I just need you to sign this right here, okay? And this will help so I can take care of things for us. What is it? It's just a document that lets me take care of bills for you, you know, so that you don't have to be involved in everything all the time here. Just take the pen, will you mom? I can't read it. We don't need to. You don't need to. I'm telling you what it is. Elder financial abuse has become the crime of the 21st century. Elders are afraid and they do not report. There are a lot of people that don't believe that elder abuse exists. It was a crime of opportunity. Maybe they got power of attorney for legitimate reasons but then they realized that it sort of gave them carte blanche to go and do whatever they wanted with the person's assets. I just need you to sign this right here, okay? People are afraid of withdrawal of care. They're afraid of premature institutionalization due to financial destitution. It's a very serious crime and we must pay attention. Daddy used to do this. Daddy used to do this. You know but I'm doing it now because daddy's not doing it right now, okay? So I'm sort of taking daddy's place so you just take the pen and you sign it and everything will be good. Let daddy do it. Daddy can't do it. Daddy's going on a trip, remember? When there's financial abuse occurring it always involves emotional abuse and most often involves physical abuse. Come on, just sign the paper. Right there. That's it. Come on. Good. Go on. The last name too. Put your last name too. Come on. Cunningham. There are a lot of instances where a victim will have signed the grant deeds. They'll have signed the checks. They'll have signed all the real estate documents to transfer a title of their property but if they didn't understand what they were signing it's no less a crime. Mom, you're not making marks. Mom, you've got to make marks on the paper. Make the marks. You could do it. Come on. Cunningham. Cunningham. Come on. Let's do it together. Write your name on the paper. Mom, please just write your name on the paper. Come on. Come on. Don't. Come on. Mom, now you're just doing this. Mom, you have to sign the paper. Mom, you've got to sign the damn paper. Would you sign the damn paper?  Mom. Come on. Come on. You'd do it if daddy asked you to. Just do it for me. Would you just sign the paper? Just so I can get things fixed up for us so we're okay? Come on, Mom. Sign it. Sign the tragedy it is to reach one's golden years and be a ripped off victim. All right, Mom. All right. All right. I'll tell you. That's real good, Mom. Give me the pen. Good. That's real good. I'll tell you what. I'll tell you what. You can wear your wedding ring tonight. I'll get it out for you. You can wear it tonight. Okay? Okay? That'd be nice, huh? Wouldn't that be nice? Thanks, Mom. Thanks, Mom. People see it in financial institutions every day where somebody may bring an elderly person to the bank and withdraw large sums of money. You may see it at the recorder's office where a person is adding a name to a deed or taking a refinance on someone's home. I think people see it. They just don't realize what is actually behind that. It's there. I think it's there every day. That's great. Okay. What, honey? What? Oh, there. Yeah. All right. All right. Yeah. Okay, Mom. Okay. Mom. Mom, it's okay. Oh, Mom. Come on. Stop it. Oh, Mom. Come on. It's all right. Just, Mom. Okay. Mom. Come on. I can't do this. Mom, I don't like this. Come on, Mom. Mom, it's all right. Okay? Come on. Just read your magazine. It happens to all socioeconomic groups and it happens to all cultures. Prevention is the key. And the second thing is the rapid response is absolutely the way to go. If we don't respond immediately and stop that looming predator, then the assets are gone. We have either recovered or prevented the loss of $71.8 million of our elders' assets. That's about saving money, but more than money, we save lives. Mortality rates for victims of financial abuse are three times higher than non-victims studies reveal. While the nation's violent crime rate decreases, financial crimes against the elderly are increasing due to the aging of the population and greater concentration of wealth among older people. California's Santa Clara County, like the rest of the country, is experiencing exponential growth of its senior populace. Financial abuse of the elderly has also been dramatically rising. Since persons over 50 control at least 70% of the nation's household net worth, they are frequent targets for exploiters, especially if they are homebound and disabled in some way. These critical factors were all influential to the development of Santa Clara County's Social Services Agency, Department of Aging and Adult Services, Financial Abuse Specialist Team, FAST. In developing a model to address the complex problem of financial abuse, it became clear that rapid response would be essential to stop the loss of the elder's estate and begin recovering those assets that may have already been lost. Hi Mrs. Cunningham, my name's Valerie. I'm a social worker with Santa Clara County. How are you? I'm fine. Good. This is my co-worker, Herlinda. Hi Mrs. Cunningham, my name is Herlinda Acevedo. Nice to meet you. I'm with Santa Clara County Public Guardians Office. How are you today? How do you do? And this is Greg, my other co-worker. Good morning Mrs. Cunningham. Greg Razier, I'm with the Public Guardians Office also. Nice to meet you. And here's my business card. We were wondering if we could speak to you for a few minutes inside. As a result, the Department of Aging and Adult Services created a multi-disciplinary rapid response team made up of professional staff from various departments within the county system. This includes Adult Protective Services, County Council, Public Guardian and the District Attorney. The team assesses reports of financial abuse received by Adult Protective Services including response to imminent danger and life-threatening situations 24 hours a day. Sources of reports include law enforcement, healthcare professionals, family members and financial institutions. The initial response is a coordinated effort and usually occurs within hours. Your report too fast starts in Adult Protective Services. Oh, he's having problems with his husband. Sounds like this might be a case that we can investigate, financial abuse. Can you give us a quick summary of your report? We've got several people that are dedicated to just taking reports. It then goes to the emergency response fast supervisor who does a risk assessment to decide whether it's something that looks like it needs to be taken care of immediately. We call those super fast if we need to convene the team immediately or if it's less risk game can wait until, for instance, our next meeting and he immediately faxes it over to the Public Guardian's office and also to the District Attorney's office and County Council. So basically all the partners that are part of fast get alerted at the same time that something's going on. And if the case is super fast then we start getting on the phones right away and try and set up the different players in the team and who's going to go out immediately. Ben? Ben? Don't quiet down.  Just give me about ten minutes without Ben, Ben, Ben, Ben. Will you? Just be quiet. Hey, Mom, I'll tell you what. I'll tell you what, you know the house is mine now. You know? And the money's mine now and there's nothing anybody needs from you anymore. You might just as well go ahead and die. What I'm looking for is the perceived degree of severity or risk to the client in the reported information. We may have more or less information at the time the report comes in depending on what the reporting party knows and we have to make some judgments based on that information. So if we have information that indicates that the person may have limited ability to advocate for themselves or manage their own affairs, that's certainly a risk factor. If there's a recent loss of a spouse that had perhaps managed the affairs, that's a risk factor. All those things come into play and help us determine what kind of response we should make to that particular report. Okay, alright. Okay, a little bit there. Good. Alright, alright, got some money. Now we can go. Thanks, Mom. One of the things that people don't realize about financial abuses is that it's usually perpetrated by family members or relatives. A typical scenario might be a situation where you've got an elderly woman who is supporting her 35 to 45-year-old son who hasn't had a job for an awful long time, probably a substance abuser. Any time you get into a dependent class of victim, there is going to be less reporting and the reasons are obvious. They're so afraid that what little support they have is going to go away. They're so afraid of becoming homeless that they'll put up with a lot. So the problem is great and that's why the public at large needs to be more aware of the problems that elders face and ensure their safety. The biggest fear is that if your adult child who's abusing you goes to jail, then you're going to end up in a nursing home and so frequently we'll get elders that will say that their adult child is not abusing them and we go ahead and proceed through other types of evidence and corroborative statements. But there is shame. Elders don't imagine that they raise their children to do this to them. For the physical abuse cases and the financial abuse cases, there is often recanting. It's like, well, I've called the police. He said he won't do it anymore. He said he's going to get a job and repay me. I might have fallen down after all. I'm really not sure now what happened is something that we hear and it is absolutely heartbreaking because it's so reminiscent of what the domestic violence victim does and it's the same situation. Their abuser has power and control over them and so they keep that power and control through a criminal prosecution. And I have to be very quiet. They're very noisy but I have to be very quiet. I can see that that's making you real upset. I don't want them in the garage. You don't want them in the garage. The red flags, you look at somebody who, they should have money and now they're not able to pay their bills. A big red flag is somebody who is confused about their financial affairs because if somebody is confused about their financial affairs, if they have not been victimized yet, they probably will be because somebody around them is going to catch on, that they're confused about their financial affairs and seek to capitalize on that. An elder person with a shiny new car in the driveway when the elder is not driving anymore, credit cards that are maxed out because in this day and age our senior citizens don't tend to use credit cards very extravagantly. A bank account that decreases very rapidly refinance on a home because think about it, a 30-year mortgage taken out by an elder, you've got to look at how they're going to pay it back if their income at that point is social security. Is this a mortgage that they're going to be able to pay back? And what are their monetary needs? Other types of cases we see are ones that are referred to as transient criminal activity. Those are the cases where you've got whole organizations that prey on elders. People stop by an elder's home and, you know, they know which elders are home during the day. They've studied the neighborhood. They'll stop by and say, well, I'm in the neighborhood trimming trees for your neighbor around the corner and I've got some extra time. I'm in the neighborhood trimming trees or we're in the neighborhood and we're paving driveways and we've got some extra materials. Can I pay your driveway? And either they charge exorbitant prices for this kind of thing that the elder can no longer do for themselves or arrange for themselves or they don't deliver the work. Other types of cases we see typically they'll call an elder at home and say, you've just won a million dollars with the Canadian lottery but you need to pay the taxes first. So I need you to wire the taxes to and then give an address. By the time we can actually locate them or the Royal Canadian Mounted Police can locate them, they've moved. A lot of cases we get that involve mortgage fraud. The loans are huge. And when you look at the loans compared to the elder's income, that should be a red flag. How is this ever going to happen? And in truth, what happens is those mortgages go into default. The crook doesn't care because they've taken the loan proceeds and it's the victim that's left holding the foreclosure notice. One of the things I would recommend that every fast team take a look at is not having some sort of dollar amount on a particular case. For us, we've always taken the position that a person who is built out of their SSI check, that's all the money they have in the world. And that's just as important to them for taking care of their needs as a person who has a $10 million estate. And so we approach all these cases the same way and consider them all with the same importance. I wondered if I could ask you some silly questions about your memory. Yes. Would that be okay? Sometimes I forget. That's okay. But I'm good at poetry. Okay. Well, you're going to feel like you're in school again. All right. And how about today's date? It's in the paper. Oh, okay. Is that how you keep track? Yes. Oh, okay. And tell me what season it is outside. It's winter. All right. And what's the day of the week today? It's Wednesday. All right. See, you're doing great. And how about the month? It's February, January. February. One of the tools we do use routinely in helping us understand risk and what a person might need from us is the Full Steam Mini-Middle Status Exam. And while it's not a perfect tool and it doesn't answer all the questions about person's capacity or abilities, it is a guideline. And it helps us have at least some objective findings early on in our casework about where we may need to be heading or what additional information we may need to get. The probate courts almost always require a medical finding of incapacity in order to establish conservatorship. But I had one victim and she said to me, well, I don't care what happens in this case because what matters to me is that you cared. And so it's comments like that that really pump you up and make you realize that what you're doing does affect people and is important. The APS social worker is the person who's dealing with the alleged victim, helping to care for that person, already setting up services, grocery shopping, ordering medications, sitting with that person and talking with them about what's gone on and how can we help you to remove the immediate risk at hand. It's a complete picture and then also we can address the victim's needs very comprehensively because while we're off going and trying to get the bad guy and hold the bad guy accountable and put together our criminal case, Adult Protective Services is working to make sure that the victim has someone to take care of him or her, is taken to the doctor, someone's buying groceries and they take care of the finances so they make sure that the bills are being paid and those are all things that really we can't do. And if we were to just go in and especially in a lot of our cases the suspect is somebody that was previously performing those functions for the victim. So if we go in and we just focus solely on the criminal case, we may have left the victim in a worse case from a human standpoint than they were before. So we need to address their needs comprehensively and the way we can do that is with the work of all the agencies together. Deputy Public Guardian is a court appointed conservator for individuals that are unable to take care of themselves. They have problems with making medical decisions, housing decisions, financial decisions. Frequently are very much exposed to potential abuse, physical and financial. Deputy Public Guardian investigators are in the home looking for assets. What is the situation? How bad is it? How do we assess what's happened in terms of preventing financial destitution? Once a case is referred to the public guardian and it's appropriate, and that's a key word, appropriate for conservatorship, then it moves us into a whole different arena. We are responsible for all the financial assets for that client. That means taking possession of bank accounts, stocks and bonds, stocks accounts, making sure the house is safe. We have, by code, we have the responsibility to secure assets, to make all essential payments for that client, to make sure that their medical care is paid for, to arrange for that within the means of the client. And sometimes what it means is you have to be very creative on how you work with that individual. You know, if they can stay in the home, but you don't have a lot of money, maybe it's a refinance. Maybe it's private caregivers. There's a lot of different scenarios that we can work out to assure somebody's in their homes. The, it's actually, the 2901 is the section that sets up a certificate, which allows for the public guardian to immediately freeze assets when there is an intention of filing for conservatorship on an individual. And where that really is significant with the FAST team in the work that we do is that a lot of times we need a few more days to do a little more intense investigation, plus be able to freeze those assets so they don't leave, freeze those bank accounts to temporarily stop a property sale, that type of thing. We've had situations and scenarios where we've actually been able to get a call in the morning, file papers in the afternoon, freeze assets and really protect that elder immediately. There's a civil matter that needs to be carried forth on behalf of a conservatee, let's say recovering property or so on and so forth. That would have to be done by our county council. And so those cases that we responded to nearly three years ago are just coming up in court because of the backlog. You're also talking about the criminal prosecution. If there's a criminal element to the particular situation, it can take quite a bit of time for the district attorney to bring something forth. In the meantime, Adult Protective Services in the public guardians office is still dealing with the needs of that particular person. You have to walk a fine line when you're intervening in someone's personal financial affairs. And we do look at these cases very carefully. But if there are the basic facts before you that show someone may be being taken advantage of and may not have all their faculties, doesn't it serve the better good to hold on to those assets while you explore whether or not the person is being taken advantage of? So I would err on the side of going out there and collecting the assets as the law allows and sorting out whether this is folly or just a frenzied caretaker able to get away with something. So there's a civil avenue. There's also a criminal avenue that these cases can take. We've gone out and we've kind of seen how cases have played out. I'll just address the criminal side. We've seen what kinds of cases we can prosecute and what kinds of cases we're not going to be a successful in court. And so we've become wiser about which cases we're going to allocate resources to. We will always conduct that initial investigation. But we've learned to figure out earlier on which cases ultimately leading us to a successful criminal prosecution and which cases are really better addressed in the civil courts. The law enforcement component is represented by the district attorney's office. So what we do is review cases, review reports to see if crimes have been committed. And in the event that they are, then we would direct the investigation and the follow-through on those cases. And we've educated the police they've got to be more proactive and we've, as deputy DAs and our investigators, have to be more proactive and actually go out and investigate cases before there's clear evidence of a crime, which increases our workload. But it's worth it because what happens is we go out on these cases sooner and a lot of times we're actually able to stop a loss from occurring, which then in the end eases up our workload because we don't have a criminal prosecution. If the facts of the case meet the legal criteria for conservatorship, the public guardian and county council collaborate to obtain an emergency temporary conservatorship. This provides the legal authority to secure assets, continue the investigation, and pursue possible criminal prosecution. Through fast action, in addition to preserving financial assets, steps are taken to improve living arrangements and greater independence, provide broader choices regarding medical care, and enhance physical and emotional health. Fast efforts have generated inestimable savings in costs to government agencies and the community as a whole. Without assets, an elder or dependent adult would be forced to turn to public assistance for support, including possible costly institutionalization. Cases are prosecuted or otherwise resolved faster, reducing law enforcement and court costs. One thing I could help you with, would you let me help you with that? I'd like to help you with that. Would you let me do that? Okay, okay, well let's see what we can work out. The beauty of this partnership is that all of the partners were able to know what their strengths were and what might be obstacles that we needed to overcome. In terms of strengths, everyone was open to know not only what their role was, but to try to understand what the others' roles were and to try to really listen and understand and work together for an outcome. In a lot of our cases that we've done the most good, our victims really aren't in a position to really comprehend it. It's like domestic violence where when you've sent someone to prison and you've really gotten them out of the victim's life, sometimes that victim comes in things you've ruined their lives because you've taken this person away and that was their source of support. I mean for some valid concerns that they have. Similarly in these cases where you've really, you've really reversed a very bad situation. Usually the reason that bad situation was allowed to occur was because you had a victim that's not in a position to really understand it. It's really reflected in our county by the environment that is set by the Board of Supervisors in Santa Clara County. When I went to them asking them for their support and for resources, they were so committed to combating this crime that they not only approved of the plan but said whatever resources were necessary they would put forward. And they made a statement that said, we want you to respond to every person in need. You do not have to triage, evaluate, assess, and only take the very emergent or urgent cases. You need to respond to each person as they come in. So that means the person who has very little and the person who has a great deal. Let me share this. When I first joined the Elder Financial Abuse Team, I applied for the unit. I didn't quite know what I was getting into but my team leader told me this. You're going to be involved with some very difficult cases. These are going to be some of the hardest cases you're going to have to prosecute as a deputy district attorney. But when you meet these victims, your heart does not go out to them. If you don't feel a sense of meaning in your work and that you're standing up for the right victims, then you need to find another job. This is what we came to BDAs to do, is to protect these kinds of victims. These are some of the most vulnerable victims in our community. Realize that we've got the baby boomer generation coming in and we're going to have to address this problem and it's better to do it sooner rather than later. Realize the benefits of specialization. Realize how much more productive you can be working as a team and realizing that this is a sufficiently high priority that the best people should be assigned in this area. To me, the essential challenge of the role and the responsibility is to balance an individual's right to self-determination with the society's responsibility to protect vulnerable individuals. In our efforts in the district attorney's office to combat elder physical and financial abuse, we have recognized that it's unrealistic to think we can do it by ourselves.


I have a series of three project updates, the first of which is from Brad Ozenberger, Program Director at NHGRI, and it's on the Cancer Genome Atlas Project. Yeah, hi everybody. In preparation for this, I went back and looked to see when we last gave an update on TCGA for you, and it's been almost three years. I went back and pulled the first slide from last time, which was this, when President Obama visited NIH in September 2009, just three and a half years ago, to announce biomedical research investment through the American Recovery and Reinvestment Act, and that included naming TCGA and NIH signature project, and a big bolus of investment, $175 million, and I guess I'm here now three years later to see, I think that was a pretty good investment, I think we've used it well, and I'll try to describe that. So just a quick reminder of what TCGA does. The Cancer Genome Atlas, our goal is to do comprehensive genomic analysis on all the major tumor types in the U.S., and a real key to this is to take each tumor type, each specimen from each research participant, and do all the analyses we can on that tumor specimen. So doing exome sequencing, RNA seek, microRNA methylation, and even more recently added some protein analyses, all on the same tissue samples from these participants. To do this requires quite a pipeline that's been built up over the years, a biospecimen core resource that processes all the samples, collects the clinical data, six genome characterization centers, the three genome sequencing centers supported by NHGRI, we've added genome data analysis centers, and then a large effort to coordinate these data. This is what it looks like on a map, just to remind you, NHGRI's investment in TCGA in terms of funds is through the large scale sequencing program, the three big centers, the Broad, Baylor, and Rick's Center at WashU, and that's our financial commitment to TCGA is through their genomic sequence and analysis. Just kind of go through a bit of history and where we're going. TCGA, the genesis of TCGA was from a report from the NCI advisory board back in 2005 that proposed actually a number of, they were predicting a number of technological advances that were in the works, and actually just part of this report was to design and develop a large cancer genome effort with, it was suggested with NHGRI, and we set off on this program really in 2007 to pilot this, starting with glioblastoma and ovarian cirrus carcinoma, and we knew we had to establish the infrastructure, a pipeline, and feasibility, and we started this, Rick's here, with capillary electrophoresis sequencing, but we all knew that we were going to hit this point. The next generation sequencing was going to come on and really make this project feasible. Of course, with the reduction in costs, if you've probably seen this graph before that is on our website, of course also there's a great increase in capabilities. So although this was coming, we started with, before NextGen kicked in, and actually this first GBM report was with just a small gene list with capillary electrophoresis sequencing and analysis and still using gene arrays. But then shortly after this, the project expanded. We're now about just past the midpoint of the main TCGA program. We're now up to 25 tumor types in TCGA. Sample acquisition was really beefed up at the NCI, at the beginning of the expansion. We added these genome data analysis centers, which weren't part of the pilot phase. It was recognized we needed both. A lot more horsepower in terms of analysis to do the integrative analyses of all the data, as well as lead in a lot of innovation in genomic analysis methods. And a major product of TCGA that really only started recently are the large benchmark papers that I'll go into a little more detail about. But the goal here for TCGA has been to achieve greater than 10,000 cases examined, and we fully expect to meet this goal by the end of 2014 in more than 20 different tumor types. In fact, we are now beginning to think about what happens after this big, the major phase of TCGA, beginning to look what happens after 2014. And I'll touch on that a little bit at the end. So just point out the TCGA network papers. These are each, really I think of them as historical data sets. These are deep into each one of these tumor types. Our goal is to describe mutations that are found in these each tumor type down to a frequency of 2 to 3%, requiring approximately 500 tumors of each type. Again, we started early on with glioblastoma. Again, this was a pilot phase that did not involve next-gen sequencing, but then that was followed in actually just the summer of 2011 with the integrated analysis of ovarian carcinoma. And this was the big shift. This involved, instead of a small gene list, this involved full exome sequencing, RNA-seq, and of hundreds of samples of ovarian cancer, and kind of set the standard then for where TCGA has gone since. Last summer, published the colorectal cancer work, the colorectal analysis. In September, the genomic characterization is squamous cell lung cancer. And then the next week, actually, the comprehensive molecular portrait of human breast tumors, the one that Eric mentioned in his director's report. Again, each of these papers really get a lot of deserved attention. These are, in each case, novel discoveries. And what I particularly, I'll come back to, what I really want to go into also is some of the clinical ramifications of each of these papers. So here's where we are today in terms of project-by-project view. On the Y-axis are the total qualified cases of the number of tumor cases that have been analyzed or are in pipelines. Again, our goal is 500. Breast, we put all the subtypes into a single project, and our goal there is 1,000 for the breast project. The ones in red have gone through a full data freeze. Either they've been published or a number of them have written, the papers have been written on our currently under review. And then there are a number of other projects now in the pipelines that are, we have full-fledged analysis groups working, and papers should be coming out later this year. And then there's this tail where accrual is still going on, and these will come, probably some of these in 2014. A number of projects, the ones start here have closed. The accrual has closed because we've exceeded the 500 goal, although we are still accepting African-American specimens to fill out some of the diversity. So all this can be found on a project dashboard, and I would point you to on the TCGA website, a project, we call it the Project Case Overview Dashboard, that gives a snapshot of all the data available for each project. Each project is listed. You can see here the number of samples that have been accrued, the number that have qualified and entered analysis, and then for every single data type, all the rows, this is just a small corner of the dashboard, every row represents a different data type, and you can see in there how much data of each type are available for that tumor project. It's quite a handy overview of TCGA. Just the top line numbers, we have now about 7,500 on our way to that 10,000, greater than 10,000 goal cases are in the bank, qualified, and most of these are at centers at this point. Greater than 6,000 cases with a full genomic data set, so this is 6,000 cases with full exome sequencing, RNA-seq, microRNA-seq, methylation, and clinical data, as much clinical day as we can get. Again, and I point out also hundreds of whole genome data files, this number continues to grow, and of course for every case, this is always in cases, for every case for the genomic sequencing, it's both the tumor genome as well as the normal genome. And right now on this dashboard, you'll find there's data available in our database on 25 different tumor types. So TCGA was set, our goal is to create a community resource data set. This would be, data would be released very quickly and then used by the community, as it is of course, but we also have a large TCGA network that also has worked very hard to integrate the data and provide first look. So things like cancer stratification by gene expression or methylation patterns, you know, every tumor type there's a list of significantly mutated genes and how those mutations are distributed across the cohort. Whole genome looks at individual whole genome data, this is a particularly scrambled lung squamous cell carcinoma genome, and then all this is then integrated into a look at the pathways involved in each of these tumor types and together. So although the goal and certainly thousands of people each day are digging into the TCGA data sets, our own network is doing a lot of work as well, but I think we didn't fully anticipate when we started the program how quickly data would translate to potential clinical utility. And I just want to briefly go through a few examples. There's just such rich data and as we learned, as the group learned to integrate across all these data type and really build a picture of what's of the foundation of the genesis of these cancers really reveals something that can translate right to the clinic in many cases. So just to go through a few of these quickly, in GBM even that very first paper early on, there was an interesting example of many GBMs that show hypermethylation of the MGMT locus and these tumors require resistance to standard care therapeutics and the TCGA data explained how this occurred through a shutdown of mismatched repair pathways and immediately suggested changes to the treatment regimen for patients with recurrent GBM tumors. The ovarian work, it was known in ovarian cancer that the FoxM1 transcriptional factor network was frequently mutated, altered, but now with the full TCGA, with hundreds of cases, this was a very high percentage, 87% of tumors showed some alteration in this pathway, not always in the FoxM1 gene itself, but all these additional nodes that feed into it, suggesting perhaps a common target for ovarian cancer. But on the inverse, also the TCGA group identified the full spectrum of frequently amplified genes were delineated. These are number in the dozens, but of course each individual tumor has a different gene or two genes or three genes that are amplified and would be predicted to help drive the disease and really points to the fact that we need to customize treatment for each individual tumor. Colorectal first, colorectal started as two projects, colon carcinoma and rectal carcinoma, but it was quickly confirmed that in fact the molecular genomic underpinnings of these diseases show that it's a single disease, so we immediately merged these into the colorectal project, but it's just one disease. And the integrative analyses showed again similar to the FoxM1, so an ovarian, the prominence of the Wnt signaling alteration and promise of inhibitors in this pathway. Breast tumors of the basal subtype were found to have the same genomic signatures in a large sense as the ovarian serous tumors. These are poor prognosis, aggressive tumors, and we can see in this shows copy number data, ovarian versus the basal over here, you can see the similarities in copy number, but not just in copy number, but other genomic analyses as well, you could see this similarity. And already ovarian clinical trials are being adjusted to test these compounds for efficaciousness also in breast basal type tumors. Importantly also in this paper, the clinically defined HER2 positive tumors, it was known that there's always a substantial proportion of HER2 positive tumors that don't respond to the normal EGFR inhibitors. And in fact, in closer analysis of the TCGA data, they could easily divide the HER2 positive into two different genomic subtypes, and one that is predicted to respond to the EGFR inhibitors and one which wouldn't and shows an important marker that would adjust the therapy for those patients with that marker. Lung squamous. Lung squamous cell carcinomas are over 25% of lung tumors in the U.S., but in fact, it's been very, rather poorly described genomically. So this was the first real hard look at genomic, the genome of lung squamous and identified a number of interesting targets. Importantly, also it identified markers that showed similar underpinnings to lung adenocarcinoma and speaking with a clinical trialist in lung cancer, that they were immediately going to test some of their compounds from a lung adenotrial and lung squamous that have the appropriate mutations where it suggests it might work. A couple of papers that aren't out yet, but will be shortly, Kidney Clear Cell Carcinoma. Again, this is one of these cases where it's known that swycinif chromatin remodeling complex is sometimes mutated in these genes, but again, in the TCJ data, we can now show that this is the majority of these tumors, in fact, and there's a lot of interest in therapeutic compounds that modulate this pathway and potentially modulate this disease. And then endometrial, a bit of a unexpected finding, 25% of endometrial tumors, again, share this hallmark, these markers of ovarian cirrus carcinoma. Here now, just like the previous slide, cirrus ovarian tumors in copy number, the basal breast, we mentioned, and also these endometrial subtype, we call it cirrus-like now, and these are associated with an increased risk of reoccurrence, and now we have a better handle from this work on what the genetic mutations are that drive this. So I just want to give those few examples, and it's although, again, it wasn't our first goal to get these data right to patients where it might make a difference, but certainly it's happening on a more rapid timeframe than I might have expected. So clearly what TCGA is driving at, of course now, if you, the cancer diagnostics, it's mostly a path from pathologists reviewing slides, of course this will still be important, but certainly we're starting to see now the increased emphasis on genomic analysis in oncology, companies like Foundation and New York Genome Center and others, and TCGA is really providing a lot of the foundation to drive this personalized therapy, I don't like that word, but individualized therapy in cancer. So looking forward, again we've had a number of papers that came out last fall, colorectal breast lung squamous, coming soon, these are under review, kidney clear cell endometrial and AML, and a number of other projects that I would hope would be out before the end of the year, and followed by some big ones such as prostate melanoma that will follow that. TCGA's created this Atlas of Mutations, really I think been successful in understanding, beginning to understand biology of cancer through this project, this compendium Atlas of Mutations that drive these cancers, new drivers have been identified, and like I said already changing clinical practice in some of these diseases. Also I don't think anybody would argue that there's now firmly established that we need to think about each patient's tumor as a unique disease, and I'm happy to say all the major pharmaceutical companies have pipelines into the TCGA data now and are using these data on a continual basis to drive therapeutic advances as well. I want to point out that it hasn't just been about the biology of cancer that I think is part of TCGA success, but also the driving of technology. The poll of the TCGA program has driven the development of cancer genome analysis methods, this is a real flagship project, but many new analysis and informatics tools adopted are being adopted to all fields of genomic research, of course not just applicable only to cancer. So in the next phase we are just a couple years out and on a good projectory, but we do think the TCGA will wind down, there'll be some final analysis certainly for a year or two afterwards, but Eric mentioned a workshop that we had in the end of November I think, and NCI and NHGRI are working closely together and separately to develop some new initiatives. Certainly we want to continue this approach, there's still even with TCGA there's still many mutations out on as we go deeper into these tumors that aren't fully explained and certainly there still needs to be some atlas development in cancer. And then more importantly I think we're looking hard at moving more towards the clinical trial area to begin to investigate now the genetic underpinnings of for example metastasis and response to therapy that's going to require us to really get a little closer to the clinical trial areas to get these specimens and get these data. All right, so with that I'm going to close just acknowledge Heidi Sophia and Lindsey Lund work with me every day on TCGA and Mark Geyer is still a real key part of the team and I want to acknowledge Jane Peterson and Peter Goode who were involved in many years of the early stage and this is the the NCI team. They have a full office for TCGA led by the Dynamo Keneshaw if you've encountered her and then they have the new Center for Cancer Genomics at NCI that we're working with co-directed by Stephen Chanick and Lou Stout. With that I'll stop. Any questions? Yeah, Jill. Brad, do you want to say anything about how the ICGC project compliments TCGA and what they've done so far? Yeah, yeah I neglected to mention that. TCGA is a major player and a major part of ICGC it's the bulk of the data in ICGC. Yeah we've always we were kind of in front of them of course but we've been very pleased to see that a lot of large projects in Spain and Italy of course the the in the UK have been catching up and and contributing greatly. We meet at least once a year and there have been a number of coordinated efforts in certain tumors. Prostate is an example where one group looked at very tumors that only occur in young men and somebody else is looking at tumors that are a refractory to therapy and so we've done a good job of synergizing across that consortium and I think it continues to be something that we continue to be very important. There's a they have their own database run out of the University of Toronto, the Ontario Institute for Cancer Research with Tom Hudson and we work very closely with getting TCGA data into there. Yeah Mark. Yeah I just wanted to add on your point about community involvement that the analysis groups have become much bigger than any of the TC than the TCGA funded groups that project has been really good about bringing in wider participation by the community in the analyses so I don't know if you want to amplify on that. Yeah so each around each of these tumors of course a big analysis group forms we designate a PI within TCGA to kind of be a leader and then usually there's a disease a specific disease expert too that they kind of co-chair the analysis but then we invite experts in each disease to come in and contribute and so yeah if you know of people who are interested in a particular tumor on the list please have them contact us and we can get them involved. Yeah Polar. This is just an informational question from somebody who hasn't been keeping up with TCGA. What's the difference in the work between what the analysis centers do and the genome characterization centers are the genome characterization centers mostly about structure is that? No they're data generator so the genome characterization centers are data generators so they're doing the RNA analyses, a SNP chip array, the things that aren't done by bulk genomic sequencing and the genome data analysis centers are strictly computational yeah. I know that TCGA has had methylation for example an epigenetic mark is part of the program but I wonder whether or not there were plans or discussion about including histone modifications I mean many of the genes that identified a number of them have been turned out to be epigenetic modifiers in some way and I'm wondering if there's any plan certainly ACR has been talking about this was a workshop report on trying to gather groups together and with an interest in supporting epigenetic analysis of those same tumors which I think would add another dimension to the data. There are residual tissues that remain in the bank and we actually want to try to make those available although there isn't a spec sheet on the website on how to do that yet or we don't really know yet but but there we have begun some protein analyses mostly in the in you know phosphoprotein chips and that sort of thing but yeah right now the histone modifiers are really not part of the project. I'm intrigued by these immediate clinical translation findings and I'm wondering as those are discovered and as they're going presumably to clinical trials with maybe existing therapies but new indication are you using the infrastructure that you've got for TCGA to analyze pre and post tumor given treatment today or is that an opportunity that one could grasp? Yeah I think it's an opportunity it's certainly NCI is making a lot of movements towards making all their clinical trials genomically enabled um but yeah really that's more in in NCI's court and they certainly see the value of that but but yeah we're it's kind of making steps incremental steps towards that but TCGA itself though those those are all de-identified those samples. I understand it was more infrastructure you've got the teams for analysis for data collection for standards I presume. Yeah there's a lot of that that's actually a point for looking at the future is yeah we realize we've got this big infrastructure built and so those are some of the sort of things we're looking at now to see if we can build on that and take advantage of it. Yeah, David. Another forward-looking question you mentioned metastasis and treatment resistance as possible themes for future phases and could you just clarify for me what the degree of stratification of the tumors that have already been analyzed is if you say 500 for a particular cancer type is that all primary or does that already include a mixture of primary metastatic failed to respond to treatment? These are TCGA's all primary tumors. There are a few cases where we have additional samples from the same patient but these are all primary so we did not design it in a way to really go after those questions. And how about the issue of tumor heterogeneity within a primary? What's the level of multiple analysis of what might be a tumor looking like mini tumor? Again we have a few things we're actually talking about doing a pilot in that because we have tissue cases where we can know we're at least millimeters apart maybe a centimeter but no there's been we really don't have didn't do the accrual in such a way that we can take samples that are far apart geographically or anything like that so it's we actually do the heterogeneity simply through one sample and going deep into the sequence to try to understand it but that's all. Yeah there's more and more of that popping into TCGA as we figure out how to do it so the AML data set for example there's extensive analysis of heterogeneity in all of those primary tumors. There's also a number of samples breast I think where there are trios or there's a primary tumor adjacent non-malignant and a blood normal to get some idea of what we see in the adjacent tissue in terms of new mutations. The so-called field effects right so it's in there and I think it's maturing along with our ability to really do those kinds of analyses. But some of this I'll have to wait till the next phase. As you're going towards that I think some both the last two questions are heading towards some of the technical challenges. You mentioned there was some technical development but for example over the last 11 years we've been sampling blood and when possible tumor from all of the NCI clinical trial studies for the cooperative group I'm involved in. We have blood on almost 90 percent of the patients but 40,000 patients worth. We have fixed tumor on about 30 percent and we have fresh tumor almost none and it's not because of trying it's because of the culture of way tissues handled not necessarily that's a bad thing but just that so you could either don kihote and try to get people to freeze the tumor and that'll come eventually or you can really push on the technology for handling the the fixed stuff and all that. I know every center has their magic way of doing it but I'm not sure that any I believe any of them including the ones from our own center. TCGA took an attitude of no platform left behind so if we don't get good quality RNA from a tissue that tissue doesn't qualify that sample doesn't qualify for TCGA but for example we've done now a lot of work with FFPE tissue and of course the the sequencers can can do a pretty good job of getting exome from those sometimes the RNA is much more difficult but so we're looking at now you know in the next iteration you know maybe sometimes we don't have the RNA data or it's not as good quality and try to do it anyway but yeah we really are looking at FFPE tissue is being very important for the future. I probably need to cut this off sorry around no it's okay Brad will be it's very interesting topic fabulous work Brad will be around if people want to follow up so Simona could you please come forward


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Now, better state or progressive congress youth leaders from the 9 local government areas of zone C have expressed their own wavering support to the state chairman of the party, Austin Agada, ordering to continue his common debut efforts for the betterment of the community and state. The parties on a youth leader, comrade Christopher O'Bully, called on those creating crisis within the party to assist in the overall interest of unity so as to fully anise the democratic gains. The APCU leaderships call on individuals such as comrade Dan Unje, Benjamin Omakolo, and the Asheshe to seize creating crisis in the zone, emphasizing the need for unity to fully anise the democratic gain achieved as a people. Comrade Agada's commitment to youth inclusion and empowerment is on parallel as evidence in his remarkable effort to engage and uplift the younger generation. Now, comrade O'Bully will particularly point out that the youth in the zone are up with President Bola Tunibu and the secretary to the government of the Federation, George Akume, for full-stream development in the state to the construction of Makodi, Utopu and Nogu Highway. Among others, and assured of them, they are continuous support to the present administration of the presidency. The APCU leaders in Buenos Aires will see under my leadership as the zone leader extend the vote of confidence to President Bola Tunibu for his role in full-stream development and to Senator George Akume for providing exemplary leadership in the state. Proudly extend the vote of confidence to comrade Austin Agada, urging him to continue his commendable effort for the betterment of the community.


Page 70 SETUALITY REMEMBERING THE FOCUS The spiritual journey can seem intense and difficult whenever a sweet girl loses sight of the focus, inner peace. The journey to awakening is a remembrance of the sacred presence within, through removing the blocks to the awareness of love. The path involves steps in which the symbols of the world are retranslated from icons of hatred to reminders of love, and eventually toward a step in which all symbols are eclipsed by the present experience of the sacred spirit which is one forever. The body is part of the perception of a sleeping mind that has forgotten its divinity . Denial of the body during the awakening process is the inappropriate use of denial, for the central focus must always remain on exposing and releasing all limiting beliefs and thoughts that obscure the light from awareness. The focus is not what must be given up. For this approach is the ego's interpretation and always involves the concept of sacrifice. The only question the seeker need ask about any practice, including sex, is one of purpose. What is it for? The ego has made a world of preferences, and sexuality is part of the pyramid. These preferences are beliefs, and they make a hierarchy of illusions that the ego jealously guards and protects. The unconscious guilt from these beliefs maintains the world of distorted perception. The spirit's forgiving perspective, on the other hand, releases the mind to again bask in a state of innocence and freedom that is its natural condition. With mind training, the spirit's perspective grows stronger and stronger in awareness, clearing away the belief in lack that distorts and clouds desire. Without mind training, the surface of consciousness is bubbling with distorted miracle impulses that seem to express in a variety of forms, cravings, and needs. Every distorted miracle impulse is actually a call to remember God. But through the ego's lens of lack, the impulse is perceived as something to get for satisfaction. The apparent satisfactions that come from making false associations of thought are fantasies of pleasure, brief, and temporary, and they never truly satisfy in a lasting way. All appetites are getting mechanisms. These distortions all have their foundation in the belief in linear time, and they are always remembered or anticipated. They have nothing to do with the divine present. Quote, sacred, sexuality, as a practice, can be thought of as spontaneous expressions of affection that are prompted from and guided by the spirit, with the sole purpose of undoing the belief in linear time. They are prompts that come from the willingness to listen and follow and flow with the spirit. As a reflection of the lesson, I will step back and let spirit lead the way. Because of the shared obedience to follow the guidance of spirit, quote, sacred, unquote, sexuality is a stepping stone on the way to releasing all expectations, needs, and desires. Approaching the purity of heart Jesus spoke of in the Sermon on the Mount, spontaneity based in following guidance, rather than counterfeit impulsivity of the ego, is a way of placing the mind under the direction of the spirit, and allowing the mind to be used for miracles which are natural expressions of love. Miracles are involuntary, and thus are always under the control of Christ, and the resulting happiness and joy are unmistakable experiences of a willing mind. Repression and indulgence are the only options offered by the ego when it comes to sexuality. The miracle offers a real alternative that brings release from the tensions associated with lack and deprivation. Miracles teach the mind that it is whole and complete, and thus the purpose of forgiveness ultimately releases the mind from all sense of lack. When the belief in lack has been replaced by the experience of wholeness, the ego with its defenses and games no longer remains to haunt the mind. The mind awakens to the pristine abstract light that shines eternally in the mind of God. Oneness has no needs, and simply extends forever and ever. Listen and follow your intuition. This is the same answer for any problem, difficulty, or area of question. It matters not whether an issue seems to involve the body, the world, or the many apparent aspects of the world. For in hearing one voice there is no problem. Before sexuality ceases to seem to exist, rest assured that the intuitive use of the body and world will come to take the place of the ego's uses of the body and world. The intuitive use for the body is the decision to allow it to be used solely as a communication device. All real pleasure comes from doing God's will, and God's will is forever for perfect happiness.


The newly appointed country director for Action 8 Nigeria, Andrew Memodou, has called for closer partnership with the media on the fight to eradicate poverty in Nigeria. Mamadou made a call in Abuja on Tuesday during a media interaction with editors and bureau chiefs of media organizations on ways to strengthen cordial relationship with civil society groups in the country, particularly the Action 8 Nigeria. It says the mission and vision of the organization is to form a united front and to hold government accountable in all fronts of human endeavors. This meeting is looking at working with media executives, bureau chiefs and editors of various media organizations to unveil the plan of Action 8 in the nearest future in the next five years. So, being a new country director, we are looking at poverty is real, the ratio of poverty is real in Nigeria. One to three million is not, it's more than 70% of our legal rights and we are saying, what do we do to eradicate poverty? These persons are major stakeholders in the Nigerian ecosystem. While responding to questions from media representatives, Mamadou reeled out his plans which includes re-strategizing on ways to further improve relationship with the media and the assurance that its activities will not only be visible in the national but at the sub-national levels too. How do we get to target one million businesses real-time that are in the rural community, that are in hard-to-reach locations? And these persons, they are targeted in such a way that their businesses expand, they can employ an average of five more persons. That gives us at least six persons. For us, education is key. We are working, like I said, with several agencies around how do we deal with the issue of education for all, particularly in the rural community. All the feedback you are giving us is in line with the vision and we are ready to deliver, like the country right now said. How are those accountable? The next one here asks us, how far have you gone on your milestones? With this, I want to say a big thank you for making time to be here and we hope that this is the beginning of the partnership. We are taking note of all the advice you have given and the recommendations. Subscribe to our YouTube channel and don't forget to hit the notification button so you get notified about fresh news updates.


So my beautiful people I am back with another hour to ring a video and today I'm going to showcase to you guys how you can get these incredible magma blades. How's it going guys? My name is DPG and if you're doing enjoyed the video, leaving a like really helps out and if you like what you see and want to see more be sure to subscribe. Okay so the magma blades are an extremely rare drop. There's only a couple of enemies I've seen in the game that can drop these and I think the drop chance is like I don't even know guys it's got to be like a 1% drop chance. It's that crazy now. I actually sat there for two hours and got two of them because I wanted to dual wield them and it makes them even better guys. It makes them even better. Really that's what I suggest you do or if you get one get a friend to dupe it with you. Yeah just do it. Do it people. Okay so attributes required 9 in strength 15 in dexterity and 16 in faith scaling with that. Oh beautiful. Beautiful. I'm actually leading towards a faith build now which I'll probably show you guys in the coming days. Amazing what I've got so far. I'm just trying to farm a couple of things trying to make it a bit better. Now this thing's special attack is it kind of creates like a lava pool. Check that out. Burning the enemies for days. Beautiful. Beautiful. I want to gather all these up guys for a showcase you're where you can get this from. But yeah it is kind of difficult to actually... well I say difficult it's not difficult. In fact it's just a rare drop that's the annoying part. It will take some farming. It will take some farming.  Another is a lower enemies obviously but I always test weapons here. Always level them up to a 9 and test them here just to see what they're like. Oh yeah.  The rest. Oh man. I'm not even dual wielding. I'm just using my special attack yeah. These are... oh yeah these are great. These are staying with me. Staying with me.  Another thing is I just don't like leaving anything on the floor. It just means now my inventory. My stuff is just absolutely late especially my weapons guys. I've got some of them. Especially shields. Yeah okay so how do you get this? Well the farm starts within this area here the temple of Eagle and I'm going to show you actually how to get here. I'm going to run you through exactly how you get here. So you need to come to this place here. I'm going to go to here. The Reia Lucaria Academy. The school of magic.  Now if you already got the temple of Eagle Grace Point you can just go there and wait or skip forward in a video. I'll try and time stamp it if I remember. So now we're here. That's where we are. Now normally there may be a seal on there. So there's the seal. You'll be outside there when you get here or it could be on this side and there's a seal there somewhere. Now the key to removing the seal is behind a sleeping dragon. Behind one of these rocks. I think it could be this one here. If you come here there will be a sleeping dragon. It's just literally behind him. Grab it come back to it and remove the seal. Okay so this is where you gotta go. Call this lift. This lift actually when you first come here should be owed it down for you. Just get on it and ride it to the top. Ride it to the top. Now I'm trying to think that I think there's one bus you will have to fight and defeat to get to where we're going now. It's a God's skin bus and the actual the temple of eagle a checkpoint is right behind him. So you have to defeat the bus to get that checkpoint which is very important. Very important. Also guys I'd recommend you use in your rooms. Spending them buying stuff or whatever because you will lose them coming this way because you have to die and that's the secret to it. You have to die. Now you've already got the temple of eagle a grace point. Just go there and wait. Just look for the time stamp out. I'll try and put it there if I remember. Yeah there'll be a time stamp the way you can just continue on from so you can skip all this. This is made for the people that actually inactivated or gone to the temple of eagle yet. So yeah come this way guys. Is that lift there? That's what we've got to ride. That is what we've got to ride. So yeah there's a fox, a boss here. I can't remember his name exactly. We don't actually have to fight him. We don't have to fight him. Not coming where we're going. If you focus further on in this area you will have to. No we don't have to fight him here. So we're just going to run up here guys. Run past these. If they let me. No they're not going to let me. There we go. There we go. Now we're out. Now we're free. Now we're just going to run up here and instead of lift on your right hand side guys we just want to ride it. So just come off and jump. There we go. And now guys at the top you just want to run over it. So when we get to spinning, when we get spinning just like that just jump, run over and ride it. Now you want to ride it all the way to the very bottom. All the way to the very bottom.  I can't remember what they're called but they're creepy as heck.  And you'll respawn on the other side of, well underneath the volcano man. Weird people yeah weird. Weird people yeah. I can't imagine the first person you find this and how you find it. It's like what? That's crazy. Okay so now we jump down here and you'll see her. There she is. All right all right. Well now pick me up and put me in your stomach. Pick me up and put me in it. There you go. It's going to take her a few attempts to kill me I think. Yeah. But if you just don't, I think if you just stand here if she'll just constantly keep picking you up and put you in her stomach. Maybe not. No don't kill me.  Pick me up.  Don't want to be doing all this again. There we go. There we go. I honestly thought that she was going to hit me with one of her arms. Now guys I lose my ruins like I said. Now we respawn underneath a volcano manna. Volcano manna. Yep simple as that people. Simple as that. And from here I'll showcase you guys the location of where the grace is and how you farm the two serpents for these. So you're spawning here guys. Okay so from here guys you just want to come in this direction. This is where we need to be. I'm not going to lie.  Jumped off to the wrong place but yep ignore that. Didn't see the cut. Real good. Now guys we just want to drop down here just like so and then we're good. We lose a little bit of health but you should be fine. You should be fine and now guys we just want to run down here. No I'm going to take a half portion and just run around here. Ignoring all these dudes and run up here people. Take a sharp left and come up here. Now you'll see a crate there which you need to get into. Ignore the serpent there. So that's one of the actual same enemies but he ain't using the same weapon. We can't farming for these bad boys so we need to come up here guys. Just like so. Now there will be a flame monk on this black flame monk here. Now you will have to kill him.  You can run past him. You can run past him if you want. He don't hit too hard. Well he don't hit me too hard but he probably hit you too hard. Now this will be the God's skin boss fight. Now I need to come in here guys.  Once you kill the boss people you can activate this grace and that's what I recommend you doing. That is what I recommend you doing. Now from here here's the lift which we will take. You'll have to take first but the farm consists of you not using that lift but using a lift out here which I'll showcase to you. There's the lift right there but you have to activate it like basically operate it from the top first. You can't operate it from there. You have to go upwards first so yeah that's why we use this lift.


Let's go to everybody Chris from jassescasebrakes.com doing 2022-2023 Bowman University Chrome Basketball four box break Random first letter first name number six 17 spots in this break some of the last four boxes from a case that we started earlier on an all-card ship break 17 spots Everyone gets a random letter from this list below a all the way at the top some combo letters all the way down to W and Z if you get the letter V any of the victor won beyond the cards will go to you And so on and so forth for every letter. Let's do it. Let's go to our fresh dice our list from James P down to Tristan grabs the last spot Majo and our letters from a down to W plus Z We'll show the dice and randomized four and one five times. Good luck everyone. Thanks again one two three four and five fifth and final time Both James P down to Michael P and five times for the letters. Good luck one two three four and five fifth and final time D down to F This one I'll have a little bit of a cherry window on a little early in the the afternoon for some people So we will see but for now James Has D Nathan with N plus out Tristan with T and W plus Z Nathan with E and G Tristan with M Derek spot V gets all the Victor over in Yama's potentially Tristan with J Daniel D with L plus H Tristan with S Kevin with R Daniel with C Tristan with a Nathan with P Tristan with the last but module gets K James P with B and Michael P with F All right We'll pause the video real quick see if there's any trade discussion when we come back We're the last four boxes of this case of Bowman University chrome basketball. Thanks. Be right back. All right We're back. No trade discussion. Like I said little early So we're just gonna print switch screens and Let's do that switch screen Last four boxes from the case the six on all four means The one for first little first name number six number seven is on the site the first four boxes from a fresh case Oh, yeah, it's it's a crazy one man There's first letter first name six in our list from Tristan at a down to Tristan with W plus Z a little grand opening grand closing I Wish I had time to read this giant info info dump screen graphic here. I Did yeah, last time I had you you see this They're in business together now folks Let's merge let's just yeah One year Probably They got it all back Like whatever it lives spent, you know, they're getting it back with this for sure Yeah, I don't know actually how that's all gonna work out He can't Or do all these other guys who are on the PGA tour now get some of that live money and just see how it all falls out I wonder if that messes with people's motivation, you know Exactly that's what I'm saying is like do people just not care and You know Yeah Exactly it's gonna be a weird one. It's gonna take some good music for sure All right, let's do it folks box one First auto gonna be Nick Smith, Jr. Nick Smith, Jr. On the base first auto gonna spot and that's gonna go to Nathan It was n plus oh point guard from Arkansas Couple guys who are mostly gonna be first-round picks here Next I'll go in a quick gonna be RJ Davis on the refractor auto That's gonna spot our Kevin This will be numbered as well 488 out of 499 on the RJ Davis non first auto But the trace Jackson Davis non shimmer or non numbered shimmer Spot T that's gonna go to Tristan but the refractor Invicta Chris Livingston spot C and Daniel Got a chance Westry Aqua spot C It's a good one to Daniel 8 out of 299 of the chance Westry and an Anthony black Lava Invicta spot a that's gonna go to Tristan Should be another first-rounder 007 out of 150 on the Anthony black in Victor Lava We're gonna shoot a junior Invicta spot e E plus G gonna Nathan this filler with the moustache It's huge like a caterpillar up there What did James box to good luck everyone first auto gonna be another first refractor Kendrick Davis On the bone first refractor auto to the spot K and Tristan last spot mojo 150 out of 499 Kendrick Davis on our auto Caitlyn cork first our first Caitlyn cork spot C and Daniel and a big kahuna auto nice Derek lively the second Very nice pick who knows usually a little rare to hit as an insert case hip type Autoed even more so 30 out of 150 on the Derek lively going to spot D and James James B And our purple non number gonna be JJ Starling spot J and Tristan JJ starring non numbered first there Purple mini diamond gonna be L J. Cry this one will be non will be numbered Going to Daniel D spot L plus H 240 out of 399 on the L J. Cryer James happy on the board with a nice one great dick refractor as Caitlyn cork Invicta one more going to Daniel D Caitlyn cork on the Invicta Nice one there got some green Green first on the Judah mints 69 nice out of 99 one more for Tristan spot J. That's what they call me.  Yeah, it's third box Third or fourth box. Maybe some more nice color there too. Actually, hmm Hmm interesting one thing I like to see here for a potentially Tristan at s or Derek at V is a Redemption low number stuff potentially coming up here. Good luck everyone.   That's gonna go to Nathan On the base try a white refractor first is a Caitlyn cork One more Caitlyn cork for Daniel. We do have some orange coming up true orange First for Colin Chandler our first auto nice orange for spot C and Daniel what up G low one out of 25 High school player on Colin Chandler. Maybe a stud. You never know. So you hold on to some of these bowman firsts Regardless of the sport spot C and Daniel out of 25 There's a Brandon Miller first as well Oh, yeah, Boston on the shimmer Tristan grabs the only a Boston spot a and the Brandon Miller first gonna go to James with B Some grade a grady dick right there. I was I was hoping that New York would get that Dallas pick Because he's kind of like the perfect guy for them right now, and I would love just math and square garden going crazy for grady dick Teal on the Adam Flagler Spot a and Tristan 31 out of 299 on the aqua. It's got cork on the sky scraping We do have some more orange What is I'm not all nervous. I'll have to ask my seniors a Brandon Murray. I'm a Brandon Miller On a Murray's and Miller is but Brandon Miller going to spot B. Oh, no. Oh, no now. I'm now. I'm definitely nervous I'll ask him when I see him, of course I think this is yeah, this busted Will not be sending you this brain or invicta in a crack open toppling yourself that there this one intact Nice Brennan Miller Invicta head in your way our orange one more orange in this box. Good luck On the bowman. Oh, nine. Nice. That's gonna be cam Whitmore 10 out of 25 Should be another Watery pick your potentially cam Whitmore From Villanova spot C one more go into Daniel. Nice one. It's starting on the refractor Derek Wiley Invicta as well spot D and James Sometimes I forget how many autos we've had the grady dick we talked about first one Alright, and then there was one one last box here folks Random first letter first name number seven on the site right now. I'll be the first four boxes from a fresh case But let's put it. Let's put a nice bow wrap it around on this case of Oman University chrome basket and just so some of you would like to know This past week of shipments from Monday to This past Friday Being shipped out today some inventory stuff. Unfortunately gotten the way Took out a day and a half from our sorting and shipping team Just trying to catch up on breaks as well. So Monday to Friday being shipped out today. All right. Good luck everyone Last box here Lava one more calling Chandler for spots. See you Daniel the lava Calling channel should be out of 135 out of 100 there's Walker skyscraping One more Caitlyn Cork Invicta Yeah, that is I guess the one for one of the fortune of things about working here if I do have something to sell Yeah, I can just knock it out here Purple mini diamonds will be numbered going to spot J for JJ Starling and Tristan 371 out of three ninety nine Derek Wiley on the Invicta Second there one more for James. Let's spot D Jaylin Wilson on the bowman first base autumn Jaylin going to spot J and Tristan One more head in his way. This guy is scraping on the Chris Livingston Inserts on the spot the great man Like this nice Vernon Miller for the bowman o9 This guy scrapings are nice too and our last auto Just how we started it off to Nick Smith, Jr One more Nick Smith going to spot N plus O and Nathan nice one here to 97 out of 499 another potential first-rounder here Going to Nathan congrats in our shimmer Jaylin bridges one more for Tristan spot J Looking to the history of the name Jaylin Very a very irrelevant name for a long time than Jaylin Rose came around Popped up huge.  I got a chair's Walker refractor Got a Grady Dick bowman o9 last card is a K level. Oh, all right. Nice That's a wrap on Bowman University chrome random first letter first name number six number seven on the store first Four boxes from a fresh case at Jasper's case breaks.com. Thanks again. Bye. Bye


I'd like to give some credit to Jim Ellis, Matt Danzinger, Mike Slasher, Jay Branger, and I'd also like to recognize Carl Dooley, who I'm pointing to, our Buffalo County Ag Agent, who really helped us along in getting some of the statistical stuff and making sure we're doing things right. The idea for working with the Malting Barley was we're really kind of starting to focus in this area on a couple main crops, corn and soybeans, and to kind of get into some diversity with the small grains, the small grains will allow us to get some cover crops in. On a farm like ours, we're mostly a dairy operation, it'll give us an opportunity to spread manure, possibly in one of the best times of year that we could while we still have growing crops out there. So it just opens up from an environmental standpoint, from a marketing standpoint, some wonderful opportunities. Some of the things that we learned in the process, growing barley is as intense as any crop. I think I've learned that in life of farming. If there's any crop you think you can just go out and throw it out there and it's going to take care of itself, you're going to get what you put into it. And with the barley, we've learned that the fungicide applications need to be timely. We do have to get them there in order to keep our quality up. We have to be very cognizant of our nitrogen applications. Zero is not enough, a hundred is way too much, especially when we're talking about the barley, because we need to keep our protein levels low to satisfy the brewing industry. And if we start applying too much nitrogen, first of all, we're going to have maybe too much growth and we're going to affect that protein content. Following in your rotations, that's another issue. When you talk about disease pressures, following right after a small grain or a corn crop where you have residue out there, not a good choice. We've in the past have grown some wheat, tried to get about 20, 30 acres in now with the malting barley. We will follow that up. Took it off last week, which was the, what is to say the beginning of August for somebody listening to this. And our plan is to come back with a mix of clover, rye and radish. And we will put that on, we'll broadcast that on the field followed by a light 6,000 gallon manure application to get some good soil contact. And if we get that done in the next week here, whether permitting, we will have some great soil penetration with those radishes. The clovers will fix some nitrogen for us for the following crop. And of course, that rye cover is going to add a lot of root mass to the soil and hold soil in place for us so that we won't have bare ground. So in our, we're a little more north here, typically cover crops are kind of hard to get on. I'll be experimenting down the road, aerial applications on different crops, stuff like that. But one place you definitely can put a cover crop in and make it work is after small grain. We all went out and grew our own acres this year. And each one took a little different approach and each one had a little different outcome. You put on too much nitrogen, guess what? Just like the plot said, it'll tip over. You know, not hit your funderside applications right on time, you'll have some disease pressure. So it was really neat in the on farm portion. But then when we actually hit the road and put in a larger scale, those two collaborated really well. So just a great opportunity and again, a lot of credit to Carl and the other farmers in the group.


While their exact causes of death will be determined by the state's medical examiner, the fact that they had tested positive for COVID-19 is going to be concerning to many Vermonters. So I thought it was important to address it tonight. Dr. Levine will get into more details about the patients, but we know they were elderly Vermonters, which is an important reminder that the virus is most dangerous to seniors. And those with serious underlying conditions like heart and lung disease. There is no doubt this is sad for all of us, but it's not unexpected news. While we have always hoped there would be no deaths here in Vermont, we are also very aware like other viruses, COVID-19 has the potential to cause serious illness, especially for the very ill or elderly, and can be fatal. It's also a reminder that even though the vast majority of us will have mild or moderate symptoms, or maybe no symptoms at all, we can still spread this virus, which puts the vulnerable at extreme risk. Now I know some are feeling very scared, worried, overwhelmed, but I want you all to know we will get through this because we're all in this together. And in times like this, Vermonters rise to the occasion, we help our neighbors, we answer the call of duty, and we get creative to solve the challenges ahead. I'm seeing the good in people every single day. The people of Vermont in their compassion and commitment to each other show me that we will get through this, and we'll do it together. With that, I'll turn it over to Dr. Levine for further details. All of us at the Health Department are feeling these first losses very deeply, and I want to express my deepest condolences to the patients, loved ones, friends, and family. The first was a male resident of Windsor County who had been hospitalized at the VA Medical Center in White River Junction. The second was a female resident of the Burlington Health and Rehab Long-Term Care Facility in Burlington. Both were very elderly. When COVID-19 first appeared in Vermont, we sincerely hoped that our community would be spared such losses. Unfortunately, this new coronavirus can be very serious, especially for vulnerable Vermonters, such as people who live in closed settings like long-term care facilities. As you know, in Vermont, we're now experiencing the type of community spread of virus that has been seen in other states. The state's been taking very strong action to prevent illness from spreading. But these deaths, and I hope we will experience no more, highlight how extremely important it is for all of us, young and old, to take extra care to protect those who are most vulnerable to serious illness, including older people and those with chronic illnesses or impairment in their immunity. Here at the Health Department, we continue to work tirelessly to identify people who are at high risk because of possible contact with people who have tested positive for the virus. That includes household members in close contacts, as well as health care workers and first responders who may have been exposed. Each person is assessed for their exposure risk and provided with guidance for their health and recommendations for self-isolation or other measures. And as illustrated by these two cases, we are prioritizing our testing to health care workers who are symptomatic, people who are hospitalized, residents of long-term care facilities, people who are immunocompromised, and other high-risk groups. As the Governor alluded to, even in such a time of tragedy, Vermonters rally and they show how resourceful and resilient and creative they can be when confronted with a challenge as big as COVID-19. Thank you. With that, we'll take a few questions. Governor, do we know that any of these patients have pre-existing conditions? I'll let Dr. Levine answer the medical questions. Yes. We don't have a complete idea of their whole health history. And again, they haven't traveled. These were not believed to be cases related to travel. Dr. Levine, is there any indication that other residents of the nursing home have been infected? So we're assessing that as we speak. And our epidemiology team is actually on-site examining who might have been exposed, who should be tested, all of that. What guidance is the Department of Giving to families who may have all of them in that home? So families that may have visited or? Now that may have some concerns about having someone in that facility. Yes. That's hard to give them guidance until we complete our assessment and our testing. So there will be guidance forthcoming, for sure. Do you have any more specifics about their age, 70s, 80s, 90s? We're not really allowed to release that information. You can only say that they're elderly. Yes. And I can assure you they're quite elderly. Sure. Can you give any kind of indication of how fast this progress for either patient, when, how fast did they go from them showing symptoms to getting tested to them dying? I can speak in generalities. You might recall it was not very long ago when we had our very first case in Vermont. We're talking maybe a week and a half ago, less than two weeks. So that's the pace. So it moves fairly quickly and quite quickly is quite fast? It can, especially in those that we've talked about who are more vulnerable. I wanted to ask about the testing and the priorities that you mentioned. How standardized are those priorities and who exactly is making that call? Yeah, those priorities are quite standardized and they're being disseminated to all clinicians around the state. Were the people on respirators and how many do you have? So I can't speak to either question, right? I can't speak to the first question and the second question is probably more appropriate for our press conference tomorrow. How old is Elder Langer when you say they're elderly? What is your threshold to consider? Yeah, I think the common standard, although it's evolving, is 65, as you know. To be clear, both these deaths occur today? Yes. We're hearing today in New York State, for instance, fears statements coming out of the government's office that they expect their hospitals to be overwhelmed very quickly by this. We spoke tonight about hoping there aren't any more deaths here. I mean, are you expecting that we're going to see similar problems in their hospitals that are coming up? So obviously, we're planning for that. We've done a lot of modeling, but the fact of the matter is today, if we talk about our number of cases to be in the 20s and the number of negative tests to be way over 700, that just gives you a little perspective. So clearly, our hospitals are not being overwhelmed today, but I have to, again, repeat that COVID-19 is not the only disease in our community. We are still in influenza season. We are still in the season for respiratory syncytial virus. And both of these are affecting our elderlies, especially in causing hospitalization, even before we had this new pandemic arrive. Folks, we have time for one more question. We have a press conference tomorrow as well. I think it's also important to remind all Vermonters, this is the time to take this into your own hands. What we've been talking about over the last three weeks is to make sure you wash your hands. Social distancing is really, really important. If you're sick, don't go into any institution. Separate yourself and take some responsibility because this is more important than ever. It transmits very quickly as we found and it really does affect the most vulnerable in a significant way. So we have the opportunity to do our part in making sure that we don't transmits this to our loved ones and the most vulnerable. Have you spoken to either family, either of you directly? Both families have been notified, but we have not spoken to them personally. You, personally, as the Health Commissioner of the U.S. Governor, have you spoken to either family? Not yet. I have not either. I don't have, actually, I don't have the names of either one at this point in time. Are you testing anybody who doesn't meet those priorities? If they're symptomatic, which is one of the priorities. And I know we're going to finish up now, but I just want to, since I'm getting the gist of where the questions are going, you can rest assured if there's a scenario we are planning for, it is a worst case scenario. So every day we talk about what is our hospital capacity? What is our ICU capacity? What is our ventilator capacity? How much PPE do we have and how much don't we have and how much are we hoping to get? How many test kits do we have? When will we run out? How are we hoping to remedy that situation? Name the issue you want and we have done a lot of modeling and we're really looking at the worst case scenarios so that we know we can be prepared. I think that's probably sufficient for tonight. And we will be having another press conference tomorrow with further details and other significant areas that we're working on. So we look forward to seeing you tomorrow. Thank you again for coming out tonight. We appreciate it. Thank you.