I've been farming about 35 years and taking over from my parents farm and do corn, soybeans, alfalfa, oats, and now in the last six years I started using cover crops. I have a cow calf livestock operation on about 140 head. I guess I've got a dual position here on the farm as I work off the farm as I teach school. I'm a fifth generation farm kid and so it's important to me, first as a teacher to give my students that experience where we've come from and to where we are going and the different farming practices that have gone through the years. Here at home it's important that we leave the land better for the next generation and take care of it best we can while it's in our session. Farming with my dad, we decided to go to narrow rows on our corn and soybeans going from 38 inch down to 19 inch and to save that moisture and get a quicker canopy for weed control and then worked into the no-till part of it. One of our biggest limiting sources here is rainfall and to conserve that water and the no-till is from an economic standpoint of not having to make extra passes of tillage to prepare the soil. Most of it was for plant health and soil benefits there and then I switched over about eight years ago to do a 22 inch row spacing just because it's more common equipment and then started implementing the cover crops for a winter feed source mostly from my cattle, going to a three way rotation with the corn, soybeans and oats. I raised the oats for grain and then sell that grazing the rest. Which is great because I've saved about 40% of my hay usage so I cut down my harvested acres that I need to put up for alfalfa or grass for my winter feed from my cattle. I have a black and red Angus crosswind some Cimetal. They're not pinned up during the winter they get exercise while they're bred and raising a calf and the manure I don't have to haul the manure out it's spread across the land as a part of the cycling process. Probably the biggest thing is just with not doing tillage the repair bills and upkeep on tillage equipment. There's fuel savings that way and just the number of hours I put on a tractor per year is reduced substantially too. One thing I'm looking at now is to try and implement having kind of almost two crops growing at once a cover crop within the growing crop during the season and get that synergy of companion crop so to speak. When this first crop begins to reach maturity and die off stop growing that the other ones there and takes off and grows. Since about 1988 look back at some of the soil tests and just about double the organic matter level in some of my soils so I think we're on the right path to build that organic matter and go back to some of the resiliency part of it that I think that's a big component of it. Kurt is very good about sharing the new ideas that are developing and involving me as much as he can. I'm not here during the day as much but it's very much a partnership as far as where he thinks we need to take the farm in the future.


Item number SCP-110 Object Class Euclid Special Containment Procedures The entrance to SCP-110 is to remain closed off at all times unless otherwise permitted by O5-███. The land covering SCP-110, roughly 6 square kilometers, is to be developed into a suburban area that will not attract the attention of the general public. Any movement that SCP-110 might make is to be explained as minute seismic activity. Further complaints are to be ignored.  Survey teams 2 and 3 concluded that the amount of surface area that the city is buried under covers approximately 6 square kilometers. Most items of high interest have been discovered within SCP-110, and will henceforth be labeled SCP-110-XX. August 11, 19███, a large earthquake occurs in rural New York, far from any city centers. The only casualties were a man and his dog, so no significant media attention was given to the event. May 15, 19███, minor earthquakes continue to occur in SCP-110's general area. The US federal government dispatches a team of geologists to the site to determine the cause. Results come back inconclusive. May 16, 19███, SCP-Excavation Team 03 is ordered to investigate the site. Upon arrival, the team is greeted by SCP-110-01, who is then detained to move to ████ for further questioning. May 24, 19███, information gained from SCP-110-01 and SCP-███ reveal that there has been a large temporal disturbance in the area of SCP-110 that has been causing earthquakes due to the displacement of soil and rock. Another SCP-Excavation Team is sent to the site. February 2, 2000███, after many months of work, SCP-Excavation Team 04 and SCP-105 are only able to reveal the strong and penetrable concrete like shell of SCP-110. Investigation is halted until further information becomes available. July 25, 2000███, due to the recent decoding and decryption of the files contained on SCP-███, schematics of SCP-110 have become available. Excavation Team 04 and SCP-05 are sent back on site to locate the primary entrance of SCP-110. August 4, 2000███, the entrance to SCP-110 has been discovered, and the excavation teams are immediately met with what can only be described as a foul odor. SCP-110 has been an active Class-4 city, but due to a temporal accident, its core services were heavily damaged and the entire city was displaced. Work begins to cover up the existence of SCP-110, its excavation, and the thousands of dead civilians inside. Layout of SCP-110 The general layout of SCP-110 is essentially a series of concentrant rings connected by tram, train, and other transportation lines. Surveyors have determined that SCP-110 has numerous sections and levels to it, all with specific functions, which shall be described in greater detail here. Core Services The numerous maps found posted in what were high-traffic areas of SCP-110 labeled a central column of assorted utilities as core services. Upon exploration, which was limited to the heavy security restrictions, SCP-Exploration Team 01 discovered a myriad of technologies that kept the underground city self-sufficient. Among these technologies were a series of matter reconstruction chambers, a combination reactor to provide energy from both nuclear fusion and geothermal sources, an elaborate water recycling system, and a large waste reconstitution area. The core is surrounded by numerous elevators and emergency stairwells. Numerous areas of the core have been assigned a certain personnel for research. Atrium colossi This large open-domed area surrounds the core and apparently once held vegetation. The dome itself with a massive display, its composition undetermined, which was used solely to depict the sky as an indication of time of day. These tram lines span at least three stories of the atrium, all leading to and from the core. Personnel had described them as looking like spokes in a wheel. Upon discovery, the death toll per area was highest in this area, suggesting it was a high-traffic part of the city. Commercial ring A ring of what used to be small, independently owned shops and chains surrounds the atrium colossi. It is unknown whether or not commercial products were manufactured within the city, however due to the immense size of the core itself and the city's apparent self-reliance, it is highly likely that the core for this is a manufacturing area. Habitation ring A The styles of living spaces found in this area suggest that its inhabitants were the wealthiest of the city. Numerous documents found throughout the city seem to have confirmed its assumption as well. Habitation ring B This entire ring was inhabited by the middle class citizens of SCP-110. The area is still being searched for items of interest. To date, SCPs have been recovered from here. Habitation ring C This ring was inhabited by the lower class citizens of SCP-110. It was found in an extremely poor condition and is currently being restored by SCP Maintenance Team 01-12. It is speculated that due to its location further from the core, it suffered the most damage from the temporal disturbance. Research to SCP-110 increases proportionately the distance from the core. Atria Veges As so named by numerous maps, these atria were only slightly smaller in area than atrium colossi and provided an estimated 80% of all foodstuffs to the population of SCP-110. These atria were once open-air spaces and thus suffered a great deal of damage upon arrival at site, as it is estimated that SCP-110 was displaced at least 300 meters below its original position. Recovery of these atria is revealing advanced plant-growing technology that has useful applications. Atrium Animus Atrium Animus was responsible for the remaining 20% of foodstuffs. This atrium has at least 20 stories that were once modeled after the natural environment of the animals that were raised there. Each level had a tightly controlled climate and was subdivided so that different species of animals had no contact with one another. Some of the genetic labs attached to atrium animus were found intact and are currently being explored by personnel. Atria Recreus These atria were used for the sole purpose of recreation. They are found between the different habitation rings and typically consist of parks, artificial bodies of water, shopping malls, and other types of civilian recreation. These atria have been suggested for use with SCPs that require an outdoor-like environment, or a temperature and humidity-controlled environment. Conversion plans have been drawn up. SCP Research Ring This city apparently had its outermost ring devoted to research of safe and eucalypt-class SCPs, although no documentation within the city is able to confirm this ring's existence. This suggests that SCP-110 was not originally designed by the private sector, and rather was used as cover for SCPs currently unknown. This ring is highly dangerous, and it has suffered the most damage out of all sectors of SCP-110, thus potentially freeing some of the more dangerous SCPs. Only two members of SCP Exploration Team 03 have survived exploring the ring. Their accounts are contained within Document No. 110-F. Architectural Styles of SCP-110 SCP-110 has been confirmed to be of human origin, and all materials used in its construction are terrestrial. The architectural styles of SCP-110 seem to vary depending on location. The main styles are listed below. Core Services, Utilitarian Atrium Colossae, Greco-Roman Revival, Applies to All Atria Commercial Ring, Post-Modern Habitation Ring A, Art Deco Habitation Ring B, Expressionist Habitation Ring C, Utilitarian SCP Research Ring, Too Damaged to Determine The different architectural styles of SCP-110 create a problem when attempting to ascertain the general error in which it was built. The earliest documents found claim the city was built in ██████ by the ██████ Group. Document No. 001-A, The Last Note To those who find this document, my name is Stephen Kulsnik. Rather, my name was Stephen Kulsnik. I will be dead by the time you read this. I was the chief engineer of the city, as well as the director of the ██████ Program, contained within the outer containment and habitation rings. Due to an accident with an entity known as ████, the entire city of ████ has been dislocated from its original area of ████. Anybody here knows where we are. For what I have been able to observe, the outer rings have sustained heavy damage and their contents are threatening the inhabitants of the inner rings, though we are surely doomed anyway as the core has sustained heavy damage. Three of the main life-sustaining surfaces contained within the core are damaged beyond reasonable repair. Any attempts to repair them will take more time than we have left to live. Life support systems will go down soon. I would estimate that they have between 4 to 10 hours of function left. To whoever finds this, contain ██████ as best you can. Do not follow the same mistake as our containment procedures had. If you do, you shall regret it. End document. List of notable SCPs found within SCP-1-10


Aspirant vying for the member of the county assembly for the ward rep of hospital ward in Transoya. And of course to my extreme right I am with Kiplagat Deniz Maguta. Also I am aspirant vying for the constituency of Kassarani. Karibunisana? Asante. Kusalamu? Nikomzima Kabisa Gangare. Asante. Kiplagat, Kusalamu? I am very good. Right I got this morning. You also forgot to say that I am a governance expert. Yes, also governance expert. Thank you.  No people. No people? Thank you for coming my brother. Asante sana fukukukuja. We value feedback. Let us know what you think about these conversations that we shall be having. And this particular show right here on youth and politics. And of course to kickstart this conversation before we kabla tukuzama wa siyasa. There are people not being arrested because of having phones during these KCAC examinations. Tianin and Elea, Simina Patikana. What do you think about that? Let me start with Kiplagat.  It doesn't matter if there are positive consequences or negative. But again as a student you need to think about yourself, about your future.  They are going again to repeat and they might go to jail. So before you do something like that as for the students who are doing the same thing they should think about their future. Because this is now about their future. They are going outside there to meet life. So if you have learned for four years you better even come out with your C plus or what instead of trying to aim for that A that is very risky for your entire life. The decision is really concerned that these examinations could be compromised because of the high level of cheating. Again the schools are failing because they really need to take care of the students because at the end of the day they are still students. So they might lie to each other, let's have phones, let's do this. So the schools where the students were caught are failing because their principals and the school management need to really put strict measures. So that they can stop these students from entering with phones to exam rooms. Because the moment they are caught with the DCI of the Ministry of Education the case now leaves the school and goes to the Ministry of Education with the DCI. So the school need to protect their children. These are their children.  So the school need to protect their children, need to make sure that their children don't have the phones. Kupi o maoniako about this particular issue? Ya, I feel so sorry for the students who are caught with the phones during the examination. And I think it isn't a good thing because as we mothers at home we train our children to be faithful. And also when they go to school they need to have that standard. They need to know that from home I was told to be faithful in every little thing. So I feel so sorry for our children that have been caught right now with the phones. And I also wonder how that the kids were able to go to the room with their phones. Because those days when we were doing our exams we had to be inspected first before we go to the exam room. So that's the problem with the inspection? So I think it's because of the inspection. Ya, I blame the people that are there for the kids because they have to make sure that the kids are okay and they are set to do their exams. And at the same time I wonder how do they get peace ligages? Wana toa busy? Ya, they are outside there and we have you know just like the way potatoes you can lack one rotten potato in a sack. The way in our community you still have some rotten people it's unfortunate but it's good that we've seen them being arrested. Like yesterday you saw those students from I think from Rongo University or something.  Let's have the reality. We still have people that can still do some rotten behaviors, do something that is very questionable to the society. So still it might spread. So that's why I insist on having the school, the institution itself really inspecting their children and making sure their children are safe from these rotten characters. You see those who are supplying those ligages are from universities. So in fact they don't have them. So they are just lying to our students and it's so unfortunate that our students are still naive. You find that from 4 a student can still be at 15 years old. So it's easy to manipulate such a student for higher grades. It's easy to manipulate his or her mind. So the school really need to watch out for it. To kumanzi mamba examinations, I love one particular two things that are being done. The schools near the examination containers will be the last to receive the examinations. The CSO of education professor Mago has said so. And also instead of schools getting their papers at 6 being opened, it's going to be open at 6.30. So that there is the interaction between the examination papers and the handling is reduced. Do you think that this idea will help? I don't think that is going to help because still if they have that time, that duration of time of half an hour and yet they don't inspect the kids when they are going in, that's not going to help. So I'm still standing there that they need to be inspected. Because if they open the exams right there and the kids are already in class, they are waiting for their papers, it won't make any difference. But I think that's strategic just to reduce the time of interaction and the spread of the same paper. You see, when the paper is open, you don't know who might leak out the questions to the nation. So at least giving that little time between the kumanzi of the examination and before, that at least works. It's a good strategy. But I think for me this leakage is done even before they take the papers to the schools. That's my thought. Because for real, how do they just open the papers and the policemen are there and they take it straight to the classes and yet the leakage is still there. They don't have that time. So for me I think they do it before it gets there. Before it gets there. Of course, let us know what you think about this particular issue here. The hashtag is why in the morning at Ram Agukon at Y2F4 channel. What do you think about these issues that are making headlines on this particular Monday morning? Let's move quickly. This week we are expecting to see mass defections this week beginning today because of the deadline that are set because those who are shifting from any party, from one party to another have only five days to the deadline. And after that no shifting. And of course after that the registrar that is under itu has given the directive that the date was arrived after the interpretation of both the elections act and the political parties act. And of course once the list has been handed over to her, they are going to take it to IBC a bit later on. But in regards to those who are vying as candidates, as independent they have until May to be able to settle on their mind. But still, this is a deadline. We have five weeks. What are your expectations? Are you going to see many living political parties this week by Saturday? For me, because I did my registration long time ago. And I think people that are serious to vie for these positions have already submitted their paperwork. So these people that have noted submitted their paperwork should hurry up and go to their parties and submit their paperwork so that we don't have this rush and all that. But other than that, I wish everyone well that we may do Tufanya Kazinsuri. Tufanya Kazinsuri. Zana Zana. Yes, you see, right now I don't think that many people are going to defect or those who are going to defect maybe they feel like they are not suited in the party that they want to go for the election with or maybe they'll feel that they'll be compromised nomination processes. But the deadline is here and the time has gone already. You see, with the time that you have between now and August, you need to have settled your mind. You need to have known which political vehicle am I using. Am I going with the Kenya Kwanzaa coalition or Azmiyo coalition? Or am I vying with the independent? Again, you need to check at your ground. You need to know where you are going at, which vehicle are you using. Now this is not the time to say that I am vying.  This is the time to defect. Yes, this is the time to defect. In fact now of course you must defect if you want to before Saturday, before 26 because the deadline is here. But you dea is losing so many people. Let me give an example of Sirissa Mema Faleben to a luke left you dea for jubili. That's why I was telling you, you need this time to check at your ground. You need to know where is your party strong, where you are, where you are vying. Which party or which coalition is strong. That is the reality. As an aspirant you cannot overdo that. You must check where I am vying. Which parties wins the day. So that's why you've seen people moving. But those who are running away from you dea, I think they don't know why they are leaving because for me I feel like this is the safest place to be. The safest party to be where nomination cannot be compromised where everybody has this democratic right. There was something that I was saying because of the issue of Ford Kenya and ANC where we have the party leaders, Moshe Zutangula and Mustafa Mudavadi respectively joining you dea some feel it will compromise their position. Now that we have these two coming in especially in the western region they feel like it will not compromise their position then they may not actually be able to get their seats so they have to move to another party so that their position is sealed. Meaning you dea is still trying to ensure that they retain their members. Are you seeing this as a negative thing? Or is it positive for you? Why people quiet about it? I don't see whether you dea seems to be concerned Is you dea concerned about it? Yes, your thoughts? Maybe. Let me say on that you see why you dea is quiet is because when you live you give somebody else a room the you dea party is quiet because they know their strength and you know these are party that is one almost one and some few months old years so when you feel like some people might feel because this party is new in this area as an individual but this is not as a party, as an individual because this party is new and I'd like to move out to another party maybe my position might be compromised but Musalia Mudavadi and Mosa Swetangulia were not foolish to move to Kenya Kwanzaa Coalition they knew that this is the winning team, this is the winning party and you see as the CEO of their parties they knew that what is best for their party this is like their company, this is their home so they knew this is my home I'm taking my home to this place so that it can nourish so I want to tell you that in the western part you dea has really picked, has really picked and it is picking well the person that left like Waluke now he has failed competition, really had competition that's why he feels like he want to hide his mischief and his future failures by running away from the party so that he could say if I didn't run away, I could have won so I am telling you the truth in western region you dea is picking well you've seen recent campaigns where our patron the party leader of you dea we live alone that remember when he was away he was abroad Dismas Barasa pulled a very huge crowd so it means that this party is really picking up well and it's good for the day but as an individual if you feel pressed if you feel you see there is competition apart from the party or pushing you you still as an individual there is competition maybe others feel like they have failed and most of them who are running away are the failures they cannot bring the numbers so if they go it well and good you dea has no problem in fact they were collateral to you dea so when you leave you giving yes, you thought I think many people are running away because of the competition in you dea people have laughed at the party and there are so many aspirants right there and we have competitors and I think he weighed himself and he saw that I am not going to make it but for me I feel so good that we have about 10 aspirants and the winning team will take the day 10 aspirants in your ward? yes and I am happy for that you guys are not going to this I like competition outa toka you dea you know move to another outa toki you dea apon yo ni nasi mamamba kamushu kwa sababu ni nasiki akomba hiyo chama ni chama ambaita kuwa na free and fair elections kila mutuka mamimi ni mamamboga na ni tepewa na fasi angu kamamboga kamama mamamboga na ni teenda kuusa se raza gupale wama mawa siki e na wile wame se maia akomba hii ni bottom up tu na ansia chinitu kienda ju na kweili tu mepewa na fasi kwa chama ja uda ata sisi wama ma mamamboga tu naweza kuenda pala inje tu kausa se razaetu na wama pia wakaweza kuinulio so mimi ni nasiki I am proud ku kwa hii chama nasi Banduki Banduki Leave alone kutoka yu dea but I won't leave the winning team that is Kenya Kwanza so if anything happens in nomination I won't leave the winning team Kenya Kwanza enjoying the losing team that is as myo so again today you plan even tomorrow even if you plan tomorrow you plan 10 years to come as you plan today your life when you are when you are looking for for your spouse you are looking for her to marry her for the future of your children so now we we came together as Kenya Kwanza for the future of the nation and the future of you as an individual so listen I am not going to leave Kenya Kwanza because even after this this campaign period there is now life after election so we need to be in the government to work for the people in various posts even those who will not win that's why people are not advised to leave UDA or Kenya Kwanza coalition because this is the winning team you will be running the government together now let me look at UDA the Mathira Member of Parliament Honorable Riga Degashabwa he has said that he wants Ndindi Nyoro Member of Parliament to actually not to vai but to be put as the running image of the deputy President William Ruto and I was a Kana I was a Kana kwa pandewangu mimi na Ndindi Nyoro nimtumzuri sana lakini kwa mamba yako deputize the president and by any William Samoe Ruto and by any namin ya kwa mba he will be the fifth president of the Republic of Kenya I have faith in him kwa saba buye ya lianza kutoka chini na sasa so Ndindi Nyoro niki jana shupafu Nliki jana mmu zum variant niki janambaya pan duki lakini hiu tunawatsia wenyo wanaiza w inicial два ta kakasอน kamaenge kwa u pandewati mimi niine wanaiza군ia kazi mizuri sana nanaeza kudeliva, lakini kwa jili ya mambu ya palindani, mimi na wa wajia. Gajago said this in a quote, when a tree falls, it gives out sprouts and dindi inyoro is one of them who we are looking up to. It continues and said, give us this man to go and help Kruuto gana votes to be able to win the election and form the next government. Yes, Rigadega Shagwa is a member of parliament of Madera but then again he's also a citizen and he's a supporter of Kenya Kwanza. Just like me, I can give opinion of who should deputize the deputy president now, William Samueh Ruto. As you've heard from my colleague, dindi inyoro can as well work perfectly as a deputy president of Kenya in the next government. But then again, we still have Musalea Mudavadi. We still have the same Rigadega Shagwa and many other people. And for the deputy position, there are many things to consider. To consider the number of votes that you might bring, how it would affect the entire nation. There are many things because for example, deputy president automatically cannot choose a car engine to be his running mate. So they might again consider giving that position to the women so that to gender balance. So I would like to say this. Those were just opinion of the Rigadega member of parliament. It didn't say it under the capacity of the Kenya Kwanza coalition. When we will start talking about the deputy and analyzing the deputy of William Samueh Ruto, when they will sit down in a press conference and say that we as Kenya Kwanza, remember Kenya Kwanza is large. We have Ford Kenya, we have UDA, we have Jbebe, we have CCK, we have a lot of parties inside there. So when we will start talking about the deputy president, we are just analyzing now the deputy president that is when they themselves have chosen and they have agreed on one thing, because there are many things to consider. So there is no problem with anybody saying I want somebody, I want somebody. Because we have heard allegation also that this Rigadega shakwa is going to deputize. So we will just wait about that. We are not seeing people like Musala Mudavadi who is also there, who is also an able man. That's what I have told you. Kenya Kwanza entails a lot of parties. We have ANC, we have Ford Kenya, we have CCK. They'll need to sit down and choose the best candidate so that they don't lose. They need to discuss and agree, because there are many things to consider. I told you they might consider giving it a woman, they'll consider giving it to a person. We'll bring numbers because at the end of the day we are looking at the victor. Nyoro is running mate. Nyoro is running mate. Okay, you have pinned me to that. But I would like to say, Ndindi Nyoro is a very good young politician, very energetic. Yaya mwenyewe kulingana na mimi, ana wez. Lakini, si wezisema kwa mba, apewe, yu deputy president, kabla yaya mwenyewe ajaitisha. Yes, yaya running mate. Kabla yaya mwenyewe ajaitisha. Ineza kwa, kulingana na mimi kumuangali atu na ona kwa naweza. Lakin yaya Ndaniake is not ready for that. Okay. Yes. Now, quickly still, there is the consistency that you're running for. And there is the word that you're running for. I want to get it from you, because now this is where we shall be rapidly this conversation up on. You believe that you've got what it takes to take your word to the next level. Kwa kilisha waa. Wale mma maboga mahaslas. Mba umkonao pali kwenye, kwenye word. Why you? Why do you believe that? If you may also, as your answer in that particular question, also let us know the plan you've got for the youth. Yeah. I feel like I am the right candidate for the hospital word because of my qualities. Which are? Kitu ya kwanza. Kulingana na chama chetu UDA ambayo Naratifia on the bottom up economy. Mimi mwenyewe kama mamamoga. Niko gangare na niko tayari kufania watu kazi. Na unadjuwa kawahida kwa familia mamandu utu wamugongo wafamilia. Wakati mama yuko nyumbani. Kilamutu wanashiba. Baba wanashiba. Watoto wanashiba. Vijana wakazi wanashiba. Naata uko umbo uko inje na paka wanashiba. Kwa ife mimi ninaona, kwa sababu mimi nina pigania hikiti ya mca. Ionikiti kizuri sana. Kwa mama kama mimi. Mama ambayo nina jua. Kula lanja nini. Mama ambayo nina jua. Kukosa skulfis nini. Na saidi wakati mwingi ukitazama na kwangaliya. Mama nio familia. Wakati mama imeku wa motosana kwa familia. Muzea anaeza katoroka ena. Lakin ni mama atazi mama paga. Lakin mimi kuna wengina mba upia wa kwa pukoni wodere punio na vaipa mwenyewewe. Mba upia wanashiba, same same thing wanashiba. Mimi mimi... Mama hawezi kubali mtu ala lanja. Kuna mama wengina pia mba upia. Lakin ni muna wewewewe. Mimi ni mchapa kazi. Na watu wa hiyo hospital wadwa nali jua kama mama mchapa kazi. Kazi ni kazi. Mimi ni na fanya kazi. Mama mboga na kazi ni kazi. Na nina jua na nminia kwa mba. Hawa wa kini pa hini chance ni wa fanya kazi. I'm really gonna deliver. What about the youths? Youths ni kuna mpango mzuri sana. Kwanza youths ni wa mminifanya ni ingiwe kwa siyasa. Kwa sababu mimi ni mama ya wa toto. Mimi ni mama ya wa toto saba. Wa toto wangu vijana mba ii ni kuna vijana wa tatu. Hawa vijana wa me ndesha border border. Mimi ni na jua uchungu yam toto kwa muka subui na kwenaku ndesha yu border border. Na wakatu wana po ndesha yu border border. Yu border border subui yaw. Wa me pewa. Kuna mdusu wawa mba ii me wapate yu border border. So mimi ni na taka ni na mpango sana na hawa watu o border border. Kwa sababu hawa watu o border border. Wana kapa jua the whole day. Hawa vijana o border border. Wana itaji kuna wengina mba ii wana wake na watutu. Na sa zingini wana kapa hale na hawa pati pesa yu kutosha. Jiyoni wana itaji kupeleka pesa kwa yule mdusu wake. Huku amechu kwa ii piki piki na lon. Na lon hiu wame pewa interesti kuju. So mimi ni na taka ni na poingia pale. Niyone vijana yakuwamba. Hata kama watapewa izima piki piki. Na lon interesti wechini. Na mimi kama mama yaw. Nita angaliya vile nita wasa idea. Kama nita weza kuchupua kama 5% ni na wasa idea na yaw wa weza kuju sa idea. Na piya ni na pangu ya kwa jengea shed. Ni na wajengea shed ko iili juwa isi wapige. Mboi na po nyesha wana kwa po konvua akuna maaliwa na heza kuchikinga. So mimi ni na taka kufanya vijana kazi. Na pangu ya filato wawena mitu wakukimbiliya na kwa. And this are some of the things that we are going to be talking about even in the future where pale, mafanya makosa ni wapi. Where have we gone wrong, where have we gone right and those who are vying for these particular positions what are they coming on board waduwa na kujana ni ni wana takapfanya faina, na of course raza wana waza. We have finished with you. Yes. As youths we have been told that we are the leaders of tomorrow and I believe tomorrow is now. Tomorrow is today. We are here because we cannot wait until we are 70s so that we start vying for positions and that there is the time for change Ikefika you cannot stop it. And I believe this is the time for change even starting from the national level. This is the time for change. We need energetic leaders and intelligent leaders. Now within 20 seconds I want to give you time also. I want to give you time within 10 seconds to tell us why you for kasarani. And that's why I was coming down. As I said at the national level we need stronger energetic youths we come now down to kasarani. We've seen for the past 4 years we have gone really down in times of social amenities and especially let me touch for the youth first before even I touch for the others we have a lot of talent raw talent lying in kasarani they cannot be exposed because of the lack of support. Me and my team we are going to start working with the talents within the kasarani and before we go to we finish the the decision 4 years or 5 years as when we will be leading we will make sure that the social amenities are again reborn in kasarani because we have poor drainage system we have problems of water and security so I would like to say this with the youths or I the youth have the capability and the ability to tackle responsibility we only need opportunity and this is the time I am asking the youths that kwa maana sisi tu kengoja inje tuende ndani sisi tu kate keiki ambaile na tutosha tu eze kujigawia na tuto angoja tena tu pangue wacha san sisi tu e ppamoja na ile kamati yaku pangana na kini ambaile pika keiki sinupia na zazema keiki na fei katwehen kiki nye tuote so sisi kamao atua kasarani keiki ambaile na toka national treasure kapkuki na kufanya kasia ngeg булоakatumatita ngaofa kamao tochi na juwane dasi ya k encontra mafanya I wish you the best. I will also host you again and again. Thank you so much for coming. Thank you so much. As always, that is the best place to be right here on Y in the morning. At Ramagukwa and at Y244 Channel is where you can be able to engage with us. Keep talking to us, let us know where you're watching us from and of course we shall sample your feedback a bit later on during this conversation. We're taking a break, we'll be back in a bit. Remember, we still have another conversation coming your way.


Welcome to the Texas Heart Institute Educational Programs on Innovative Technologies and Techniques. The next topic that we are going to discuss today is current status of TAVR. I'm Zvonne McRayser, I'm an Interventional Cardiologist at the Texas Heart Institute and Baylor St. Luke's Medical Center in Houston, Texas. Join us today is Dr. Vino Turani, he's a Marcus Chair of Cardiovascular Surgery and Director or Marcus Valve of Piedmont Heart Institute. He also has multiple positions and accolades as you can see. He's the President of Southern Surgical Association and the President of Heart Valve Society, as well as the President of South Atlantic Cardiovascular Society and Co-Chair of SDS-ACC National Transcarriage Valve Therapy Database. In addition to being co-principal investigators on many TAVR clinical trials. It's a pleasure to have you here, Dr. Turani. Thank you, Dr. Craig. Here are our disclosures. I have no conflict of interest pertinent to this presentation and Dr. Turani states that he has no conflict of interest pertinent to this presentation. So, Dr. Turani, we recently saw this publication of the SDS-ACC-TVT Registry of Transcarriage-Triotic Valve Replacement and the trends in the United States with TAVR from 2011 to 2020. And you are one of the participants in this particular study but also you have tremendous experience from other studies as well, which is the base of this information. Can you share with us a little bit about this particular study? What are the new developments? And let's start with how many sites were performing TAVR that were included in this study and also a little bit about TAVR volumes. First of all, thank you to you and the Texas Heart Institute for the invitation to be with you for this session. And this is some of the latest data. It's not only part of the manuscript that we published with John Carroll in 2020, but also some additional data that's unpublished. And I'll go through those over the time period. You can see this slide really talks about the geographic distribution. The next slide will talk a little bit more about the volume. But you can see, for instance, in Texas, you see an epicenter in certain areas of Texas. And for those of you watching this, you'll see that there's a lot of sites in California. There are a lot of sites in Florida, a lot of sites in Texas, and then in the Northeast corridor around New York and Boston. And so this just gives you a geographic distribution with a paucity in the middle portion of the country that is west of the Mississippi. And you can see that there is a lot less sites. But this just gives you a glimpse of where the sites are. And on the next slide, what you're able to see is that the right-hand side, you can see they're now year-to-date for 2020. This was the first quarter of 2020. There are 701 sites doing TAVR in the United States. And you can see that the volume has gone up through in 2019. There were 73 isolated TAVRs performed. And you can see there was 4,492 valve and valve procedures performed. So we're just knocking on 78,000 cases. You can see Q1, 2020, they were already in Q1, they were 15,000. But remember, COVID came into play. So I'm not sure that we'll hit that number that we thought we would, that growth that we would see with the low-risk patients. It'll be interesting to see, Zinnabar, whether we're going to hit that number because of COVID. But you can see the trends are pretty impressive since 2012, since we've started the registry. So can you mention a little bit about what has happened to the outcomes as far as TAVR is concerned over the last decade or so? And particularly considering only overall mortality and mortality with different risk groups. Absolutely. So this just shows you the one-year mortality. So let's go through this a little bit. The blue line represents in-hospital mortality. The red line represents 30-day mortality. And the green line is the CMS-linked one-year mortality. So we're a little behind on the one-year CMS because it takes a while to get that data. So if we just concentrate on the one-in-hospital 30-day mortality, you can see that our original, when we had extreme risk patients in 2012, you can see the mortality was up to almost 8% in 30 days. And you can see how over time that has really dropped over this seven-year time period to 2.3%. This is all patients. It includes low-risk, intermediate-risk, high-risk, extreme risk. So it's a different patient population, but you can see overall, you can see that it's about 2.3% in 30 days. If I go to the first quarter of 2020, you can see that we're down to 1.1%. Now, I think that the next slide will really show you what we're talking about within the risk groups. It's very different. I think that just the previous slide showed you just generic numbers. I think it's not fair anymore to look at that. When you agree, it's in every way that you have to break it down into risk categories. So if you look at 2019, all patients had that 1.3 and that 2.3, what we talked about. But look at the differences. Low-risk patients had a under 1% 30-day mortality, a high and extreme risk-ribid patients out of 3.7%. So really, when I start to think about this, I think this slide is more important to me than is the previous slide, which is talking about today. And I can constantly tell my patients that are getting low-risk, low-risk tavers that they'll have a less than a 1% chance of mortality at 30 days. What are your thoughts? Do you agree that this is kind of what you're seeing in your populations? Oh, absolutely. I think this is absolutely remarkable, particularly when we start reviewing the data from the early experiences and you were co-principal investigator of the partner trials. And you remember the problems and issues related to mortality and also to morbidity. So I think it's a tremendous progress. Yeah, I think that another progress that we'll talk a little bit about in the future is that I was doing 45, when I did my first tavern in 2006, we were doing 45% of our patients were trans-apical. Remember, we've gotten away from that. And we'll talk a little bit, you and I will talk about that a little bit in a minute. So one interesting thing is, and maybe this is appropriate time to mention this, but it's related more to the future. We can see that we can reduce the mortality, hospital and 30 day mortality dramatically in patients that are so-called low-risk and intermediate risk. So it wouldn't be prudent therefore to be a little bit more aggressive in treating those patients earlier rather than waiting until they get to the critical condition. And then you have serious aspects as far as mortality and morbidity is concerned. No, I think you're right. And you're talking about sometimes asymptomatic patients, but also those patients that have maybe moderates and those patients that have worse and moderate but quite not severe. I think those are ongoing studies that are going on. There's an asymptomatic trial called the early tavern study that's currently enrolling patients. And there's a couple of companies that are working on a moderate AS trial also, moderate AS and normal EF, not the moderate AS and low EF. I'm talking about the moderate AS and normal EF. There's contemplation of starting those trials. So I think that over the next couple of years we're really gonna dive into that. But I think in the lower risk patients, we still need to look at long-term outcomes. I think 30 day mortality is probably not adequate for a 65 year old. I think we expect those patients to live over 15 years. So I think we still have a lot to figure out over the next five years. Very good. So one very important issue is a median length of stay. So what has happened in median length of stay? And this is a very important question because I actually was at your institution to learn how to do a fast track tavern. It means just a 24 hour stay. So you have tremendous experience in it. And one of the earliest publications in the United States related to this particular approach. Yeah, I mean, you know, resource utilization, I think for the physicality of an institution has become more and more important. And we did adopt that early on in the minimalist pathways that I did when I was in my prior institution and you can see the length of stays at 2014. You're looking at, again, high risk patients in green, red or intermediate risk patients in low or low risk patients are in the blue. You can see now over time, we've gone from four to five to six days all the way down to one to two days. So I think that for the most part, most of these patients now are, you would expect them to have a median length of stay after the procedure of less than two days. I think this becomes important. But what we needed to set out a little bit more clearly is we haven't stepped up from in-hospital mortality to 30-day mortality. I would rather a patient stay an extra day but decrease that gap of in-hospital to 30-day mortality. So I think we need to be cautious in not pushing patients out too fast. And we need to, in our own institutions, need to figure out how to close that gap of in-hospital in 30-day, even if it means that we keep the patient for one or the day. What are your thoughts about that? Well, I think for low risk patients, it's pretty straightforward that they can be shared within 24 hours. In great majority of instances, that's what we do practically routinely. It also depends on a patient's underlying condition, which plays a significant role as well. And many other factors, but I absolutely agree with you. We should not be discharging the patient just for the sake that we wanted to reduce the cost that we have to think of the patient's benefit first. Yeah. And it becomes more costly if they get reinvented, quite honestly. Right, that is absolutely true. But just one more comment relating to this shorter length of stay, which is like you say, minimalist approach that you've authorized and also what we call a fast track protocol for TAVR, which is not a topic of this presentation, but certainly it's doable for a lot of institutions and for a lot of operators, but you have to pass a certain learning curve. Yeah. And you have to know how to do it to avoid serious problems. You're right. I had done over 400 or 500 TAVRs before we started. I don't think we need to do that now anymore, but you probably need to have 40 or 50 under your belt so that you feel comfortable understanding where the snakes are underneath the rocks. All right, let's move forward. So another thing is that we would like to know what has happened with the trends as far as the age is concerned and time of procedures over a period of time. Yeah, this is great. So what I've elected to do is break it down into the different categories. I think that's important as we dissect these patients out. It's interesting to me, the intermediate risk and the high risk patients at the top haven't really changed in the last two or three years. They're still hovering around 80 to 81 as a median age. Look at what the low risk patients, you see some low risk patients in 2014, but that's all because what the team, the hard team designated that patient to be, but you see that we're down to 75. My prediction is that we'll be down to a median age of 70 by the end of 2020. So I think that this will continue to decrease. I think the high risk patients and intermediate risk patients will probably stay in the low 80s to upper 70s. Interesting. What is the hard team reason for the procedure? What has happened? Yeah, I mean, there's two ways to look at this, right? There's one which is the SDS score and then one is what the hard team designated that patient to be. And the SDS score sometimes don't match with what the hard team says. For instance, there may be a patient with a porcelain aorta that has a very low SDS score but is considered an extreme risk patient. So to me, this is a very, a better way to look at it is what did the hard team decide? Look at the growth of low risk patients in blue. It is now 26% of the tavers in 2020 of Q1. That blows me away. It's a faster increase than I had anticipated. Look at 2019, 12%. So if the rest of 2020 holds into place, I would guess that you're gonna have low and intermediate risk will be the dominant players for the reason for having a taver. And I think that we'll continue to see extreme risks and high risk, but the growth will be in low risk patients. Yeah, I agree with you. Nothing can replace the human factor and physicians experiencing, experiencing making the judgment. Who's at low risk? Who's at intermediate risk and who is at extreme or high risk? Yeah, that's great. And I do wanna show you what the SDS scores look like. So look at the high risk in green. It's about the same. It hasn't dropped as fast as I thought it would. You can see that in 2014, we had 6.7% as the median SDS score is now at 6%. If you look at intermediate risk, it has dropped from 5.3 to four. And already we're seeing low risk patients go from 3.1 to 2.3. But really if you look at the, from 2019 to 2020, it's really 2.3 and 2.3. So roughly we're seeing most of these patients, I think will be around the one to 2% range for low risk patients. Very good. And here, this is from the Jack article. You can see that the majority of these patients are going home now. Look at the difference in 2011 to 2013, only 2.3 of the patients were really going home, but now over 90%. This just shows you the reflection of moving from extreme risk prohibitive patients to lower risk patients in my opinion. Right. Another thing is that maybe it's not well represented here, but it's certainly true in your experience, in my experience, using the minimalist approach, local anesthesia and conscious sedation, for continuous approach, offers us the benefit to discharge patients sooner. No doubt about it. Have less complications, whether it's vascular or cardiac or whatever else. What we noticed that we actually early on, one of the things that drove us to do this is that when you have octogenarians who are intubated, they almost, most of them, greater than 2.3 of them, had some type of swallowing issues and they had silent aspiration. And you don't get that if you don't intubate the patient. Right. So let's talk a little bit more about some issues that have been a major problem in the past, particularly as far as access side preferences are concerned and reasons for those complications and what has happened in the last decade or so. And how has this affected the outcomes? So I think this is probably the number one reason that our outcomes have improved. You can see that a third of the patient, 30% of the patients were trans apical at that time in 2014. We only had trans aortic or trans apical. Subclavian was not that popular at that time. Look at, and you've seen our curves for mortality, they're absolutely inversely related to this. Look at the growth that in right now in the United States, 96% of patients have a transformer arterial access. And that I think is a large portion of YA patients are going home at one to two days afterwards. B, they're going home instead of going to a nursing facility. And three, I think our survival is better because of that. So there's no doubt in my mind that this is a very important reason of the improvement in the outcomes for trans catheter bowel therapies. I'm sure you would agree with that, Zenibir. Absolutely. Actually in the early trials, partner trials, the incidence of vascular complications was close to 16%. Yeah. And we have dropped down tremendously to definitely below 5%. 5%, yeah. Yeah. And I think that has been huge. And think about how that's happened over a decade. And to me, that's absolutely remarkable that the companies have been able to do that within a decade. And definitely the closure devices have helped us agree to do that as well. 100% agree. And so we did want to just tell you what are the different pathways for alternative access. So you can see trans apical has significantly decreased. I've done over 300 trans apical valves, TAVR valves, and that was my mainstay. But as you can see in the United States in 2019, only 200 were done in the entire United States. So a major decrease. Direct aortic cylinder has gone way down. Accelerate becomes a dominant so far, but the fastest rising is the transcarotid that we are able to publish the first paper in North America in doing that case when the valves were first available in 2014. So I've now done over almost 75 transcarotids. That's my second choice, but you can see the country across the board is doing more axular subclavian. And I think these are interesting. Other includes trans cables. So trans cable is also an alternative access that is being used, but not in huge amounts as you can see here. You know, interestingly, I was a little bit surprised to hear that your second approach is transcarotid. We do a significant number of TAVRs and I personally have not had any scenarios where I felt like I have no other option, but transcarotid. Part of the reason for it is, number one, we feel pretty comfortable with femoral acids and percutaneous closure devices. That's number one. I've been doing that for several decades for EVAR, T-VAR and so on. But also now with the advent of shockwave, we can treat those and gain access through the femoral artery. So I have not had a need really to use a carotid access. Occasionally we'll do a subclavian, but most of the time we are successful with a trans femoral and trans-cable. Yes, it's reasonable in certain scenarios, but the technology is not there to remedy the access sites. And then it adds a cost tremendously. I know it adds a cost. So our pathway as transform arterial, number two is shockwave to your point. But remember that was only available for the last year or so. Before that, we didn't have access very much to that. Our third choice is trans-cable. Our fourth choice is trans-carotid. So what I mean is our second choice, it's after shockwave, after trans-cable, then it's trans-carotid. So people have to have gone through four rejections before they get to trans-carotid. And another reason that this is less and less needed alter the access is because the profile of the devices have decreased. And I expect them to get better, don't you? Right, absolutely. So there is less and less need for alter the access. I agree, 100% agree. Okay, so let's talk about differences as far as the growth is concerned between TAVR and SAVR.  So you started with SAVR first and now you're embracing more and more TAVR. But what is happening? What are the trends? Yeah, so I think you're right. This week for me is a mix of both, right? I did five TAVRs today. I've done three aortic valves since Wednesday, right? So in two days, it's been a total of eight of ways of eight valve patients, aortic valve patients. Three have been open, five have been trans-catheter. So I've embraced both of those equally. But what we'll see in the country is the black line represents TAVR. You can see the exponential growth of it. Number one represents the intermediate risk patients. Number two represents the low risk patients. So you can see the escalations in late 25 and the escalations in 2019 from those two components. And the very top line, which is all SAVR, that includes AVR cabbage, AVR mitral valve, bental procedures, root replacements. As you can see, that's now for the first time it's starting to decrease from 64,000 to 57,000. The blue line is isolated SAVR only. And you can see that line is slowly decreasing, I think since 2016. So overall now, there are more TAVRs implanted than all surgical valves. But you must also acknowledge that we are now treating more patients of the aortic stenosis as a whole. So if you look at 2012, the number of weird patients we were treating was only about 66,000. Now you look at it and it's over 130,000, 40,000. So the overall number of patients we're helping is more, and I think TAVR is leading the charge of helping those patients. Very interesting. Now, one of the hottest issues is valve valve procedures. And what is your personal point of view and then what did the literature show as far as the trends are concerned? Yeah, so of course, we're only going to talk about TBT tonight for this session. We're only talking about TBT, so we're showing trends. We do a lot of valve and valves. Now, lately, quite honestly, we've been doing some TAVR and TAVRs. That's a whole new ball wax. This doesn't really include that part of it. This is more of TAVR and SAVR. I think that these are something that we're seeing more and more of. I get very upset when I see 19 valves and 21 valves from surgeons because they've become a bigger problem for you and I when we do a valve and valve TAVR because the gradients remain high. And so that becomes a problem. Look at this. You're starting to finally see an increase. This is the orange, the red lines, or the actual elective planned TAVR and SAVR. And so this is escalating from 1,300 patients to 4,500 patients. I think this will increase more and more because more and more surgeons are putting in tissue valves. The number of mechanical valve implantations has gone down dramatically in the United States over the last decade. You can see immediately and during TAVR, that's a complication. That's an intraprocedural complication that is going down. And so the need for a implantation of, let's say, one valve and then right away you had a periodic leak or you had embolization and you have a second valve, that complication is going down. But the overall elective cases for TAVR and SAVR are going up. It's nice to see this, but I don't think we've cracked this nut yet. I think there's a lot of issues with gradients and thrombus that we still have to work on for this patient population. Now we need to discuss a little bit of the issues that are still persisting or the unmet needs as far as TAVR is concerned and what is coming in the future or what are we doing at the present time to overcome those unmet needs? Yeah, I think that stroke has always been there for us. And I would say that the best data is the 30-day data in hospital data. The CMS link data is not a complete data set because it's in older patients. But we have not made a significant dent. We've gone from 2.8 to 2.4. Remember, I showed you the mortality slides that has declined in mortality over this time period. We've seen decline in the length of stay, decline in the age, everything. We haven't seen a huge decrease. We're still seeing a 2%, just north of 2% stroke rate. Even when treatment protection was added in 2018, we're still seeing a 2.4. Let's see what happens with 2020. We did see a small decrease as you see in the in hospital because I have that data for 2020 Q1. It went from 1.6 to 1.4. So this is adjudicated through the TVT through DCRI. So this is the one of the endpoints that we do adjudicate through the TVT database. So I think the data is good. I think that we need to find better ways to decrease the stroke rate. So how does this compare with the cyber? So it depends. So I actually published a paper on animals of thoracic surgery. It depends dramatically on the risk of patients. And I think that we need to dissect this out in the risk categories of patients. In low-risk patients, the stroke rate was very low, similar to this. But in high-risk patients, it was higher. So it'll be interesting. I think that overall what we originally saw from Part 1, we had a much higher stroke rate in TAVR. I think that right now we're probably seeing a lower stroke rate in TAVR than we are in surgery. Yeah, so there is an issue whether cerebral protection devices significantly improve or reduce the risk of symbolic events. And what we have seen here is there's no dramatic drop. And this is understandable because any manipulation with catheters or wires across the aortic arch that has a lot of ethnometer changes can contribute, including placement of the cerebral protection devices. When you use a transcranial Doppler, and you start at the very beginning, you can see that any manipulation of any devices contributes to those hits or micro-embolytes. Now you're absolutely right. I think our experience, the positive thing, even though with issues that we still have to deal with is that those strokes are really minor. There are cognitive changes to a certain degree or minimal changes and very, very few patients need a major rehabilitation. Is that your experience as well? Yeah, I 100% agree with you. I think that the amount of stroke burden is less with transcatheter valve than it is with surgery. I do believe that. Commonly with the surgery ones, it's a large particulate matter that I think causes a very heavy or debilitating disease process. You're right. So pacemaker rate originally was about the 9% to 10% range. When we introduced self-expanding into the market, there was an increase in pacemaker rate. It has come down to about 7.8 to 10.6%. I think this is somewhere that we need to be better at. I think 11% rate maybe in a high-risk patient's okay and maybe not so good in a low-risk patient. And these are across the board higher than surgery when we look at these patients. So I think this is something that we're either gonna be setting ourselves up with a lot of tricuspid regurgitation down the road, but I think that we need to get better. The devices need to get better to decrease the amount of pacemaker rate. I'm not okay with 11% low-risk pacemaker rate personally. Right. Well, we have seen now numerous publications from different centers, talking about special techniques, so-called CUSP over lab technique to reduce the pacemaker rate all the way down to somewhere in the range of no more than 3% to 5%. And that's what I have. Last year I looked at my data for 2020, our data at Piedmont Heart Institute and ours was less than 5%. And so I think it does make a difference. Okay, so let's mention about some newer technologies and techniques that are available or that are on the horizon. And we already did discuss a little bit about cerebral protection devices. Yeah, I just wanted to give you a glimpse of what are the... People ask me, is what percent of the device in the United States are using Sentinel? So when it was introduced in 2018, 7%, right? Right. It went up to 11% in 2019 and 2020 we're sitting at in the United States, 13% of all TAVRs done are using the Sentinel device. So everybody, I do them in valve and valves, I do them by cuspids, I do them in certain scenarios, those with previous strokes, those with heavy calcium burden, but not at every patient. That's probably represented. This is why we do about 15% of our patients are have a Sentinel device. And that's what the country's showing right now from our database. And there are some other devices on horizon that might be... That's right. That will cover all major cranial vessels and hopefully that will... Right, including the vertebrals and everything. Right. Yeah, so this just gives you an overall look at the adjuvant technologies that are being captured in a TBT registry. One is a Sentinel device, which is prevention of embolic strokes. As you can see the total number from 2018 to 2019 were over 11,000 native TAVR patients and 960 of the valve and valves. There's fracturing of the surgical valve rings, which is reduction of post prosthetic PPM, the patient prosthesis mismatch and valve. You can see there are over 300 of those put in. And there's the basilica procedure at the prevention of coronary obstruction, post a TAVR, so in a valve and valve case or others. And you can see here that we're starting to just getting close to maybe 200 patients for these. So we're starting to increase overall these unique techniques that are being done in the country. And it says no one site is doing too many. This will... The TBT database allows us to aggregate those in a much larger population. Very good. So let's summarize, if you don't mind, all the achievements that have been made in the last decade for treatment of patients with aortic stenosis and using TAVR approach. Well, I'll summarize in the TBT and I'm honored that the STS and ACC have allowed me to be on the executives for the registry. And what we've learned a lot from the United States database is that the procedure is now approved for high intermediate and low risk symptomatic patients. Mortality over the last five years, six years has significantly lowered. And I'm very happy and glad to see that. Bascular complications have significantly improved over this time period. The length of stay has been rapidly improving such that most patients are going home at one to two days. Femoral access has gone from in the 60 to 70% to all 96% now. And I think that's been a huge reason for the improvement in all of our outcomes. I think that the postoperative pacemaker implantation and also the stroke rates have decreased, but at moderate rates. And I think that's still what we, you and I and others need to really work on to provide better care for those, for our patients in that regard. And I think that, well, and I mentioned this earlier for us to really adopt this in all low risk patients, we need a longer follow up. And that's something that we're working on not only the TBT database, but also in the randomized trials. So it looks like the future is bright as far as stamina is concerned. Absolutely. And maybe the last comment that I wanted to ask you to give us is what do you see in the future as far as improvements in TAVR are concerned? What are the potentials? What's coming as the new technology and what will make TAVR even better? Yeah, I think that, you know, we'll start, we've been working with alloys that are a little bit antiquated night and all and also Chromium cobalt. I think that we'll start to see a development of more better alloys that'll allow us to get down to maybe 10 French instead of 14 and 16 French. And that'll give us a lot more capability of doing procedures. I think we'll streamline them so that we can better predict by computer simulations. We can decide this valve is better for this valve for this patient scenario. I think computer simulations, I know we're working with some guys at Georgia Tech on this that's gonna, I think, improve which valve is the best, which valve has the least amount of thrombosis, which has the best amount of coronary access. So I think that computer simulation is gonna become important. I think that having a technology that allows us to have better federal access to 99.9% and allows us to get to 10 or 12 French sheets will become really important adjuncts to improve this procedure. And of course, that will somehow will need to work on computer simulations also for pacemaker implantation, where to put it, where not to put it and decreasing stroke rates. So I think we have major areas of improvement. I think the next five years is gonna be an absolutely exciting time for patients to have this new technology. Very good. Vinod, I greatly appreciate your participation and to give us the opportunity to join this Texas Art Institute educational programs. I think you are one of the shining stars as far as staff are concerned and promoter of this technology. And we are all indebted to you and appreciate all of achievements that you have made in this field. Thank you very much for your participation. Thank you. I'm very honored that you asked for me to participate. Thank you very much. Thank you.


and welcome to Restaurants Hawaii on Think Tech Hawaii. I am your host, Cheryl Matsuoka, the Executive Director of Hawaii Restaurant Association. And twice a month, we discuss important and timely topics centered around the Hawaii food service industry. So today I'd like to give my guests an opportunity to introduce themselves and tell you a little bit about them.  Tell us a little bit about the company you're with. So Ed Chung, I'm General Manager of Hager-on Media Group. In short, we are a food service digital marketing agency that helps businesses grow their sales by leveraging technology, creative design, and sensible marketing strategies that work with most budgets. Hager-on Media Group is part of the Hager-on Corporation, which is a billion dollar company that operates a fully diversified portfolio of businesses ranging from media companies to hotels and even casinos and golf courses. We are part of the, as part of the media group, we focus on digital marketing and operate in four states, Idaho, Washington, Montana, and Hawaii. We have a centralized production center in Idaho with a team of SEO experts, programmers, content writers, and graphic design departments. Here in Hawaii, Robin Kennedy, these are digital marketing efforts and has done a tremendous job by helping our clients increase their sales. It's also noteworthy to know that the Hawaii division also publishes this week magazine, which is picked up millions of visitors each year. Our work and experience in the visitor market has great synergy with our digital marketing services because we know how to reach a transient market that is only physically present in Hawaii for an average of seven to 10 days. And that's what we do. Thank you, Ed. And now, Robin, could you please introduce yourself? Here, hi, you guys. Thanks so much for having me. My name is Robin Kennedy. I'm the vice president of Haggadon Media Group. My sole purpose originally, when I was hired by Clint Schroeder, which many of your listeners or followers, I'm sure we'll know. He hired me almost seven years ago to come in and really kick in a digital marketing division. We knew based on my years and years of experience, I've been in Hawaii 22 years, so the majority of my time has been in media. So TV, radio, print, you know, 12 years at Paycom, servicing any customers looking to work for the military. It was there that we got excited about digital. We saw technology that the military was using to specifically target individuals at the street level. So we put our names in the hat and told the community we were looking to do some different digital than some of the other strategists were doing and Haggadon picked us up and we've been happily here ever since. So seven years, we are basically a full service agency, but we focus mostly on digital strategies for our clients. Yes, and Robin has a wealth of knowledge in this area. Robin and I have known each other for how many years, Robin? 22. At least, girl. Back on TV and radio. Yeah, yeah. We're happy to have you on the show. Thank you so much. Yes, and Mike Palmer. Hey, Mike. Why don't you introduce yourself? Yes, I'm Mike Palmer, owner and managing partner of Ho'okipa Partners, a hospitality management consulting firm, and we are currently operating the Kuhio Avenue Food Hall in the heart of Waikiki International Marketplace. I, too, have been in Hawaii for 22 years, originally from California. And so we have a lot in common right there. Right, awesome. Thank you so much. Today, we're talking about digital marketing for restaurants and businesses. So the name of the show is Digital Marketing 101 for restaurants and businesses. And as everyone knows, right, the power of digital marketing. Today, we're going to talk about how you can target your customers with the power of geofencing and geotargeting technology. And Ed and Robin are going to demystify that whole digital marketing industry and how you can use it for your advantage. Geofencing can work as a multi-channel marketing strategy and can even help you with your social media presence. More specifically, geotargeting allows you to set targeting criteria while inside a defined location radius. So today, we're going to be discussing it in detail. So this is a really great opportunity for businesses who understand that to drive your brand awareness and to drive traffic, you need to have this tool of digital marketing in your marketing toolbox. So let's start talking about it. So I'm going to first start off with Robin. So how do you help businesses increase sales and awareness in general? Well, basically, we've created here a very conversion-oriented business strategy. So we start with all of our customers, regardless of the restaurants or doctors, lawyers, whatever kind of business with a discovery call. We truly try to pinpoint exactly what it is that the advertiser is trying to accomplish. So not a big fan of branding. I mean, it's always great. Let's say it's a new restaurant and nobody has any idea that they're there. We'll spend a little bit of the budget branding just large amounts of people getting everybody aware. But at the end of the day, especially with COVID and all the things that have gone on in our market and worldwide, frankly, there's not everybody has these billion-dollar ad budgets anymore. So again, we specifically have separated ourselves from the pack and that we're really about targeted conversion traffic. So finding out who that specific customer is, geo-fencing that you shared, there's a lot of different strategies within that geo-fenced strategy, but you can typically geo-fenced. Our tech has the ability to come within 18 inches of a building. So you can geo-fenced specific buildings, not waste impressions on people that are not your customer or we can also curate lists or let's say a restaurant has a rewards program, they have a CRM full of their customers. We can take that file, upload it into our technology and we can serve specific ads to those people at the household level. They can cross the way, smash. So there's all kinds of amazing opportunity but what we typically do first and foremost is find out what the client's conversion strategy is, what are they trying to accomplish? And then we build all of our campaigns and what technology we're gonna use digitally based on their goals. Cool, oh my goodness Robin, that sounds like a lot. So that's great. Mike, so what's your experience with today's digital marketing capabilities and how's it helped your restaurant? Well, actually, if it wasn't for geo-tracking and geo-fencing, I wouldn't be sitting here talking to you today. I've got a pretty interesting story about it. So back when I first joined, actually it used to be called the street food hall by Michael Mina. My first day on the job I was told that it was very large possibility it was gonna be shut down in about three months unless we could figure out how to turn the place around. So I did whatever I could to increase sales and cut costs and things and try to make it a viable business. What happened in about, I'd say a six month period it's got a happy ending to the story. So the mall actually did a geo-tracking survey of where the customers were going when they entered the mall either CaliCala or Cahuillo Avenue. What that survey showed them was that we were the most highly trafficked spot in their entire mall. So now it really swung the pendulum from, oh, we gotta shut this place down and lease it out to someone else to, oh my gosh, we can't do without this place. This is what's bringing people to our mall. So they realized we're more of an anchor than say Saks Fifth Avenue, bless their soul. Yeah, with five whole people in there. Yeah, yeah. But they realized that people were coming to see us and then dispersed throughout the mall after visiting us or before visiting us. So their attitude about the food hall changed significantly after that. And so I'm a huge fan of what those capabilities do. Geofencing is definitely cutting the edge. Every year I think more and more people are getting on board with geofencing and how they can capture customers, whether it's within 500 feet of their space, a few blocks, a couple miles. The technology is really cutting edge. And I think a lot of restaurant owners don't know about the possibilities with geo-tracking and how you can increase your business and drive people into your restaurant by utilizing it. But I'm a big fan. Nice, thank you, Mike. Thank you so much. So we, our restaurant industry is not only restaurants. Sorry, our food service industry is not only restaurants. We have bakeries, coffee shops, farmers, distributors, produce suppliers. So what's really important is the talk about social media, social media, Facebook, TikTok, Instagram. So what's the difference between social media marketing and social media posting and boosting, Robin? There's a difference, right? There is a difference. Thank you so much for asking that question because I feel like it gets missed. I'm not sure I might give you experience that, but the posting and boosting, and I truly appreciate people that pay us to do that for them. I haven't ever been a huge fan as a marketer. I'm not that big excited about people paying me to post because my personal opinion is that nobody's gonna find your Facebook page. I mean, when I'm trying to figure out a restaurant, I'm not going to Facebook to search, restaurants near me, right? So posting and boosting is great when you are doing your lifestyle, you're communicating things that are going on, maybe daily specials, et cetera. But at the end of the day, you're talking to your friends, your friends' friends, very specific relationship with the people that like or follow your pages. The Facebook marketing gives us the ability to get out of that seven degrees of Kevin Bacon thing where it's all people you know. And you move on to marketing into people's new speeds that are your potential customers. So let's say you're a fine dining restaurant, you're not gonna wanna be reaching an 18-year-old or even a 25-year-old that's talking about whatever happened at Waimea Bay this weekend. You want to be able to target people that are your customer that have, basically it's targeted like potential customers versus friends and family. I guess that's the best way to do it. We have the ability to target potential customers. Your own Facebook feed, boosting and posting is very limited. So the marketing has a way better ability to target more people. That totally makes sense, totally. So Mike, moving forward, how will digital marketing capabilities change your overall marketing strategy over at Cahill Avenue Food Hall? Well, I think digital marketing is really where it's at nowadays. Print is obviously, I think all the media companies that had print like Haggadon are moving more to digital. Although this week is a great publication that's probably one of the most recognized ones with tourists and Waikiki. But most print media now they have an online element with their website or their Instagram or whatever. I personally haven't utilized Facebook yet. It's definitely in my plan to start driving business into our restaurant. Instagram I have utilized, but like Robin said, you're only as strong as how many followers you have. So if you're posting stuff on Instagram, you're not reaching a huge audience unless you have a huge following and then they're sharing it and things like that. What we have done is teamed up with them all and we have social media influencer events.  And that has been really helpful. I mean, I can give you instances where we had an event and it's not my Instagram page that's blown up, it's theirs that features us kind of thing. And then they tag or collaborate with us. So I think there's a lot of benefit to that. But again, to Robin's point, it's about your followers. And if you don't have enough followers, your impact of putting a blast out there is only reaching a limited audience. So I'm interested to learn more about the Facebook thing. Website, I think it's absolutely critical that you have a great website because I can use Google Analytics or whatever and see how many people visit the website. And what was fascinating to me is once we got our website up and running to see what percentage of those viewers are looking at it from their phone versus a computer and the numbers are mind-boggling. It's like over 80%, sometimes 90% are browsing on their phone, not from a computer. So that gives me another idea of your audience and what they're doing, they're mobile, they're moving around, they're walking around, which again, ties into the geo-tracking, right? Very interesting. So Robin, what's the difference between programmatic, display strategy and other display strategies? Well, I was gonna turn this over to Ed, but because we're- Okay, go for it. It's okay, I mean, bottom line is this, since the day I started doing digital, I was like, why do we have to name everything? But programmatic, it's like acronyms with the military, right? Programmatic is that is, sorry, Ed, he's, I'm looking at, go ahead, Ed, you go for it, have it, Ed. Well, I mean, to just keep it simple, it basically just focuses your display dollars and makes it most efficient delivery to your targeted audience.  Programmatic focuses on behavior and tendencies of the user on the internet. And we're targeting those people that specifically align with your goals and your strategies. And so, we're making the best use of your advertising dollars in that regard. We're not wasting any impression. And that's as simple as I can put it, right? Right, and basically the programmatic are the platforms that we're using to optimize and target more focused. Display strategy is the type of ad, right? So the display are the picture ads that follow you around. So programmatic is the entirety of whatever strategies we're using and platforms within the tech and the display is the type of ad you're serving. So, yay. Good job. Thank you for explaining that. That's something I can probably go back and listen to again. So as you know, the Hawaii Restaurant Association, we have restaurants that are fast food, quick service restaurants, family dining, fine dining, the large chain restaurants. We also have, of course, the bakeries and the coffee shops, all the other types of organizations. We even have hotels that have restaurants. So is there a difference in strategies for restaurants that compete in all the different categories? Is that for me? That's for Robin or Ed. Okay. Ed had his chance, I'm just kidding. No, Ed's really with the CFO. So he's done an amazing job catching up. Trust me, he's great. Yeah. Wait, tell me again the... Oh, if we're talking because we could do many... Oh, different types of... Right. Right, fast food. Yeah, so all strategies starts with the clients strategy. I mean, honestly, every campaign is based on what the client is hoping to achieve, what kind of budget they have. So I am a big fan of not going in with asking for huge budgets initially because there's a lot of data and a lot of opportunity in those first few weeks to really garner some really great information about how the campaign can be optimized and move forward. So basically we start with getting a good understanding of what they're trying to accomplish. And then we talk about budget.  So we go in with a minimum spend. We talk about what they're trying to accomplish. Is it butts and seats? Is it order online? Is it join our rewards program? So whatever your type of restaurant is trying to accomplish, we base the strategy on that opportunity as well as a budget. So if they have a smaller budget, you'd probably get one platform as the budget increases we made add additional because there can be pay-per-click as well as display. The display strategy alone has four or five tactics, right? Geofencing, conversion zones, contextual keyword search. So there's a lot that goes into each different type of campaign. So depending on the budget is how we will decide how many platforms and how to move forward. So there's room for every budget, but I can tell you the more you spend, the faster it comes. I'm not sure if Mike can attest to that, but definitively the more opportunity. And then Mike, I'm not sure if you use conversion zone strategies with your tech, but our technology has the capability to serve ads to people in specific locations, but then also track them offline back to Mike's area, back to his, I still call it, sorry, eat the street. I was there for the opening. I went to so many parties, but that whole venue is amazing. So we can track how many people we've served ads to outside and then track them back offline into the business with a conversion zone. So that same type of geofence is drawn around the business that we can tell them, hey, we served an ad to your competitor over at home on a center food court, and they came three days later over to your venue. So we track who we serve ads to coming to the venue offline after. So that's really cool. Some people think it's creepy, but I totally dig it because we can prove what we're doing work. So I love that. So yeah, if there's an opportunity there with your tech to do the conversion zone, I would encourage everyone to use it. That's awesome Robin. And today's discussion is all about smarter marketing, utilizing digital marketing. So before we, we've only got another five minutes. So before we close the show, Ed, do you have anything else that you wanna say before we close the show about digital marketing? No, it just works. And from what I've seen and our clients, they typically start with a smaller budget, but once we start proving ourselves and they can see the results and we can show to them, typically we see our clients wanting to increase their budgets and it just happens over and over again. And Robin's done a great tremendous job in guiding the clients along and helping them achieve their goals. This is the basic of that. No, you're right. Robin is awesome. We've known each other like 22 years and he knows her stuff. So Robin, as we talk, close the show about digital marketing, is there anything else you wanna say as we close the show? No, I just would encourage people to like anything shop around, talk to everyone. I mean, there's a lot of agencies and businesses dabbling in digital, but you gotta find the people that actually focus full time so that they have a good understanding of exactly what your needs are and what platforms to use to get the results that you guys are hoping for. So yeah, we're here for all of you. I'm grateful to all of you guys for having us and we're here to answer any questions, free consultations always. Happy to look at people's current strategies. We're one big family. I mean, HRA's family, HLTA, all of these organizations come together to support businesses and we're here from Hagenon to help you guys in any way we can. Very nice. And Mike, you have the experience and have seen the success come from digital marketing. Is there anything you would like to say before we close the show?  And I would say you wanna spend probably the majority of it in digital marketing would be my personal recommendation. Every location's different, but I think the best advantage at digital marketing is you can actually track the results.  You can, if you take it to the next level like Robin and Ed spoke to, you can track them coming into your place of business and knowing if they came from the food court at Alamwana to international marketplace. If you take it to that extent, as creepy as that may be. As a business owner, it's amazing to be able to get those kind of statistics and see that money I spent worked and it paid off. So I think that is probably the greatest thing about digital marketing is it can be measured and you can see if it works, if it doesn't, you can change your strategy to something else, but it is the way of the future and I think anybody that isn't using it needs to seriously consider partnering with Haggadon or like, I love it, shop around, look at restaurants out there that you admire that you like, look at what they're using and what companies they may partner with because there's a lot of restaurants that do a really good job at it and then there's a lot that don't use it at all and there's a lot in between. So I think definitely do your homework. The HRA is a great way to network and talk to other business owners about what they do. So that's what I'd recommend, shop around but definitely get on board with it. Thank you, Mike. So Ed, if a business wants to get started, what is the best way to get started? I think we've scheduled a meeting, do a discovery call with Robin and I think we just call from there because everyone's situation is just a little bit different and their goals may be different. And we asked a lot of questions. We really try to understand the business before we even come up with a solution. Thank you. Thank you, Ed. So viewers, members, if you're interested in learning more, your next step is to contact Haggadon Media Group. Their information is on the Hawaii Restaurant Association website or you can contact me. Again, my name is Cheryl Matsuoka, the executive director of the Hawaii Restaurant Association. I'd like to thank all of my guests today. And again, the Hawaii Restaurant Association is the voice of Hawaii's restaurant and food service industry. Thank you, everyone. Thank you so much for watching Think Tech Hawaii. If you like what we do, please like us and click the subscribe button on YouTube and the follow button on Vimeo. You can also follow us on Facebook, Instagram, Twitter and LinkedIn and donate to us at thinktechhawaii.com. Mahalo.


rāti pāhi le ajuddhyare śrūṣṭi heba itihās. rāma-mandeera re rāma-lālāṅka prāna-pratistā uchha vare mūkhari tāheba purādesa. bhiṣśa dekhiba bhārata ra gorabamaya sanātan dharmara parākāstha. sepate āshānta madhyo prācče ra jūddhara chhita padila iran pāk simāri. Ātāngistān pākistāne vangi iran mohamuhi. Āmerika nir bācana re hebaki bada pari vartan. Samna samni punitare trump biden.  द हूँ ैत्ताका च ब वमावांण इ की च्रेकमा innocence ूआप कर्च मैंईदिरा टेछाता,। हतोई मैंएफॉःगें ून्जा करतिमाँङ काई्रा। tecnिका पिर्च सि finances ुईरा आप हो आपड्स जलत्तें एतु,। मुखा न expressions ।우 phon ratio pås80 vaardhi na f dat dhanus kodi antarkata arichal munahire pahuchi pujaachana kari chanti langkare pahuchi wala ki prabhu ramoche usthana re suphade thile polibhi suasakarajay aji sehisthana re radhanmantre modi uspanchalite chanti virore boat orgasmage atanki deshare atangra pakistan upare gata solotari ki rati re iranra mijail madha atanki ku paliposhi bada kari thiba pakistanku praharkarichi iran madhya prachare juddhara ghanagata maddhya re iran pakistan bhi tere arambu hoichi bibada pakistan iranra praharko sohozare grahan kari na thiba bhele samastho padusi deshaw pakistan nijad jaalare nijhe chandi hoichi wali pratikliya deba arambu kari chanti atanki deshare atangka pakistan upare iranra mijail madha akka madhala phada phada phaya bhaaya bhaaya bhaaya jetamani dela pakistan atankin ko atta pakistan ebe nijhe atangkare deshare atangki maranku luchahi rakitiba pakistan posichi atangko ghere re janwari solotari re iran pakistan odhikrutab eluchistan upare mijail madha jeu tere chare janakara muruttu ghati tibara khawar mirichi iran rati odhare pakistan re thiba atangabadi sanghatana jais e adal thikana ku drone mijail redtarget karitila ehi atangabadi manya atangabadi ngamruttu hi tibara dhabi kari chi iran iran re apari atangabadi naku nahi raga jara jara hoichi pakistan apari kari iran dui deshara kuta nahi tika samparka ku nastakari chi e bangi aso ita aakash simane omko langhan kari chi jahara phalo iran ku bhogiba ku padibabali dhamakteichi pakistan i think the question that really needs to be asked is why is it that virtually every neighbour of pakistan is blaming pakistan for harboring terrorists iran was actually attacking a notorious terrorist a sunni terrorist group called jaishel adal so iran has a problem with pakistan and claims that pakistan is harboring terrorists in fact afghanistan is today blaming pakistan for harboring daish and being hand in glove with daish india of course has constant complaints against pakistan and then you have the chinese for example who also have concerns of the presence of militants Uyghur terrorists in pakistan so clearly one is this question that pakistan has become a hub of terrorism in the region now iran has attacked them because i think partly the threshold of tolerance was crossed in the attack in karman on the mausoleum of the iranian general qasim sulamani so iran has been wanting to lash out for a fair bit of time for all the neighbours of pakistan this is the one country that all the neighbours are upset with it because of its support to terrorist causes i mean what can be a better proof of being a terrorist state second you know surprising that iran says that it fired missiles and pakistan couldn't detect them pakistan has attacked the iran army on the border of luchistan today the iran is trying to attack the iran in january 16 the iran has reported that the iran's revolutionary guard is trying to attack the iran this terrorist has attacked the iran's army so pakistan has attacked the iran's border this terrorist has targeted the iran's army this terrorist has attacked the drone and missiles so iran's army is trying to attack the iran's army so iran's army is trying to attack the iran now there is no other basis as to what iran's people sees humour is a limit humour is an income humour is a limit humour is a limit humour is a limit sada junicism ka, mole ka, aksamuse kog guru Almighty Kitac kar ka, eatar ka, nishghe se ra. nirb عalata yaragari anthank raka nirb ka, sao regardez. naangi dilimiesn sofa America, Bharata heu pas samastha islami ki rastra Pakistan ku samala chana kari chandhi E par istitre Pakistani Iran ku challenge karibane Sande srishti hui chi Partheu chi e Atankistan Barbat karidabha Iran Puni awye ko jud dharapadad dhani Atank birodre Bharata Barhila ap Pakistan Iran bhi baad Iran akramad aprati sodre aprati akramad kala Pakistan Iran pakistan upre akramad karibane Barathe goti e din pare Pakistan Iran upre akramad karichi Jhe uti re nao janankara murthi gati chi Pakistani bayusana Iran simare praves kari Air strike karichi Pakistan re hi mark bar Sarmachar operation re Pakistan re Iran rasistan e bang Baluchistan pradeshra Sarvan soharare Baluchistan Liberation Front e bang Baluchistan Liberation Army post upre akramad karichi Tebe attack pare Pakistan Iran ko e pari Vivaadya paristiti srishti Nao karibane ko appeal karichi Jhe ha Pakistan re Dho moha niti ko sarmna karichi Nijawdeshare Atankin ko Lucha ira ki Parosi deshaku upadesh Jhaaduchi Pakistan Charipade Parosin ko Satru kari Nijawdeshare Atankavadi ruppi Saapanku Paruchi Pakistan In this particular case Pakistan can use terrorism as an instrument of its foreign policy and get away with it without repercussions First it was USA who took out Usama bin Laden who was being protected and sheltered right next to its military academy by the Pakistani establishment Then it was India who struck the jesh camp in Balakot with astounding results and now it is Iran's turn One thing is for sure it's high time that Pakistan bends its ways If you don't remember Islamabad your history will not be in your history Pakistan government or the Pakistan military is either tolerating or giving refuge to militant groups and terrorist groups Something which India has been saying for a while Something which some people in the west or elsewhere have been slow to understand In this case India's Minister of Foreign Affairs Ajay Shankar has been thinking about Iran's Minister of Foreign Affairs during his visit to Iran Iran and Pakistan have been fighting for a long time because the authorities of the country have come here to discuss the truth of India In this day the government was late by the government of Pakistan and was caught up by the leaders The result of this is that the official of Pakistan is to be done by Iran The Minister of Foreign Affairs is the Minister of Foreign Arts and has to be hired by the Chinese his family in Iran His fellow Ummay నినేన్ర్రసతే వారినెత్సత్డి� Paint? వార్ర్రయెగొర behalf of Pakistan ఠ్సడ్ మకిరఫింనిరంి ఆవంచి వన్�一下 MS- Vijj, వూఠింధరల నిరాపంపై grande challenge for Iran  animated ಕಾವ್ಟು ಕಿರ್ರದಕಾ ಕಿತ್ಯಾತು ತು ಠ್ಸಿತುರು ಮಾರೆಕಾಣಿನರಿಕ್ದ್ರದಡು ವಾರ್ತರಾರಿಕೆ ನಶಿಗಾರೆತುರಿಕಾರಿಿ ನಚ಺ದದಾರ್ರಿಮುಗೆದಿಸಿದು. cos the biggest one? This isn't... They said, well, if you win by 12%, that's a big win. That's gonna be very hard to do. Well, I think we're more than double that, I guess. Triple that maybe. They only want to see one thing. They want our country to come back. They're embarrassed by what's going on. Our country is left at all over the world. They're laughing at us and they want our country to come back. They want America, you know, they want us to be great again. It's a very simple, maga, make America great again. And America first, America first is a very important part of America. America Rashtupati nirbhachana prathit tore Donald Trump vartwan Republican party ne aagwa chanti. Thibet Trump vartwan tango birodhre chaliti baag, mode case, vivaad, mokthiore, ehi bijo hasalkar chanti. Aiva re prathipadapai samarthana paibapare, Trump rashtupati Biden ku ekaprakar siddha shalakao challenge kar chanti. Konosi paristiti re bhi, America rashtupati nirbhachana ru tango durakara chai paribani boli dabi kori chanti, Trump. Onyapote Florida gavadna Ron Desandis. Ebang jati sangar purpa tana kutaniti gyan, Nikhi Helinka modehre, aiva kya kaushre dutiyas tana pa ek koda pratijogita lagi doichi. Ehani modehre Trump ko bijo rakichi samapare hi, Bharatiya Amerike uddiogi bhibe kramswami White House dhodar hu oori jaiti le. Aiva re Republican Party re prathaman aman konare bhiapare hi se Trump ku samarthana ka chanti. That this has to be an America first candidate in that White House. As I've said since the beginning, there are two America first candidates in this race. And earlier tonight I called Donald Trump to tell him that I congratulated him on his victory. And now going forward he will have my full endorsement for the presidency. And I think we're going to do the right thing for this country. We report our best future. Thank you for watching.