Ευχαριστώ και καλώς ήρθατε. One of the most common questions that I get is how do I start with ARGENALING, especially from card makers. So today I'm going to show you a really simple method that you can follow to create stunning backgrounds.  So if you are a card maker or if you just starting with ARGENALING, then the best way to start is small.  So here I have created a mini ARGENAL just to demonstrate today and the paper that I'm using is thick watercolor paper. It's widely available, you probably have watercolor paper on your stash already. Nice and thick and takes any type of medium. Now the size is 4 ¼ x 5½ If you are a card maker you are already used into working on this size and that means that whatever I create today could be easily turned into a card front. Now there are available dies and punches to cut out those holes for the discs and you can get discs separately but in any case you don't have to bind the book the way I did. You can just cut out 4 ¼ x 5½ paper and just go for it. Now I'm going to show you a method which is really foolproof. You cannot go wrong with this method and you will end up having a little color for a lovely little booklet. For that you are going to use your watercolors or if you have any watercolor brushes they work the same. I'm going to bring in my aquaflow watercolor brushes since I haven't used them for a while and remember you can do exactly the same with your watercolors. These are just brushes that have watercolor inside the barrel. I brought out 6 colors all in rainbow order. For each and every one of the pages on our journal we are going to use just 2 of those colors in that order. So for the first one I'm going to use red and orange. For the second one I'm going to go with orange and yellow, yellow with green, green with blue and finally blue with purple. These colors work lovely together just because they are next in the color wheel so you won't end up with mud. To help the colors blend even more I'm going to start by spraying a generous amount of water on top of my page. Remember this is watercolor paper so it's going to take enough water without warping. You may see a little bit of warping in the paper but when it dries it's going to try completely flat. For the first page I'm working with red and orange and remember if you don't have watercolor brushes then you can just dip your brush into your watercolor palette. I use those just because I have them and they are quicker. I don't have to dip the brush again and again on the palette. All I have to do is to just squeeze a little bit and a lot of watercolor comes on the page. I love how the two colors bleed on one another and you can even turn your pages in different directions to help them blend. You can even add more water on top but I'm just going to leave it as it is. I think it looks just fine. I'm going to clean up my area so that I can move on to the next page while the first one is drying. For the next one I'm moving on one color in the color wheel so this time I'm going with orange and yellow and I'm repeating the exact same steps. I did spray all over the page with water and now I'm going to use the two colors just blend them on the page. You will see that my yellow is a little bit dry. I didn't have enough in the barrel but it is going to work at the end. Now you can see that these don't blend so well just because my yellow was a little bit dry that's why I will use a little bit of the water to help them blend in one another and I'm going to leave this aside to dry. Moving on to the next page again the same steps this time with yellow and green. This is a great exercise if you're just starting with arginal ink. I'm going to show you some tips and tricks on what you can do on top of those watercolor backgrounds that we are creating now and then you will end up with a colorful background booklet that is ready to go. All you need to do is to just stick a quote on top a motivational quote and a focal point and of course you can find focal points everywhere if you have already stumps you can use those if you have dyes you can die cut things and stick them there but you can always print out images from the internet cut them out and stick them there or you can even cut out images from magazines. As you move on creating those pages you will find it easier more and more and you can see here I'm creating two pages with one go. Remember for this technique to work you need to have plenty of water on your page upfront this will really help those colors blend together now we didn't like these colors so I'm going to move on on a darker shade of purple and I'm going to tilt them help them blend with water and leave them aside to dry. You can leave them aside to dry naturally if you are impatient like me you can always use your heat gun. Always remember that depending on the brand of watercolors that you are using they may end up paler than they look when they are wet. I used my Nuvo aquaflow so I know that they are going to stay nice and vibrant. So here is my booklet ready to go I didn't do the back of all the pages because the video would take forever but you can go ahead and do the back as well. Now let's do some go-to techniques on top of these watercolor pages just to add some visual texture at the background for that you can grab any stencil that you have at home if you don't have any stencils you can grab something with texture and the design for example a lace I'm spraying water over the stencil not all over the place in some areas and while the stencil is still wet I can place it on top of another page I can switch stencils just for some variation or if you just have one you can go with it all over for all the pages. You will find that this effect that we are going for is going to be more visible on top of the darker colors and this is natural so don't worry if it doesn't show too much over yellow which is going to be the case for me as well. Now use a clean paper towel and remove any excess water this is going to lift some color and you will end up with a ghost design of your stencil on top of the darker areas of your paper. You will see that on my yellow it didn't work that much but this is not really a problem I can always go back and add even more water if I want to. Now the next step is super easy just go ahead and add some white splashes or even black splashes if you like those you can even use the same color as your background the darker one for each and every one of those pages so that they blend nicely. I like to keep my backgrounds quite subtle I don't want them to be very busy because I always like to stick on top a focal point and I want that to pop. For these splashes I'm using a spray paint which is going to stay nice and vibrant and super white but you can always dilute with water gesso white gesso or even white paint and even wash. The next step is to do some stamping. For that we are going to use borders as well as patterns. I am going to demonstrate this technique with this stamp set which is new by Tonic Studios. It comes with lots of borders and patterns on top they are quite generic these designs so they are really versatile and perfect for pretty much any page. I'm going to use all of them today and there is even a giveaway on this stamp set as well as the matching ties so make sure to visit my blog to find out how you can enter the giveaway. Now I'm going to pick up different patterns and borders to stamp on top of the background making sure that every time I am using the darker color that I have on my background so here I have orange and red so I'm stamping with red. This way I'm keeping the colors to be only two again. I'm not introducing any new color and I end up having visual texture at the background without turning it into being super busy. Every time I'm going to use a different pattern from my stamp set but always using an ink that is the darker color of my paper. Now there is always a method in my madness so if you follow these tips you will end up having lovely designs no matter which stamps you decide to work with. Always remember that there is no right or wrong in our general link I am showing you just the way I am doing my pages so that you can start from somewhere and then you can build your own style. You can always go ahead and stamp with different colors you can stamp with black if you want which I'm going to demonstrate later on so you can see how that looks. Always remember this is something that you do for yourself to have fun there is no our general police so just do what makes you happy. If you are already a card maker just keep in mind that this is not about having the perfect impression on stamping. Having imperfections is just lovely when it comes to our general link actually we are after them since things are going to look quite organic at the end. So for the first pages I went quite subtle for this one I decided to go with a slightly darker shade of blue. Again without introducing any new color however I went with darker shade so you can see it is more visible here that's why the visual texture that I get is not that subtle as the first examples. Also notice that I'm not trying to get any impression of the whole stamp just bits and pieces of the stamp here and there not everywhere making sure that the finished look is going to be random and organic. That was the last page and I'm going to zoom in so you can see a close-up look on all the patterns that we created. Now the orange and yellow one was quite subtle you cannot really see that texture at the background that's why in this example I'm going to go with black and I'm going to stamp one of the patterns included in the same stamp set using black archival ink and you see this looks equally beautiful as the other background so there is no right or wrong in our general link just do whatever makes you happy and let's take a quick look on the other backgrounds here is the yellow and green one this is the green and bluish and this is the last one with the purple. The plan for this video is to just create the backgrounds and stop here however I couldn't stop myself and I had to turn two of those backgrounds into art journals. One way you can go with those art journal backgrounds is to use dyes to demonstrate today I'm going to use this dye set which is the matching one with the stamp set that you saw before with all those backgrounds and borders you can use a dye on top of your paper and run it through your dye cutting machine to create different patterns and little windows just to add something extra and fun on a page this way you will be able to look through to the next page. Another way to use the dyes to dye cut different elements and stick them on top which is something that I'm going to do for the other page that I'm working on so for this one I decided to go with this large one which I'm going to dye cut and stick on top at this stage I don't even know what I want to do for each and every one of those pages I'm just playing here creating backgrounds that I like and it turns out that on my yellow green page I do have a theme I'm working with hexagons there so here you can see I did all the dye cutting I'm using again white watercolor paper for all the dye cuts and I decided that for the first page I can go with something simple just create a flower there if you have stamps you can stamp it cut it out and stick it there you can always print out a flower stick it there or cut it out from a magazine I'm going to create my own focal point so I do have a circle this is a watercolor circle watercolor paper and again I used my watercolors to add a couple of colors there yellow and orange orange only on one side and I helped those colors to blend together on one another by spraying water directly on top I'm not going to fuss around with that at all I'm just going to leave it aside to dry and I'm going to move on and color that border that I did for the other page now my uh black watercolor brush is quite dry so I'm going to bring in another one that I have again use your watercolors with a simple brush notice that I'm not covering everything with my brush and I'm going to spray water on top just because I want to have the same look and feel as my backgrounds this way I will end up having some variation on the color nothing is going to turn out super black all over and variation really helps in our general link it makes elements not look super flat which adds lots of interest that's what I'm doing here for those hexagons and I'm going to spray water on top to help them blend and now let's work on the first page and make a focal point for that now I do have this circle which is going to be the center of my flower and I'm going to create a daisy so I'm going to draw the first petal so you can see about which shape I'm going to cut out again working on watercolor paper I'm going to fuzzy cut that and then I will go ahead and cut out even more petals I'm not going to draw all the petals I can do that nothing has to be perfect after all this is an art journal remember just cut out as many petals as you need to go all around that circle you can always create a template and draw all the petals if you like so that they are identical I don't like to have identical I like them to be more organic like that so that's the style I'm going for I use my nouveau deluxe glue to secure all the petals at the back then I'm going to place my daisy on top of my background to decide where I want this to go top bottom left right whatever works fine if you have some petals coming out of the page it's okay this is an art journal it's fun to have elements going out of the page but you can always use your scissors and trim them out if this is a card for example you can always trim it out to fit inside an envelope you can draw your own stem or cut out a thin strip of green cardstock I decided to go with the stamp that was included in the porters and backgrounds that you show me used before and I'm going to color every other one of those little areas black and the ones in between with white now I'm going to use my white gel pen and you may find that white gel pen reacts a little bit with the color underneath so it's not going to stay super vibrant and white however you can use a post cap pen if you have or any other paint marker or even go with gesso on all these areas if you want to have that super bright I'm also going to bring the pattern of the stem on a couple of edges just to bring everything together and again I will color it the same way black and white I can have some dimension on this page since this is going to go inside the discbound journal and even if this is a card front you can add some foam tape at the back of the flower just to pop it on top of your card on all my art journals I like to have a motivational quote which is uplifting so it makes my day when I see the page for this one I'm going to cut out the word love again the die comes from the same die set that I used before I'm not going to use black cardstock I'm using only the same techniques from the beginning so here I'm working with black watercolor on top of watercolor paper I'm going to spray to help it blend and have some variation on the color and after this is completely dry I'm going to cut out the word love of course if you want to add your motivational quote you can print it out and cut it out and stick it on top of your background you can even write if you love your handwriting or even you can stamp if you have a quote that you love in my case I'm going to compile the word love with a sticker this is a booklet with lots and lots of quotes by Tim Holtz I'm going to use one phrase that includes the word love which I'm going to replace with the die cut love that I have on my page already I like those stickers because they are quite forgiving you can always lift them and move them around until you're happy with their placement and I always like to add a dub of glue at the back just to make sure that they are going to stay put later on I'm using my black pen to draw some lines around the stickers helps them pop against the background and you can call this page done one of the hardest things to do in our general link is to know where to stop so here I don't know where to stop I'm just going to go and add more doodling around the petals that I created which I think binds it better with the rest of the look and feel of my page one of my favorite finishing touches is to add some highlights here and there and you can see here some close-up photos on the finished layout and of course this can be an art journal or a mixed media card since it's exactly four and a quarter by five and a half don't punch out the holes and just stick it on top of a standard card base and now let's work on the green and yellow background and finish it off For that I did cut out this border with my dies I'm going to stick it down and remember I did color it with black watercolor and then on top I'm going to stick those hexagons I like to work in odd numbers that's why I decided to go only with three of them and I'm not going to cover up all the hexagons on my page but I didn't want to leave that black space empty that's why I decided to go with flowers I used a basic flower die that I hide in my stash you can always draw your own flowers and cut them out fuzzy cut them with your scissors let's just like I did with the first page and now here is how my pages evolve just because I have that black border on my page I just wanted to have a little black on the edges as well just to balance that out that's why I'm using again one of the border stamps that I had been using for the background and I'm going all around that here I'm using nouveau drops to add the centers on my flowers and of course this should be the last step since from now on I have to be super careful not to touch that center but anyway I'm still not happy with how this looks so I'm bringing in a white pen this is a paint pen I'm going to color in some of the areas in the border and then not happy again so I'm bringing in one of my text stamps so that I can stamp here and there and I think that looks better now now just because I am working with hexagons the next idea that came in my mind was to use a B and you probably have a B stamp on your arsenal I do but instead just because I promised I will create my own focal points I'm going to draw one so you can see how easy it is and nothing has to be perfect again I'm working on watercolor paper I'm drawing a novel with my pencil and then on one side I'm going to draw a triangle then draw two droplets which are going to be the wings later on so I'm going to draw how this is going to show but I'm going to color it in later on with my watercolors use your scissors to fuzzy cut all those elements and then use your eraser to make sure that you don't have any pencil lines now I'm just going to use a black marker to draw in all the details on my B super simple and quick no need to leave space white space for the eye I'm going to add the eye later on by using nouveau drops I'm going around my focal point with a black marker to get rid of that white edge and now it's time to add some color on the B and the wings again by using my watercolors these are my aquaflux brushes for the wings I added a touch of blue on one side of them and just sprayed with water to help it blend out for the B I did use orange and blend it with yellow if you like projects like the one that I'm creating today where I make backgrounds and then create my own focal points let me know in the comments below I can always make a second part for this video for the next three pages that I haven't shared today and I can even share on future videos even more 101 art journal link with methods step by step that you can easily follow again for my focal point I'm going with foam tape at the back to add some dimension I'm using white nouveau drops to give an eye on my B you can always use your gel pen I'm also going to draw a couple of antennas and now with my pencil I'm going to draw a swirl as if it is the trail of the B and then with my black pen I'm going to draw some dots I will leave those to dry and then later on I will use my eraser to erase completely that pencil line and since I'm using today only one stamp set and one die set I'm going to bring this one again and there is the word you that you can cut out which again I'm going to combine with one of my stickers so I'm going to look for a sticker that has a motivational quote an uplifting one that includes the word you and I'm going to replace that small you the printed one with the big you that I have died cut I picked a sticker that says you can never have too much happy I'm always using uplifting messages on my art journal pages and again I'm going to add some glue at the back just to make sure that this is going to stay put I did add some highlights with my white gel pen I'm also going to draw some lines sketch lines around my quote and I'm going to call this page done I'm so happy with that page I absolutely love that B that I created I think it looks super adorable and here are both the pages that I created for today I hope you will try this method to create colorful backgrounds with just two watercolors you will have lots of fun let me know in the comments below if that video was helpful for you and if you want to see more videos like this one using basic supplies and drawing your own focal points if you did enjoy the video don't forget to like and leave me a comment down below as well as share it with your friends don't forget that tonic studios is giving away this stamp set and the die set make sure to visit my blog to find out how you can enter the giveaway you will find links down below on everything I used I hope that you had fun today that you got inspired thank you all so much for joining me today and I'll see you all next time


So before we can go in and calculate the p-value, the way that we have in the past, we need to convert this array into a data frame. And this will help with visualization later. And so we can say chi-square vf is just pd dot data frame of chi-square and our columns, we'll just call them chi-square. So we can run that. And then when we go to actually calculate our p-value, it is the length of chi-square df in which chi-square df on the chi-square column is less as greater than or equal to chi-square Sam and then divided by n. So we've got a erroneous space there. And so we can print this and we can see that our p-value is 0.176. And so we can write a conclusion. We can say that the p-value is greater than 0.05, which is our pretty standard significance value. So we fail to reject or we can say that we accept the null hypothesis. In other words, there is sufficient evidence to say that the proportions all equal 0.25. Or we can say that the proportions are as specified, which is 0.25. And this is how we can then include that chi-squared test.


Your coca-cola bottler presents Claudia Claudia based on the famous play and novels by Rose Franken Brought to you transcribed Monday through Friday by your friendly neighbor who bottles coca-cola Relax and while you're listening refresh yourself. Have a coke and now Claudia what time are you calling me today David? What about about my coming to New York? What have we been talking about for the last 24 hours, but I was hoping we'd start talking about something else We won't they're flipping that piece of toast with it. Oh listen. This is a dry crusty one.  I don't be so noble. I like dry crusty. Don't you be so noble you like him nice and hot and fresh So I'll make you a nice fresh hot one. I like dry crusty one. Just saying that to be self-sacrificing You can wait two minutes. We'll hurt you Any complaints? I like dry crusty one. I say you don't Listen, what time you call me David as soon as I know whether you're coming or I'm going How much notice is a little notice well be wonderful when you got to the office You'd find out right away whether you're staying in tonight or not Then you could call me and I'll have all day to get ready in stumps me what you're going to need all day to get Ready in for details David Oh details. I have a million of them You went over two million of them with birth at last night Of course, it's none of my business none. You want to make life complicated for yourself.  You just go right ahead. Thank you. You're very sweet today Your toast sir. You take that piece. I'll take the dry crusty one after I went all the trouble making this one for you Insisted I wasn't going to deny you the pleasure of making it, but kindly kindly Pass me the dry Crusty one you're dry and crusty yourself. I suppose that's why you like your toast that way and precise Now tell me Mrs. Norton What are some of the millions of details that you have to attend? I'm not going to discuss it with you you take too much pleasure in making fun of it my details are my details It is the good executive who knows how to detail details to others running a house and running an Architectural firm is running two different things my good man. I suppose running a house is much more complicated much That's because women run houses. Go on. Go on. The men ran houses. It'd be simple and efficient Methodical and speedy go on. I'm listening the first secret is not to feel that you have to do everything for yourself After all if you can afford to have somebody in the house to help you if you you have to have respect for that Two persons doing the same job as a there's a waste of one person.  How about another piece of toast?  Glad you like it shame. It doesn't mean something pleasant, isn't it? Although I don't think it's so terrible to be deluded to you. That's not the best people are Well, that's enough breakfast For one breakfast where are you rushing off to you have plenty of time before you're trained I thought I'd go up to the barn and say good morning to Fred good I'll come with you. I haven't seen the heifer in a couple of days. I'll put on something warm It's kind of bleak out. It'll feel awful funny to have to get dressed up in New York every morning moment Don't you dress up up here? Well can't call slacks and shoes very dressy David while you're in the closet take me out take me out my overcoat. Will you take you out your overcoat? I have it out already. Thank you No, I certainly don't think you can call slacks and shoes dressy In New York. I'll have to get into a dress and stockings and gloves I'm not sure I'm gonna like it either here. I'll hold your coat for you. Thank you. You like it. All right Lining's torn and New York will be nice for a change You know, it's very funny till I was offered the change. I thought I needed a change No, I'm not so sure I need it anymore.  I am It's cold Oh That poor old rooster out in the cold.  Yeah, what makes you think he's so pathetic? Well, he was smarter. He'd know better than to stay here over there David he's gonna feel as if he's the last friend. He's got his left in when we go to New York Poor old bird another two months and it'll be spring and warm again April certainly a long time in coming Like having a baby. Are you going to call mama or shall I? What made you think of mama at that moment?      Oh, no, you're very different Have the way barn doors always creep just like a barn. Hey Fritz Fritzie in the barn. I'm just milking majesty. Oh good, and you'll be sitting in one place for five minutes Well, hello majesty old girl. How are you? Hello yourself you beautiful girl How's she milking Fritz? She's milking fine. They're like usual good only better. How many courts is she giving us now? She's breaking her own record yesterday twenty three Say there's a fine time for us to be going to New York and majesty's giving us 23 courts Well, we're not drinking it all ourselves. Anyway, it's a crime not to be here You know what'll happen David when we get back. She'll probably go dry. That's the way of cows It is because cows are women. Oh, all right girl. That is all if I were a cow I'd be so conceited. You're conceited enough without being a cow Fritz, I suppose you've gathered that Mrs. Norton and I are going to spend a few days in New York Bertha told me Mrs. Brown will be pleased to have you for a change Everybody's so happy to get rid of it Bertha rubbed her hands and said it's nice for you to go to New York the baby gurgled when I told him Dogs are the least bit depressed and now fritz. I'm starting to feel positively unwanted Change is nice. Do you want to change? I oh, no Why is it change always nice? I wonder for everybody else You know very rich will be in town for a few days. So the place will be all yours I take care of everything for you when you come back. It will be as if you had never left I hope not better. I'm not sure whether Mrs. Norton will join me in New York today Or tomorrow, but in case I stay over tonight But I just wanted two things that I'd better check with you first. There is a pale, Mr. Norton Please After all you know the place as well as I do and after all David doesn't believe in having to give people instructions Or having to meddle at all for that matter. Yeah, David, aren't we funny this morning? Very funny. Now fritz will go right on selling our surplus milk to mr. Tucker He'll probably be needing it for several more weeks now Mr. Tucker has come in very handy or we would all have drowned in me just now take some to New York home ground milk It certainly tastes good in New York.  Well, I do There's no Ruby over there, too.  I think I've forgotten you. Hello Ruby This is David if we're in New York when Ruby flowers, I'll never forgive you. That's all, you know You're starting to make me feel as if you don't want to go to New York I do I do but I don't want to miss anything on the farm. I will let you know in advance I thought you didn't know so much in advance about pigs fritz. Ruby and I are very good friends. Oh say fritz. I Think perhaps we ought to include more protein in Ruby's diet. What I was thinking of that wouldn't hurt her She could certainly use it. I've been planning to oh say I called the carpenter about building the new equipment shed In case he comes today or tomorrow while you'll be able to take care of it I show him everything. I understand what you want. Mr. Norton good and now in case you need the vet Here's the number. I wrote it down here for Dr. Beard in Eastbrook Center vet. I will not need a vet I know my animal. You never can tell what comes up here. Why should anything come up? Nothing comes up when we're here. Why standing come up just because we're gone because things have a way of happening that way Oh Anyway, here's dr. Beards number now In case you can't get him. There's dr. Lane in Bridgeport Dr. Lane. I don't think I like him. You've never met him I hear stories from mr. Ward. I do not like it. All right. All right Here's the number of dr. Ingram the other side of cream Hill. You better have the name of two vets Certainly are taking precautions. You think we're going to North Pole instead of just an hour in New York You hush up anything else, mr. No, well in case mr. Tucker wants to talk to us about dividing up the meta line where you go right ahead and talk I will wait for you. There is no hurry. Oh, oh, yes one more thing Ruby had a little trouble with her hind leg a while back I looked at it yesterday and look to me if as if it was starting up again So in case I have this prescription filled out that the drugs in case in case Honestly David for a man who doesn't believe in telling other people things. You're in casing an awful lot. Oh Hello, Ruby show me and Fritz if the price of hay goes down while you buy Hey, this is the way Bertha knows when to order vegetables and when not to order vegetables or Doesn't he shut up? Let me see. I'd made out a list of some other things. I want you to take care of Fritz.  And why shouldn't I make out a list because lists are only made out by women who feel they have to run everything Who said that You're talking nonsense quoting you very funny. I thought Mr. Noten I do not want you to worry about the thing. Oh, I'm not worrying about anything Fritz I I just want to help you be prepared for any eventuality that might arise while I'm not here That was a lovely sentence. Thank you so important sounding. You know now now you listen to me Fritz Few very important things first I want you to see the majesty gets plenty of sleep and the ruby gets plenty of weight They know attention and don't let her on the rain without her over shoes and fritz Please please don't let the heifer out if it's below freezing so delicate the heifer You know, this is not and thinks that she's kidding me for it I think she is kidding you know Mrs. Noten thinks it's a very simple matter for a man to leave his farm for a few days And he can just walk out without a backward glance is not and only thinks that if what you say applies to a woman It should apply to a man, too It is always very nice to worry about things that you don't have to worry about Oh, I'm not worrying but it's one thing to leave a house with nothing but a baby in it And another thing to leave a barn with a cow and a heifer and a pig with a litter coming and a rooster in it The rooster in the litter my goodness, but it's all right now, David I couldn't possibly have loved a man who'd think more of his son than his cow So you just make all of us. You were darling. I understand. Oh, you do Certainly, I do. Oh, but that reminds me David They're about 50 more things. I forgot to tell Bertha in case the baby gets a cold and in case the price of eggs goes down And in case the radiator springs a leak and in case I bop you one you'd better run The parts of Claudia and David on this program were played by Catherine Bard and Paul Crabtree and the entire production is supervised and directed by William Brown Maloney Ask any party guest which he prefers a big elaborate party at which the hostess wears herself out with preparations Or a simple easy-going evening with coke enough to go around and a light-hearted untroubled lady of the house You know what the answer will be Just keep a good supply of ice-cold Coca-Cola on hand and you'll be prepared to act the role of Miss Hospitality 1949 Every day Monday through Friday Claudia comes to you transcribed with the best wishes of your friendly neighbor who bottles Coca-Cola So listen again Monday at the same time And now this is Joe King saying or a boy And remember whoever you are whatever you do wherever you may be When you think of refreshment think of Coca-Cola Or Coca-Cola makes any pause the pause that refreshes and ice-cold Coca-Cola is everywhere


Well hello friends welcome back to my channel. It's dinner time so I am going to be putting together one of my go-to dinners. I use these noodles. I just really like them. I already decanted them into a different container obviously but this is the brand it is. It's the Rosini Healthy Harvest 100% whole grain. Typically a box of this is about two dollars. This is going to be kind of like on a budget obviously. I do have my Aldi receipt which is where I got all the rest of my stuff from. So I got two containers of mushrooms. Those were $1.59 a piece. I also got two containers of their zucchini and these were 99 cents a piece like per container. I also got these vine on cherry tomatoes which are three dollars and 69 cents for one. I don't know if this is a pint no I don't know whatever this is the container. So anyway this is what I put.  I've done this with rice, quinoa, all different types of things too but this basically turns into my sauce even though it has like lots of chunks and yummy veggies. Obviously if you like other vegetables you can use that too. The reason for me it becomes into a sauce is because it seems like the cherry tomatoes gives off enough juice and I don't really need like a sauce to congeal the pasta together. So anyway that's it but let me get to chopping and I'll explain more when I feel the need to explain more. It's a free thing and I'm gonna switch camera angles and show you guys my cooking so I will be back. Okay so this is the weirdest camera angle and I hope everything stays consistent and yes I'm wearing pajama pants because you know retired life. Anyway I'm gonna turn my oven on here and I am going to put in this is my saute pan I have actually some water over here already for my pasta noodles when I'm ready for them. I'm going to take a little bit of this extra virgin Mediterranean olive oil. I did get this from Uldi maybe about a year ago. I think when I moved in here so it's been a little less than a year but I don't know how much this was but most people have olive oil on hand. I like to put a little bit of this down just so things don't like stick right away and then I like to put my veggies in order of how long it takes to cook them so my zucchini is a little bit harder and that's going to take a little bit longer to cook down and then after that I'll do my mushrooms and then at the very end I throw in all of my tomatoes so let's get the zucchini going in here. I will let this sit and steam with the cover on for just a little while. This stuff honestly the zucchini takes a little bit longer to cook down but I'm going to keep checking in on this about every five minutes just to see where it's at and then I'll start adding more ingredients a little bit later and once I start adding more ingredients then I'm going to turn this water on and get that going as well so I'm going to turn the camera off for now because nobody wants to sit and watch this cook down so I'll be back in just a few minutes. All right so this is starting to cook a little bit it is definitely sizzling and the olive oil is pretty well coated on here already so what I'm going to do now is put in all of my mushrooms. I normally don't make this big of a batch but the veggies and the produce looked so good at Aldi when I went the other day that I just couldn't resist so this definitely will last me quite a while in leftovers so I don't want to cook this down too far because when I reheat this later on it will get really mushy and I don't really mind the mush um I just don't want it to be like super mush the first day because then like on day five it's going to be like really really mush so let me go grab my mushrooms so these will cook down pretty well very very quickly put my cover on so they steam up a little bit better and then I'll put my tomatoes in at the very very end but right now you can't really see it it's off camera this pot of water whoop I can't show you very well this pot of water I'm gonna start get this thing going so I can put in my pasta in just a few moments all right so now that this has had a few minutes to cook down like I said the mushrooms cook down fairly fast just because they're an easy veggie to cook and this needs a little bit more moisture now so tomato time so I'm gonna dump all these bad boys in and this will give the concoction a little bit more moisture and the tomatoes honestly I probably should have bought more but it's fine the tomatoes add a lot of juice to this and they will cook down and they will not look like this anymore they'll be pretty deflated almost is what they look like but I don't mind it's kind of like when you just cook down tomatoes anyways they kind of just look deflated they don't keep their the bounce I guess so I'm just kind of kind of fold those in a little bit put this little guy back on and then let them steam for a little while I'm gonna put this now on like low like I don't know my my thing over here says like low is one and then like up to 10 or sorry up to nine I guess and it's on like a one and a half right now so I'm gonna let it just sit on like a one and a half and um let this kind of simmer for a little while and then I'm gonna drop my pasta as soon as the water starts boiling which it hasn't yet these noodles I can't remember if I said it earlier um but a box of these noodles the rosini noodles I think I yeah I did show a box of the brand but a box of these noodles is typically around two dollars sometimes I can find them for like a dollar fifty um at the grocery store so um I will be using probably about half of this today because the rest of this uh well not the rest of it but anything I don't use I'm gonna be putting in a glass container and I'll heat up you know later on in the week and whatever so anyway I'll put about half this in there and then if I need more noodles which I probably will need more noodles later on in the week I can just make fresh noodles and that's just totally fine by me all right so let's drop some pasta kids and this pasta takes about eight minutes or so to get al dente so I'm just gonna let it go all right time for another stir oh this is looking so good yum yum yum all right so I've drained my pasta it is done so I'm just gonna take out as much as I want and put it on my plate and then I'm gonna put a little bit of olive oil in here and then put the rest of this in a container and then I'll show you the leftovers in just a moment so here is the pasta I just did basically a thin layer of the plate and then I'm gonna put this stuff on and I'm gonna be grubbing and here are the leftover noodles and it's in one of my Ikea containers I will leave the link below for my Ikea glass containers if you want a link so I'm gonna pop this in the fridge for leftovers for tomorrow all right let's turn this bad boy off oh it looks so good all right so here is what I do I just basically put as many or as little veggies as I want on there there's really no rhyme or reason and see how like juicy it is now that's all that liquid I'm gonna toss some of the liquid out while I am making up leftovers like little things for leftovers but my rule of thumb is you can never have too many vegetables so I like to basically cover all of the pasta with veggies so this looks just about perfect love it also something I like to do is put a little bit of shredded mozzarella on there so I will put that on here as well but this is this is it guys this is exactly what I eat it's amazing and I love it this is obviously a vegetarian option if you wanted to you can make some grilled chicken and top it with some chicken or some other kind of protein but I love it just like this but if I do have chicken breast on hand I will usually cook that up as well but I don't today and I just love this it's so delicious and here's it with my cheese on top I'm gonna put a little bit of cracked pepper on here and then I'm good to go all right but last but not least we need to put all of this into containers all right so this is it took the camera off the tripod but here is all of my leftover containers basically it's four dinners um for sure maybe even well actually it's five because I have this and then here's just my extra noodles which probably lasts me like a day day and a half um yeah probably probably two servings in there maybe a serving and a half but I can always make more noodles if I want to but pro tip I do like to put a little bit of olive oil in there so the noodles stay a little bit separated and they're easier to take out so they don't just all like congeal together but yeah this is it love all of this stuff it's absolutely amazing and delicious and if you guys decide to recreate this on your own please tag me on facebook or instagram and let me know if you guys have any more cooking ideas in the kitchen especially on a budget I will leave down below all of the prices and then what it breaks down to for five meals so I hope you all enjoyed today's video if you have any questions feel free to post them down below I will leave any links or anything that I talked about down below as well for you guys and I will see y'all in the next video bye guys and see I've already put the crack pepper on there I am gonna dig into this right now are you excited about dinner you don't like any of these things besides the noodles do you want a noodle okay you can have a noodle go ahead go ahead oh good job buddy good job


With a shortage of first responders across the state, Park Rapids High School is offering a new program to its students. Josh Peterson shows us how hands-on learning and real-life stories are training future first responders. Park Rapids High School had a few visitors who decided to drop in. Emergency personnel from the North Memorial Level 1 Trauma Center flew in to share first-hand experience and answer questions from students who are part of a one-of-a-kind pilot program that helps train and certify future first responders. Kind of a shortage of EMS workers in ambulance services and other areas, but also volunteers. First responder volunteers here in the community, and in a lot of communities it's just kind of going downhill, and we'd like to see some more people get involved. For our new program, the response and the level of interest from students has already impressed staff members. I guess I'm pretty impressed with how engaged they are, and the questions they're asking, they're very good questions. Even if students decide not to go into the medical field, the class has still provided them with important skills and knowledge. And worst possible scenario, we're going to have 22 kids that are going to walk away from this class that until the day they die, if something happens near them, they will know what to do. For the students, it's a chance to learn hands-on and hear stories from those who work in the career field. They really like the stories or the real life things that we can bring to the events that we've experienced and can bring to them and tell them how this is what applies here. With the class wrapping up for the year, plans to offer the course again and expand the program are already in the works. The hope is that other schools will use Park Rapids as an example. I hope that there's other schools out there looking at us and wow, that's pretty cool to be able to bring professionals from your community into your classrooms and help work with teaching the class. As students watched from a distance, they said goodbye to the medical team, who hopes their stories and their visit leave a lasting legacy. In Park Rapids, Josh Peterson, Lakeland News. Students who pass the course will officially be recognized and certified as first responders through the state of Minnesota. If you've enjoyed this segment of Lakeland News, please consider making a tax-deductible contribution to Lakeland Public Television.


Good afternoon. Thank you all for coming. Dr. Selwyn Rogers, who's in the back, and I are delighted to welcome you to this, our sixth lecture in the 2017-2018 series on ethical issues in violence, trauma, and trauma surgery. I'm delighted to introduce our speaker today, Dr. Marie Crandall. Dr. Crandall is professor of surgery at the University of Florida, Jacksonville, the director of research for the Department of Surgery, and associate program director for the general surgery residency. Dr. Crandall obtained her bachelor's in neurobiology from UC Berkeley and attended medical school at the UCLA Charles Drew program in Los Angeles. Dr. Crandall did her general surgery residency here in Chicago at Rush and at Cook County Hospital. In 2003, Dr. Crandall completed a trauma and surgical critical care fellowship at Harborview Medical Center in Seattle, where she also took a master's degree in public health from the University of Washington. Dr. Crandall spent 12 years at Northwestern University working in the division of trauma and surgical critical care and held faculty appointments at Northwestern, both in surgery and preventive medicine. Currently, Dr. Crandall is a member of the division of acute care surgery at the University of Florida, Jacksonville. Dr. Crandall performs emergency general and trauma surgery, works in the surgical ICU, and is an active health services researcher. She's published extensively in the areas of injury risk factors and outcomes, health disparities, geographic information systems in trauma research, gun violence, and violence prevention. Dr. Crandall is chair of the Publications Committee of the Association of Women Surgeons and is the co-chair of the American Public Health Association's Gun Violence Prevention Workgroup. Dr. Crandall's talk today, as you see up on the screen, is using geographic information systems and trauma research. It's a pleasure to welcome Marie Crandall back to the University of Chicago. It is such a pleasure to be here at the University of Chicago. I had never actually attended the University of Chicago. Dr. Sigler asked me when was the last time I was here, and I recalled that it was when I came to hear an Angela Davis lecture at U of C about six or seven years ago. But then I realized that I was actually invited to some social justice meetings that occurred around the time of some of this research that I'm going to talk about. So I promise you that the second most boring thing about this talk, which is the title, and there's one slide that's really boring and feel free to slip into your coma for that moment or two. But it's actually really exciting to be able to talk about something that we that, I mean, people use maps for as long as there have been a way to put pictures on paper and describe things. But in terms of health care systems, it's a relatively new concept. And it ranges from fairly simple to sophisticated. And I'm going to talk a little bit about geographic information systems and research in general, but also how it's been used in trauma and then how it's influenced my own work and some of the things that have affected even the University of Chicago, but also other trauma systems around the country. So as Dr. Siegler kindly pointed out, this is, I pedigree. I've been working on stuff relatively straightforward path. I had the pleasure of being able to go to the medical ethics research meeting or meeting today and all have such amazing, rich wealth of experience in a lot of different areas and range of ages and different backgrounds and coming from different disciplines. It was wonderful to meet all of you. My path was pretty straightforward. I did the other than running out of money in college and having to take a job for a year, which was at the NIH. So it looked, even though I was washing Petri dishes essentially, but good on my med school application and probably helped me get here. It was a really sort of linear path as opposed to some of the directions that you have all taken. And I'm just, I was really humbled to be in the presence of people doing such wonderful creative things with medical ethics. So I had, you know, newly out of fellowship. I actually hadn't really thought I was going to be an academic surgeon. I went to Harvard to get a master's in public health, but I thought I would use those tools and skills to be able to develop an injury research program. Not so much injury research, but injury prevention program. And I allied myself with the preventive medicine department and met people there who ultimately became really strong mentors in research and advocacy. And one of the things that I found, along with many people, including Dr. Rogers in the room here, is that wherever we looked for disparities, we found, right? So from a social justice perspective, we looked for racial or socioeconomic disparities and outcomes, we found them. But we didn't always know why they existed. It was a black box. Cancer outcomes were worse. Trauma outcomes were worse. But why? And so in looking at different aspects of interpersonal violence, domestic violence, injury in elderly, injury in childhood, some racial and socioeconomic disparities in trauma care, I was interested to know if geographic location might influence outcomes. And certainly we know they do evolutionarily from a macrocosmic perspective, right? That's a whole principle of evolution. But what do things that are hyper-local have to do with health? And of course they do, a Flint water crisis, or high rates of pollution in New Delhi affecting hospitalizations for airway disease. Right, we know this. So how can we map it? And in the mapping of things, can we devise solutions? So geographic information systems is, it helps to visualize, analyze, interpret data to identify associations, patterns and trends and computers have really helped with this because you can put multiple layers of aggregated data to look at things like social deprivation or unemployment or even things like green spaces which have an amazing effect on occurrences of poor health outcomes. So researchers can map locations, densities and also statistically associate relationships between these things. And this is the slide. This is the boring slide of promise to you that I'd have. Because this is 98% of the work in GIS. It is looking at these address data and unless because when I started doing this GPS wasn't a thing, it hadn't been invented yet or maybe it was only being used in the military. So even now, most data is retrospective. You have address data and you have to correct in a patient database of 20,000 people every misspelled Chicago and every zip code that is 62223 as opposed to 6222223, it's agonizing. So my advice, if any of you are interested in GIS find someone to do that for you. Find a medical student, a graduate student who's willing to go through all 20,000 of these and figure out what the address is at the corner of 75th and Cottage Grove. Find just anything you can do because this is the most painful slide in the whole thing. But this, then computer programs translate to these dots and you can edit simplest, simply look visually at spatial association of patterns but you can also mathematically take into account these dots and other things by using geographic regression. So similar to putting age and race in a multivariable model, you can put geographic location into a multivariable model and look at its influence of independent effect on your outcome of interest. And that's fascinating. The fact that geography can have that much influence. So I think that maps can tell us a lot of things. It can tell us what is currently happening. So this is clearly a map of a bed and you'll notice the one thing missing from this is the actual person sleeping in the bed. But how true is this, right? And it'll take into account all of your cat's behavioral, all of your cat's behaviors and it gives you a temporal relationship too, right? Because this is the nighttime sleeping region but here is the nighttime foot is a tap zone and then here is your napping quarters especially when you wanna change the sheets on the bed which is generally in the middle of the day. So you get so much information from maps. I think they're incredible and I'm a little geeked out about this but I think maps are very informative. So when did we really start using maps for health? And this is the classic example, right? Is Sir Dr. John Snow who was looking at cases of cholera in London and he was able to by mapping the occurrences along the street trace the source to a single water pump on Broad Street because back in the day you'd have to take your bucket of water, your bucket and go fill it up at the local pump and then bring it back and do your washing and feed your kids and do all that stuff. And by using this map to demonstrate that all of these cases of cholera were occurred because all of these folks used the same pump on Broad Street, he took that information and that map to the local council and they removed the handle and stopped the outbreak. And because the UK is often better than we are kind of like Canada, which is always better than we are there is actually a memorial to this in Broad Street pump in the UK which is pretty cool. But it's been used in trauma research as well. So one of the earliest examples that I could find in the literature was in Hartford, Connecticut. These are all auto versus pedestrian incidents around Hartford. They mapped them and found that almost half of the incidents occurred on these three roadways. And what they did is brought this information to the city council and they employed traffic calming measures like speed bumps and stop signs and they effectively showed a decrease. They were able to affect a decrease in auto versus pedestrian incidents along those streets. Now what they didn't do which I thought would be really interesting is then look prospectively a year later and see if there are more auto versus pedestrian incidences and these streets that people were going to avoid going over speed bumps, right? Or if there were more, I don't know, deliberate auto versus pedestrian incidents for people sauntering out into a pedestrian walkway. Because actually when I was in Seattle one of the things that they found which was of dubious enthusiasm to the investigators is that elderly people were more likely to be hit by cars in a crosswalk than they were in non-insimilarly trafficked intersections that didn't have a crosswalk. And they didn't really wanna publicize this because crosswalks are good, right? But the problem was is that people felt safe in crosswalks. I don't really care if there's a car anywhere in them to get splattered. And so for similarly trafficked intersections if you didn't put a stop sign then people were more likely to get hit. So they ended up fixing it because Seattle, more like Canada, better than us. But it definitely was, it was definitely a finding that was concerning to the researchers. Another example is mapping burns. So the state of Utah wanted to see if there were high risk areas for burns. And they found seven high risk counties that had potentially modifiable risk factors. And these are the darker, the higher risk counties. So you'll notice some of them are centered around the urban areas and others are more rural. What do you think to make this interactive? What do you guys think? Let's see, young people in the audience. What do you think would be risk factors in Utah for burns? Young people. What's that? Camping, sure. So like open flames outside, what else? Meth. Meth, exactly. So that was the popular one in the more rural communities. And also some of the traditional, so some of these were on tribal lands and there were traditional open air cooking rituals that were being used, but which are also potentially less safe than a microwave, I guess. So meth was a big one. And if you're interested, almost, let's see, this was in 2010. In about 2013 or 14, a single pot method of creating meth was invented, which made it much safer. So you don't see anywhere near the number of meth lab explosions that there were in the past. So if you are interested in being entrepreneurial and cooking meth in your kitchen, you should go to the internet and find out the single pot method because it's statistically associated with a decrease in burns in the house. All about public health here. And the next is access to care. And again, Canada. Canada is better than we are. And that'll be a theme. And what they wanted to do is look at access to care, to see if Canadians all had access to care either within an hour by driving or an hour by air flight control. And they found that more than 90% of Canadians were able to access trauma care even if they lived in the most rural areas like Inuits and people up in the Arctic Circle. And they were using that for trauma systems planning. So all of this work had been done and I had been doing work in disparities and really looking at the geography of Chicago trauma. And wondered if there were ways to make our trauma systems practice better. And I was at Northwestern. We had a high proportion of patients. At the time, it was about 1200 patients per year, about 35% penetrating. And so we saw a lot of gunshot wounds. And I felt that our follow-up, just like everyone at any trauma surgeons in the audience, trauma follow-up, notoriously poor, right? That's something that we say. Trauma patients never follow-up. But in Northwestern, they really didn't. I don't know about where you practiced. But in Northwestern, they really didn't. But if you think about it, of course they didn't, right? Because our patients were coming from the South side and would have to take three buses and two shuttles and maybe a train to get in Northwestern for follow-up. And we did not have infrastructure. We didn't have clinics. We didn't have outreach in those areas to help provide services to our trauma patients. So the first thing we did is we wanted to look at individuals who had suffered gunshot wounds. Cause those were the folks that came from the furthest distances other than people who were traveling across in the interstate and happened to be brought to us. And what we found is these are shootings and homicides in Chicago. And this is Northwestern up here. And this is where our patients came from. You'll see the vast majority of our patients are coming from like nine, 10 miles away. In a seasoned Chicago trauma system, remember Chicago trauma systems have been around since the 1960s. We have had an organized trauma system for 50 years. And yet our patients were traveling more than 10 miles to get definitive care for potentially life-threatening injuries. But that was what it was. And we thought, how can we partner with community programs in those areas to better prevent further violence and also to better care for our patients? So we connected with community clinics in the South Side of Chicago, particularly the Southeast Side of Chicago. And we also had continuous funding for about eight years, eight or 10 years with Ceasefire, Illinois, now known as Cure Violence, who provided a hospital response model. So anytime somebody was shot, a hospital responder, an interrupter was notified. But to be fair, 90% of the time they already knew it happened. These are community embedded folks who have been given conflict mediation training and social work experience in case management experience and they would show up at the hospital and their goal was to decrease the likelihood of someone getting shot in retaliation. And this has been studied, Bureau of Justice Statistics studied it, multiple other replica sites have studied their experience and have found that in two out of three communities this can significantly decrease the likelihood of future shootings up to 60 to 70% in some communities. So it uses the credible messenger model. But I hesitate to say that this was a hospital-based violence intervention program because it wasn't. We didn't direct this, we contracted services with community members who provided this community-based resource. And these were some of our partners. It was La Rabita, the Children's Rehab Institute, Ceasefire Chicago, La Causa, which is a Latino-focused community organization, Claritian Associates. Claritian Associates works on the South Side of Chicago, affordable housing, job care, case management, and of course, Northwestern. But we were also interested not just in quality improvement and patient care. A University of Chicago medical student came to me and said, you know, I've read so much about this golden hour of trauma. Do you think it really exists? And I said, I don't know, let's look at the literature. And we looked and there was some controversy about it. A large study, large multi-centered study had come out that showed that if you were in whatever quartile of time it took to get you to the hospital, the soonest quartile or the longest quartile didn't really make a difference for any trauma patients. But in terms of outcomes for mortality. But the caveat to that was they only had about 16% trauma patients that were injured by gunshot wounds or stab wounds in their cohort. And of those, the vast majority of those patients were in urban areas where their hospital transport times were lower. So they couldn't really say anything about penetrating trauma. The other thing is that we know the outcomes are worse for rural trauma patients. A lot of that is just because, you know, test of time, right? So if you're really injured, I remember we'd have somebody trim in trees and some island off the coast of Alaska. And they'd have to be puddle jumped by some helicopter somewhere. And then six or seven more flights, they're in Anchorage. And then they come to Harborview because it was Washington, Alaska, Montana. Idaho, the four state area that we'd take care of.  Maybe their initial injury score wouldn't be bad, but after getting 50 liters of crystallite in 16 hours of flights, they were really, really sick.  Trim trees has a couple of cracked ribs.  You send them home the next day with a handful of Norco. Which is a whole other story in the whole lecture. But it was definitely difference in injury severity and it clearly impacted outcomes. So I was interested to know if this happened with penetrating trauma. And this is a map that we had created back in about 2011 or so. And these were, again, shootings around Chicago and these are trauma centers. And you'll notice that there are fair number of shootings on the west side. This kind of Austin, South Austin, that kind of area. They're handful up here by Evanston, but the majority are here on the south side and the southeast side of Chicago. But look where the trauma centers are clustered, right? And this was five years of data from Illinois State Trauma Registry. So it looked just on the surface that there might be a question to study. So the first part of the question was do people have worse outcomes if it takes longer to get to definitive care? And this was our first study that looked at that. So we used five years of data from Illinois State Trauma Registry and looked at the death rate for patients who are hypotensive and have been shot or stabbed in the chest. Bad place to be shot or stabbed. And hypotensive, low blood pressure. For those of you who aren't clinicians in the room. Low blood pressure, bad. Shot stabbed in the chest, bad unless you're lucky.  And if you're not hypotensive, your blood pressure's normal, then to some degree you sort of stood the test of time. And that's what these data show. So we had in that time period, this was to all the Chicago trauma centers, we had almost 1,000 patients and almost 20% of them were hypotensive, low blood pressure.  But there's no relationship with pre-hospital transport time.  It is a predictor of mortality. And in fact, what we found was that the patients had up to a 13 fold increased incidence of dying just by being hypotensive and having a longer transport time. So that was our question. Is a longer transport time associated with higher mortality for patients with a potentially life-threatening injury? And it turned out it was. But it was only 900 patients and it really didn't ask the question for a larger audience that we wanted to know which was does distance impact that? Because we didn't look at distance in this study. It was just the map. We presumed that patients further away would have a longer transport time but we didn't know that. So around about that time, who was working on answering that question is a distance and time relationship. And that isn't as obvious as you would think. This is a 40 year, 45 plus year trauma system. Pre-hospital providers argued that they can get anyone anywhere within 10 minutes. That was the argument and that that would make no difference in mortality because no matter where you are, we can get you somewhere within 10 minutes. And we wanted to know if that was true but the question certainly wasn't settled. And around that time, Damian Turner, who was a charismatic young person, 19 years old, just graduated from high school and was an anti-violence activist. And I can't underscore this enough. This guy was doing stuff that, you know, when I was waiting tables at his age, he was working to stop human rights abuses at the Juvenile Detention Center. He traveled with Stop to New Orleans to fight against demolishment of urban public housing. He was knocking on doors to keep his own housing complex afloat in a sense of community and investing in community. He was a really dynamic kid and he got hit by a stray bullet across the street from here. And he was brought to Northwestern. His transport time was almost 40 minutes. Now he had a lethal injury. He had a non-survivable injury, penetrating wound to the chest, the back, with injuries to the orda and the superior vena cava. That was non-survivable injury in virtually anyone's hands. So he would not have survived. It was a terrible injury. But it galvanized the community and there was keen interest in the work that we were doing because of the lack of a trauma center on the southeast side of Chicago, which was where most of our catchment area was because people thought and argued rightly that a 40-minute transport time for some kid who's dying is probably too long. So we looked at 11 years of data from Illinois State Trauma Registry and looked at transport times and mortality for gunshot wounds. Unfortunately, during that time, there were almost 12,000 gunshot wounds that were brought to Illinois hospitals. Now this doesn't include people at the morgue, or people who just went to community hospitals because they were shot in the foot. These are trauma center admissions. And almost 5,000 were shot more than five miles from a trauma center. The mean transport time was higher for those who were further away, almost 17 minutes versus 10 minutes for those who were shot within that five-mile radius. And we picked five miles in an arbitrary fashion because it divided the data into one-third, two-third control, one-third case, two-third control in a nice mathematical way. But when we looked at four miles or six miles, there was a linear relationship, actually starting to be exponential relationship as well. And we found that the risk-adjusted mortality was also higher. Just by being shot more than five miles away from a trauma center, your transport time was likely to be longer and you were more likely to die, even if you control for having low blood pressure or the severity of the injury. And I don't need to tell you because you're all at University of Chicago, you know that this was a controversial and really challenging time with a lot of complex high-level discussions. This is the map that we created. This is how we used GIS for this and we used GIS for the analysis. We used the findings from our map in our regression equation. So this is the five-mile radius. And you can see that there are some high-risk areas. So this is gunshot wound mortality. There are high mortality areas but there's a lot more dark down here in these areas that are outside of the five-mile radius. In a post-hoc subset analysis, we found that these areas that are outside that radius not only are people more likely to die, they're even more likely to be male, more likely to be African-American and more likely to be uninsured in a population that is already mostly African-American, mostly uninsured and mostly male. So we are subjecting, or it is a city-wide problem that our most distressed communities are also outside of this range of trauma care that can improve mortality from gunshot wounds. So we likened it to food deserts. This was a trauma desert. So the next question was, is this a remediable situation? So what? So what if you're further away? Just drive faster or employ helicopters. And so we looked to see if this was something that could be changed. If we could eliminate these transport time disparities by simply adding another hospital in the mix. And happily, there's a natural control, right? Because the University of Chicago is a level one pediatric trauma center. So we looked at, again, unfortunately, there are so many pediatric gunshot wounds, we were able to look at pediatric gunshot wounds controlled with adult gunshot wounds. And what we found was, oops, sorry. What we found was, this is pediatric gunshot wounds. And these are trauma transport time clusters where more than 25% of the gunshot wounds experience a greater than 30 minute transport time. So it's terrible that there are any, but they're randomly distributed in the city and there aren't that many. This, on the other hand, is adults. And you can clearly see that a huge chunk of the South and Southeast side were experiencing greater than 30 minute transport times from up to like 25% or more of its transports. I mean, no one who is designing a trauma system would think that's okay. And this work was also published. And it was one of the things that the Alderman and state senators and House of Representatives of Illinois and actually national state representatives were interested in hearing. I was really careful to say this doesn't mean that a particular place should be a trauma center. All I can say is that transport times and distance from a trauma center are associated with higher mortality and we can address those transport time differences and disparities if there's another trauma center here. And there were some obviously community and civic concerns galvanized the community, but the American College of Surgeons even weighed in and said that we should put trauma centers in places that they're needed. And I think you all know the outcome of that. I was saying earlier to some of the junior faculty that it's extraordinarily gratifying to me to be able to see our research influence the potential for social change because I think this year trauma center is probably gonna save lives, but it also demonstrates an investment in the community to the University of Chicago that I don't think was there. It's engagement in the community, it's gonna provide jobs and security and save lives. And I am just so gratified that this has happened in your community and many of you made that happen. And it's also really nice because I was telling the junior faculty that I could have studied, told like receptors for the last 10 years and saw no new drugs or anything that would save anybody's lives. So it was nice to be able to see our research translated into action. And this is Dr. Rogers who just stepped out, I believe, but I really can think of no one more perfect for this job. I mean, you think about it. Guy took a demotion and probably a huge cut in pay to do the right thing for people in the community. And that's someone, I mean, you don't necessarily wanna pay him less, but it's definitely somebody that you want, somebody with an interest in this mission to change things and make things better. So what are some of the other things that we've done? In a study that was much less warmly regarded, we looked at the proximity to an establishment with the liquor license in Gunshot Wounds in Chicago. We did this using geographic regression. So we were able to control for neighborhood factors, the prevalence, the per capita incidents of Gunshot Wounds, the deprivation indices, things like female head of household, poverty indices, educational attainment. And what we found was in these dark areas, there was an up to an odds, and I've never even seen odds ratios like this. And the odds ratio of over 500 that if you're within like a half mile, like if you're within that, like actually less than half mile, it ended up being like a quarter mile of an establishment with the liquor license. It was much more likely to be shot. Our control populations or our controls were the same point in concentric circles around the area with the liquor license. And by the time you got to a quarter mile away, the association went away. So we were able to definitively show that this is a problem and Crane Chicago business just hated on this like you wouldn't believe. It was actually, but they're right because what's a solution? Do you wanna shut down a liquor store in distressed communities? And if that's the only place that people can go and congregate because there's absence of outlets for social interaction and that may be the only place that you can buy fresh fruit and vegetables in your distressed neighborhood, you don't wanna shut that down. And then what if you do? Is it just gonna move half a block over?  So I don't have a good answer. And I certainly don't have a good economic answer, but it is clear that a liquor store in particular is associated with increased risk of firearm related violence. Again, not warmly regarded and clearly nothing has happened. So not everything leads to social change. One of the other things that we found is I worked with a woman who's done some incredible work in hospital closures, Rene Shah. And we looked at data from the state of California and I was at Martin Luther King. That was where I did my third and fourth year rotations in Los Angeles in 90, would have been 94, 95. And it was an insanely busy trauma center. It was the only level one trauma center for Compton Watts and Willowbrook. This was in the 90s when busy and it was terrible. There were little kids coming in with a hundred holes. It was the most awful thing imaginable, but they were providing good care. There was a highly publicized closure after a series of inability to meet basic standards of good care set by the Center for Medicaid and Medicare Statistics. But one of the things is that trauma care is not included in those outcomes or metrics. So the hospital was closed down and communities rallied around that because they were concerned that they were losing trauma care. And they did appoint another hospital nearby to be a level two designated center. And they worked with the city, the state, the county to ensure that the paramedics could take affected shot, car crash individuals to the nearest hospital. And they really invested a lot in that. I will give them credit. So what we found, so we looked at the neighborhoods that were served by MLK. And these are some of the other hospitals around there. These are the neighborhoods that were served by MLK. And what we found was that in general, the closure of Martin Luther King did not make a difference in trauma mortality. So this is looking at all types. So we looked at stabbings, gunshot wounds, motor vehicle collisions and pedestrian incidents and falls. And this is the observed versus expected mortality and 95% confidence intervals. So you can see over the course of time it follows the general pattern. This is the community outcomes for those zip codes that are most affected. And then these are what it would be for the whole county, like all the trauma centers in the county. However, when we looked at gunshot wounds in particular, we found that before and during the closure time, so this is when they started to close and they started to close various services of MLK and this is when it actually closed. Before and during that time, it kind of parallels the line, but then you start to see a sharp divergence of mortality for gunshot wounds after the closure of MLK. And it's hard to know if this persisted because those data aren't being collected anymore. It's also hard to know if what the underlying cause is. Is it because people are experiencing longer transport times? Is it especially in LA where the distances are so large? Or is it any number of other things? Higher lethality of weapons. Hard to imagine because this was during the peak of the effectiveness of the assault weapons ban and the Bradyville, but possible. So I don't have, I can't say causality, but I can definitely show an association and that's concerning. And interestingly, MLK is opening up as an outpatient services and arguably the thing they did best was trauma. So if they were gonna do anything, opening up a trauma center might have been a good idea. So then what am I doing in Jacksonville? So about two years ago I was recruited to be the director of research and now the associate chair for research in Jacksonville. And I'm working with a pediatric resident who's interested in pediatric surgery who is, who was interested in the pattern of gunshot wounds around Jacksonville. Because it was my observation and what people told me is that kids are getting shot in the same areas that they were shot 20 years ago. And what do you know, that's true. So while there is variation in the numbers of gunshot wounds that have occurred, there's no variation at all in the neighborhoods where kids are getting shot. These are population adjusted risk factors and they're getting shot in the same neighborhoods. This is 20 years, 20 years of difference, getting shot in the same areas. And unsurprisingly, though Jacksonville is not the most diversity in the world, most are male and most are African-American, most are assertive, very few are unintentional. And about the same mortality as you'd see anywhere else around the country. So for 20 years, map after map show the exact same neighborhoods that are being affected. Which to me says, nobody's paying attention in city and nobody really cares that kids are getting shot in the same neighborhoods over and over again. So here's another graphic representation of that. This is a deprivation index that's been applied to the city of Jacksonville. And this takes into account things like socioeconomic status, housing availability, food deserts, education, employment. And I know this won't come as a shock to anyone. It's the same neighborhoods. So our hope is that this will be presented and published and we'll have some items of discussion for the city legislature. So I'm also working with Florida Health, I'm the chair of the Data and Surveillance Committee. There've also been some concerns about expansions of for-profit level two trauma centers in the state. Of Florida and effects on cost of care and injury outcomes. But the geography of structural violence and health disparities is a huge untapped area for research and I'm very interested in working with anyone in any city who's interested in looking in those topics. And finally, when I've been called to consult with Columbia University to examine associations between willingness to travel and cancer care outcomes for the state of New York, which I think is interesting because rural people and urban people have different thoughts and we know outcomes are better at centers of excellence for patients with cancer, but why won't people go? So triangulating the data with location and with attitudes surveyed, I think it'll be really fascinating. So just to end on a lighter note, this is my favorite map joke ever. For heaven's sake, Elroy, now look where the earth is. Move over and let me drive. Because this is medical ethics focused, I put a couple of questions up there about the ethics of this. So was it ethical to focus on trauma systems instead of primary prevention? So there's still 12, if there's 12,000 gunshot wounds and we help a couple of kids survive, yay, great, but there's still 12,000 gunshot wounds. Maybe I should be looking at something else. And then how ethical was it to testify about our research? Again, I was careful to say this is research about trauma systems and I'm not positing that outcomes will be better based on any solutions you may have, but I did testify. And then requests from other researchers to access our data. I got at least three calls from people saying, I don't believe you, I wanna look at your data. And as a relatively, you know, it's got an early mid-career at that point, I wasn't sure how to handle that. I mean, happily the memorandum of understanding said pretty clearly I can't share the data. And if you want those data, you have to go to the state of Illinois and request them yourself and go through the year-long process of getting it. But it was interesting and people were asking me in a fairly hostile sort of way. But those were some ethical dilemmas I experienced which is doing the research. But with that, I will end and ask for any comments or questions. Yeah, not initially. So initially it was a pretty straightforward process to just give my research plan to Illinois Department of Public Health when they provided the data, which was great. I think they were less happy when they discovered the results of our research. But by then it was sort of too late. Interestingly, IDPH had then imploded and they were no longer maintaining this registry. I don't know if that's recovered in the last two years but as of like 2014 and 2015, they weren't, we can't check this anymore. We don't have this level of granularity which is disappointing because it was really rich. Sure, so we estimated, and we just did this with mathematical modeling, we estimated that about eight fewer people per year would die in the city of Chicago based on having an additional trauma center. So then we calculated the amount of money, but the value of a life in actuarial terms to be $150,000 to $200,000. And it turned out to be that that was less than the cost of the initial funding of a trauma center. Per life year, yeah. Yeah, so it turned out to be less than the cost of the trauma center which I don't know if it was persuasive but that was the thought. About 80% of the per trauma center you're in to change it from a desert to an act program, you would use that as fighting? That it would be eight people per year based on the number of people expected to be shot per year. That was what we figured out because there'd be a 23% less likely to die. So based on the typical injury severity, the typical number of people shot in that neighborhood that we're experiencing higher mortality than they otherwise would, that it would end up being about eight patients per year that would live who would have otherwise died. But again, that's an estimate and would have to be looked at prospectively. A paper awaiting the dangers come through three years later. Yeah, yeah we did include that as like one sentence in our paper that was about it. I think there was a hand up back there. Yeah, so this is a two-part question. Just clarification for the licensor, for the liquor license, if it was any like a beverage liquor license or like a restaurant or a grocery store type thing. There were anything, it was a packaged liquor store versus tavern and those were compared with like grocery stores and it was very neighborhood specific. I don't know if you saw the map but you could be downtown and be right next to a bar and there was no increased risk at all and for the overall city of Chicago there was no increased risk. So, but even when you controlled for areas of higher deprivation, higher stress and higher baseline number of people who were shot that still increased the likelihood of being shot over 500 fold. Okay, thank you. And then the second question was in regards I'm a statistician so I'm more into about like the data. In terms of the collection of data you said out of the state of Illinois, did you use any hospital data or was it just public or government data? The hospitals in the state of Illinois trauma systems are maintained by the Illinois Department of Public Health so they had done the certification for trauma centers. So the accreditation of all these trauma centers was that and each of those trauma centers that are accredited by the state submit their data to state. So it is hospital data maintained by the state but everything came originally from each trauma center, patient level. Any other questions? Thank you so much for your attention. I really appreciate it. Thanks for the opportunity to be here.


My name is Natasha Spieger and I work as a cloud operation engineer at Kickstarter. Today I wanted to tell you a little bit more about my unusual path to ops engineering. A few years ago, I had one of the toughest jobs in the world. I had become a standard mom to my two wonderful kids, Max and Anna. I realized that gaining painting skills really prepared me well to be into the workforce. For example, I picked up time management, tried to do 28 hours of work in 24. I also learned about problem solving, communication, collaboration. Another fun example is trying to get a toddler to do something they don't want to do. That's a true challenge right there. I also picked up dedication and reliability. Parents have truly mastered what it means to be reliable. Time becomes such a precious commodity that it cannot be wasted on survival. A few years later, I was really excited to be into the workforce and thought I could face anything that would come my way. Unfortunately, the views and opinions, the views of potential employers were very negative about state-owned parents. They considered it a risk to hire me. So I went back to the drawing board. We found out about the skills I had just picked up and the things I liked to do and I started to teach myself how to code. I was lucky enough to get a web development fellowship at the Flatiron School, a 22-week program that was created to enable diversity in a New York City tech pipeline. Upon graduation, I got a job at the Wall Street Journal as DevOps Engineer. The enthusiasm of employers in the tech industry was rather refreshing compared to what I had encountered before. Just a few months ago, I landed my dream job at Kickstarter, where I really started to develop a passion for DevOps Engineering. At Kickstarter, we have Ruby on Wheels monolithic application and we are moving towards a microservice-oriented architecture leveraging Docker. We also wanted to use AWS Lambda to enable automation. So you're going to ask me, what is Lambda? Well, Lambda is a serverless compute service that runs on code triggered by specific events. We use Lambda at Kickstarter for resource creation in cloud formation template. To use them, we needed tools, for example, the deployment service. So we picked Apex, a great deployment service that allows for a great workflow. We also needed to start thinking about testing. So we write on Lambda as a node and write unit tests that we would do for any other code base. And we also use a module called Lambda Local. It allows you to brand new functions on your local machine with using sample event data. Now that we had all the tooling set up, it was time to start building them. So, for example, we built a Lambda Finder that would gather all the information needed to split up a new instance. This Lambda Finder would be triggered by a cloud formation template and would, for example, retrieve the VPC ID and the subnets associated with this VPC or even use Logic to retrieve the latest AMI for your instance. Another example is recently we built, we used Lambda to build access control lists for other services such as BOT, a secret store, or console or services cover tool. So these were just a few very quick examples on how one ops engineer can leverage Lambda to automate the infrastructure. I hope it will give you a few ideas on how to use that. And as I'm reaching the end of my talk, I just wanted to say that this big career chain would not have been possible without the help and support of a few key alloys along the way. I could not have done it without them. Thank you and find me on Twitter and I would like to take to come for more questions about Lambda.