Hello everybody, welcome back to another episode of Anabaptist Perspectives. I'm here not with Corleen Bean. This is your name from Ontario and we're doing this obviously remotely given the current situation across the globe. So Corleen, why don't you go ahead and just introduce yourself and tell us about where you're from and and what you're currently involved in. Sure. Yeah, so my name is Corleen Bean and I am I live in New Hamburg, Ontario. So that is close to Kitchener Waterloo, if you're familiar with Southern Ontario in any way. I'm married to Richard Bean who is a pastor of a new church. We've been going a year and we're located in the city of Kitchener. And I have four children. So ages three to ten. That's our family. And right now we're we're hunkered down in our basement actually because there's renovations taking place in my kitchen and upstairs. And so I think ever after we're going to connect COVID-19 with basement living and not because of COVID-19, but they're they're going to be simultaneous. Bad, bad, bad timing there on the renovations. Well, can you tell us a little of the situation up there. We had heard through one of our advisors actually on our board about some things you're involved in and ways your church is responding to the current situation. How did you find out about the need and what is it that you all are doing. Okay, well, it's a bit of a story and you know it started with with simply my own Desire, I guess, to do something. So yeah, I am a stay at home mom and I'm just at home with my kids and obviously now I'm homeschooling because the kids are home. However, my husband is an optometrist in addition to being a pastor and so his office was one of the first to shut down. He's now taking He's on call several days a week. I'm just taking emergency basis, but he's at home too. And so he offered to take the homeschooling responsibilities. And so I found that I had time and I started asking the question. What can I do. Recently in Sunday school I was in my study prior I was learning about some of the the the plagues and things that have happened in history and how Christian stepped in and they were the ones that That moved in and did things when others would not And and I don't feel like I'm in any way in that position, but that's kind of where my thoughts were we're beginning from this was three weeks ago. Right. It's feels like a lifetime ago, but it's only been three weeks ago and So asking myself the question. What is it that I could do now I'm very much Believe the the stay at home orders and and and we're we're hungered down. I think that that is our way to love our neighbors right now. But maybe there was something I could do from here at home. And so I started talking to some of my nurse friends and some of our Some of the ladies at church who are working on the front lines and we have one young woman who's working in ER And saying, you know, I've I've been seeing people making mass online. Is this is this okay like like does this actually help. Do you need this. And I kind of got mixed answers and and the next thing I did was I reached out to a local doctor a family doctor in our town. And I asked her that question. I said, you know, I have a sewing machine I can so many of our people can so I've heard about mass. Do they help. Can we make mass for you. And I got an email back from her and she said, no, we don't want mass right now. But yes, you can help. We want gowns. And so she put me in touch with a just a newly formed group in the KW area that had been started by her and another doctor or two. I'm not entirely sure of all the details. But there was a group of doctors that got together just a few days prior to my question saying we've got to do something. Our PPE is running out. How can we, how can we Handle this. What can we do and they call themselves the PPE task force this group of informal doctors for just our region and they've put together they have a website they're collecting equipment, whatever they can get And they reached out three days prior to my question to some of their friends who they knew could so and said, hey, we need stuff so can you find people to sell for us. And so I stepped into this Just a few days after it formed my doctor. Directed me to this group and said, I'm going to put you in touch with these people. You can work with them. And so that's how it started with a simple question to my doctor and a week later. That was Friday, a week ago. So we can a day later. I'm it's grown much bigger than I ever thought. So, yeah, so we started with making gowns. I don't know how many details you want to know here, but Yeah, no, this is really interesting. So is this the kind of thing where they basically They're working with a coalition of doctors and different health care providers. And those people submit requests and then you all are basically the people to fulfill that. Is that right way of saying it. That's essentially it. That's right. So I'm not communicating with the doctors directly myself. But the contact that I it's it's in a sense a chain right so the Doctors, the midst their request to to the volunteer org that was just formed. And I get my request from them. And so I'm just a piece of the puzzle. And I pass on what I learned to to the women in our church and a few other churches that have joined to help us. So how many do you have any idea how many people are are sewing to fulfill these orders just in your own church and surrounding area. It that is a moving target. So originally, so so our first request.  But But so so the group was gifted not gifted. They they did have to pay for it. So they were looking for donations as well. A huge amount of fabric to make these gowns out of because who has, you know, the right kind of fabric lying in their closet for 600 gallons, which is what they needed done at that original request. And so they had people cut out that material and we picked up the fabric. So my ladies did about 50 gowns in that first three days. I think we got those done. And so you asked how many are sewing the original email. There was seven ladies that sewed those. We did 50 gowns those seven or eight ladies did those gowns. Now from there, it has grown. And Now there are so so every day I get an email or two from from somebody else who's found out and said, I hear you're doing this. How can I help. And so there's other churches starting to get involved. But within our own church, I've tried to organize it. My husband has helped me immensely. We've set up a live Google Doc for our seamstresses and then there's people who want to help and other what they don't sew maybe. And so I have a few ladies who drive for me. And so they're doing deliveries when we get a stash of them done. One of my drivers will drive them out to the drop off location, get them into the hands of the doctors as soon as we can. That is really neat. So this is supply and yields just for the hospitals right there in your area. I'm guessing facilities. That's right. And I'll clarify because it's not for the hospitals. Okay. Okay. Currently, we still have in our region, as of the last I knew, enough PPE of the proper PPE for the hospitals. Okay. And so this this doctor task force, what their strategy is is to get to keep the proper PPE with the hospitals that are dealing with COVID-19 patients. And these other supplies that we are providing are then going out to family doctors, midwives, homeless shelter workers. Any of these other health organizations that could, I mean there's the risk they'll run into COVID, but they're not working directly with it as far as they know. So it's providing protection to them so that all the proper PPE can go to the hospitals and the doctors and nurses there. Are y'all just doing gowns or are you involved in sewing any masks at this point? So we started with gowns. So it's it's it was a roller coaster ride at the beginning because the doctors are saying, yes, we want gowns. And then they came back and said, no, we don't want gowns because there's industries that are going to make them for us. And then half a day later, they came back and said, yes, we do need gowns. Those industries can't get the approvals they needed. We don't know how long it will be until they get them. We need these gowns. So we did that. And then I think it was about two days later, they came back and said, okay, can you do surgical caps? And so we've done those. And that's been one of the things we've actually focused on maybe more so in the last half week is the caps. They came back and said, can you can you get us 100 caps ASAP? And so I sent my women to work and sent up patterns. I drafted a pattern because we needed to they had a certain one they wanted and it wasn't free online. And people were so willing to pay for it. So I started drafting a pattern and I was sending that out. And so this is actually one that my son made. He's even my eight year old son has even gotten making surgical caps. So this is a surgical cap that kind of what they look like. And so you asked about masks and our doctors have been really hesitating on that one because the stats are not good. They really don't give very good protection. But just in the last two days, she came and said, we're going to cave, we're going to ask you to make some masks. Wow. So right now, we they have a request out for 700 masks. Now we're not filling all of those. There are other stores in the community that are working as well. So, so we had just done an interview a couple of days ago, I think, I don't know, five days ago or something. And for the record, this is April 4. So these situations change a lot. Come back a few days, you know, it could be a different story. This is more for reference points for people who are wanting to know how to help. And where we were at, I think it was 31st, they did another interview with Matt Landis and it's a group that I'm a part of where we're helping in New York City. And in that case, that's what they wanted. They didn't want the gallons they needed masks. And they're they're saying was, well, if we can get these masks, we know they're not as good. But then it'll spare the really good masks for surgeons, you know, people actually working with patients, and then all your, you know, EMTs and, and, you know, just general hospital staff or even like police officers, firefighters, whatever, can wear these on a day to day basis. And they asked for 2000 just for one hospital. Like immediately, oh my goodness, there's and there's so many more hospitals in New York City asking for the same thing. And similar to that, where the masks here are not being used in the hospital setting, but for those other, other people that need them. Yeah, exactly. Or like long term care facilities. Exactly. Homes are starting to require a lot more strict measures and things. But oh my, that's, that's amazing. That's like, one of the things I want, I hope this interview will do is inspire people to just go out there and ask questions like for yourself. You wanted to help, but you didn't even know where to start. So you, you literally just cold emailed somebody. Am I right on that? That's how this all started. Wow. So if you just said, well, let's, it's not worth it. Let's not even send that email. Yeah, be a different story. Yeah. And that's what I would say too. Like if you, if you, if you have a sewing machine, if you have something you can use and you have time, reach out and ask somebody, ask some questions, what can you use? What would you need? Is there something that I could do to help you? And sometimes that's all it takes is a question. Yeah. If you're in the KW area, I'm going to put a plug in here that, you know, I'm not necessarily looking for more emails myself. I feel like my workload is, is, is high enough at the moment, just organizing who I've got on my team. But check out. They've got a Facebook page. If you just look up KW COVID medical supplies, you can find what we're doing and join the effort even just from there. Yeah. That was actually, that was something I thought about there. If there's things like that that we can reference so that people that watch this can, can click through and see, and then see how you all are doing it. And then hopefully in their own churches and groups model that. Like for example, how did you figure out what patterns to use? Did you make all that from scratch? Did that hospital staff help you with that or? And in our case, the, the, the, the doctor team that we're working with has, has done all that. So, so everything gets sent out to us with a pattern or with several patterns that these are what we would like. This is kind of the style where this would be our preference. Can you make this? And so I know some of the volunteers in the, in the chain above me have done some of that work with the patterns. Some of it was just a YouTube video sent out. This is the pattern we want. That was the case with the, with the surgical cap. It was a YouTube video and it looked easy enough. The pattern looked easy enough, but you had to buy it, which was, which was fine. And some of our ladies did buy it. But it was a very easy one that, that I just drafted it myself then. But yeah, they handed us those patterns, those instructions, they gave us, you know, a whole, this is the material you need to use. This is how you do it. I mean, we're trying to be as careful as we can, as far as calmliness. If you're in isolation, if you have symptoms, you do not so. The material needs to be washed in hot water before you start and, you know, try to hand wash as much as you can throughout the process, limit the number of people that are touching that fabric and the finished product. And I mean, they're still going to sanitize it once they get it, but trying to take precautions all the way along the way. But yeah, I'm not organizing those steps. I'm taking what I'm told and then just passing it on. And I think that's a really good point for people to keep in mind is everyone can play a role in this. Everyone from your health care workers all the way down to the person sewing it and everything in between. There's a long, hopefully not too long, but there is a chain of supply that needs to be filled and there's slots all along that chain that people need to plug into. Maybe, you know, what would you say to anabaptists all over that they're going to see this different people around the country, Canada, US? What's the first step? Like, what can they do at this point? Probably ask those questions. You know what, we're far enough into the crisis, like I just got an email just before this interview that Cam has put out that they now have patterns and that if you want to sew gowns or masks, get in touch with them, they can facilitate some of that. So some of our, some of the groundwork may not have to be done at this point. As in, if you want to help, if you can sew, there's organizations out there that are mobilizing at this moment and starting to get it happening so that you can just start sewing and don't have to figure out the logistics of, okay, where do I send this? What do I do with it? How do I find a pattern? Start doing some looking and I think you'll be able to partner with someone who's already working and get going on it. Don't reinvent the wheel, maybe. Just come along with somebody who's doing it. Yeah. Yeah. And that's, you know, that's a piece that's been exciting for me is that in this process, I've been able to work with other faith communities in the community. Like this is not just our church doing this. This is something that humanity are all in together and it's something that we can partner together with other groups as well. And at the end of the day, I think all this comes back to, this is us wanting to serve and love our neighbors in whatever way we can. And each community is going to be different. Like in my community and Tennessee, you know, it hasn't really hit my area too hard yet. So the needs are going to be a lot different here than they are, say in New York City, which is like frontline. They need medical supplies immediately. It's a very different field than what say my church may do in response. And maybe out of all this, people could start thinking creatively, you know, and I wonder and maybe you can comment on this, but a crisis of this scale, which is basically encompassed pretty much every country in the world and infected over a million people that we know of, it brings all of humanity together. And maybe this is a way that is going to allow our Anabaptist people to get outside of our own churches and reach out to the neighbor that may live right beside us in a way that we may not have had the opportunity, you know, months ago. Yes. Have you seen that happening in your communities? It's an open door into people's lives that you didn't have a few months ago. You know, just speaking personally, I've seen it in our own street here, in our own, for us. Now, it's not that we didn't know our neighbors. We're in a small suburb. And so we do have a great little community, but it has facilitated more conversations. You know, we're social distancing, of course, but when we're outside and from our two meter distance from each other, there's conversations happening that didn't happen before. And I hear people asking each other like, are you doing okay? Like, is there anything I can do for you? And it's enabling us to care for each other in ways that maybe we didn't feel the permission to ask some of those questions before. For example, our neighbor is a single man. His parents are elderly, and he's been caring for them for the last year.  Like, what can we do for you? And my children and I got out and we raked his lawn for him because we knew he was gone long days caring for his parents. And it felt like a simple thing that we could do to help care for him even, you know, in this time. And it's open to those conversations and people care for each other. That's what that is really neat. That's really neat. And maybe we can use this as a reminder, look for those open doors that may not have been there before. Right. And be willing to ask those questions again. Even people we barely know, you know, how can I care for you? Yeah, wow. Wow, this is really interesting and inspiring. And I hope, yeah, people see this and can see that just the practical side of how we can get involved. We're all seeing the stats and we're all, you know, there's a little bit of fear amongst some people. And then there's other people who don't seem to, it doesn't really, hasn't really affected their lives. And I would like to bring both of those groups together, the people who are really terrified and those who are not taking as seriously, bring them together and say, all of the, all the details aside, how can we serve people? How can we actually love those people around us? How can we be the hands and feet of Jesus to the people that are right in front of us, whether that's my children in my family, my medical community, or my neighbors outside? Yeah, let's do it. I want to acknowledge all the people. I'm just a piece in the chain. And so all the, all my sewers and all the other people, they're doing so much. And I want to most of all give honor to God for his, yeah, he's, he's at work. And I want my piece in, in this story to, to bring glory to him. Wow, that's, that's really neat. This has been very enjoyable. And I appreciate you taking the time to share your, your story. And hopefully I'd like to post some links to your Facebook group and things. I'm in this and maybe there will be some people getting in touch that want to do this in their own churches. That would, that would be really neat. So sure. Thanks again so much for your time. I really do appreciate it. You're welcome.


Well, thanks very much, Kim, for the invitation and opportunity to come and speak today. And it's great to follow Dan George, who's really a leader and someone we look up to in this field of renal cell cancer. I'm going to do this a little bit differently than Dan, but I think it'll be helpful to look at some of the data in the way that we look at it. And what I'll do is I'll speak over some of these slides. So don't worry so much about some of the details, just to give you a sense of sort of the information that we look at as physicians and how we ultimately translate this information to the patients. And so after drugs like Pizopinib or Votrientsinitinib or Sutent or Temserolimus, otherwise called Toracel, what happens to patients who progress on those first line therapies? And so what I'll do is I'll review some of the main studies that have been done related to second line therapy. These are acronyms for those studies. We love acronyms in medical oncology and in medicine in general. And so we'll go through the record one trial, the access trial, the intersect trial and the record three trial. We'll talk about some potential biomarkers that may be used to predict response and then we'll talk about some proposed treatment pathways. And people in this audience like Kim Rathmael, Billy Kim, Dan George have really been instrumental in bringing to the attention of the medical community the use of potential markers, whether it be blood based markers or other type of markers to be able to select patients who are most likely to respond to particular therapeutics. And so this is sort of the landscape when looking at second line metastatic RCC, which is renal cell carcinoma. These are a series of studies that have been done with different agents, which are listed in this column. And this is related to patients who have previously received what are referred to as cytokine therapies. So these are historically patients treated with Interferon and Interleukin II. And I can tell you that when I was in training back in the early 2000s, the only agent that we had were cytokine therapies. And in fact, we use a lot of Interferon in patients, which can be toxic. And unfortunately, the response rates were not nearly what the response rates are with the new targeted agents. And what we're seeing and looking at many of these therapies is that we're seeing responses with essentially all of these therapies. And this PFS refers to something called progression free survival, which is an endpoint that we use in oncology, which incorporates a number of things. It relates to the progression of the cancer, the growth of new tumors. And it also includes things like cancer-specific survival. So living or dying is related to the cancer or overall survival. And so we call it a sort of a composite endpoint. And we use that to measure the success of agents. This next table demonstrates, again, second line therapies for metastatic kidney cancer. But these are looking in patients who have previously received some of the new agents, so some of the ones that Dr. George has described, like Pizopinib or Sunitinib. And so here, Avirulimus, which is also a Finitor and Accytinib, which is in LIDA, as well as a series of other agents. Once again, after patients progressed on first line therapy, what we saw is, in fact, we were seeing responses. And we were seeing historic, as compared to historical series, improvements in survival is related to these agents being used after patients had already received some of these new very exciting drugs. And so one of the most important studies that you should know about is what's referred to as the record one trial. And so this looked at the drug Avirulimus, or the trade name is Finitor, versus placebo after progression on one of these VEGF receptor therapies. And so it took patients with clear cell disease who had progression on Seraphinim, Sunitinib, or both, who had a good performance status, which is what Dr. George was referring to, the vertical that he mentioned, and randomized them to receive Avirulimus in best supportive care versus placebo in best supportive care. And what you could see is that patients who received the placebo were able to go on to Avirulimus if they were progressed on placebo. And what was exciting about this trial is that the Independent Data Monitoring Committee actually recommended stopping the study because of a significant benefit for the Affinitor group over the placebo group. And what was seen, and again, these are these sort of fancy curves that we look at in oncology, but this is really the probability of survival, so 100% being very good, of course, and then these are the months. And this is for progression-free survival, that end point that I mentioned before. And what can be seen is that the Avirulimus curve is on top of the placebo curve, and so Avirulimus is better than placebo. And these with immediate progression-free survival are sort of the average numbers. And I always say to patients, I'm going to give you the average numbers if you want them, but I've never met a patient who's average. And so if one looks specifically at the record one study and looks at the prior therapies that they received, you can see that the majority of the patients received that drug, Sutent, which is the drug that Dr. George referred to. And so what was particularly exciting here is that we were beginning to get a glimpse into the effectiveness of some of these new agents in patients who progressed on these first-line therapies. And this was really the first large randomized phase 3 trial that demonstrated a significant benefit associated with this new mTOR inhibitor. These drugs are not without toxicity. Dr. George mentioned this. And things like mouth sores and slight increase in incidence of infection. Some patients can develop some inflammation in the lungs related to the affinity or Avirulimus drug. Rarely is it significant, oftentimes what we'll see is some abnormalities on the CAT scan of the chest that really don't ultimately amount to much at all. And so we generally just follow those. Some patients can develop, although rarely, significant cough or shortness of breath associated with those symptoms. But in general, this is very manageable. And we can even treat those severe cases with things like steroids. Another drug that's been very exciting is one called ExitNib or NLIDA. And this is a series of phase 2 trials. So phase 2 trials are those trials which are designed to look at the preliminary activity or efficacy of a drug. And these phase 2 trials of ExitNib or the trade name again, NLIDA, looked in patients who had previously received, here's one trial, cytokines, another trial, some of the drugs that we just talked about, and again demonstrated very promising response rates and survivals in patients who had previously received some of these exciting therapies. And so once again, it looked like we had a winner with respect to a drug that could work after patients progressed on these first line drugs, which unfortunately don't work in the majority of patients forever, although some patients can be on them for years and years. And so this was the trial design. Again, one of the schemas that we typically look at as physicians in oncology, so patients after disease progression, randomized to ExitNib or the serathenib drug. And this was again looking at that end point of progression-free survival. And here, again, without going into all of the details, you can see that the ExitNib curve is above the serathenib curve, demonstrating a significant benefit with respect to this progression-free survival over the drug serathenib. And so based on this, much like in the record three trial, in LIDA or ExitNib was FDA approved for the treatment of patients who progressed after first line therapy. In terms of treatment-related side effects of these drugs, so they're not without side effects. I agree with Dr. George that the most substantial period of time for patients is that first cycle, and getting them through that first or second cycle of therapy is really crucial. And explaining to patients that actually the symptoms get better, again, unlike chemotherapy, where we think of things becoming more cumulative over time with respect to side effects. And so diarrhea can be a side effect. Hypertension or elevation of the blood pressure, and Dr. George has done work related to elevation and blood pressure, and its significance in monitoring patients on these therapies. Fatigue, there are rashes that can be associated. This is a rash that's associated more commonly with serathenib or nexivar, which can occur on the hands and feet and can be painful and uncomfortable for patients. And in fact, there are things to do for it. And I know Mary Dunn's going to be talking about some of the symptom management issues. The real question is, now that we have these two drugs that are FDA approved for the treatment of patients who progressed after first line therapy, which one do we use? And that's a tricky one. And so these trials are different. They were accrued, in other words, patients went on study during different times. They had different comparator arms, right? The Varylimus or record one trial at placebo, the Axis or Exydnib trial was compared to serathenib. There were differences on how many patients received two or more therapies before, typically patients that are more heavily pretreated may have a more difficult time or potentially a lower likelihood of response to therapy. Their poor risk, and Dr. George mentioned those very good risk patients where there are poor risk patients as well who have more adverse or bad features. And so those were different. And there were a series of other things that were different as well. And so it's not completely appropriate to try to compare these trials. That being said, in an ideal world, what we'd love to do is have a randomized trial, right, where we took patients and we randomized them in the second line setting after progression on first line therapy to a Varylimus or finitor versus Axis and Exydnib. Well, unfortunately, we don't have that trial. And that's a nature of the design of clinical trials, the pharmaceutical companies wanting to design their trials in particular ways. But what we do have is we do have a study where we compared an mTOR therapy, much like a Varylimus or a finitor, to serathenib, which has multiple targets, but one is that VEGF pathway. And so this was a randomized trial. It was called the Intersect Trial. And again, this is perhaps ideally what we would have liked to have seen. And what we're seeing here in the Intersect Trial is that there was really no significant difference with respect to the progression-free survival. There was a suggestion that there may be a benefit to the use of the serathenib drug over the Temserolimus drug with respect to survival of patients. You can see the yellow curve for serathenib over the blue for Temserolimus. I think that this really doesn't answer the question completely about which drug is better or which class of drugs is, frankly, better because we didn't really use the best drugs to be able to answer this question, but at least it provides some information related to the use of these different types of therapies in the second-line setting. And finally, one of the questions that many ask are how do we sequence these drugs? What do we do? How do we put one after the other? Unfortunately, when all of these drugs came out, there was tremendous excitement about how many drugs were coming out one after the other, but it really didn't give us a great opportunity to be able to figure out how to give them. And Dr. George mentioned the issue of combination therapies and a lot of those things are being investigated. There are toxicities and side effects that we need to think about when we give combinations and some of those haven't worked, but I think there are certainly others to explore. And this was a trial that sort of looked at that question of sequencing. And it said basically, well, our standard format is to give synidinib, or the pseudon drug, followed by the affinitor drug, based on the record one data. And it asked the question of, well, what if we were to give the avarylimus drug first and then follow it with the pseudon drug? Would the outcomes be just as good? And what this basically showed is it didn't appear to be the case that if you gave the avarylimus drug first, that it was similar to giving the synidinib drug first or the pseudon drug. In other words, pseudon followed by the affinitor drug appear to be better than affinitor followed by the pseudon drug. And this is important because it was, we begin to think about how we manage patients and how we sequence these agents. At least this begins to provide a framework for some of the data that we need to look at to be able to best answer these type of questions. And so the question of biomarkers are ways that we begin to think about who do we select for which therapy? And again, there have been a lot of work in this area. There's been some information to suggest that we can use, for example, blood pressure as a biomarker or a marker of response. So we can actually escalate the dose of the exidinib or inlidid drug based on patients' blood pressure trying to obviously work toward increasing the drug but at the same time managing the high blood pressure, which can be a significant issue for patients on this therapy. And I'm sure Mary will talk more about that. And then what we've also started to do is look at certain genes within patients to try to predict those patients who are most likely to respond to a particular drug or for that matter are more likely to experience a particular toxic side effect. That's something that we're working on a lot at UNC and I'm sure it's happening at Duke as well. And so what are the guidelines? What do we use to make these sort of decisions? So as physicians, obviously we individualize, we sit down with the patient in the room and we make a decision with the person sitting in front of us. But we also like guidelines to be able to use to make these decisions. And these are often used in the community to be able to make decisions. And some of the nuanced things that Dan was talking about that perhaps don't go on in the same way in all community settings, these can be extraordinarily helpful. And I think what's really exciting is what I started with today, which is when I was a fellow in training, we had interferon and interleukin-2 and that was it. The response rates to interferon were somewhere between about 15 to 20%. And here we have a list of the therapies that we have available for patients who progress after first line therapy with advanced kidney cancer. These are the national comprehensive cancer network guidelines, these are the guidelines that are used throughout the United States. This is another algorithm that was proposed to look at how we think about patients being treated after progression on first line therapy. And there are slight differences, but the bottom line is again, there are multiple agents that we could think about. Or we could think about targeted therapies that haven't been previously used. So if a patient may have progressed on the drug like Pozopinib or even Accydinib hadn't received synidinib in the past, one could consider using those agents. And then these are the European guidelines. So these are guidelines that are used by our colleagues overseas to make decisions about second line treatment as well. And so again, you see similar names of the drugs that we've talked about. But again, I think going back to this, it really tells an extraordinarily exciting story about what's gone on over the past 10 plus years in the management of patients with kidney cancer. And I can tell you that there is a tremendous promise for what the future is gonna bring based on our enhanced understanding. And I think you heard about this about some of the genetics of patients' tumors and beginning to better understand not only the biology of the tumor, but also understanding more about the patient sitting in front of us. And so with that, I'll end. And I think we'll hear Mary and then take some questions at the end. Thanks so much.


Hey guys, it's Tilly here. I'm doing a quick video on the Perth Supernova, which is coming to town on the 26th and the 27th of June. I'm very excited because I'm going to be the literary host for this event, which means I not only get to meet some amazing authors, but I also get to meet some more of the Perth book community. So the authors that are going to be attending this event are Maria Lewis, T.C. Shelly, Jerry Muzow, Amanda Bridgeman, Luke Arnold, Juliet Merilia, and Alan Baxter. The convention's going to be following all of the safety protocols, and hopefully nothing happens before then, and we can have a bit more normality that we haven't had in the last few years with Supernova coming back. Let me know down in the comments if you guys will be attending, and hopefully I'll see you guys there. Have a lovely bookish day!


hey guys got some good news for the six of you no maybe eight we got a Subaru but not just any Subaru well it is just some any Subaru now but it's going racing when I'm done hopefully anyways this is it it is an L6 2.5 single overhead cam well there's the single overhead cam now it came with a little bit of weight reduction a free dent or a couple and check this out a racing hatch a nice red racing hatch a hacked up exhaust just kind of a plus half the work is done still gonna do an axle back most likely the mid pipe is two and a half and the rest is two and a quarter suspension is decent actually it's got some rust issues here and there took off the front subframe this is going for sand blasting and the coating of some kind and here's the engine so that's the single overhead cam you can tell it only has single cams on each side now why it took this out well because it was it was leaking quite badly you can see all this oil you can actually see still a little droplet here it was so bad but it was actually leaking on the exhaust manifold you can see here and smoking very very badly this is probably from spillage over the years now this is not the original engine on this Subaru this thing has 170,000 miles on it this this engine supposedly has about 70 but judging you know once I took it out I could really take a closer look now a really close close look I have noticed that the head gasket needs to be replaced this is a coolant leak and this is an oil leak same situation on the other side and my dog anyways so yeah and we got a check engine light and for code P0028 which is this variable intake thing solenoid this guy here and now this one is for the passenger side you can see it's got four bolts easy to take out take it out you most likely well I don't know what I'm gonna do now about it well this one's good the code is for the driver side to get this one the timing needs to come off you can tell the the two 10 mil bolts are hiding behind the the back cover so all this needs to go I am gonna replace this sending unit oil pressure switch you can see a little bit of oil buildup I had one of these leak before like inside through so just they're cheap the main reason why this was this is out because of that oil leak and at first you could only kind of tell that it's leaking from the oil or the valve cover gasket but you know once it's out you can really look at it and find always find more issues you can see that I actually blocked a few holes like for this brake booster vacuum line for the intake manifold throttle body here for the power steering pump both in and out and what else oh yeah and the fuel lines evap and or return whatever this is and your feed most likely plugged up all these holes just to get it ready for cleaning before I take it apart you know I'd rather work on a clean engine than a dirty engine for obvious reasons all right guys check this out like new so heads need to come off got to drive them to the machine shop they're gonna deck them the black we're gonna check for if it's level with a straight edge so I may not need to I hope I want me to send the black out for decking so I hope I won't have to seriously man my dogs alright so I hope I won't have to send out the black for decking so I'm gonna take as little off as possible to get the heads out and I will have to completely strip the heads off of everything valves everything so as of now intake manifold this gets this EGR pipe all these everything that's on the head timing needs to come off harmonic balancer exhaust manifold power steering pump or maybe not actually is it no it's is it attached to the head let's see is it with the head where does it end and here no we're good okay so this guy can stay for now we'll see once all that's stripped before I take the heads off I'm gonna do a leak down test with this tool here this way once the timing is off all the valves will be closed I won't have to do top that center and whatnot it'll be just be easier with the leak down test I'm gonna know you know get info on if the valves are sealing properly or not and we'll go from there because I need to take them off anyway so if they're bad I'm gonna have to relapse most likely the exhaust valves that took about not too long so belt is off which means all the valves are closed I have the intake ports open and the exhaust so we take the exhaust manifold off ideally the oil pan should be off too but kind of lazy do their I'm probably gonna do it just to reseal it maybe not we'll see anyways I need air compressed air that is gonna start with numero uno and let the air come in there we go now you want to get it to 100 psi on the left gauge watching this gauge can you see this we are right on the edge of the green and the yellow which means well the least amount I call this 11% which is good but I do hear air escaping okay so it's not the air intake I do hear some noise from number one from now this intake here but not that much flip this over you hear that so with this means the exhaust valve is not sealing properly all the way which is it's normal the exhaust valve you know gets his ass kicked the most and I already seen it through here it is it's actually not that bad so labbing job shouldn't take long okay moving on to number three remember one two three four exactly the same a little bit here mostly the exhaust valve the compression test was very good actually was 170 something on cylinder number one and everything else was like 170 you know almost almost there 168 so very close to each other no worries there I'm not even worried about the pistons or the rings and I am gonna we're gonna take a closer look of the cylinder walls look if there's any scratches because the heads will be off obviously see if the cross hatch is still there and this thing needs to get under on the racetrack as soon as possible well that's a lot close this exhaust valve they're both open okay so this actually moved from the pressure from the other one and three tests so right now the pistons are about halfway ish or so so I'm gonna try and close these up okay now they're closed the intake ones are open call that a successful test not number four you can't do a proper leak down test I mean we could there's another way can we close all the intakes exhaust and intake at the same time all right time for the left head fixed all right taking the head off right so now you can't go and just take these bolts off any way you want you gotta do it in order so one two three four five six just a cross pattern all right all right so you can see can you see how it's all dark right over here all right but like expected these cross hatch come on now turn this with him by hand this cylinder well it's a little bit worn here and I have tiny tiny scratches but it actually looks pretty good I'm gonna get you in here are you gonna see this there we go so you can see the cross hatching and over here it's a little bit shiny all right there see that right in the middle of your screen it's a little bit shiny but I can still see the cross hatching there too and adjust a few vertical lines over here and one here that's it can't even feel these lines check this guy out kind of the same deal a little vertical single line here and kind of multiple together right over here but I can see a lot of the cross hatching this is good all right


Hi! Today I would like to explain how to find Deaf people using the Gallaudet University Library, the Deaf Biography Database. Scroll down to meet your librarian. Look for my name and click on View Info Guides. I will click on the Deaf Women Info Guide, but there are other info guides that have information about Deaf people that you can use. Notice the link in the first paragraph. It says Gallaudet University Library Guide. Click on there. You can browse this database. Well, you can browse the whole database by typing in your keywords. You can search by name, by country, by race, or by job field. Suppose I'm interested in Princess Andrew of Greece. She was a Deaf mother to Prince Philip in England. It gives you a summary about her life and resources that you can explore, like books or articles. You also can search by name. Suppose I'm interested in Levi. He was one of the first students at the American School for the Deaf and he published a newspaper. Here, you can see additional information about him. Now, I'm interested in looking for a person from either a different country or of a different race. This person was the first Native American to go to Gallaudet University and he became a chemist. Again, it's easy to find more information about him. You can also look up different fields and jobs. I'm curious about dancers. And here is a dancer that I want to research. She's from Ohio and she danced professionally with her husband. That sums up how to find information about Deaf people using the Gallaudet database. Once you get started, you'll find more information about that person and you'll have more specific information and important key words that you can use.


Hi, William. Hi, Fatima. What's up? I have something that I need your help with. I have this data set from all over the community with different posts. I'd love to get an overview of the sentiment associated with each post so I can better understand how the community is feeling. Got any ideas? Sure. Let me show you a project that I have been working on. And we can prototype a solution for your task. So this application uses a Hogan Face model integrated with a streamlit user interface. You can upload a CSV file containing text comments. What the application will do is to classify the sentiment associated with each one of the comments. I think we might be able to adapt this solution for your specific task. However, I currently have it running only on my local machine. And I will require your help to deploy it online. What do you think? This looks great. I can help build a delivery pipeline for deployment. OK. So I will push the prototype code to a GitLab project. And then we can work together on it. So it's done. You can take it from here. Great. Thank you. We have this open issue about automating our apps deployment. So I'll start there. I can create a merge request directly from the issue and then open the merge request in GitLab Web IDE. There I can add our initial GitLab CI YAML file. This file is just a baseline to get us started. I'll push this YAML file up from the Web IDE and we'll see what happens to the MR. Looks like the Docker build is failing. Could you check why? OK. Let me open the MR and check the build log. I see the error here, but I don't understand. By the way, Fatima, have you seen maybe we can give you a chance to this root cause analysis AI feature? Let's give it a try. This will help me to analyze the log and probably suggest a solution. What does it say? Oh, I see. Yeah. Copy-paste error. When I was creating the Docker file. Let me just copy this and I will add it to the MR and we can retry the build. I can do it from here. I will add this suggested fix to the Docker file. Yeah, here it is. See the error? OK. I will commit the changes unless test again the build. It should work this time. And here we go. The pipeline is running again and it works. Cool. Root cause analysis saved us some time. Oh, nice. I'm going to go back to RCI YAML and enable all of the CI jobs so we can have a full run through. Once that's committed, I'm going to switch over to the MR and wait for that build to pass. Yay, the build has passed. So now we can check out the review app that we've deployed. GitLab review apps allows us to test our application early in an environment that was created just for this MR. Hmm, William, can you take a look into this error? It looks like our app can't find the config file. Maybe you can add a function to load our config file correctly. Sure, let me do that. I also think this function is a perfect candidate for GitLab Duo code suggestions. I will just prompt the model with a comment and it should generate the Python function for us. Yeah, here it is. I think this looks great. I will accept the suggestion and commit the changes to the MR. OK, the pipeline is running again. And once it completes, we can proceed to test the application using review apps. So it has finished. And here, let me check it. You can see this is our review environment. Let me test it with this DOMI file that I have in my computer. And now it works. It's able to properly load the file, and now it's analyzing test. Cool. We saved time using code suggestions. It was very quick. OK, but Fatima, do you know what we are missing? I feel like we're missing a lot of things, but what's something that machine learning applications need? Machine learning applications can also benefit from security. Do you know how to add security scanners? Let's say SAST. Yes, I remember that SAST scanners are added via an include in a YAML file, but I don't remember the exact include. Why don't we ask DuoChat, our AI helper? DuoChat replies with an example and the include template. We can add that to our CI YAML and push up those changes to the MR. Normally, I could look up this information in documentation, but it's a lot faster than just SAST DuoChat, and you don't have to lose contacts by switching windows and clicking through links. What do you think, William? This is very helpful. With this, we make sure to reduce the likelihood of introducing security vulnerabilities. So I will give my approval, merge these changes, and this will trigger our pipeline to production. Let's check it out. Here is the production pipeline. It builds the application, tests for security vulnerabilities, and when ready, deploys the Kubernetes cluster. Now it's time for me to try this application with my own data set. I have this data set of comments from across the community from the past couple of weeks. It's a pretty small data set, but I'd love to see how the tool analyzes these comments. I'll upload my data set to the tool and wait for it to analyze. And it works. As you can see, it has categorized each comment that I provided as positive, neutral, or negative sentiment and has done so correctly. This is so great. William, now that this application works and is deployed, could you tell me a little bit about how it was put together? Sure. This prototype is simple and scalable. A frontend built with stringlet and an option to add CSV files. Here, the frontend consumes a model endpoint, sending the text comments written in natural language to a hogging phase pretrained model for sentiment analysis. Wow, thank you for explaining this. This application is really cool. Do you think other people might be interested in using it? Yeah, sure. Let's make this break available for anyone trying hogging phase on a stringlet with GitLab.


You need a financial advisor with the freedom to focus on your specific needs. Whatever your goals, Reid Potter can create a game plan tailored to you. Call Reid at 432-0777 at Pikeville, Kentucky to learn more. Country music artist and star of MTV's The Real World Los Angeles, John Brennan, who briefly called Pikeville home, visited mountaintop media to talk about his career, being back in Pikeville and his new music. I went to Pikeville High School for seventh and eighth grade back in 1986 and 87, moved across the state to Owensboro and that's where I feel like I'm from. From Owensboro, but I'm a Kentuckian so we're blue a lot. And I started singing country music in high school there in Owensboro and then I went to Nashville for college to Belmont University and that's when MTV cast me onto The Real World. I didn't apply to be on there. They said you want to be on this reality show. Of course I said what's a reality show? Brennan is open for country music stars including Alabama and George Jones but he says his music is heavily influenced by his time living in Kentucky. And though he only lived in Pikeville for a few years, he was happy to know that local radio stations played his music longer and louder than anyone. Pike County's rural and I kind of dug into my country roots while I lived here. And then when I moved from here, I was still in Kentucky. So, you know, Kentucky is a hard working blue collar, back breaking type place and so it's country. You can find John Brennan's music everywhere you listen to music. You can also visit his website at johnbrennan.com. For Mountain Top News, I'm Kelsey Dean.


Period drama was written by Dr. Sumerian, that's me. You can find it on the SCP Wiki in a link in the description below and it is under Creative Commons 3.0 share alike attribution license. SCP-6613 Object Class, Euclid Special Containment Procedures Information asserting that SCP-6613 is a mundane parody of traditional soap operas and telenovelas has been disseminated to the public. Traditional measures are unnecessary as SCP-6613 is not strong enough to be detected by most terrestrial receivers. Description SCP-6613 is an analog television signal in the 700 MHz range originating from a stationary source approximately 64 km above Wichita, Kansas. The content, a soap opera called Period Drama, is broadcast between 0200 and 0300 local time. The program, which is broadcast in English with poorly translated Spanish subtitles, follows the periados, a wealthy ranch-owning family. Several subplots involve the financial and romantic troubles of the working class individuals surrounding the central family. The individuals in the program itself are anthropoid iterations of punctuations. Their resemblance to humans varies between individuals though each has arms, legs, and a face regardless of the type of punctuation they represent. Importantly, only named characters appear as punctuations. The remainder of characters all appear as normal humans, though they treat the characters of the drama as though they were human as well. The program is generally structured with a cold open, then opening title screen followed by the remainder of the episode. Various commercials are presented throughout. All content broadcast alongside the program, as well as the program itself, are produced by Vikander Need Technical Media. The following is a typical example of the program's cold open. Maria Periados, a comma, is seen in a hospital bed. Jonathan Millen, a question mark, paces outside the room as a number of doctors attend to Mariah's needs. Mariah appears to be in pain and it is slowly revealed that she is in labor and will soon give birth. Jonathan is comforted by Ruiz Sanchez, a colon. The two appear startled as Maria cries out and Jonathan bursts into the hospital room. Doctor slowly turns to face the camera with a bundled child and speaks. It's... It's a semicolon. The camera pans over to Ruiz, who is standing at the door. There is a delay of 3.4 seconds as the sound of a crying child can be heard in the background and the camera slowly zooms in on Ruiz's face. Smash cut to black, the title card slowly fades in. Episode 96, The Pregnant Pause. Attempts to find the source of SCP-6613 broadcast have proved unsuccessful. Thank you very much for watching. I was going to do a bit more of an in-depth video today, but some stuff happened yesterday that took up a little bit of my energy and time, so we'll try and put that off until at least Tuesday, maybe Thursday. It's one of those things where it's like you want to make a really good video and so it takes a lot longer. But yeah, I thought I'd do a little reading of this SCP I wrote a couple of days ago. No, it's like four days ago I think now. It's doing pretty good. It's plus 77, but give it a look. If you like it, you know. Great. And if you didn't like it, I still got you. Anyway, I love writing fegoods for the SCP Wiki, and if you don't know what a fegood is, you can look them up, but they're essentially stories that are built to contextualize an ending pun, in this particular case, the pregnant pause, although the name of it is also period drama, which is its own pun title, but yeah, good times. Thank you very much for watching. If you enjoyed the video, hit the subscribe button and then hit the notification bell next to that so you're notified when I upload new videos. And then head on over to patreon.com forward slash de-samaritan and pledge at any level like everybody here on the screen already has, including Sinjeriki, who has pledged $100. It is nice to know that I'm not alone out here. And I will see you all again on Thursday. Nope, Tuesday. I got it wrong. It's Thursday now.


Managing the cost of cataract outlay. Welcome to this presentation on managing the cost of cataract outlay. By the end of it, you should be able to understand the concept of cost versus price and how this is applied to cataract outlay, describe fixed and variable costs in cataract surgery, understand the relationship between cataract cost and surgical output, and be familiar with the concepts of cost containment, cost recovery and income generation, as used in eye care. Cataract surgery is one of the most cost-effective medical interventions. It takes a short time to do and has a high impact on patients' quality of life. The key priorities are to increase the volume of surgery and to reach everyone who needs it. Outcome must be kept high to restore sight and retain patients' confidence. Services must be delivered at a low cost to ensure affordability and sustainability. To achieve all this, we need to understand the relationship between cost and price. Cost is the expense to the healthcare provider to do the surgery and price is what the consumer pays. Different relationships between cost and price have different impacts. If cost is greater than price, then the program is in trouble and will make a loss or have to be subsidized. If cost is equal to price, the program has a chance to carry on and break even. Over the long term though, it will be difficult to invest in and expand services and additional funds will need to be found. And the system will not be responsive to any shocks or difficulties, for example in natural disaster. If price is greater than cost, then there is a profit. There are varied margins of profit and this depends on the setting and on the wealth of the population. When we break down the cost of running an eye care program, we see that it is made up of fixed and variable components. Fixed costs include capital costs, the building, equipment, instruments, etc. and running costs. And this is the money spent on salaries, utilities like electricity and water supply, maintenance of the building, rental or lease costs, etc. Even if no surgery is done, fixed costs are the expenses that will have to be paid for. Variable cost is the money spent on the consumables used in cataract surgery, materials like sutures, IOLs, eye drops, viscoelastic and so on. For each surgery carried out, this is a cost that must be accounted for. If no surgery is done, then none of this will be purchased, so no cost. The cost per surgery can be calculated with a formula, the fixed cost divided by number of surgeries plus the cost of consumables for one surgery. So for example, dividing a fixed cost of $400,000 by a plan to do 500 surgeries gives us $800. Adding this to a cost of consumables for one surgery of $200 makes the cost of one surgery $1,000. This graph illustrates the relationship between productivity and cost of cataract surgery. The cost per cataract surgery is shown on the y-axis and the number of surgeries on the x-axis. Looking at the graph, we can see that when 50 surgeries are done, the cost per cataract is $400. But if we increase the number of surgeries to $200, this cost comes down drastically to $100. And when we do between $800 and $1,000 surgeries, the cost drops again, this time to less than $50 per cataract. This is because the fixed cost is spread across many more surgeries. And this helps to reduce the price of surgery for the patient and increases affordability. Managing outlay has three steps. In step one, the cost of surgery is brought down through cost containment activities. Steps two and three are cost recovery and income generation. These steps aim to reduce the fixed cost and this is passed on to the patient through a reduced price of surgery. Cost containment is achieved in two ways. Firstly, by increasing the number of cataract surgeries carried out. And secondly, by reducing the variable component of the cost of surgery by intelligent purchasing. This means negotiating bulk prices for consumables. Sourcing cheaper generic drugs and IOLs. Or even using effective low cost technologies. These are decisions that can be managed by lobbying with management. Buying intelligently means comparing prices and selecting the best options possible. In addition, using group purchasing to achieve better prices. Maintaining a good inventory of materials to reduce wastage. And storing materials appropriately to reduce damage will also all help to reduce costs. The International Agency for the Prevention of Blindness has a standard list and website with useful guidance for purchasing. Visit IAPB.standardlist.org. Cost recovery systems can be put in place to recoup fixed costs and reduce the cost that is passed on to patients in the price they have to pay for surgery. It is important that clinical standards are not compromised or outcomes affected by cost recovery. However, non-clinical facilities can be varied. For example, the type of room a patient pays for can help substize free patients. Healthy Prasad in India uses four types of rooms. If 5% of their patients are willing to pay $100 for VIP recovery rooms, which have en-suite and air conditioning, then the IUNIT will have some profit. If 10% use deluxe rooms, which is en-suite but has no air conditioning, then the IUNIT is still in profit. The economy room, which is private but without en-suite or air conditioning, requires 20% occupancy for the IUNIT to break even. With these rooms occupied, LV Prasad can ensure that 65% of its patients can be poor and get free services. This is called a tiered system for charging patients. It is explained to the patients during the early counselling stage, and patients can then have a choice in what they want. The success of a cost recovery system depends on a population's socioeconomic status, willingness and ability to pay. Income generation for the service can be achieved in several ways. By charging fees to the rich to substize the poor. From making money through a hospital can team for relatives and friends of patients. By selling eye drops and even spectacles in some cases. Many IUNITs in areas of poor socioeconomic status depend on direct government subsidy. For example, salaries are paid or the infrastructure is owned by the government. Local or international non-governmental organizations, NGOs, can sometimes be lobbied to pay for components of fixed or variable costs. Insurance schemes are another option which will sometimes pay for their client's surgeries. In conclusion, cost per cataract can be reduced by increasing productivity. Cost containment strategies include bulk purchasing and negotiating. Income generation supports subsidies for poor patients who are unable to pay. And cost recovery is possible through tiered fees for access to non-clinical facilities.


All right, so here we are, London Animal Rights March 2018. I don't know how many people are back there, but it looks double as big as last year. Absolutely massive people standing for animal liberation. Look how many. A sea of vegans. Now, we as a movement exist in the millions of individuals, but together we move as one. And as one, we cannot be stopped. We will not be stopped. And these industries, the ones who exploit others, they feel what we feel, and they fear it. And they fear us. And they should fear us. And they fear us because they know that we will not stop fighting, that we will never take a day's rest, and we will never take a day's break until the animals liberated from the shackles that our species has imprisoned them with it. How many more animals need to die? How many more days of torture inside a lab? How many more photos do you need to see? What is it that you need to get angry enough? We are here today for the cars taken away from their mothers. We are here today for the hens who are exploited for their eggs. We are here today for the chickens who are exploited and murdered for their flesh. We are here today for the pigs who are locked in farrowing crates. We are here today for the lambs on the way to the slaughterhouse. And we are here today for the millions upon trillions of animals who are mercilessly dragged out of the ocean, the marine animals who are killed by any dignity or respect. Today, for all the animals tortured in laboratories, for all the animals abused and tormented in zoos and circuses and aquariums, we are here today for all the animals who are plucked and sheared and skinned and murdered for their flesh, their feathers, their fur and their wool. We are here today for every single animal who is commodified, mutilated, exploited, used and murdered at the hands of our species. When every kid is at the beach! Thank you. Hi, man. So big fans of you. Oh, thanks. One month begins. Wow. And my parents and my brother is also bigger because of what you do and what you do. Amazing. That's really good. I have no clue what's going on. So what you do is... That's so good. Wow. Now you are doing it too. Was that it to do? Wait, wait, wait. You went vegan from the RTV? Did Piers Morgan or the other one? The original one. This morning show? Yeah, that's right. I was the first one and I just looked into a stuff and then it was obvious that I had to be vegan. They did my work for me by putting me on that show. And they were trying to turn us against veganism. It didn't work. The truth is more powerful than their lies. That's right.  You can look at my past and see that I used to be an asshole or you can look at what I'm saying and see that it's the truth. Exactly. That's a good work, man. I love the t-shirt. Keep it up, my brother. Where's Piers Morgan? Where's Piers Morgan? Where's Piers Morgan? Where's Piers Morgan? Where's Piers Morgan? Where's Piers Morgan?  Let's see how long you've been an activist for. I'm really proud of you. Thank you for doing what you do for the animals. So do you, I'm sure. Thanks for marching. Of course, of course. Thank you for everything you do. Thank you. Thank you so much. There's a little activist there. Oh my God. You're sleeping. There's too much for him today. This is loads of your videos. It's definitely influenced here. We've never met before, but I'm a big fan. I really wanted a hug.  And all we have to do is reach out and take it. It's not going to be given to us. No one is going to hand it to us, but there it exists in front of each and every one of us, waiting for us to seize it. So feel it. Believe in it. See it. Manifest it. But importantly, create it. Make it. Take it. The world that we want, we decide when it is created. And every time that we rise up and we stand up and we speak together and we fight for what must be fought, we bring that world closer and closer to the present day. So for the next minute, I would like complete silence, please, as we remember why we're here, the beams that we've marched for, the reasons why we have to take to the streets. The animals, it never ends. Every passing moment is this living on relenting hell for them. Because there is no excuse for their suffering. We must not turn away from our eyes what they are forced to endure with their body. As blood is pumped through my veins, an oxygen flows through my lungs. With every second of life that I am given, I will fight. Because my life is a privilege. And with that privilege that I have been given, I am obliged to fight for those freedom has been denied to. I made a vow of every second of life that I am given, I will fight for those who need me to fight for the most. Will you stand up? Will you speak up? We defiantly walk towards the road of animal liberation. Because when we do so, when we fight in unison and as one, we can change the world. And we must change the world. The animals need us. They need you. So what will you do from tomorrow onwards? The path that we walk down together does not last forever. And at the end of that path is total salvation and liberation. So never look back. Only ever look forward. And defiantly march as fast as you can towards the end of that road to ensure those animals who are screaming in terror in this very second. To ensure that one day, their screams will be silenced, not because of knives, but because of liberation. And so I ask you this one final question. Are you with me? A vegan world is coming. So bring it on. And who's Joey named after? Yeah. Joey's named after... Oh my God. What are you doing? Your name came from me. He doesn't care as much as I do.


Mayakori was born on the 7th of November in Warsaw, Congress Poland and Russian Empire. She was the youngest of five children born to a well-respected couple who worked as teachers in reputable institutions. At age 10, Mari was sent to a boarding school where she attended the gymnasium for girls and graduated years later with a gold medal. After completing high school, Mari and her three sisters couldn't further their education due to some financial difficulties that the family faced at that point in time. Women weren't allowed to enroll at local university and Mari's parents were not financially stable enough to send their daughters abroad. Mari and one of her sisters desperately desired to attend college so they both decided to map out the plan in order to achieve the objective of going to the university. Some months later, Mari hatched the plan. She worked as a governess and supported her sister's studies in medical school. For years, she had to endure a very uncomfortable lifestyle until her sister completed her schooling. After graduating, Mari's sister got established and returned to favor. Mari packed her bag and headed to the University of Paris where she was greatly inspired by a renowned French physicist who discovered that uranium emitted some unusual rays that no one had ever noticed. Intrigued by this, Mari began studying uranium and the mysterious rays it produced. While conducting this research, her normal studies were affected, making her lag behind her parents in school. However, curiosity couldn't let her abandon the research. Later on, Mari met and fell in love with an accomplished physicist whom she married shortly after. Her husband, who was well-experienced in the field, left his personal project and joined her in the research. The couple examined some minerals that contained uranium and realized that the uranium-contained minerals were about 4 times more radioactive than the pure and normal uranium. Eventually, their research led them to discover a completely different element, which they called polonium. Their new discovery was announced and published in July, 1898, 5 years later, Mari and her husband won the Nobel Prize in Physics, making her the very first woman to win a Nobel Prize. In 1906, Mari's husband died immediately after accepting a professorship at the University of Bari. This was a tragedy that struck unexpectedly. Devastated by her husband's death, Mari spent several months in mourning, however, she recovered and continued working on other projects. In 1911, she won another Nobel Prize for the remarkable work she did in chemistry. She was later given a professorship at the University of Bari, which made her the first female professor in the school. Today, history regards this woman as a game-changer who had ground-breaking achievements in physics and chemistry. In a bid to achieve an objective, it's very important that you come up with a plan. Mapping out the plan helps you to stay on track, maintain focus, and finally succeed at what you intend to do. Hans Glein said, The sooner you start planning your life, the sooner you will leave the life you dream of. Making an accomplished life of greatness definitely requires a plan. Long before you can have such a desired life, it's a wise decision to start making plans in ensuring a comfortable future for yourself. Bran Tracy said, A clear vision backed by a definite plan gives you a tremendous feeling of confidence and personal power. When you have a vision, you need to hatch a plan by which that vision would be achieved.  Winston Churchill said, Let our advance worrying become advanced thinking and planning, instead of getting worried over a difficult situation that presents itself before you. Think and devise a plan to save yourself from that trouble. Worrying solves nothing, so you should not resort to it. Rather, ponder on a possible plan to solve the problems that get you worried. When Mari and her family were confronted with financial difficulties which prevented her from attending college, she had to map out a plan that saved her future. Sitting down to plan can save your future. Don't sit and watch. Start planning today.


MIRACLE As to me, I know nothing else but miracles. Whether I walk on the streets of Manhattan, or dart my sight over the roofs of houses towards the sky, or wade with naked feet along the beach just on the edge of the water, or stand under trees and the woods, or talk by day with anyone I love, or sleep in a bed at night with anyone I love, or sit at a table at dinner with the rest, or look at strangers opposite me riding in the car, or watch honeybees buzzing around a hive of a summer forenoon, or animals feeding in the fields, or birds, or the wonderfulness of insects in the air, or the wonderfulness of the sundown, or of stars shining so quiet and bright, or the exquisite delicate tin cove of the new moon in spring. These, with the rest, one in all, are to me miracles, the whole referring, each yet distinct and in its place. To me, every hour of the light and dark is miracle, every cubic inch of space is a miracle, every yard of the cyphus of the oath is spread with the same, every foot of the interior swarms with the same. To me, the sea is a continual miracle, the fishes that swim, the rocks, the motion of the waves, the ships with the men in them. What strange your miracles are there! And the poem, this recording, is in the public domain. Miracles by Walt Whitman, read for LibriVox.org by Amalor Mierniks. Why, who makes much of a miracle? As to me, I know of nothing else but miracles. Whether I walk down the streets of Manhattan, or dart my sight over the roughs of houses towards the sky, or wade with naked feet along the beach just in the edge of the water, or stand under trees in the woods, or talk by day with any one I love, or sleep in the bed at night with any one I love, or sit at table at dinner with the rest, or look at strangers opposite me riding in the car, or watch honeybees busy around the hive of a summer forenoon, or animals feeding in the fields, or birds, or the wonderfulness of insects in the air, or the wonderfulness of the sun down, or of stars shining so quiet and bright, of the exquisite, delicate, thin curve of the new moon in spring. These with the rest, one and all, are to me miracles, the whole referring yet each distinct and in its place. To me every hour of the light and dark is a miracle. Every cubic inch of space is a miracle. Every square yard of the surface of the earth is spread with the same. Every foot of the interior swarms with the same. To me the sea is a continual miracle. The fishes that swim, the rocks, the motion of the waves, the ships with the men in them. What stranger miracles are there? This recording is in the public domain. Miracles by Walt Whitman. Read for LibriVox.org by Ankela. Miracles by Walt Whitman. Why, who makes much of a miracle? As to me I know nothing else but miracles, whether I walk the streets of Manhattan or dart my sight over the roofs of houses toward the sky, or wade with naked feet along the beach just in the edge of the water, or stand under trees in the woods, or talk by day with anyone I love, or sleep in the bed at night with anyone I love, or sit at table at dinner with the rest, or look at strangers opposite me riding in the car, or watch honeybees busy around the hive of a summer forenoon, or animals feeding in the fields, or birds, or the wonderfulness of insects in the air, or the wonderfulness of the sundown, or of stars shining so quiet and bright, or the exquisite delicate thin curve of the new moon in spring. These, with the rest, one and all, are to me miracles. The whole referring, yet each distinct and in its place. To me every hour of the light and dark is a miracle. Every cubic inch of space is a miracle. Every square yard on the surface of the earth is spread with the same. Every foot of the interior swarms with the same. To me the sea is a continual miracle. The fishes that swim, the rocks, the motion of the waves, the ships with the men in them. What stranger miracles are there? As to me, I know of nothing else but miracles. Whether I walk the streets of Manhattan, or dart my sight over the roofs of houses toward the sky, or wade with naked feet along the beach just in the edge of the water, or stand under trees in the woods, or talk by day with anyone I love, or sleep in the bed at night with anyone I love, or sit at table at dinner with the rest, or look at strangers opposite me riding in the car, or watch honeybees busy around the hive of a summer forenoon, or animals feeding in the fields, or birds, or the wonderfulness of insects in the air, or the wonderfulness of the sundown, or of stars shining so quiet and bright, or the exquisite, delicate, thin curve of the new moon in spring. These with the rest, one and all, are to me miracles, the whole referring, yet each distinct and in its place. To me every hour of the light and dark is a miracle. Every cubic inch of space is a miracle. Every square yard of the surface of the earth is spread with the same. Every foot of the interior swarms with the same. To me the sea is a continual miracle. The fishes that swim, the rocks, the motion of the waves, the ships with the men in them. What stranger miracles are there? End of poem. This recording is in the public domain. Why, who makes much of a miracle? As to me I know of nothing else but miracles, whether I walk the streets of Manhattan, or dart my sight over the roofs of houses towards the sky, or wade with naked feet along the beach just in the edge of the water, or stand under trees in the woods, or talk by day with any one I love, or sleep in the bed at night with any one I love, or sit at table at dinner with the rest, or look at strangers opposite me riding in the car, or watch honeybees busy around the hive of a summer forenoon, or animals feeding in the fields, or birds or the wonderfulness of insects in the air, or the wonderfulness of the sundown, or of stars shining so quiet and bright, or the exquisite delicate thin curve of the new moon in spring. These with the rest, one and all, are to me miracles, the whole referring, yet each distinct and in its place. To me every hour of the light and dark is a miracle, every cubic inch of space is a miracle, every square yard of the surface of the earth is spread with the same, every foot of the interior swarms with the same. To me the sea is a continual miracle, the fishes that swim, the rocks, the motion of the waves, the ships with the men in them, what stranger miracles are there? End of poem. This recording is in the public domain. Miracles by Walt Whitman. Read for LibriVox.org by Diane Wood. Why, who makes much of a miracle? As to me I know of nothing else but miracles, whether I walk the streets of Manhattan, or dart my sight over the roofs of houses toward the sky, or wade with naked feet along the beach just in the edge of the water, or stand under trees in the woods, or talk by day with anyone I love, or sleep in the bed at night with anyone I love, or sit at table at dinner with the rest, or look at strangers opposite me riding in the car, or watch honeybees busy around the hive of a summer for noon, or animals feeding in the fields, or birds, or the wonderfulness of insects in the air, or the wonderfulness of the sundown, or of stars shining so quiet and bright, or the exquisite delicate thin curve of the new moon in spring. These with the rest, one and all, are to me miracles. The whole referring, yet each distinct and in its place. To me every hour of the light and dark is a miracle. Every cubic inch of space is a miracle. Every square yard of the surface of the earth is spread with the same. Every foot of the interior swarms with the same. To me the sea is a continual miracle. The fishes that swim, the rocks, the motion of the waves, the ships with the men in them, what stranger miracles are there? Or wade with naked feet along the beach just in the edge of the water, or stand under trees in the woods, or talk by day with anyone I love, or sleep in the bed at night with anyone I love, or sit at table at dinner with the rest, or look at strangers opposite me riding in the car, or watch honeybees busy around the hive of a summer for noon, or animals feeding in the fields, or birds, or the wonderfulness of insects in the air, or the wonderfulness of the sundown, or of stars shining so quiet and bright, or the exquisite, delicate, thin curve of the new moon and spring. These with the rest, one and all, are to me miracles. The whole referring, yet each distinct and in its place. To me every hour of the light and dark is a miracle. Every cubic inch of space is a miracle. Every square yard of the surface of the earth is spread with the same. Every foot of the interior swarms with the same. To me the sea is a continual miracle. The fishes that swim, the rocks, the motion of the waves, the ships with the men in them. What stranger miracles are there? End of poem. This recording is in the public domain. Why, who makes much of a miracle? As to me I know of nothing else but miracles. Whether I walk the streets of Manhattan, or dart my sight over the roofs of houses toward the sky, or wade with naked feet along the beach just in the edge of the water, or stand under trees in the woods, or talk by day with anyone I love, or sleep in the bed at night with anyone I love, or sit at table at dinner with the rest, or look at strangers opposite me riding in the car, or watch honeybees busy around the hive of a summer forenoon, or animals feeding in the fields, or birds, or the wonderfulness of insects in the air, or the wonderfulness of the sundown, or of stars shining so quiet and bright, or the exquisite delicate thin curve of the new moon in spring. These with the rest, one and all, are to me miracles, the whole referring, yet each distinct and in its place. To me every hour of the light and dark is a miracle, every cubic inch of space is a miracle, every square yard of the surface of the earth is spread with the same, every foot of the interior swarms with the same. To me the sea is a continual miracle, the fishes that swim, the rocks, the motion of the waves, the ships with the men in them. What stranger miracles are there? End of poem. This recording is in the public domain. Miracles by Walt Whitman. Read for LibriVox.org by Karen Savage. Why, who makes much of a miracle? As to me I know of nothing else but miracles, whether I walk the streets of Manhattan, or dart my sight over the roofs of houses toward the sky, or wade with naked feet along the beach just in the edge of the water, or stand under trees in the woods, or talk by day with any one I love, or sleep in the bed at night with any one I love, or sit at table at dinner with the rest, or look at strangers opposite me riding in the car, or watch honeybees busy around the hive of a summer forenoon, or animals feeding in the fields, or birds, or the wonderfulness of insects in the air, or the wonderfulness of the sundown, or of stars shining so quiet and bright, or the exquisite delicate thin curve of the new moon in spring. These with the rest, one and all, are to me miracles, the whole referring, yet each distinct and in its place. To me every hour of the light and dark is a miracle. Every cubic inch of space is a miracle. Every square yard of the surface of the earth is spread with the same. Every foot of the interior swarms with the same. To me the sea is a continual miracle. The fishes that swim, the rocks, the motion of the waves, the ships with the men in them. What stranger miracles are there? Why, who makes much of a miracle? As to me I know of nothing else but miracles. Whether I walk the streets of Manhattan, or dart my sight over the roost of houses toward the sky, or wade with naked feet along the beach just in the edge of the water, or stand under trees in the woods, or talk by day with anyone I love, or sleep in the bed at night with anyone I love, or sit at table at dinner with the rest, or look at strangers opposite me riding in the car, or watch honeybees busy around the hive over summer for noon, or animals feeding in the fields, or birds of the wonderfulness of insects in the air, or the wonderfulness at the sundown, or of stars shining so quiet and bright, or the exquisite delicate thin curve of the new moon in spring. These with the rest, one and all, are to me miracles. The whole referring, yet each distinct and in its place. To me every hour of the light and dark is a miracle. Every cubic inch of space is a miracle. Every square yard at the surface of the earth is spread with the same. Every foot of the interior spawns with the same. To me the sea is a continual miracle. The fishes that swim, the rocks, the motion of the waves, the ships with the men in them. What strange miracles are there? End of poem. This recording is in the public domain. Once upon a time, there was a star shining so quiet and bright, or the exquisite, delicate, thin curve of a new moon in spring. These with the rest, one and all, are to me miracles. The whole referring, yet each distinct and in its place. To me every hour of the light and dark is a miracle. Every cubic inch of space is a miracle. Every square yard of the of the earth is spread with the same, every foot of the interior swarms with the same. To me the sea is a continual miracle, the fishes that swim, the rocks, the motion of the waves, the ships with the men in them. What stranger miracles are there? End of Miracles This recording is in the public domain. Miracles by Walt Whitman Read for LibriVox.org by Mark Wilson Why who makes much of a miracle? As to me I know of nothing else but miracles. Whether I walk the streets of Manhattan or dart my sight over the roofs of houses toward the sky or wade with naked feet along the beach just in the edge of the water or stand under trees in the woods or talk by day with anyone I love or sleep in the bed at night with anyone I love or sit at the table at dinner with the rest or look at strangers opposite me riding in the car or watch honeybees busy around the hive of a summer forenoon or animals feeding in the fields or birds or the wonderfulness of insects in the air or the wonderfulness of the sundown or of stars shining so quiet and bright or the exquisite delicate thin curve of the new moon in spring These with the rest one and all are to me miracles the whole referring yet each distinct in its place To me every hour of the light and dark is a miracle every cubic inch of space is a miracle every square yard of the surface of the earth is spread with the same every foot of the interior swarms with the same To me the sea is a continual miracle the fishes that swim the rocks the motion of the waves the ships with the men in them what stranger miracles are there end of poem this recording is in the public domain Miracles by Walt Whitman read for LibriVox.org by Sean McGahey ducktapeguy.net Why who makes much of a miracle? As to me I know of nothing else but miracles whether I walk the streets of Manhattan or dart my sight over the roofs of houses towards the sky or wade with naked feet along the beach just in the edge of the water or stand under trees in the woods or talk by day with anyone I love or sleep in the bed at night with anyone I love or sit at a table at dinner with the rest or look at strangers opposite me riding in the car or watch honeybees busy around the hive of a summer forenoon or animals feeding in the fields or birds or the wonderfulness of insects in the air or the wonderfulness of the sundown or of stars shining so quiet and bright or the exquisite delicate thin curve of the new moon in spring these with the rest one and all are to me miracles the whole referring yet each distinct and in its place to me every hour of the light and dark is a miracle every cubic inch of space is a miracle every square yard of the surface of the earth is spread with the same every foot of the interior swarms with the same to me the sea is a continual miracle the fishes that swim the rocks the motion of the waves the ships with the men in them what stranger miracles are there end of poem this recording is in the public domain miracles by walt whitman read for leper vox dot org by teresia sepashie player who makes much of a miracle as to me i know of nothing else but miracles whether i walk the streets of manhattan or dart my sight over the roofs of houses towards the sky or wade with naked feet along the beach just in the edge of the water or stand under trees in the woods or talk by day with anyone i love or sleep in the bed at night with anyone i love or sit at table at dinner with the rest or look at strangers opposite me riding in the car or watch honeybees busy around the hive of a summer for noon or animals feeding in the fields or birds or the wonderfulness of insects in the air or the wonderfulness of the sundown or of stars shining so quiet and bright or the exquisite delicate thin curve of the new moon in spring these were the rest one and all are to me miracles the whole referring yet each distinct and in its place to me every hour of the light and dark is a miracle every cubic inch of space is a miracle every square yard of the surface of the earth is spread with the same every foot of the interior swarms with the same to me the sea is a continual miracle the fishes that swim the rocks the motion of the waves the ships with the men in them what stranger miracles are there this recording is in the public domain miracles by walt wetman redfieldrocks.org why who makes much of miracles as to me i know of nothing else but miracles whether i walk the streets of manhattan or dart my sight over the rows of houses toward the sky or wade with naked feet along the beach just in the edge of the water or stand under trees in the wood or talk by day with anyone i love or sleep in the bed at night with anyone i love or sit at table at dinner with the rest or look at strangers opposite me riding in the car or watch honeybees busy around the hive of a summer for noon or animals feeding in the fields or birds or the wonderfulness of insects in the air or the wonderfulness of the sundown or of stars shining so quiet and bright when the exquisite delicate thin curve of the new moon in spring these with the rest one and all are to me miracles the whole referring yet each distinct in its place to me every hour of the light and dark is a miracle every cubic inch of space is a miracle every square yard of the surface of the earth is spread with the same every foot of the interior swarms with the same to me the sea is a continual miracle the fishes that swim the rocks the motion of the waves the ships with the men in them what stranger miracles are there


Convention attendees reported that their cards were used to purchase clothes and even one unknown bold purchase of $100,000. However, this brings up a larger issue of day-to-day credit card security. Investigators discovered that the breaches did not occur inside the convention center, but rather from local businesses. Some Boston residents say that they use their credit cards freely when purchasing items, and they do not think about identity theft. You don't really think it's going to happen to you, seriously?  So it's, you really get a false sense of security, and I don't really think you think about it until it happens to you. Hunrod is visiting from Iceland, but she says she is very cautious when purchasing with her credit card after money was stolen from her husband's credit card recently. Yeah, I felt safe, but now, recently, for example, money was stolen from my husband's credit card, then you realize perhaps this is not as secure as you thought. So nowadays, I think I'm more aware about the security issues. Others say that people have become so accustomed to using their credit cards that they forget about protecting themselves from theft. Oh, it's terrible. It's awful. It's our money, and, you know, it's something that needs to be very enclosed, and no one should be able to get to the information. Obviously, I think most people would think the same, right? I contacted the Massachusetts Convention Center Authority, and we are still waiting for comment.