model for ambient mesh. This model is still in progress. We were able to run this model on virtual clusters by manually doing all the things. And we will going to automate the model. So similar to the previous diagram, we have introduced plugin to offload the architecture. So in this one also, as soon as you deploy the user port, the transmission of data between the CRI and the CNI will be intercepted by the CNI offload layer. Then this layer will going to allocate one interface to your application port. And we're going to send the data to the DPU via GRPC connection. So plugin will receive that data. And plugin will then give all that data to the CNI plugin. And according to that, CNI will going to attach the other side of the interface to the data path. And everything will work in the same fashion. So we already, so it's like the last diagram which I showed is to shift Zeta along to the DPU. So why to leave Waypoint then? So Waypoint does all the layer 7 processing work we know. And let's see how DPU can help in that. So DPUs have hardware blocks that can do policy enforcement. Layer 7 policies can be accelerated using these specialized lookup blocks present on DPU. And similarly, DPUs provide crypto accelerators for any security and authorization protocols. So this is the final ambient mesh offload architecture where the whole data path and its functionality are being offloaded to the data processing units. Well, we can not only run CNI, but also Zet Tunnel, but also Waypoint Proxies onto the DPU. So instead of having Zet Tunnel on servers and dedicated nodes for Waypoint, we can offload all these components on DPU, which will be more beneficial for scaling them according to the increase or decrease demand of the traffic. So Abed, he'll come for the key takeaways. Key takeaways, one, increased capacity. So as of today, you can run CNI on the DPU as well. If you attach a DPU card, you can actually run application workloads also if you want. But if you are actually moving, transitioning the infrastructure workloads onto DPUs, you have more capacity on the servers to run those. There will be higher performance because DPUs are tuned for these workloads and lower power and costs. Initially, we can use just the same EBPF data path as well as the IP tables data path also on the DPU to have day 0 have this up and running. And slowly, we can transition into using those accelerators, which can be the protocol accelerations for TLS, IPsec, more crypto workloads, policy lookups. Those can be transitioned one by one. And the target is to be ready for the future upcoming compute requirements. Mainly, there will be enhancements like quantum cryptographic algorithms will come, which will have a higher compute requirement thrown at us. The new Ethernet standards that are being defined require a lot of hardware acceleration that would take a big toll on the server resources if they're not offloaded. And of course, like AI ML, we are seeing a lot of new traction. So maybe in the next few years, there will be a lot of AI ML related workloads that would come on the networking as well. Having specialized accelerators take care of those will free up our server workloads and give us a more optimized cluster. Thank you. So if there are any questions, we can take them. Hi, thank you. This was very exciting. I was wondering, what is the current state sounded like some of these things are planned for the future? So where are you at with the current state? And is this something that's going to be publicly available? Can I get one and play with it? Or is it going to be sort of private work that Marvell is doing? No, we intend to open source all the stuff that we do. In fact, these are models that we are developing. And we would love to hear the opinion of the community on that. So we have already have a POC for Selium. And hopefully for Isti also in the next few months, we'll try to come up with one POC, which we'll try to present and we'll solicit comments on that. And the DPU also is available. There will be a Quartz hardware that will be available that can be tried out. All right, if there are no questions, thank you. Hi, do you compare the performance and networking Istio-company Selium? So we have not reached the stage where we can do those studies. I mean, it's in a very POC and very initial stage where we are first targeting the functionality move. And our initial aim is to actually get some framework where we can actually utilize the DPU. And that's what we are working towards. Once we have that, we will definitely work on more power and performance comparisons. And I think what we have seen from standalone, because we have been running these workloads, all these workloads, whether it's routing or IPsec or TLS, we see a huge, huge performance difference when we utilize the DPU. Yeah, of course, there are challenges in the models. The software models are not mature enough to utilize all the accelerators as of now. And that's the target that we continuously work with the community. We've been trying to open source. Initially, DPDK, VPP, these are frameworks which are able to utilize the accelerators to its full potential. Linux as well as the cloud native are not. I think there's still some software frameworks missing. And I think we will work to enhance that so that all the accelerations can be utilized. And we'll start seeing those benefits. Awesome. Any other questions, folks? If you don't have a DPU laying around at your workplace and you want to simulate this, try it out, what is the easiest path, is there virtualization for testing, or do we have to meet the hardware at hand? So currently, when we are doing development, we do it using virtual clusters. So I think the model can be dried out without the hardware as well. But to utilize the accelerations, the simulation is not available. You'll need the hardware. There are in-house simulators, but it's not publicly available. Artie, awesome. Thank you, everybody. Thank you all. Thank you.