Thank you very much, Rob, and maybe belatedly, I think it's important to say that, you know, the Nexus Institute is doing a real important job here, because we're demonstrating the best tradition of European enlightenment, having a public debate in front of an audience who will adjudicate at the end, change its mind or be confirmed in its opinion, because that is a pillar of democracy to have an open, plural debate, which unfortunately is not possible in some countries that we know, the dimension Turkey, for example, or some other places. Europe is a complex place.  And how do we go about stopping that? And to put it all too simply, well, the way we're going to stop that is to create institutions that are going to be shock absorbers to conflicts, differences of opinion, cushions, to frictions, and one need not go back to Machiavelli, one of the founding fathers of politics, to say politics is conflict. And Natalia, it is politics. That's good that it's politics. Politics is about political parties. It's good that Ukraine has a plurality of views. Or in my country, Serbia, or in all of your countries, that's what democracy is about, difference. I use the word politics in a different sense. I use the word politics in the best tradition of, again, the enlightenment. Political parties are there to represent our views, and we vote in political elections to have our voices heard. So it's about the will of the people. And the will of the people from what I understand, watching and observing Ukraine, is that they want to belong to this family. I come from a country that no longer exists called Yugoslavia. I'm sure many of you have vacation there. It is today, seven countries. We did this to ourselves. The Yugoslavs did this to ourselves. It was peppered and salted afterward by everyone. But we exposed ourselves instead of doing what the European Union does, work within the institutions to find that language and maybe separate quietly like the Czechs and Slovaks did. We unfortunately didn't. There was a plurality, but it used arms to do it. And we want to join the European Union, all of the seven countries, because we had a communist regime, an authoritarian regime. We didn't have democracy and the possibility to express ourselves as Democrats, leftists, socialists, et cetera. People were able to express themselves as Serbs, Croats, Muslims, Albanians, et cetera. That was ethnic politics, the ethnification of politics. And so the European project after World War II was one that left out those who fell under the Soviet yoke. There was an imposition. This was not free will. So when 89 happened, people said, well, we can now finally decide. And what they decide, lo and behold, surprised they wanted to return to Europe. And I beg your pardon, the enlargement has been touted as the biggest success by no others than many and most people and leaders in the United Kingdom. Because it has enhanced trade. It has enhanced profits for companies. And one need only take one example, and that is of Poland and Ukraine who have the same starting point in 1989 of their GDP. Poland is up here and Ukraine is down here. So it shows the positive effects of it. And finally, although there's much more to say, and I hope we will, the fact that we, for example, the Western Balkan countries, and of course every example is different, we have had the promise of membership. Turkey is unfortunately the example I want to mention. So you can begin a negotiation, but the European Union and any member state, including the Netherlands, can stop it at any moment. And Turkey is the best example. It's a process that's been going on. But I tell you, as someone who lived under communism in an authoritarian regime, I have always been for the proactive. Bring us in, and you can stop us at any time because the benchmarks are there all the time. And again, Serbia is the best example. And the Netherlands, God knows, had the arrest of Radavan Karadzic and Radkom Ladic as a benchmark. And we, the citizens of Serbia, wanted them in the Hague. They are there now. Karadzic was now condemned to 40 years, rightly so. And so, but at the same time, without the arrest of Radic, and I came here when the Stabilization Association agreement, we met with your politicians and with your NGOs, and we said, don't stop us at this point because you are only reinforcing the conservative nationalist forces by keeping us out. And final word, I think the same applies for Ukraine. It is good that they are in the garden moving forward, and you can stop it anyway. But you give these people the hope that with this burden sharing of democratic reform and structural reform, which is extremely hard, they can actually start becoming a more rule of law democratic efficient country. And what you are saying, why should you continue yourself European, and then what you are problem with the EU? Well, European is a difficult concept. I consider myself as a fan of the European project. I think that the idea to make Europe strong and better by sharing our wealth, by having a common market, and by making sure that our faith depends on how we work together, it has worked because it has brought peace, lasting peace to Europe. And I think that was the original idea of the European Union. Now I see people who have hijacked this project and are trying to create the United States of Europe with a central government. We have people like Mr. Boholstein, and in our own country, Mr. Pettel, who wrote a book, The United States of Europe, who really think that we can only make Europe a real democracy if we have a central government in Brussels, if we give up national sovereignty, if we make sure that everything is done by majority rule, and if we have a European Parliament that has taken away the positions from national parliament. I am willing to retire if that happens, because then my job will be with us. I have no function there. But I don't think there is public support for that in this country, and the people who are in favour of this idea have hijacked this project. And I think that is very dangerous, because we should work on maintenance of the original project. We are about to lose the United Kingdom. We have a crisis in the south. We cannot solve the refugee problem. We have a euro crisis at hand. We should solve our problems first, because we go further on the path of enlargement before we make new associations. We should solve our problems. Otherwise, Europe will fall apart, and we have seen in the former Yugoslavia what happens if a country falls apart. It is a very dangerous project. John, your perspective? I wrote a book in 1997 called The Undemocratic Origins of the European Idea. But first, why do you consider yourself a European? Well, it is a matter of geographical and cultural fact. I was born in Britain, and I live in... So they are Europeans as well? Yes, of course. The Union is not equivalent to Europe, very obviously. There are numerous European institutions as the Council of Europe, the OSCE and others. The European Union, as Harry said, has taken a departure, particularly after the end of the Cold War with the Maastricht Treaty and the introduction of the Euro, a very strong departure towards federalism. And this federalism has massively damaged the democratic credentials of the European Union. Every single expert on the European Union agrees that there is a democratic deficit. That deficit consists in the fact that European laws are made in secret, in secret, in the Council of Ministers by governments. If you boo, that shows you don't know what you're talking about. Because it is the case that European laws are made in the Council of Ministers by governments voting in secret. If you disagree, you can tell me please which government voted for which law in the last European regulation. You can't because nobody knows. And that is the democratic deficit. The democratic deficit is aggravated further by the attitude which I referred to earlier in my discussion with Ivan, according to which the superior interest of the European Union in some cases would go against democracy. Jean-Claude Juncker said it. There is no democratic vote, he said, against European treaties. These are very dangerous ideas because as soon as you put the overall, so-called overall interest of Europe above basic democratic accountability, and this happens daily in the European Union because there is no democratic accountability, and it happens once every five years when a referendum goes against the European Union. In 2005 in this country, as I've already said, and in France, the European Constitution was rejected, but it was reintroduced by the back door in the Lisbon Treaty. And that is undemocratic. And there's no point booing or saying that I'm not right. I am right about this. To make my point, I'll be simply maybe simplistic.  It's not that Europe doesn't have problems and we acknowledge that there is a democratic deficit. There are individuals who would like to see it federal, but I think that will never happen. I mean, we were talking on the way here. The European Union at base is an inter-governmental institution because of European history. Yes, there is shared sovereignty, but again, I go back to the reason for that. That was the way to avoid conflict. That's why my country went down the drain because we were not part of the peace project. You had shared sovereignty in Yugoslavia. You had shared sovereignty in Yugoslavia. We were a communist, authoritarian country. We didn't have democracy. John, we didn't have democracy. Fine, that's a different issue, but you were saying it was shared... I'm sorry, he said it was shared sovereignty that was the key to peace. You had shared sovereignty in Yugoslavia, and you had war. Communist shared sovereignty, John. There were three communist federations that fell apart. So it's the democracy that's the key and not the shared sovereignty. Thank you. But Europe overcame its conflict because it put its head to its finger, as I said, and said, how do we avoid it? We do need to share something. Coal and steel were the things by which weapons were made, and so if we agree on how we use coal and steel... The coal and steel community was... Let me finish. So the inter-governmentalism is really what's there during the war. Inter-governmentalism is really what's there during the day. And Europe is, in fact, a multispeed from the very big... the caveats. I talked to a Swedish diplomat at the beginning of their negotiation, or rather their idea to join Rio. From a big European country, he was told, you Swedes will never join Europe. So this is... we've been seeing this, and the European has an open-door policy. You look at the map and where and who belongs to whom. You cannot impede it. Yes, there are difficulties, because Europe needs to deepen. You're absolutely right. We need to strengthen the institutions. But I think that Europe will muddle through this. And the one thing that I want to say that I think we're all aware of, but we're not saying here, the reason we are debating all this is both Europe and the United States, as we see in the electoral process. We are all in a very difficult situation where the ordinary person is uncertain about tomorrow, about their job. If they have one, will I have it? Because of the way the global economic crisis has gone. There is a fact that parents are saying for the first time in the United States, but also here, our children will not live better than I. And I think the framework of this uncertainty is prompting us to ask questions, one which is very good. But then there's this, what we call the re-nationalization. We're turning back on ourselves because it's warm and fuzzy when we're with our own, whoever our own are. But that, I think, as Roger Cohen today in his New York Times op-ed said, we are moving into the 21st century, but we must not forget what happened to us in the 23rd century. I'd just like to say the following. I think that the issues are purposefully being complicated, whereas the question before the Dutch is very simple. I have attended a business forum on Wednesday between Ukraine and the Netherlands. And I spoke with Dutch businessmen, and they have demonstrated a lot more faith and belief in a better Ukraine than the people sitting in front of me who have not invested anything in Ukraine and have not experienced the new Ukraine. And they certainly do not know that Ukraine, the way it is changing today, the way it is adapting its legislation to European standards, will ensure that when Dutch businessmen are traveling to Ukraine, they do not have to figure out, like in a foreign land, the laws that govern their relationship, how to do business in Ukraine. When students travel, when people vacation in Ukraine, they will not be traveling to a foreign land, they will be traveling to a country that is as European as any of the 28 EU member states. And at the end of the day, the simple question that one has to ask himself or herself on April 6th is the following. A country the size of France with a population three times that of the Netherlands wanting to embrace European values and live and be governed by legislation, regulation, administrative and judicial processes akin to the European standards. Why would anybody say no to that? Well, they can. They can. They came without a treaty and they are changing and reforming. They can adapt European standards tomorrow. They don't need a treaty for that. Well, sir, the agreement, you said earlier that I've mentioned at the beginning that there were more changes made in the last 24 months. What you did not tell the crowd was that this agreement had immediate application of many provisions of that agreement. And those provisions are forcing the necessary changes that Ukrainian civil society wants, that Ukrainian civil society stood under Maidan 4. And I think that those changes are the changes that the agreement, the support of the European countries will transform Ukraine into a purely democratic European corrupt free country. And that is in the best interest of everyone, including of the Dutch.


Greetings, everyone. Welcome to the USGCRP listening session. My name is Sarah Curran from the University of Washington and on behalf of the National Academies Committee to advise the US Global Change Research Program, also known as the USGCRP. I welcome you to this listening session on global chain issues, global change issues with a specific focus on health related challenges and opportunities. Through USGCRP federal agencies coordinate climate and global change research and use the results to create tools and assessments to help people make decisions in the context of global changes. Through this session and others in the five part series we aim to connect more directly with users and researchers who are building on and applying global change information and tools in their work. And to gather insights and information that the USGCRP can consider as a plans implementation of its work over the coming decade. In these sessions we are welcoming many people from across the spectrum of users and researchers, including staff from the USGCRP and agencies that comprise the USGCRP members of the National Academies Committee to advise the USGCRP of which I am a member. And all of you users and researchers who are engaged in building on and applying the types of knowledge and tools that the USGCRP is charged with developing and supporting. So we'll start with our agenda. The next slide. In the next session we have a series of speakers who will provide remarks all of whom expressed interest in contributing when registering for this session. Everyone here will have opportunities to contribute through an engagement platform that we will introduce shortly representatives from the USGCRP and the committee to advise the USGCRP are attending and listening mode. Thank you for joining us and we look forward to hearing from you over the next 90 minutes. Next slide. To start, I'd like to acknowledge, I think we're going to do a next slide here. I'd like to acknowledge that while today we are gathered virtually, the National Academies is physically housed on the traditional land of the Nacochtank, Anacostan and Piscataway peoples past and present. We honor with gratitude the land itself and the people who have stewarded it throughout the generations. We honor and respect the enduring relationship that exists between these peoples and nations and this land, and we thank them for their resilience in protecting this land and aspire to uphold our responsibilities to their example. We also acknowledge that our understanding of health and global change issues are closely related to an informed by indigenous knowledge and experience and that many native communities are on the frontline of the impacts of these changes. I am joining from Seattle, the traditional land of the Coast Salish people, including the Suquamish, Duwamish, Mucletio, and Samamish peoples. Next slide. I and other members of the committee to advise the USGCRP are looking forward to these sessions to connect directly with researchers and users who are using and applying global change information in their work. As part of our regular meetings throughout the year, we provide this and other opportunities to engage with and hear from broad audiences to inform their this important work of theirs. This series of listening sessions include to gather useful information actionable input for USGCRP for implementation of its work to make connections and expand the group of researchers and users who are directly engaged with the USGCRP and its work, recognize connections across researchers users and themes of USGCRP work and products, and inform future potential engagement mechanisms and opportunities, including forms approaches and participants for such engagements. Next slide. Today we are seeking input on how USGCRP may implement its work to better understand and address global change issues. You do not need to be familiar with USGCRP to provide input. We are specifically seeking to connect with a broader audience in these sessions. If you are unfamiliar with USGCRP we hope you had a chance to view the introduction video on our event pages before the session, or we encourage you to view it afterwards. In preparing for these listening sessions USGCRP requested input and insights on the following themes to inform the implementation of its strategic priorities and activities. Diversity, equity and inclusion, which which action should be prioritized to fully incorporate these values in research, community engagement and workforce development. How do we implement them? Advancing science. What are the priority gaps in foundational science or methods that require enhanced long term investments. So far in research, how do we ensure that USGCRP science and products are better driven by and connected to users, including for example, improved use of consultation collaboration translation dissemination informing climate services socio economic sciences integration. What are the priorities for integrating socio economic sciences into our program and to inform critical decisions. Particularly helpful feedback might include ideas on emerging large scale scientific questions related to global change and or the response to global change, especially those where interagency collaboration will be critical. The information on how science is or is not being used to inform societal response to global change and why, and knowledge gaps and obstacles to implementing scientific tools or knowledge. The USGCRP is developing its next decade old strategic plan and expects to release a draft prospectus with a public comment opportunity before the end of 2021. While these listening sessions may help inform the development or implementation of this plan individual feedback on the prospectus should be submitted through the public comment mechanism. To ensure all have time to speak, we will be holding you to the five minute limit. Next slide please. So we have a few expectations for conduct, we are committed to fostering a professional respectful inclusive environment where all participants can participate fully in an atmosphere that is free of harassment and discrimination. If you have any identity based factors, please report misconduct immediately to Steven sifter whose email is at the bottom of this slide. Now I'm going to turn it over to Steven for a few housekeeping details. Great. Thank you Sarah, and welcome to everybody who's joined us. If you would go to the next slide please. Today we're using two different platforms for a couple of ways of having you engage and give input to USGCRP. First of all, we're all joined together via zoom for the video and audio portions of this of this session. And we encourage you to view and seek in speaker view we will have a series of speakers who will be following this introduction and that's the best mode for seeing them as they're speaking. We'd like people to find you if they wish to and encourage you to change your name the name on your, your screen which I see I have not yet to your full name and your affiliation so people can more easily find you in the list. We're also providing a live closed captioning of this event. If you wish to display that closed captioning please choose the live transcript option in the bottom of your screen. And finally if you need assistance with zoom please, if you are on on the platform and having trouble using it. Please send a chat to one of the hosts myself or Rob Green Greenway, or send an email to Rob Greenway, our Greenway at nas.edu. Next slide please. In addition, we will be, we will be using the Slido engagement platform for text input for for the sessions. So we encourage you to join us on Slido, and there are a couple of different ways to do that. You can if you're using a mobile device you can use the QR code that's shown on the screen. You can go to Slido.com and then enter this event code. And then we will also put a link in the chat so that you can join Slido. And a couple of notes on that will be using the Q&A function. And even though it's Q&A we're asking you to put your thoughts and ideas and recommendations, rather than questions as Sarah noted USG CRP and the advisory committee are in, in listening mode here so we're not going to be answering specific questions that are raised. But we welcome all of your input through this platform. We will within the question and answer mode, and you will have up to 300 characters per, per entry that you put into the, into the Slido platform. But if you have additional comments that you want to make there's opportunities to reply either to your own thread or a thread that somebody else has started. Again, all those contributions are up to 300 characters and we encourage you to, this will be part of the record for these, for these sessions, we will not be producing a report out of this but USG CRP and the advisory committee will access to these recordings and also the, the outputs of this engagement platform so we encourage you to, to join with us in all of these different modes and finally in, in whatever way you are contributing on the next slide please. As I noted, we, these are the sessions are part of our public. They fall under the Federal Advisory Committee Act and we are the outputs of these sessions are part of our public rest record for this event. And so please be aware as you're participating in this in these sessions that the event will be recorded and the outputs of our engagement platform will also be included in the public access file for this event. With that I'd like to invite Mike Cooper Berg to give a welcome on behalf of USG CRP. Hello, good afternoon, Steven and Sarah thank you so much for your welcome and opening comments. My name is Mike Cooper Berg, I am the executive director of the US global change research program. The USG CRP as we call it is managed by the subcommittee on global change research, which consists of representatives from the 13 federal agencies that make up the program, you can think of that subcommittee as our board of directors. We're representing those 13 agencies. And we want you to know that we're serious about our legislative mandate, which tells us to assist the nation and the world to understand, assess, predict and respond to human induced and natural processes of global change. On behalf of USG CRP. Thank you for your interest for your time and your expertise we look forward to what you have to say. The input will be heard and considered as we draft and implement a 10 year strategic plan for USG CRP a new 10 year strategic plan. In addition to the staff from the National Academies and yourselves, there are a number of federal agency representatives and folks from the USG CRP National Coordination Office on the line today. Be careful in taking notes. Those notes will inform our discussions and writing for the new plan. That plan will be completed late next year. Between now and then, you can expect to see a prospectus a very high level outline the plan coming out for public comment soon, hopefully the next month, and a full draft of the plan that will be released for public comment and review by the National Academies in the middle of 2022. Please watch for these opportunities to comment both on the prospectus and on the draft plan. Finally, on behalf of USG CRP are sincere thanks to you for taking the time to speak with us today to the committee to advise USG CRP and the staff of the National Academies for organizing these sessions. My name is Sarah Curran Steven Stitcher, Amanda Stout and Amanda Purcell. We very much appreciate it. My sincere thanks to Katie Reeves and Julie Morris from the USG CRP National Coordination Office for their roles in making this possible. We very much look forward to your comments and your input and we'll be listening carefully. Thank you very much. Sarah back to you. Thank you Mike. This is great. I would now like to, we would like to hear from you and really thank you all for making time today to join us and to participate. I think what we'd like to do now is turn to our first speaker Caleb dresser from the Beth Israel Deaconess Medical Center Caleb, I think you can unmute yourself now. Hello. You are audible. Alrighty. Thank you for having all of us here today to provide our perspectives. I appreciate your commitment to soliciting a diverse array of viewpoints through these listening sessions. My name is Caleb dresser. I'm an emergency physician I practice in Boston, Massachusetts, and much of my research focuses on understanding population health implications of climate related disasters. There are two big picture suggestions I would like to share with this group. First, in terms of communication around this issue, I think it's important to make health a more visible issue in the discussion of global change. Many of the policymakers I've interacted with are not particularly aware of the health implications of climate change and other global changes. But those health implications have a lot of meaning for the people that they represent. And what this means is that health facilities emergency medical services public health issues in general are sometimes left out of municipal or regional resilience planning initiatives. And given the immediacy of health to those of us who are going through this process. I think it's really important that in future assessments reports communications and other products that we include some reference to health, as a key implication of the hazards referenced throughout the text, so that we don't wind up with all of the health information being aimed at health people, but instead make this a core piece of how we talk about these issues. And this can help ensure that policymakers other key decision makers and the general public are exposed to the health aspects of this shared future we are now in and understand what those human impacts are. And the second key issue I want to mention is that a lot of the health impacts of climate change are being measured and talked about on a very grand scale. But these are experienced at a very local level, and are mediated by a variety of factors that are intimately related to local geography socio economics governance and community characteristics. And how we respond to these challenges has to be guided guided by a combination of sound science, and also knowledge from the populations that are affected. To this end, I have a couple of thoughts on programs or initiatives that could support place based multidisciplinary research in keeping with the big picture goals of the US gcrp that would support population health protection. There are a couple of things I want to mention here. First item. Health equity is a really big concern as we talk about the impacts of global change and our efforts to protect populations from health impacts. To this end, I would argue that future calls for funding and future programming should either require or incentivize involvement of members of affected communities as key participants or leaders in projects that are place, place focused or location oriented. And that the inclusion of these people in real decision making roles on those projects will help me and the solutions we arrive at are equitable and are effective for the communities of question. Second, I would argue that in many situations there are people in organizations that are concerned about climate change and other global changes may understand what some of the hazards are, but don't necessarily know how these people are working with or what to do with this information. And so we need to be continuing to work on small grant programs focused on translational rather than basic research tool kits for health protection models such as the brace framework and publication of regional studies so that concerned communities can emulate what has been successful for others nearby. A lot of work is being done at local levels by individual municipalities nonprofit organizations healthcare systems, which need access to good data. And a lot of this data is technically complex, but many of these organizations don't have full time science staff. And so the more that can be done to create a perhaps cross agency clearinghouse of global change data that is an easily accessible format for organizations without specialists in climate change would be really helpful, particularly as we talk about adaptation planning at all levels of society. I will pause there. Thank you for all of your efforts to address the global change issues we are facing and your work to highlight human health in the forthcoming USG CRP digital plan. Your work is essential. I look forward to seeing you. Thank you. Thank you Kayla. That was helpful. I now like to turn to Teddy Potter from the University of Minnesota. Thank you for the invitation to speak about health of the USG CRP listening session. I'm also grateful to the 13 federal agencies at the USG CRP collaboration for your ongoing commitment to quality science to protect the health of our nation's citizens. My name is Dr Teddy Potter and I am director of planetary health at the University of Minnesota School of Nursing. I am the chair of the American Academy of Nursing's expert panel on the environment and public health, and I am a member of the steering committee for the planetary health Alliance at Harvard. I live, work and study on the land of the Dakota people, the original planetary health experts. Today I bring concerns from the global planetary health community, especially underrepresented communities, including our youth. We are witnessing the failure of many national and international leaders to make the necessary changes to keep global warming below 1.5 degrees Celsius. We therefore are turning to non governmental entities and community partnerships to get the work done. We rely on you to provide good science to inform our actions. I define health with a planetary health lens. Planetary health is a solutions oriented transdisciplinary field and social movement focused on analyzing and addressing the impacts of human disruptions to earth's natural systems on human health and all life on earth. In September, the Apollo declaration on planetary health was released by the planetary health Alliance. The decision written by many global experts from all sectors states, we need a fundamental shift in how we live on earth that we are calling the great transition, achieving the great transition will require rapid and deep structural changes across most dimensions of human activity. The declaration makes the following recommendations for the research sector, and therefore it's pertinent for the discussion today. Interagency collaboration and research must engage with the engage with and initiate transdisciplinary efforts to inform and operationalize planetary health focus research policy and practice, and that's what you're doing today. But note this addition in the declaration with an emphasis on solution focused inquiry and applications that are inclusive of all ways of knowing and backgrounds. Research must promote open science principles and practices, elevate co designed and participatory based research with communities, and better communicate methods and collaborations to increase public and political awareness about planetary health. In closing, I want to emphasize that every human system much must change if we are to solve the planetary health crisis crises before us previously previously research has primarily focused on the nature and urgency of the problem. We must pivot and ensure that our national programs provide science based solutions that individuals families and communities can take to protect their health and health of all life on the planet. Thank you. Thank you. I would like to, and thank you for staying within the timeframe. I would like to invite Rebecca rare from eco America to join us. Thank you. Thank you for hosting these sessions and for the opportunity to provide comment. My name is Rebecca rear and I'm the director of climate for health at eco America.  This released the 2021 edition of mental health and our changing climate with the American psychological association. The impacts of a changing climate on mental health stem from both acute events and longer term change individual mental health impacts from climate disasters include trauma and shock PTSD and anxiety and depression. Community wide impacts include strains on social relationships reduce social cohesion and interpersonal violence. Longer term climate change can cause equally significant mental health impacts. For example, air pollution has been linked to increase anxiety and use of mental health services, lower happiness and life satisfaction and other negative well being impacts. Climate change coupled with worry about the future can lead to fear anger feelings of powerlessness exhaustion stress and sadness referred to as eco anxiety and climate anxiety. The inequities of climate change are vast and significant. While the destructive impacts of climate change will be felt by everyone. As with other climate impacts the burdens of the mental health impacts will fall heavily on those oppressed by historic and present social economic and political power dynamics. Importantly climate solutions build mental health resiliency, mitigating temperature rise, better air quality and access to nature all bolster physical mental and community health. The report delves into levels of engagement and responses for mental health providers, local governments communities and individuals. USG CRP can use its convening power and cross agency reach and engagement to incorporate information about mental health and well being into climate research and solutions. Please make sure to engage with the substance abuse and mental health services administration and the National Institutes of Mental Health. Mental health did get one mention in the global change research needs and opportunities for 2022 to 2031 report, and I hope that grows in the decadal plan. The second point about environmental justice is, we need to start valuing community wisdom and qualitative data, the same way we value quantitative data. The needs and opportunities report does talk about community driven solutions that address immediate vulnerabilities while building resilience and protecting livelihoods in the long term. This is a great start and can be further detailed and framed through grant requirements for community engagement and also proper training for scientists engaging with communities, going further than community based participatory research to make community owned and manage research models the gold standard pay for community input and leadership folks on the ground and community should be paid for their intellectual property the same way scientists and researchers are. Finally, solutions USG CRP and its member agencies have done a comprehensive job documenting the problem of climate change and impacts to the environment and our health. Majorities of Americans are now concerned about climate change, but they need support to act. In my work, the question I get most often is not, what is climate change, where is it happening does it impact me it's, what can I do about it. I highly recommend the USG CRP helps people answer that question. I applaud the needs and opportunities report for its focus on the interactions of multiple systems and on reducing inequities, which are important anchors for climate solutions. The integrated risk framing approach to identify research priorities is also a step in the right direction, as long as those research priorities include studying solutions and support engagement in action. We're going to use solution science, studying what works resilient energy grids clean transportation more green space efficiency measures youth leadership, and how to scale it. USG CRP has for 30 years taken an all of government approach to climate change because that's what solutions will take to all of us. Thank you. Rebecca. Thank you so much. Now I'd like to turn to Vijay Limaye from the Natural Resources Defense Council. Great. Thank you. Just pull it up. Hi there good afternoon. I'm Vijay I want to thank USG CRP for organizing this listening session. I'm trained as an environmental epidemiologist and I'm also a former EPA staffer so I'm very thankful for all of your work. I now work at NRDC as a climate and health scientist. This year now and USG CRP should enhance its focus on supporting interagency efforts to investigate climate sensitive health problems and their associated financial costs on individuals, families, employers, insurers and the federal government itself through Medicare and Medicaid. We know from the science that burning fossil fuels is contributing to extremes and each of these climate problems is causing a range of premature deaths, illnesses and costly injuries. These worsening climate hazards have very real consequences both in people's pain and suffering, and in the associated financial costs that are largely absent from our public federal accounting of climate rate related damages. Moreover, these costs pose a wider array of impacts, especially on vulnerable groups, least able to access affordable medical insurance. As noted in NCA for climate sensitive events are expected to increase in frequency, intensity, duration and scope in the future. In fact, NCA for of course spoke to quote hundreds and billions of dollars in economic risks tied to the climate problem. NOAA tracks the damages inflicted by these costly disasters, but neither NCA nor the NOAA billion dollar disaster compendium delves into really any detail on the health role of those skyrocketing costs. NOAA's focus is understandably on things that can count property damage, infrastructure losses and crop failures, things that are insured, but the health and health cost data is an important gap for USG CRP to try to tell health and fill, especially because public polling indicates that more than a third of American adults currently experiences medical financial hardship. That is an inability to afford necessary prescribed medical care. The science indicates that delaying or completely foregoing necessary care as millions of Americans are doing right now can make them even more vulnerable to the health problems from climate stressors. The projected future burden on health and health related economic costs will be enormous if climate pollution continues unabated and communities are not prepared. But those costs are not only a future concern they're right here right now and burdening American families. I led a 2019 peer reviewed analysis demonstrating $10 billion in health costs related to climate sense of events from nearly 1000 premature deaths. 20,000 hospitalizations and approaching 18,000 emergency department visits, all associated with just a sample of climate sensitive health problems in a single year across the United States. These are the damages that Americans are paying for right now but unfortunately efforts like the NCA are not shedding needed light on this financial issue. Our study identified Medicare and Medicaid patients are most vulnerable neighbors as the disproportionate numbers of the illness costs identified in our study, but we lacked visibility into these costs in terms of who's paying them right now, individuals and families are being stressed by medical bills worsened by the climate crisis but we lack needed visibility into that problem. Now is the time for USGCRP to step up and coordinate federal efforts to better understand the terrible public health and financial burden of climate change. This is a key equity problem that has gone unmentioned in major federal reports. USGCRP should also work to establish a federal integrated data tracking system that can help the public and researchers to better grasp the current and future burden of climate change and public health. Right now we lack real-time visibility in that problem we're relying on journalists and press reports in order to understand what's happening across the country. In 2021, we certainly should be relying on CDC, NOAA and EPA to support more comprehensive analysis of the health impacts and costs of climate change. This indicates that actions to achieve climate pollution reductions and bolster preparedness can help our country to avoid or reduce tens or even hundreds of billions of dollars in future health costs by keeping people out of harm's way. But we need USGCRP to facilitate more federal action to make those costs of inaction and benefits of strong climate policies even more clear to policymakers in the public. Thank you. Thank you, Vijay. Now I'd like to welcome Dan Buchelich from the Association of Medical Device Reprocessors. Well, thank you very much. I'm Dan Buchelich. I'm president of the Association of Medical Device Reprocessors or AMDR. This is our first opportunity to speak or introduce our issue or issues of concern to the GCRP. So thank you. I'll stay on topic and I'll certainly take advantage of the opportunities outlined here as future perspective reports are put out and we'll submit comments. My members are FDA regulated firms that reprocess or remanufacture devices that have been labeled for single use by their original manufacturer. So that entails collection of devices that have been used in American hospitals, cleaning, disinfection, testing and sending them back. But we do so meeting the same standards that would be required as if these devices were sold new. We serve most hospitals in America. We serve all of the US news and world reports on a role hospitals. We serve nearly all DOD facilities. We serve nearly every private or public healthcare integrated delivery network. The one institution we do not serve is the United States Veterans Health Administration. And we think this is a huge loss opportunity for the government to be taking care of our veterans by literally throwing away medical device assets after one use. In our experience, and what's happened of late with COVID is that the US healthcare system is addicted to disposable medical equipment. Unlike most industrialized nations we have nearly twice the global greenhouse gas impact from the American healthcare sector is the rest of the industrialized world. And this was data that was available pre COVID and everybody is now intimately aware of how many syringes, masks, gloves are being thrown away, which means they're being incinerated. Unfortunately, in a field where we take the mantra to do no harm healthcare is doing exactly that in our zealous treatment of patients in front of us under the guise of infection control, we're just throwing everything away in America. And that waste needs to be incinerated. The incineration of all this medical waste literally causes harm to our patient populations with as other speakers have pointed out increased asthma increase cancer because we're putting toxins into the environment. The healthcare sector is responsible for 4.4 to 4.6% of worldwide greenhouse gas emissions, according to data published in the journal health affairs last December. That's twice the aviation industry. How irresponsible of it of us who are in charge of healthcare for our patients to be making your own patient population sicker, not just by emitting greenhouse gas emissions, but by literally burning the trash we're we're creating that makes our population sicker of the emissions that healthcare is creating over 80% are coming from the supply chain or scope three. And so we believe that research that focuses in particular on ways that we can solve problems with the healthcare supply chain by encouraging reuse, reusability or reprocessing, we think would be advantageous for American healthcare purchasers. We've started by conducting lifecycle assessments of some of our products compared to disposable. We've begun with one device at cardiac catheter. These are devices that are thread into the heart to make a diagnostic image. They range between $500 and $2,500 apiece, but the data shows that on 13 of 16 environmental measures the re-manufactured or reprocessed device was preferable in a lifecycle analysis than just throwing away and using a disposable version, and just as safe and effective as using a brand new device. We're also moving forward in the rest of the world. NHS in England did not sort of take a break these last four years. They are pressing forward and pushing for a net zero healthcare system. And so they're really getting behind efforts like medical device reprocessing and remanufacturing. And so we think collaboration with what other countries are doing to help elevate and bring attention to these issues would be would be beneficial. And so lastly looking at the things that we think that would be beneficial to help clean up the toxic healthcare supply chain that we have would be more lifecycle assessments to demonstrate to purchasers the preferability of reusable or reprocess equipment versus this disposable culture. More research to underscore that perhaps just slapping single use on everything isn't always needed to protect patient safety. And so actually adequately informing our healthcare practitioners as to what needs to be disposable and whatnot. And we'd also like to see research or regulatory oversight over manufacturers used to force obsolescence to put kill chips or software into their devices to ensure they stop working after just one use. Thanks for this opportunity. I appreciate it. Thank you Dan. Now I'd like to turn to Guto Elval. Elval from the Georgetown University. Hi. Thank you very much for this invitation to. We have two assignments one is here jarred Talbot also has a Zodicor Foundation Brazil, where the senior researcher there, and that the point I want to make here is more looking into the global health community and how the global health community can be engaging in this very important initiative on the US GCRP. So, all the materials from from these initiatives have been used worldwide in many different places with different use of a search or dedication. I think Dr Potter and Dr here because they already advanced most of the arguments I want to make so I will keep only the, the, the part that have to do with the international part of that so I, my first point point was about planetary health as an emerging area that incorporates not only human health but also the well being of the earth and the equity all together. And that, as was said here before, after the some public declaration, there are a very important momentum on planetary health so I think that is an important point to leverage national efforts not only us but also globally, and that will help to look into solutions for the, the global change, we are seeing happy now. The second point is about the specific populations and Dr Harold already talks about that. But I want to make a point on the very specific population that's the homeless the people who are in the homeless situation are the most vulnerable people for climate change. The, the acting on that particular situation where it's everywhere in the world will from advanced not only social justice but equity and inclusion, and also gave a focus and a very practical point for the intersection of action and so on particular problems so I want also to promote that particular idea and particular action in this population. And finally, is about the materials and the documents and all the reference at the US GCR RP, providing us, and has been used as a reference for research and teaching. And I think a global network of the people who are using this educationally or in his search will improve the formation and also will promote the interchange between different realities like I do that all the time between Brazil and US but also with Africa, and that may be increase the, the basis for the case for global change and how important and how usually is to act on the on this many crisis and health crisis we are having now in the world. So, if you use the approach of open science and the field proofs have a very important experience on that we can accelerate the energy and also promote not only the global change ideas and actions out of the 13 very important agents that are doing this efforts here in the US but maybe engaging other agencies other people around the world. Thank you very much for this opportunity. Thank you very much. And now I'd like to invite Max Kiefer from the CDC and NiO SH. Hello. Thank you for the opportunity to speak. And my name is Max Kiefer and I'm retired from the CDC. I've been asked to. There we go. I have recently retired from the Center for Disease Control and NIOSH, but I'm here trying to take advantage of this opportunity and thank you again to advocate for research on occupational safety and health, and give a pitch for ensuring that we remember occupational health is a core component of public health. Workers are often the tip of the spear and are certainly the most at risk to the health impacts of climate change. I'll give some examples of both from primary impacts as well as secondary impacts of this of these vulnerable populations we call workers. Just an example would be wildland firefighters. We know that fire extremes are occurring more rapidly at a greater strength, and that the fire season is increased by approximately 80 days over the last 30 years. We also know that wildland firefighters such as hotshot crews have a lung deficit measurable after the end of the fire season, and then have a recovery period before the next fire season starts. But we don't know with what the impact of an additional 80 to 100 days of firefighting has on their health. Those are questions that need to be answered. We also know that outdoor workers are more at risk to Lyme disease, for example, than indoor workers has the range and the reproductive cycles of those vectors increases, what's going to be the impact of that. For example, toxicity or demarcosis or valley fever is now endemic in the state of Washington, and certainly workers, whether it's construction installing solar panels etc are very much at risk. And on the topic of infectious diseases were saying the use of pesticides in areas where they were not used before, which certainly has a health impact on the applicators. I'd also like to affirm and echo the comments from the gentleman from NRDC, I think surveillance is key to all of this, both from an attribution standpoint, as well as intervention effectiveness. It's something we can measure. It's going to take a lot of work to design those types of surveillance systems and epidemiology to provide the necessary attribution and the effectiveness of the interventions. But there are some agencies that are equipped to do that, for example, in the Senate for Disease Control, the National Institute for Occupational Safety and Health, certainly has the talent and researcher researchers necessary to do that kind of work. With the secondary response to climate change that I referred to earlier, I'm talking about the safety and health impacts of our response to climate change, whether it's carbon capture construction implementation and maintenance of, for example, wind towers. People have to go up to the nacelle, they have to climb up the tunnels, the towers, and go into all sorts of environments that we don't have much data on. So one organization that possibly could help with that is the National Renewable Energy Laboratory in Denver, Colorado, a DOE funded organization that could do that type of research, as well as ensuring they are considering worker safety and health impacts as they're conducting their research on new designs to address climate change. Finally, I think health communications are all too important. As I'm sure we all know in communicating the impact of climate change on public health. In my case, my interest is on workers. Thank you. Thank you very much. I want to turn now to Carl Mayer from Salisbury University. Hi, thanks for the chance to share my thoughts here. I have an interdisciplinary background in psychology and behavioral medicine, so I've been applying that for the past several years developing curriculum that integrates the social sciences with climate change and health. And so my scholarship likewise includes transdisciplinary systems thinking around environmental change. And some of this may help address each of the four themes identified for the listening sessions. But mostly I want to suggest a conceptual framework that fits with the Academy's consensus report that I'm sure they're all familiar with now. And that recommendation is integrated risk framing approach and that recommendation response to the need of course to have greater coordination and communication about complex interactions. And that's between, you know, physical and human systems. So, on that note, I think it's critical to include biodiversity, since that is impacted by many of the same drivers of climate change and it's probably really a more immediate threat to the population, give it's the implications really for zoonotic diseases like COVID and our food web. And also to echo some of the prior speakers, this integration really should be framed around communities. And so kind of community based participatory research should be kind of reinforced through the program. And so this all fits with my main suggestion about how to integrate across this complex set of problems and risks and complexity, of course, makes the job of global change reporting difficult. But we also know that it's important to have a simple way to represent that complexity. So the researchers and also consumers can talk about it and collaborate and organize what's known and also identify what's not known. You know, many of you may be familiar with the biopsychosocial model, and that for over 40 years it's helped shape a more complete understanding of health and disease that really integrates biological factors with behavioral and social factors. So that basic concept has been extended to an ecological framework, where we can look at these biophysical, psychological and social domains at multiple levels, kind of from the micro level factors like cells and genes, all the way to the most distal influences like climate and economic forces so think of the basic biopsychosocial concept but stratified according to different levels of scale and system complexity. All these domains and levels then kind of interact as one ecological system. Now, if that sounds a little confusing. It's actually pretty simply illustrated in a rectangular grid format, and that provides a heuristic that can help organize thinking and research findings. And there really is a need for that, because just today in PubMed if you search climate change you'll find over 60,000 articles and over 400,000 articles from the Web of Science core collection so without some structure it's hard to even know what questions are being addressed and all that research, much less really draw any conclusions from it. So, one basic way this ecological framework could advance or science is that it can guide the infrastructure for data and information sharing. And I'll include an example in my text summary points on Slido in a moment where I've started some pilot work on what eventually will be a database where artificial intelligence will be used to help classify all the climate structure into that framework. And I think the global change reporting program could use this structure for organizing and presenting consensus findings, and it can also help guide gap analysis of the research. And I think inherently it can also support communication and collaboration across, you know really all the disciplines and stakeholders who typically don't have as much dialogue with one another. And I'll also finally point out that I recently used this to map out issues of equity across the different areas of the framework. So, and if I may one final point being a social scientist for the theme of integrating socio economic sciences that was listed as one of the areas. I would simply say that prefer social sciences because it's a little more inclusive of field like psychology and sociology. So, with that I appreciate consideration and I'll be happy to discuss more at any point. Thank you Carl as a sociologist I agree. I would like to now invite Elizabeth plus from USA ID. Yes, hello. My name is Elizabeth voice. I'm with the US Agency for international development. And I have a bit more of a brief question, but not one that's more simple to answer. I would be very interested in seeing research that's done focusing on financing for climate change action, especially climate change adaptation. And what are some structures that are underutilized, but could be used in the future for this purpose, both domestically and internationally. And also what are some barriers, especially in that case looking for private sector engagement, what are opportunities that are sometimes successful and the factors that lead to that success. So what are the barriers, what is standing in the way of different potential partners joining together to take action to leverage money from the private sector on adaptation and alternative financing mechanisms such as long guarantees should also be considered, as well as debt for nature swaps and grants. And I would encourage looking at which mix of those is most appropriate in different contexts and what the potentials are, and what the downsides are of some of those would be very helpful in trying to frame some of the work moving forward, especially on adaptation. Thank you. Thank you Elizabeth appreciate that. And now we'd like to turn to Nathan Patterson from Carlton College, I believe. I guess he's having trouble using his mic. Shall we go to the next person. I'm just waiting for my. I'm going to turn the mic over to Donald Edmondson from Columbia. Vanessa maybe we're out of speakers. I have a dawn here. Would you like, I guess we're out of speakers. And turn to Steven or Mike to help me out here. Where are we. Great. Well, Sarah, thanks for, for walking us through that. We, we appreciate the inputs that people have have given we have we have five sessions over the course of this set of listening sessions on various themes, but recognizing that many of these themes are cross cutting. And getting inputs from people who are engaged with, for instance, this theme of health in some of our other sessions so we, we, we were welcoming these, these inputs and future ones as well. Nikki, could you bring on the slides. Well, and the, our next steps for you go to the next, the next slide please. The next steps for this session, I mean for this series of listening sessions are that we will be following up with everybody who has registered for, for this session. And that, that follow up email will provide links to a couple of questionnaires that we'd like you to engage with. So first of all, an evaluation for this session. And also we have a broader call for input so as I said at the beginning we have a couple of different modes for you to engage with us DCRP in this listening session activity. And so one of those modes is a is this questionnaire so please pay attention, look out for a follow up email from us, and we appreciate your contributions to both of those questionnaires and evaluations. We will also be posting materials from these listening sessions on the event page. The easiest way to find those event pages is through the National Academies. And we've also included it here on the in the chat. But if you, if you search what under the board on atmospheric sciences and climate under the events you can find to find all of the sessions after the material after the sessions the materials will be available on the individual event sessions. So all of the, all of the contributions that were provided today and in other sessions will be available to us DCRP and the advisory committee, really to inform all the work that they are doing going forward. Next, next session, next slide please. So today is the second of five sessions, we invite you to engage with us in the three additional sessions that are coming up on Thursday, November 18 this week, we have a next session on energy and global change. And the first full week of December we have to two additional sessions, one on food, and the other on transportation and infrastructure. So we invite you to come and register and participate in any and all of these events and we look forward to the, to all of the contributions that you provide. Sarah, do you have a final thought from the, from the committee before we close out today's session. No, I thank you Steven it's been an honor to be here and to listen in and thank you everybody for your contributions. We just add the same thing thank you very very much fascinating conversations we very much appreciate we have to say thanks.


This study examined the association between e-health literacy in online health communities, OHCs, and patient adherence by employing social cognitive theory. The results showed that physician-patient communication, internet health information seeking behavior, and the perceived quality of internet health information are significantly associated with improving patient adherence via a guiding of e-health literacy in OHCs. This article was authored by Ciny Lu and Ruintong Zhang.


Hi, everyone. Welcome to this talk. My name is John. I'm an open source engineer at Hackages and During the next 25 minutes. We are going to talk about the web In my opinion, the web is an amazing platform and I think that we can all agree on One fact is that it the web has evolved a lot since its beginning We went from sending simple Text over the wire to providing a full experience to the end user and I think one key component within the web that has brought this experience is JavaScript, right But so JavaScript built in 1985 Shipped within the Netscape browser was aiming to provide some dynamism to the static content of the web but What we were trying to achieve with JavaScript that time it's a much more It's a much smaller part of what we are doing with it now So the way that that it was executed at that time is quite different from the way it is executed nowadays So at that time JavaScript was interpreted, okay, and take a closer look at what interpretation is is for example Here we have in the middle our interpreter JavaScript interpreter Okay, and on the right side we have kind of like the very middle machine the CPU on the left We have a bunch of JavaScript code lines calling add functions passing numbers and when the execution hits the first line The line is sent to the interpreter the interpreter does his job Okay, evaluates both parameters their type what we are trying to achieve and then output some machine code that gets directly executed by the CPU next line same process again Evaluate in both parameters same what kind of types they are and then output in some machine code and the thing here that this mechanism worked until kind of 2005 when big JavaScript apps started to come onto the scene and one example is Google Maps which which browser started to hit kind of like a performance issue with those JavaScript app and why because at the end Doing a simple addition in JavaScript is not trivial you have to check both operands types and regarding their There regarding the evaluation you will output some different code So you cannot really count on the language it by itself you have to wait until runtime So one of the mechanism that Browsers applied to solve this issue. It's a very well known mechanism Which is called just in time compilation and if we take back the same example. We still have both Items there, but you have a third one a third component within the system, which is the just in time compiler. Okay We take again the same lines first line is sent to the interpreter It does the same evaluates interpret it output some machine code and that's it second line Same process Evaluate it both parameters and then output some machine code, but this time The interpreter has monitor the code and the execution and it has some feedback about the execution So it can see that okay. We try to Execute twice the same function passing twice numbers. Why don't so It marks that function as hot and then pass it to the just in time compiler to compile it and Output some the same machine code that it was previously put it store it somewhere else somewhere in memory and Lock that memory region so we cannot override Third line comes to execute it and then there the interpreter say okay. I know this ad function It's not the first time. I just asked the just in time compiler to comp to compile it and put it somewhere in memory so All steel are still both parameters numbers. Yes, okay You can then take the one that I just compiled it and directly execute it and if you see this here what we have done what the the engine have done is just that he made a shortcut for the execution of a function and we call that a fast path, okay and That's when JavaScript gave us his top speed and just to show you the difference between non-jitted code So non-jitted JavaScript and jitter JavaScript. I just launched an instance of Chrome Disabling the optimization of JavaScript and you can see for eight robot dancer It's kind of laggy on the left side, but on the right side. It's kind of going very well You can even I think I increase until 15 and it's still okay, but then Well, we had the performance issue with JavaScript With interpretation we compile it and it works pretty well. Why don't we why do we want to go further? Well, the thing is that I Didn't tell you the whole story If we go back to example and they this time I'm sending instead of two numbers one string and one number The interpreter will try again to say okay. I know this function. I just told it somewhere but Although are still those two parameters numbers nope So what he's done is doing is that he is going to fall back to interpretation and Erase the compile version that he had Yeah, super animation So then what's the problem with JavaScript? Well, I mean not the problem. I don't want to fend it. I'm sorry I'm sorry I didn't what's the thing what JavaScript is lacking to be optimized before execution well JavaScript is just lacking predictability if you take the same version the same I mean two versions of a same code one written in C and another in JavaScript. You can clearly see that in C The language provides some hints to the compiler so he can optimize code before runtime When if you look at the JavaScript side, there's not much going on there Even the number of parameters are not really fixed so you can pass more than two if you want So if we quickly recap what we learn here. Oh, no, maybe what we have to so we Opt we can optimize JavaScript and it's cool and you can have really good performance with it's not problem But the thing is that JavaScript is not predictable. So The industry browsers have tried to solve this problem I mean to solve that to fix this and they try to run some more predictable code within the browser and one of the initiatives is for example portable native clients from Google which was to to run some Some c++ modules within the browsers sandboxes. So it's secured But it isn't really took off After that Mozilla came with an idea of just taking a subset of JavaScript, which was more predictable With and they call it they called they call it as enter JS, but it wasn't enough Because it was still JavaScript at the end and in 2015 browsers reunited and Tried to come up with something that they could agree on to Go a step further to push the limit of the web and that's where WebAssembly came onto the scene And what is WebAssembly if we take quickly just the the text from the official page, which is quite dense I'm gonna read it. So WebAssembly abbreviated wasm is a binary instruction format for a stack-based virtual machine Wasm is designed as a portable target for compilation of high-level languages like C C++ Rust Enabling deployment on the web for client and server application a lot of things that we are going to try to Read it again, but step by step. So what assembly abbreviated wasn't is a binary instruction format So it just means that it is set of instruction and code it in a binary way. So it's quite efficient to load it Design as a portable target for compilation. So two things here Portable it means that WebAssembly is not just designed for the web but it's also designed to run outside the web on all the platforms and Target for compilation means that you don't have necessary to write WebAssembly. It's quite low-level You are more kind to you're more likely to write in a higher level languages like C C++ Rust Go C sharp Java whatever and You compile to WebAssembly So how the process goes simply you take a bunch of file C C++ here I just okay. I mentioned just C and C++ you compile it to intermediate intermediates a representation It's almost always LLVM. I will skip the details about LLVM Okay, but normally this part is quite hidden from the developer perspective Okay, and then you compile as a backend compilation to a Simple.wasm in this case is the name but a wasm module Okay, and with which tool for example one of the main tool to compile to WebAssembly is in scripting Which first mission mainly mission is to provide to bring other languages on the platform on the web So then how do you consume this simple that wasm? Well You fetch the resource I think you all know this you fetch the resource and then you just call the JavaScript API WebAssembly APIs that are nowadays available in all all the browsers the major browsers and then you receive You receive wasm module which you can call function on it Here exported from and those functions were originally written in another language So what all the goal of WebAssembly? WebAssembly wants to be performant run at nearly native speed After that what assembly wants to be portable. Okay, so not only running on the web, but also running in all the platforms and Secure secure by default. It's one of the main concern of WebAssembly being more secure than JavaScript performance well I might disappoint you, but JavaScript is not I mean sorry web assembly is not So much faster some are more faster than super optimized Compiled JavaScript at the end they quite run early at native space a speed. Sorry, but the thing is that JavaScript I Mean web assembly will more likely to stay on the fast path when you have an optimized version of it While JavaScript will kind of de-optimize easily and falls back to interpretation and for to illustrate my point here you have A multiple just diagram showing multiple execution of the same code in JavaScript and then the same code in WebAssembly in blue WebAssembly is faster. Okay, but the point here is to show that for Multiple execution of the same code in JavaScript You don't have you cannot predict the performance while in WebAssembly is quite the almost the same Also was can be decoded validated and compile in a fast single pass Equally with either just in time or ahead of time compilation if you check how JavaScript is handled within a browser You first fetch the whole resource and then you parse it compile it and execute it All that in the main thread. There are some exceptions. Okay, not everything happens sometimes in the main thread But that's kind of the regular way of doing it But browsers handle WebAssembly in another way So while fetching the packets while fetching the resource the wasn't modules The browser will directly compile the bytes dark on the fly and when it and when it when it's done It will execute on the main thread and the compilation doesn't happen on the main thread say does not block users Just to show you the difference of performance. You have 30 rubber dancers Here and you can see that in JavaScript is quite laggy when you switch the execution to WebAssembly It goes back to normal and you can even increase the number and I'm going I go there until I think 120 But you will not see the difference because the screen is too short. Yeah Okay, so portable at the beginning was Was meant the first version of was made was meant to to at least Works work on the browser. So the way of execute was was to Provide some GS glue code that when a wasn't module was trying to do something that the browser couldn't handle at least the JavaScript will handle the call and Simulate something emulate something for example calling a file system. You cannot qualify system within the browser So when folks tried to run wasm outside of the of the browser What they tried to do is just to run the existing wasn't module outside the browser and So there were kind of emulating GS glue GS glue code that was emulating a system interface So it's not really the most optimized way to do it. So a need of As much as wasm is a language for a conceptual virtual machine. It needed System interface a standard and standardized system interface for conceptual operating system That's when WebAssembly system interface claim onto the scene. It's just a specification that runs that that WebAssembly modules can call to Make some system API school kind of it's just an operating system. It's not it's in let's say It's kind of like a posix way of doing it So then the diagram becomes like that you have the non-browser or browser runtime that implement wasi and Provide exposed some system interface API that wasm modules can interact with I Wanted to show you one tweet of Solomon Hikes, which is the from the founder of Docker That's that is saying that if wasm plus wasi existed in 2008. We wouldn't have it to create a docker That's how important it is it is web assembly on the server is the future of computing a standardized System interface was the missing link. Let's hope wasi is up to the task Also folks from clever cloud a French company that is I think here. Maybe you have met them Are running function as a service in web assembly? Directly on the hyper that is a so no operating system between the code and The the hardware Okay, what the same it wants to be secured by default Nowadays when you code It's the the the result set of binaries is just 20 percent your that your code and 80 percent Dependencies that you haven't written Then what happened is that the way that we execute programs nowadays is just they execute within the ambient authority So me as an admin of my machine I'm going to Ask my problem to run and then I'm going to provide him my whole set of keys the Permissions that he can so he can run. Maybe he doesn't need it, but it's okay I just wrote the code so I know it doesn't will not do some malicious things the problem is that It also passed the whole set of keys to their it's dependencies Okay, and sometimes you have a malicious dependency Okay, so that malicious dependency can then use all the rights that you provide to execute some malicious code web assembly wants to execute itself as a Capability based systems so it means that I still have this whole set of keys But when I'm going to run the whole program, I'm not going to pass All the permissions I'm just going to pass the permission that I think my program needs to perform his task. Okay, so I'm just passing here kind of one key and then this key is passed to all the other Dependencies, but this time the malicious code is quite blocked and cannot really perform the malicious task Also one abstraction that the web assembly wants to provide is called nano processes. So The the idea here is to execute competing modules wasn't modules in this in the same In the same process. So kind of the result is kind of like that so you have the whole process which is like the big box blue box and then inside you will have like the first one is like your main module the one that you have written and It has dependencies to other models But they all run within kind of in a sandboxed way and they think that they are alone within the memory space the process It's it's just a software fault implement isolation so Why was wants to be secure because first it provides capability based systems Also, it's sandboxed by default. Okay, so you can run low-level code in a secured way and also a Nano processes provide a way to to communicate between different modules a lot lot lot much faster than Interprocess communication, okay, and The end result is kind of like that So you write your first You write your main module in for example rust and then you consume some dependencies that were originally written in all the languages Like C++ go and so on. I mean there are a lot. They're not only these languages There are a lot of more but well so Projects I Just took two examples. There are a lot. Okay, but you can check as you are all JavaScript developers. I Wanted to show you assembly script, which is just it's a subset of type script that does not compile to JavaScript or transpile to JavaScript but compiles directly to was modules and web assemblies, okay, and Because I'm a dotnet guy. I Wanted to show you I'm also that that guy I Wanted to show you That you can run now The CLR so the dotnet with on the browser through web assembly and they provide now kind of a framework Which is quite similar of like Angular to write front-end applications in C sharp Go check this link. It's really interesting. There are a lot of things and that guy and basso I Think he's Italian and he's doing a C++ front-end library to write Front-end application that compares to web assembly and it has also provided kind of like gs6 syntax for c++ Super interesting the bytecode aliens So big companies reunited and Try to push web assembly and a secured by default web and They call themselves bytecode aliens. They are these all the four founders of the aliens and You see pretty big names and just to tell you fastly is running 10% of the Internet and I will end up my talk with One quote that I think it's kind kind of resume What I feel about the web assembly is that web assembly is the first fast multi language retargetable and safe Intermediate representation that we have a that we have ever agreed upon as a community CTO of FASD Voila, thank you Okay, any questions Yes Yes, of course It's a question that a lot of folks are asking To be honest, I think that For now, it's c++ that will continue to be like the major solution to To provide native performance within note models But at the end it will switch to web assembly models because I don't know in my humble opinion I think it's kind of like the future of the industry or indeed in this perspective But they all they've both fixed some of your issues, which is giving you performance and so Assembly is a fairly young language Do you have another view of the tools and debugging tools around it because as it's a binary format I guess it's a bit harder to debug them Let's say vanilla JavaScript Yes, okay, so there are already I think some browsers that provide debugging tools To work with web assembly modules You have I think within module a firefox so you can already kind of work with it and and the ball The thing is that I didn't mention and you're right Web assembly has two representation. It has the one that browsers use to To execute it which is the binary format because it load efficient and so on but for human readable It's it's not the most human readable format. So they also have a text Representation which is web assembly Text I think what or something it's called what? And then you can really clearly see that it's low-level it kind of like an assembly code I have a question about the micro front-end and how assembly will do in this in this architecture Assembly yeah web assembly web assembly will do in which architecture in the micro front-end The micro front-end architecture, okay Web assembly are quite I mean it's composed of several modules. So if your concern is to say Do I have to download the whole module big big big module to execute it? No, you can kind of speed it and and in the in the future you will able to you will be able to lazy load it so Yeah, I think you can already do that now to be because at the end as you see as you saw I mean you're just fetching a resource on the internet and then you can fetch whenever you want if it's Sorry Yes, I will say yes. Yes, there is no really they're not competing I mean if they're loaded into your browser you can run it On both sides, but maybe you will struggle a bit to make them Work together, but I think it's competitive feasible of course Okay, is web assembly able to access to the GPU? okay, so This talk that I've done. It's normally a much much larger and I'm covered all the topics One thing that so your question is Is it possible to call some GPU? APIs from the web assembly right now? No, because the only thing that provides that That is standardized is was he which is kind of like a symptom system interface to call some the OS API's the thing is that was he wants to extend itself and so you in the future You would be able to call some specific domain specific Low-level API's and for example GPUs, okay, or you will be able to call I don't know something related to blockchain or whatever so Go check was he got check on the internet was it's really that we want to extend themselves and and they're open to Feedback from the community Thank you so much. Thank you He might be available just outside for questions


The issue of unethical clinical trials, flouting the legal boundaries, has been a concern for long. The last decade has seen India emerge as a favored destination for clinical trials, largely sponsored by foreign MNCs. There has been a massive rise in the number of clinical trials conducted in the country since January 2005, when restrictions on clinical trials of foreign companies were removed. The Indian Council of Medical Research itself admits that it is impossible to keep a check on these activities. The ICMR states that the data and reports of various trials are often difficult to find and in some cases do not even exist as many trials are abandoned or are not published due to negative or equivocal results. The recent expose of illegal trials in Indore by the Editor of Monthly Index of Medical Specialities has yet again brought the issue to the fore. Trials are regulated by Drugs Controller General India, which works under the Ministry of Health. If a trial is supposedly taking place in a country outside India, then you can conduct it in India also. Now the difficulty with this kind of a rule is how do you monitor whether a trial is taking place abroad or not. So these things are not at all implementable in our country. So to that extent the law is defective. Sama, resource group for women and health has been campaigning for poor vis-a-vis unethical clinical trials. News click in association with Sama did a story in July 2010 when it was found that 14,000 tribal girls of Khammam district of Andhra Pradesh were subjected to trials without their consent for a commercially licensed human papillomavirus vaccine manufactured by Merck. The vaccine claims to provide protection against cervical cancer. The vaccine trials in Khammam had to be discontinued after reports that four of the girls who had received the vaccine had died. What was shocking was that the exercise was conducted under the name of National Rural Health Mission with due permission from the state government. The trials were conducted with the active participation of the ICMR and the US-based International NGO, PATH. It raised serious concerns regarding the ease with which ethical norms were flouted, especially in the way guidelines regarding informed consent were disregarded. Such violations of ethics and law continue even today. Dr. Chandramohan Gulati, editor of Monthly Index of Medical Specialities, exposed in May 2011 a slew of unethical practices in the conduct of clinical trials in MGM Medical College in Dore. The editorial that he wrote for MIMS revealed that though 2,365 patients were enrolled for drug trials in five government medical colleges in Madhya Pradesh, six investigators from only one institute, MGM Medical College and Associated MY Hospital recruited 1,521 patients. It included a whopping number of 1,170 minors. Shockingly, for use of Tedela Phil in pulmonary hypertension, otherwise used for male erectile dysfunction, seven out of nine subjects were females, while one was a 17-year-old minor boy. No compensation was paid to her family. Not even one patient was paid in the medical trial in complete violation of ICMR rules. Even though trials were conducted using government infrastructure, the funds were deposited in investigators' personal accounts. Approval for the trials was not obtained from the on-site ethics committee, but non-verifiable entities situated in far-off places. So, the focus was that now the attention of these doctors has been diverted from their routine teaching and looking after the patient to conducting clinical trial on behalf of multinational companies. One of the major reasons for conducting clinical trials on third-world population is its cost effectiveness. If a clinical trial costs $100 in America, then the cost in India is only 20. In an interview with NewsClick, Dr. Amit Sengupta spoke about the larger context in which the indoor case should be seen. The whole issue of MGM Medical College indoor and the exposure that has been done by Dr. Gulati has to be looked in the wider context of government policy in India and the regulation that we have in the country. Today, we are joined by Dr. Amit Sengupta, who has been associated with all India People Science Network and Jan Swasthi Abhyan. Welcome to our show, Dr. Amit. So, Amit, industry and the government claim that opening up the opportunities for conducting clinical trials in India is essential to ensure that medical research improves in the country and the foreign investments also come in the country. The experience of the last five years, does that support the claim that the pharma companies and the government is making? Yes, first we need to understand that the whole premise based on which this argument is made that if we make it easier to conduct clinical trials in India, then our research capability will improve is entirely erroneous, because the way today for example, and we have about five or six years of experience now, since the whole process was made much easier in 2005. And what we clearly see is that one, most of these trials are conducted by foreign sponsors largely foreign multinational corporations. The design of these trials are worked out by the foreign sponsors and the data goes back to them. So, what you do in India is just to create the environment where you can conduct the trials, gather the data and send it back. It does nothing really to indigenous research capability. It does nothing really for Indian science. So in a sense, it is not very different from say a hundred years back when Indian Chad labor went into the West Indies, the only difference now is that they are wearing coats and ties. So this is based on the premise that if you allow foreign countries to come into your country and use your people for conducting trials more or less as guinea pigs, that will improve your research capability. It is not something that is borne out by the evidence or the experience of the last five or six years. Last year, clinical trials for HPV vaccines in Khamam district of Andhra Pradesh had to be stopped, because four tribal girls died in the process. So do you think that Indian subjects are being used as guinea pigs by the big pharma companies, international pharma companies? Let us examine what are the reasons that are used as to why clinical trials are done in India or why India has become one of the favorite destinations. One of the reasons that is put forward is that patients in India are treatment naive, which essentially means that they do not have access to public health, which basically means that the fact that the Indian people are deprived of public health is an advantage that we wish to use to make a little bit of money for a few people. The second sort of reason that is put forward is that the costs are lower. The costs are lower because people in India who become subjects of clinical trials are much more vulnerable. They are vulnerable on one hand because they do not have access to health care. So being a participant in a clinical trial often is the only way when you can access health care, especially in a disease where the cost of medication is very high. So or you are much more easily induced through payments. So what you are basically doing is utilizing the vulnerability of the Indian population. Now you can call that a guinea pig, you can call that anything, but essentially that's what the whole clinical trial business is predicated upon. The Indian Council of Medical Research itself admits that it is very tough to keep a check on the mushrooming ethical review committees that have come up. And we know that a lot of these committees actually receive foreign funds. So in this context, how can the regulation be done and within the given legislation that exists, what changes would you like to propose where we can actually deal with this matter effectively rather than just saying that something unethical is happening on the ground. We have various gaps in the system which do not lend themselves to a situation where you can actually run ethical clinical trials. You have one what we call the ethical gap. There are huge problems of ethical norms not being followed in clinical trials. You have what is what you can call a public health gap that because people do not have access to health care, so they are vulnerable and become subjects of clinical trials. You have what is called a regulatory gap. In 2005, when the norms were liberalized for clinical trials, you had less than 100 clinical trials a year taking place now. You have more than a thousand taking place now and you just do not have the regulatory mechanism to be able to actually oversee the conduct of clinical trials including the conduct of ethics committees that are now mandatory. And you also have what you can call a capacity gap. In the six years, there has not been a concomitant rise in the number of personnel that you require technically equipped to conduct clinical trials. So, essentially what you are seeing is a huge increase in clinical trials without a concomitant increase in the kind of in the kind of facilitatory environment that you require to conduct these trials in an ethical manner. Now, that does not mean that India should not be a place where you conduct clinical trials. But the point is that if you are going to actually conduct clinical trials to promote Indian science, to promote Indian capability, the number of trials, the trial sites, who conducts these trials have to keep pace with the various regulatory and other mechanisms. Thank you, Amit. It was nice having you on our show. Thank you.