Hey everybody, this is Jason from Steinbach when it's over. We're at the I-90 at the moment And you are watching Dr. Josh the Love. Enjoy! We're from the sky. We're delivering some of this stuff today. We're getting two deliveries done There's six deliveries on here. Our first delivery here is Oxbow Saskatchewan That's that unit there. That's this here and when we get there, it's just down the road We're in Karndorf, Saskatchewan Hopefully when we get there, this rain will have decided that it has rained enough because it was raining all night already It'd be very nice if it would leave me alone Right Right Right practicing my Scottish Right or is it right? Is it all right or is it just right? I'll have to ask my friend Wadi Hopefully one day we can go and visit there yet. There's so many places we want to go and visit Love to do a Europe tour and United Kingdom and Ireland We'll see life is only so long There's only so many things you can do Turn the lights on release the brakes. We are good to go I'm just gonna double-check that what I saw with my fifth wheel is true that we are still attached And give her a little going anywhere except with me Okay, we gotta go deliver some stuff drove till two in the morning central time last night In true trucker Josh fashion. It seems that that's always my schedule on the road. I'm actually I like that It's good. I don't know why I don't know why this is a driveway or is this a road? I think that's a driveway to that business. Oh, whatever. I stopped anyway The rain is slowing down at least hopefully continues to slow down and I got had enough rain For there is carnduff Saskatchewan never heard of it before me neither carnduff Not corn car C-a-r-n-d-u-f-f. I think that's a spell it carnduff It's carnduff a funny name. I'm here all day.    Not on purpose. Anyway, I mean sometimes it's an accident All right, here we go. Here we go my farm equipment My farm boys deliver these buckets. So oxbowse Saskatchewan here is taking one bucket and one crate and then we run up to Another town Redburns, I think that's the one I don't know. We have a second drop today that we're gonna get done It's about an hour and a half away a little further south here I think I have five and a half or six hours to our next delivery and that one we're gonna do tomorrow We four stops. We're gonna do tomorrow and get them all done. So today is Tuesday we'll get them all done Wednesday and hopefully we can get reloaded Thursday. That'd be nice Very fancy. We got some fancy farmers fancy farmers Very nice Good to see the farmers doing well. It's carn doff a fine fancy car. I messed that up script cut that out Josh Carn doff a fancy car carn doff a fancy car Fancy car that just came to car and I'll shut up now all right very nice people here They took one loader and One crate and now we go to Redburns to sketch one which is a little under an hour away They're also just taking One loader and one crate Can I get around the back this way? Kind of soft back here. Hope I don't get stuck Though I'm not really worried about it if I would I mean I think they got the equipment to get me out Can I get out this way? They told me I could go all the way around. I'm pretty sure Oh Branches on the ground here branches all over the play all the way over here to Tornado warnings here yesterday, right? My phone went nuts and sent me the alarm all of some trees that broke down over there that reminds me We really need to get our oh I can't get out this way. Okay. Well, I can't go that way Okay, they meant to go. Oh, okay Let's get our tires a little muddy why not Branches all over the place here. Yes That does remind me though We need to call the arborist to get those trees taken down on our backyard before that happens and takes out all those power lines. I Don't think it will happen, but I just I don't want to risk it. It makes me uncomfortable Yeah, that tree must have come down last night. It was windy here I don't know if a tornado touched down anywhere, but I was definitely getting the warnings on my phone Yikes.  Don't worry. I can see my trailer back there through the window I'm back down the driveway. It just came from Okay Well that way and we shall go this way. Look at this. Yikes. That's carnage out here Wow, that's a huge tree It wasn't like super super windy to the point where I was like nervous that my truck will get blown off the road but it was definitely to the point where I was Concerned especially once my phone started to tell me there's a tornado warning in your area. Seriously Yeah, I don't got time for no tornado That's tough to do Okay, now we can go back out the way we came. All right We made that way harder on ourselves than we had to my tires are all muddy now Now well, it is what it is We'll wash it off and it'll be clean again Never been to this town. It's actually a nice place. We're gonna go right through town here again I'm gonna show you it a little bit Oxbow's the sketch of all on Seems like a mixture between agriculture and oil a lot of oil rigs out here and sustained in the beginning I'm sure it brought in by rail All the farmers would bring their feed and their grains and stuff to here And then we load it on the trains and head out to wherever it goes Now we got truckers like me it's a little faster a little more personalized I'll take your load directly to the customer. No need to go through the train where it takes like Three to six weeks. I'll get it there tomorrow downtown. I guess The gas prices are $1.90 a liter here, which is a little over six dollars a gallon US gallon Or about 550 USD per US gallon Five and a half bucks. American old a gallon With no relief in sight We have people in charge that are intent on kneecapping their own people Why help us thrive when you can Shove our face into the dirt just cuz you can you know Stoped here in Balgoni grab some fuel in a shower Purchased five hundred and twenty seven liters of fuel 138 gallons US Cost me a thousand forty eight dollars Canadian. Who knows what that is in US? 900 bucks 800 bucks I guess I don't need these anymore son's going down I'm gonna try to get David's in Saskatchewan spend the night there Only averaged five point five seven miles per gallon on that last tank We're fighting the wind pretty hard last night going through that storm It is what it is. Maybe I still will need those shades. That makes me kind of sad The fielder. I love it so much better when they're green because it's so much summer ahead of us Yeah, once they start to turn golden, you know harvest seasons coming and then after harvest season fall comes Winter comes so we just got this left on us now It's the next morning again, we're gonna continue this trip a little bit This is Chamberlain Saskatchewan those of you who've been following me for many many years know that Right over there in front of that truck in the dead of winter several years ago Is where I broke down That was the the day I learned about how diesel fuel can gel in the cold weather Tough lesson to learn, but I got pretty lucky Getting kind of bright out here now. Let's uh, there we go better Yeah, this was the town. I was actually just north of here between here and Davidson was closer to Chamberlain So I turned around I started coming back here when I noticed the truck was sputtering. I didn't know what was going on. I Learned that day that you never go to sleep in the winter time with empty tanks of fuel Always go to sleep with full tanks always especially if you have American fuel in the tanks The fuel in the US is mixed a little bit differently than the fuel here in Canada in the winter time in the winter time Our fuel is designed for extreme cold weather Whereas there's even in the northern states is designed sort of for really cold weather It's pretty good But once you get up here, it was minus 65 that day Celsius if you're wondering what that is in Fahrenheit What is minus 65 Celsius in Fahrenheit? Minus 65 degrees Celsius is equal to minus 85 degrees Fahrenheit That's how cold it was it was cold fuel froze up and I Went to bed the night before in Montana Which is south of here and I slept with a quarter tank of fuel Macau fuel in the morning whatever no big deal no big deal Well the whole tank I Guess the condensation on the tank Turns to water that goes into the fuel mixed with the fuel It's a bad a bad thing and it gels up the jet the fuel turns into gel Which plugs up your fuel filters and shuts off your truck your truck won't run so now it's minus 65 my truck won't run and so I Managed to limp it back here barely and Go and beg the hotel over there To let me have a room with my dog diesel because they're they weren't a pet friendly hotel And they were kind of me and I had a dog But I'm like it's minus 65 what do you want us to die out here, please please let us have a room So they let me have a room with my dog very nice and actually they're very nice people They just had a no pet policy and you know once you explain to them the situation of course they they Let us stay there right away, which is really nice of them the next day We had a tow truck come here pick me up from here I picked the truck up from here and tow it into Regina south of here Where they pretty much just put it in a shop overnight change the fuel filters and Good to go. I learned how easy it is to prevent fuel gelling and how easy it is to fix it It's just really scary when you don't know what's going on and when you're not aware of the fact that fuel can gel That's not something that they'll necessarily teach you in trucking school That's not something that's maybe they will maybe they do already. I never taught that I Mean, maybe they did maybe they mentioned made people have mentioned it to me before but it's never really sunk in what do you mean fuel jelly? I'll be fine. I'll be fine Nothing bad ever happens to me So here we are in 2022 bad things happen to me it does yeah, I'm not immune to those bad things I'm not invincible. So you got to be prepared. You got to be ready And you got to know what to do Okay, we need to get moving It's rock and roll and take my trailer with me. That's good Nice shiny Kenworth. Wow. You see that? That's a nice one, too Why am I so close to my steering wheel? Okay, here we go. Here we go. Here we go. Oh, this is a Two bikes on there and one here I Always get asked if I would ever pull them. Yeah, of course. I'd pull them if I had the chance I wouldn't want to do it all the time. I don't think I Wouldn't want that to be my full-time gig, but of course I'd love to add that to my resume and Pull a set of 53 to 53 foot pipes. I mean, I I think it'd be fun make a great video and is Settled right along a beautiful valley over there Runs all the way through Saskatchewan Day begins. It's the same day for you guys Sometimes I like to split the days up like this and you get more content in one if not a lot happened and like not a lot happened yesterday Take you along for a little bit more of a ride today This Is Outlook Outlook Saskatchewan not Microsoft Outlook Saskatchewan Outlook Oh, here's the town. Okay Welcome to Outlook everybody in Saskatchewan Big hot spot for tourist destinations if you're looking for one They got a gas station Gas prices are slightly lower than Manitoba that's exciting Looks like they've got a hardware convenience store all in one. They got a bargain shop What a bargain come on down to Outlook Saskatchewan They have people At least a couple of them They got a liquor store. What else what else do you need on your vacation? Why is there a bag in my lane? I don't want to drive over that. I don't know what's in it I'll go around that one They got a printer store. Well, they got another liquor store in case you're on this side of town They got one on this side of town too sort of like Tim Horton There's one on every corner within walking distance. I haven't seen a Timmy's yet though Did we pass it already? They've got to have a Timmy's if they don't have a Timmy's forget everything I just said they got a little war memorial over there It's good. Are you stopping too? I stopped first. I got to go. That's the rules. I don't make them I just follow them Nice little town the way Not bad This is a prairie town for you Feels like home they even got dead trees just like us Reminds me again. I have to call the arborist get them to cut that dead tree down in our backyard That one I can't do myself. There's way too many buildings around us and power lines. I'm gonna have to get a professional in there who has insurance Instead of they messed something up they can deal with it. I messed something up. My insurance companies be like What were you doing cutting down a tree in town? I just don't want to answer those questions.  Look at this. I'm a tour guide now Very nice car wash in case you get a dirty car more people So you can talk to people Absolutely, look at this even a subway every little town has a subway Wealth management for all you rich folks. There's a wealth management store over there. Whatever that is. Here we are Rose towns the sketch one My sister's name is Rose. She has her own town Look at this Your destination is on the right. Thank you. Thank you. I noticed Where would they like me to park Guessing they're probably gonna want me around back but for now Hmm, I'm gonna park up here and walk inside there and they can let me know where they want me People can get around me from here. I'll let the load gods know I have arrived composed arrived at stop-off number three in Rose town Rose town Sketch a wall and always felt rose town wrong. Whoops Rose 10 rose town. There you go. Send that away. Yes. I'm sure I'd like to send that message Absolutely, that's why I that's why I wrote it We will put this on-duty status to on-duty Unloading cargo where to go here Unloading cargo so that it is on record that I am here on duty not driving Trying to get unloaded Wonderful, wonderful Maybe they'll unload me right here then I don't have to go through that mud No need to waste fuel while I go inside Okay Just make sure I know I'm in the driveway here But I think I left enough room for people to get around me while I figure out where they want me. Oh, I have plenty of room.  So this is theirs here this cutter. That's the only thing Yeah, they're just taking this so it shouldn't take too long. We should be out of here soon all right, I'm just gonna maneuver myself over this way a little bit and They're gonna come and unload me right here Just in case if some kind of big heavy truck comes in or a big tractor that Look at these machines though. Hey, I know I'm a highway tractor guy, but Must be fun driving those tractors, too. I just love big machines Don't those look like fun? I Got to drive a big combine when I was younger My cousins my cousin or my parents cousins One of our puzzles We lived in the farm for for a while and I helped them with harvest That's the drive the grain truck. It's dry like not by myself, but I got you know Act like I was combining for a while.  So like the eight wheels and it pulled a big air seeder combination So much fun so much fun I love farms Okay, so they got their moor off of here now brought it in over there And now I got this left swift current. This is my next one And I'm gonna have to do that in tomorrow's video because we got quite a bit of footage now I think this is enough for one day. I Think we'll be good. There's just a fly that landed on my GoPro. Do you guys hear that? It landed like right on the mic Huh, that'll be many ways. Hey, that's it for today Me and old blue Old blue and I proper English old blue and I will see you tomorrow. Take care


This is FDA Patient Safety News. In this edition, a recall of certain defibrillators made by Access Cardio Systems, new warnings on the drug Miphaprex, more on what practitioners can do to prevent transfusion-related deaths, and a warning for consumers about treating sexual problems with certain dietary supplements. These stories and more on this edition of FDA Patient Safety News. Welcome to the program. For the U.S. Food and Drug Administration, I'm Mark Barnett. And I'm Anita Reiner. Let's start with a recent recall. Access Cardio Systems Incorporated has recalled some of its automated external defibrillators because of two potentially serious problems. In some of the units, the shock delivery circuit can fail so the defibrillator can't deliver a shock. Units that could be subject to this kind of failure have serial numbers from 075690 to 077140.  Units that could be subject to this kind of failure have serial numbers from 075180 to 084760. So is the company going to repair or replace these recall devices? They can't do that because they're out of business. They can't repair them. They can't replace them. They can't supply replacement parts. So what are users supposed to do then? Well, the company says that if you have one of the defibrillators whose serial numbers are in the two batches we just mentioned, you should immediately take them out of service. What about other defibrillators made by this company, the ones that have serial numbers outside those ranges? Well, they say two things about that. First of all, as soon as your supply of disposable parts for those defibrillators is used up, remove the units from service. The company is no longer going to be able to service any of the defibrillators or supply batteries and electrodes, but they also advise customers to consider replacing the defibrillators as soon as possible. And that could mean before the supply of disposable parts is used up. FDA and Danko laboratories have notified healthcare professionals about important new safety changes in the labeling for mithoprex or mitheparastone, also known as RU-486. Mithoprex was approved in 2000 for the termination of early pregnancy. That's 49 days or less. These labeling changes were prompted by reports of serious bacterial infection, bleeding, ectopic pregnancies that have ruptured, and death. The black box warning on the label has been updated to add information about these risks. Now while these risks are rare and they can occur following any termination of pregnancy, including miscarriage, the new warnings and an updated patient medication guide provide the latest available information to both practitioners and patients. The warnings point out that serious bacterial infection and sepsis may occur without the usual signs of infection, such as fever and tenderness on examination. The warnings also caution providers that prolonged heavy bleeding may warrant surgical intervention. The label also warns that healthcare providers should be vigilant for patients with undiagnosed ectopic pregnancies, which can be missed by physical examination and ultrasound. Some of the symptoms of an ectopic pregnancy can mimic the expected symptoms of a medical termination of pregnancy. Mitheparastone is not effective for terminating these pregnancies. The patient medication guide instructs patients who've received mitheparastone to contact their healthcare provider right away if they experience any one of the following. Severe abdominal pain, a temperature of 100.4 degrees or higher for at least four hours, or heavy bleeding that soaks through two full-size sanitary pads per hour for two consecutive hours. Patients should understand that severe abdominal pain or fever can be signs of ectopic pregnancy or infection and that heavy bleeding may require surgery. Also, if patients having problems seek help from an emergency room, their advice to take their medication guide with them, this alerts the practitioner that the patient's undergoing a termination of pregnancy so she can be appropriately assessed. FDA is going to continue to monitor the use of mitheparastone, may take further action. In previous broadcasts, we've talked about many cases of medication error caused by mixing up drugs whose names looked alike or sounded alike. These kinds of mistakes are more likely to happen when poor handwriting or poor oral communication are involved. Jaco has now made look-alike sound-alike drugs part of its national patient safety goals for 2005. That means that organizations are required at a minimum to annually review a list of look-alike and sound-alike drugs used in their facility and take action to prevent mix-ups. Jaco has also posted a list of the most problematic drug name pairs for specific health care settings and facilities must include at least ten of these drug combinations on their own lists. Many of the name pairs on Jaco's list come with specific safety strategies for that particular name combination. But Jaco also has a number of general recommendations for preventing drug name mix-ups. Let's take a look at just a few of those recommendations. Prescribers should write both the brand and generic name on prescriptions for drugs whose names are known to be problematic. They should also include the intended purpose of the medication since in most cases drugs that look or sound-alike are used for different purposes. And they should give verbal or telephone orders only when it's truly necessary and encourage staff to read back all orders, spell the product's name, and state the indication. Facilities and practitioners should be aware of look-alike and sound-alike drug names and regularly provide this information to professional staff. They could computerize prescribing for these drugs using pre-printed orders or prescriptions. And when possible they should list both the brand and generic names on medication administration records and automated dispensing cabinet computer screens. In a previous program we warned about dangerous and sometimes fatal overdoses that occurred when the drug Methotrexate was accidentally taken daily rather than weekly as intended. In a recent article the Institute for Safe Medication Practices points out a similar hazard with the chemotherapeutic drug CNU or LeMustine which is used to treat brain cancer and Hodgkin's disease. A single dose of oral LeMustine should only be taken once every six weeks. But like Methotrexate, LeMustine has sometimes been dispensed and administered daily, often with tragic results. In one case a 24-year-old woman with brain cancer died as a result of a LeMustine overdose. A physician had written a poorly legible prescription for LeMustine 190 milligrams every six weeks. The pharmacist misunderstood the direction, says daily for six weeks and dispensed a six-week supply of capsules with directions to take 190 milligrams daily. The patient's physician hadn't explained how to take the medication so the patient followed the label directions and took 190 milligrams daily for 21 days. She was hospitalized with severe bone marrow suppression and acute bleeding and she died a month later. ISMP says that Bristol Myers Squibb has enhanced the labeling in the packaging of CNU. Single dose only is now printed in red on the label and dispensed single dose only is embossed on the cap of stock bottles. However, even these warnings can be overlooked so here are some of the other safeguards ISMP recommends. First, program warning messages such as single dose only into order entry systems. Also, configure the system to limit the quantity prescribed or dispensed to 300 milligrams or less for each prescription or order. Use unit of use dose packs that are available for the manufacturer. Each 300 milligram dose pack contains two 100 milligram capsules, two 40 milligram capsules and two 10 milligram capsules with instructions for the pharmacist to select the correct patient dose within 10 milligrams, place the capsules in a single vial and attach the special patient label that's provided. When possible, use bold font or all capital letters when presenting dosing frequency directions on patient labels and on nursing medication administration records and use large print to help elderly patients with poor eyesight. Prescribers should counsel patients directly so they understand that taking extra doses is dangerous. They should also ask the patient for verbal confirmation to ensure that the patient understands the dosing schedule. Finally, follow up by giving patients written information that contains clear advice about the single dose only dosing schedule. Pharmacists should also review the prescription label with the patient or the caregiver. In a previous program, we told you about the importance of recognizing and promptly treating a potentially fatal condition called trally or transfusion related acute lung injury in patients who have recently received a transfusion. Now we want to talk about an older but still persistent cause of patient deaths from transfusions, ABO incompatibility. Why are patients still dying of ABO incompatibility? We know that the blood is pretested for blood type and then it's matched to the patient. The problem is that most deaths from ABO incompatibility don't occur because the blood isn't tested properly. These accidents happen because the patient is misidentified. In other words, they happen when the hospital staff fails to use established procedures to identify the patient when drawing the pretransfusion blood samples. So what's the FDA recommending? Well, the key here is having and using standard operating procedures. That goes for pretransfusion testing and for the transfusion itself. And it includes procedures to accurately identify the patient before drawing the pretransfusion blood sample, procedures to ensure that the proper unit of blood is released by the blood bank, and procedures to identify the patient again just before the transfusion. You're talking about identifying the patient right before the transfusion. Now the FDA has a new barcode regulation that will require a barcode on blood products. How is that going to affect that? It should help healthcare personnel make sure that the right unit of blood gets to the right patient. FDA is now going to require that blood products be labeled with a barcode similar to the ones used in supermarkets. The barcode on the container can be read with a scanner at the patient's bedside to be sure that it's the correct unit of blood for that patient. The Institute for Safe Medication Practices cautions that it's easy to make potentially fatal dosing errors when administering epinephrine injections because the terminology on the label can be confusing. They cite the case of a 16-year-old boy who received four milliliters of undiluted, one-in-a-thousand epinephrine solution intracavernously to treat priopism. A one-in-a-million solution should have been used, so the boy received a massive overdose. He arrested and couldn't be resuscitated. The physician who administered the drug mistakenly thought that the label on the vial, which read one to a thousand, meant that the epinephrine had already been diluted with a thousand milliliters of fluid. To prevent this kind of error, ISMP recommends that you not stock the large 30-milliliter vials of one-in-a-thousand epinephrine. If you need this strength, stock only the small one-milliliter ampules. That way, a massive overdose can only be administered by using a large number of ampules, and that should alert the practitioner that something's wrong. The FDA has issued a warning to consumers not to use a product sold on websites for treating erectile dysfunction and enhancing sexual performance. It's called ACTRRX, or Yilishin, and it's promoted as a dietary supplement. The problem is that it contains prescription strength quantities of sildenafil, which is the active ingredient in Viagra. Well, aside from the legal aspects of selling sildenafil without a prescription, where's the harm to patients? We do know that sildenafil is effective in treating erectile dysfunction. Well, there are two potential hazards here. The first one has to do with simply potency and purity. The consumer can't really be certain of exactly what's in this product or how much of each ingredient it contains, but the most immediate risk is that sildenafil can cause a significant and sometimes life-threatening drop in blood pressure if it's taken in conjunction with prescription drugs that contain nitrates. Now, these nitrate-containing prescription drugs are commonly taken by patients with diabetes, hypertension, hypercholesteroemia, and heart disease, and unfortunately, these same patients often have erectile dysfunction, and those people might be especially susceptible to ads for these so-called dietary supplements, and of course, that would put them at risk for serious adverse events. Now, how widespread is this problem? Is it limited to just this product that you mentioned? It's not just this product, and even if we didn't have this product, the problem wouldn't go away. It is a long-standing problem. Last year, the FDA issued warnings on several other so-called dietary supplements that contained either a sildenafil or a tidalafil, which is the active ingredient in Cialis. Some of these products were also promoted for sexual enhancement in women, and so products like this are likely to continue to pop up on the internet. So what should health professionals be telling their patients? Basically, the message is that if you have erectile dysfunction, you should see a doctor rather than trying to treat it over the internet. Well, that's all for this edition of FDA Patient Safety News. Remember, you can get more information on all the stories you've seen here today by visiting our website. We also urge you to use the website to report problems you've encountered with medical products. That's how we learn about problems so we can alert others. We'll be back next month with another edition, so watch for us. Until then, for the U.S. Food and Drug Administration, I'm Anita Rayner. And I'm Mark Barnett. See you next time.


Something to think about, 44% of U.S. economic activity according to the U.S. Small Business Administration employ almost half of all American workers. Now if you take this and if you put it in Canada or in most other countries, you'll see the statistics are pretty much the same as well. North America's based on the dream of the entrepreneurial dream. Yet what we're seeing today is the complete disillusion of your ability to provide for you and your family. This is a war on small businesses. Now I find it kind of ironic where, wait a second. And before I begin, I'm gonna be mentioning big brand names, Costco, Walmart, McDonald's. I'm not here to hate them. What I don't like about their policies is lobbying. I'm not in favor of lobbying. Lobbying destroys the free market. It doesn't create a fair market for you and I to participate as small players. So I'm not here bashing the companies themselves. I always say show me the incentives. So I get their incentive. It's not like I'm sitting here saying, oh wow, I really don't understand why Walmart's doing that. Oh, I really don't understand why.  If they didn't do it, then I'll be baffled. Wait a second, why aren't they doing that? So before I begin, I just wanted to clear that out. Now you have places like McDonald's. You have places like Costco who are allowed to stay open.  They're allowed to stay open.  And in some places like Ontario and Red Zones, depending on which type of business you're in. So let's say gyms forget about it, restaurants forget about it, retail like clothing, forget about it, anything to do with fitness. So for example, would it be like spin, sauna, any of this like let's actually get healthy? No, forget about your clothes. You can't even allow one human being inside. So you're not even allowed. You're not given permission to even provide for your family. And it's funny how we see people react online. And people don't really think about the second order, third order effects when it comes to businesses. We had a report where a huge, I won't name the name, but a huge restaurant chain in Ontario.  Oh yeah, well, blah, blah, blah.  One of the owners of this chain of restaurants or I would say chain of hospitality options came out. It's like, you guys don't get it. Like this is what the general public doesn't get and this is what the powers to be. They put it into place where they try to divide people. Like, yeah, I hate business owners, hate entrepreneurs, but yeah, I don't see people hating on McDonald's. I don't see people hating on all these big mega corporation. How much money these guys have made in the last six months? Billions of dollars from the stock, billions, because they're the only players in town and they're sucking up everybody. Amazon just the other day hired 400,000 people in America, roughly 400,000 people to do a warehouse work. Walmart and Amazon are literally becoming the social security net of the United States where we will pay you your minimum wage so you can barely get by. And now remember, I'm not hating Amazon and Walmart as a corporation.  What I don't like is the crony capitalism and the lobbying behind it. That's what I don't like. So you have this group, let's go back to this.  Well, let's talk about second order effect, third order effect. What happens when they claim bankruptcy and miss normal? Bankruptcy doesn't mean disappearing. Bankruptcy means restructuring the company. It might mean disappearing. It might mean, hopefully that's not the case, but for the most part is restructuring the corporations around assets they have, debt of their own, management, et cetera, and trying to reestablish something that might work in the future. Okay, that's the whole reason why corporations and trusts exist in the first place is so you can do that. Okay, but that still doesn't fix the second order, third order effects when it comes to the actual supply chain that a business is part of. See, people think everything is a linear fashion.  That means that the person they're employing, guess what, that person is gone, doesn't have to paycheck. Well, maybe that person was doing business with somebody else. Well, that person had to pay rent or mortgage. Well, that person can't pay rent or mortgage anymore. That's just an individual thing, right? People really don't think about the domino effect. Let's look at the bigger picture of the domino effect. The hospitality chain, it's really important because they're also tied into the transportation industry, meaning airplanes, right? Commerce, me going on vacation, me going visiting somebody. They were all intertwined, restaurants, restaurants, Airbnb, hotels, they're all intertwined for greater, bigger experience and they all share in one shape or form the supply chain. What is in the supply chain? Well, we have providers of food in the supply chain. We have farmers in the supply chain. We have cleaners in supply chain. We have maintenance crew in the supply chain. This is what people really forget.  That's not how business works.  And if you look at the supply chain, if you take out, let's call it the big fish of the supply chain, everybody else suffers, everybody. And this is what we're seeing right now. We're seeing, there's some early statistics, we're seeing roughly, they're saying one third of all small businesses in North America will foreclose completely. And so this whole idea of we're gonna get back to a V shape economy, there's two economies by mind. You have the socialist stonk market where you have the Fed printing trillions of dollars as much as you want through the Kentilinian effect, giving that money to the crony capitalists on the top, the Wall Street bankers, and then they can buy back their stocks before you can buy it.  That's the whole point of the stock market today. This whole value investing in stock market as of today, I find it hard. I don't see any value there. All the price earning ratios you can think about, how to evaluate a stock, forget about it. I don't see whatsoever, it's a Ponzi scheme as of today. And now we have one third of small businesses that are pretending, in my mind, I think it's gonna happen.   Oh no, 10 o'clock, let's get out of here, it's curfew, let's go, let's go. Our leaders are so incompetent, but yet we only have one person to blame us, that's it. We need to blame ourselves, we elected these leaders. They've never run businesses before, they've been in the political arena their whole lives. They are actually devoid of day to day normalcy, they are. They really don't understand day to day actions. And above all, the number one thing policy makers don't understand across all different levels of government, and most people, but primarily they, is second order, third order effect.  And we're seeing that right now across the board with COVID.  Some of these businesses should have been out of business a long time ago. Some of them, not a lot of them, but some of them. And a lot of these businesses that shouldn't have been out but are out now, I think this gives opportunity for us to rethink our priorities in life. I think this gives us opportunity to rethink, listen, the government it's not here to help us out, it's not.  There's never been a government in the history, whether you wanna call it a regime, a government, a governing body that represents the people. There's never been a time in history when they haven't turned their backs on their own people in some shape or form, period, end of story. It always happens, it's the old Boris, it's the oldest mythological, psychological trait of us human beings, snake eating its own tail. It happens, I keep on telling you guys, read René Rajard, read his work. It's so simple, you'll understand it, just go out there and read it. And so we're seeing the cycles repeat. We're seeing the changes in different zeitgeist psychology from millennials to Zoomers, different power vacuums coming in, people fighting for different ideologies in North America. Now Marxism, once again, is cool and people want socialism. We call them the champagne socialist.  Remember what I said, I'm not fearful of them, they're just pawns in a greater scheme. However, I see this as an opportunity now to expand our thinking of the possibilities of what we can do as a community. I think there's a lot of opportunity for us to create better lifestyles for us than we had before. Before we were, most people are still trained in the classical way of thinking, well, what should I do? If I want to become successful, I have to go to school, go into debt, $100,000, get this job, blah, blah, blah, follow the line, go into corporation, go up to a hierarchical ladder, blah, blah, blah, and even entrepreneurship, right? We've been programmed to think that there's certain ways to do business. Well, entrepreneurship, at least on the lower spectrum, not in the upper echelons of the lobbyists, it's a little bit more free market, it's more cutthroat. I don't have any special handouts for the government. I don't have any special regulations that helps me out. I have to be, I have to provide the best product or service for my customers and hopefully they like what I offer and it's a free voluntary exchange. And so the whole idea of how we've done business in the past, I think it's gonna start changing. I think more and more opportunities that we have where how do we digitize what we're offering? How do we create hybrid versions? How do we start thinking outside of the box that we can become more anti-fragile as businesses as opposed to fragile? I can't tell you personally in Ontario, I just know Ontario, I can't tell you any businesses I know just function on government grants.  They just accept handouts. It's ridiculous. I'm like, that's not a business.  But I think, and we see with the retail collapse, Tip Top is collapsing. A lot of these big brands, they've never really adapted. But I think for the entrepreneur in the unfortunate circumstances with the lockdown and the ability that they have to fight back the lockdown as much as they can without them going to jail and they don't wanna go jail and they have their wife or husband and son and daughter et cetera. There's a lot of variables that play over here. I think people need to really start thinking of A, is this the best place for me to live? B, moving forward because I always tell people the greatest gift that you have is not the gift of, hey, I have money. That's always good to have. But the greatest gift you have is the mentality that you develop, the skills that you develop, the grit that you develop during your process. Joseph Campbell always said, it's not about the end, it's about the journey.  You've built a mental blueprint of how things can be done. You've built grit. You've built the ability to be agile if you can.  I'm firmly in the camp.  I'm in the camp that is a born natural trait. It's very hard to learn because of genetics and nurturing. Now, with this experience that you have, I think it's time for us to audit what we think is the norm. And we start thinking outside the box and let's stop fear mongering. This is what they want at the end. They want you, they want us to be scared. They want us to bend over.  Who is imposing these laws? You have enforcement is done by local enforcement and if it escalates then it's federal enforcement.  The article passes once or twice. They vote this bill into action. Now this bill is here in case of an emergency situation like COVID, we have amendments where we have, well, superseding rights where we don't need to have a vote as governors do, bang, bang. I just say what I want to say or I do what I want to do, boom. This is in law right now. So that's they, it's policymakers at the end of the day. So these policymakers for the most part, they're not really looking after your back.  They have their own incentives, they have their own skin in the game and the more you take emotions out of it and just look at who gains what, what incentives are structured for who, then everything becomes a clearer picture. I always keep on saying show me the incentive and I'll show you why and how people behave a certain way. That's it. It's not convoluted, it's not conspiracy, it's not complicated. That human being or that group of people are behaving a certain way because there is an incentive attached. That's it. And so I just want to wrap up this video guys with we, I think, I think in the future people who've come out of this, who've learned from this, who've personally experienced pain and utilize this as Victor Franco says, utilize this as input and knowledge to respond healthier as opposed to reacting. That's what they want. Victor Franco said the best, the most important thing in your life is how you respond as opposed to how do you react.  Take this, don't react.   What pisses policymakers off the most is when you come out with better technologies, when you come out with better ways or better methods to supersedes any of their policies or regulations. That's the key, as I said before. The best thing a small entrepreneur can do right now is become an apex predator and create better methods, systems and technologies that will supersede any of these different policies or regulations they've put into place. And I'll leave it at that guys. Leave a comment below this video. Make sure to subscribe and I'll see you tomorrow. Peace out.


This would be a good idea to do so now if not we can proceed with the presentation. I see Lisa Krasna in the back, which is with public health in order. I'm actually on a trip with China now. So you've been with me? Yes, I've been with you. Public health, sir? I came from the Indian Department. May I come in here? It's good to be here. Is that Eric? Eric. That's with public health. Oh, I'm going to go to the studio. It's alright. I'm gone, just for a couple of seconds. So I am very, very delighted to have Dr. Obade Chano here with us today. We've been having ongoing discussions often on for about a year. And this is really a watershed in having this participation in our program, partly because we want to reach out to those on our campus who are actually in the field of doing public health. And he was trained as a physician and as a researcher. And his expertise is in cardiology. He has had lots of publications and experience in research. And a few years ago he traveled to China on the invitation from a professor there. And essentially fell in love with the culture, with people, with place, the public health issues that he felt a significant difference. And he has taken students and colleagues over to China to, especially if we rather have to look at heart disease. And today he's going to talk to us about these experiences and I hope we can follow up with him with additional questions and discussions. Thank you, Professor Obade Chano. I'm going to talk about the growing academic hypertension and heart disease in China and what the small organization that I belong to, which Professor Obade belongs to and some of you may know about, the China-California Heart Watch is trying to do in confronting this. So first of all I would like to start this with some questions. And I want you to, you don't have to tell me the answers to these questions but perhaps you could jot them down really quickly and then think about what your answers would be. Chinese farmers, the rural population of China, what percent of the world's population is it? 5%, 10%, what is it? And what is presently the most important cause of death in this sector of the world's population? And how rapidly is this cause of death increasing in China in terms of the number of deaths in terms of mortality? How rapidly is that increasing? There's a hint there that is increasing but how fast is it increasing compared to the United States. What source of support in terms of healthcare support is the most likely to solve the problem of heart disease in China? Private sector, Chinese government or what support? And how could a small organization best influence the potential source of support to do more about it? If you try to think about these questions you'll understand my logic in founding this small organization and working in China which is not only to directly do something and make a difference but perhaps to influence the powers of the beat to make even a bigger difference. Let's start with the first question. Rural Chinese people make up one-eighth of the world's population. More than there are people in the United States. 800 million people live in rural China. Western rural China in particular is poor and as I said as a response to one of the questions is in the sense of getting even poorer there's enormous inequality between rich and poor. There is a great neck urbanization with people rapidly moving from rural villages into little sized and large cities. And I'll show you an example of that, an amazing example of that in just a minute of a city in China that some of you I know I visited but you may not know the facts about its population increase. And there is no economic base in the private sector or even in the local government they could possibly meet the healthcare needs of this enormous population. The local economies are just too poor. They could not do it on their own. They have to get help from the outside. This is from 2006 so it's a few years old but it's statistics today are pretty much the same. There are 100 million rural Chinese that earn less than $1 income per day. We talk about the poverty in small countries like hate enormously poor and a fortunate population there's 10 times as many people in China that are that poor. If you're getting poorer between 2001 and 2006 the poorest 10% of households saw reduction in their income from $546 to $420. There's enormous inequality both between regions and between the rich and the poor in given regions. Urbanization is depleting labor in rural areas making it difficult for rural poor regions to attract investments. This table here shows the gross domestic product comparisons. It's flashing, you can give me upwards. 2005. China, I'm told the main thing is to look at the comparisons here. If you look at the eastern coast of China it's $3,528 GDP per year and if you look at the southern hinterland which includes Yunnan province it's three times smaller. So this is the kind of inequality between regions that you have in productivity and income. Urbanization, this is about Dali city. Who has been to this city? Dr. Wang has been there. Dali city is right in the middle of Dali state. This is Dali state or Dali prefecture. Dali city is right in the middle. It's in the southern part of Lake. This is our lake, our high. And in the year 1000 it was the 14th largest city in the world. It had 90,000 people. So in the year 1000 the city was very big. Dali was a big metropolis. It was a big metropolis. It was the capital of a small kingdom. And between 1000 and 1983 its population did not change. In 1983 its population was still about 90,000. It actually went down and then went back up a little to 90,000. So it reached its year 1000 population in 1983. Since 1983 what's happened in Dali city? This is what's happened. Its population has gone from about 100,000, 90,000 to about almost 600,000. It's increased more than five times in that short period of time. So where did all those people come from? They came from the countryside. They came from the villages. They came from the small towns in rural areas. Is this trend pretty much true for most of the larger cities in Yunnan? Dali is one of the fastest growing in population. The very large cities like Kunming is about now about 6 million. Not five to 6 million. They're also increasing in size, but not at this rate. And even the very large Shanghai and Beijing are also increasing. Do you know if this is the wrong for most of the Chinese cities? I've just seen that. People go back to the countryside because of the economic downturn. 10,000 in May, 30,000 in turn. The question is in the economic downturn, the worldwide recession, which we are now in, has that caused people to go back to the countryside? I think, once again, I'm not an economist. I think what happened was the people moved from the eastern manufacturing cities like Shenzhen and Guangzhou, Shanghai. They moved from those cities and they went back to their provinces. And then they went out and got jobs in local cities like here. So I don't think these cities are decreasing in population now because of that. They're still building and developing. It's not as fast as they were in, say, 2000 or 2001, 2002, but they're still building. And they need labor. A lot of these people work in construction. They need labor for the building. So in this setting of poverty, inequality, and breakneck organization, what is happening to heart disease in rural China? Let's take a look at what's happening in China in general. And let's compare it with the United States. What happens with the mortality from heart disease in the United States? Dr. Wang, you could probably take over from this and do a much better job than you could handle this very well. In between 1900 and about 1970, there was an increase in heart disease, mortality in the United States and death from heart disease. And then in about 1970 or so, it leveled off and its state leveled off. And some of the, I mean, there are all kinds of hypotheses as to why that happened. But I think the major ones involve healthcare improvements. Healthcare in terms of caring for people with heart disease, chronic care units, defibrillators, coronary bypass surgery, percutaneous interventions, and very importantly, preventive cardiology. Treatment of hypertension, treatment of hyperlipidemia, earlier diagnosis and treatment of diabetes. I think these are considered to be some of the factors which cause this to level off and not to continue increasing. Some people say, even if you didn't have any of this, it would have leveled off. But I really don't think so. I think our healthcare system did have an effect. I mean, with all of our defects in our healthcare system, I think it did have a positive effect in causing a leveling off of mortality in the United States from heart disease. Well, in China, in rural China, in particular, this business practically doesn't exist. When I go to villages, and I had one man, he walked three miles with chest pain. He came and he, to me, with the chest pain. We had an ECG machine, we had an ECG. He had an acute mild current in the fracture and then his ECG. And he did not, he refused to enter the hospital. Not because of money, because I would have paid for that for him. He didn't trust the hospital. He didn't trust the doctors. So his mild current fracture was treated with pain medications, the beta blockers and aspirin, which I gave him at home in bed rest. So no CCU, no defibrillator, no bypass surgery, okay, no PCI, and essentially, except for my advice to him to control his blood pressure and no preventive cardiology. So let's compare the U.S. with China. This is the U.S. and this is China. Okay? If nothing is done, the number of deaths in China, of course, this is number, not percentage. Okay, so you understand that. It couldn't be percentage. The number of deaths in China is going to continue to increase until about 2050. It's going to hit maybe 10 million deaths a year. Once again, going back to the poor country of Asia there's 10 million people. It's like there's a population of a small country dying a year. That's how many people will die from heart disease and stroke in China. In 2050, if nothing is done to address this problem. Why is heart disease, and it's increasing in China? My thoughts, number one reason is hypertension. Number two reason is hypertension. And number three reason is hypertension. Of course, there are other factors. Of course, there's hyperlipidemia. There's poor, high fatty foods, which are increasing. There's less activity, some degree of less activity. There's smoking. That's been going on since the 50s. I think uncontrolled high blood pressure, which is increasing in severity, which is increasing in prevalence, is the main reason for the increased incidence and mortality from heart disease. Have there been some studies that have looked at, for example, attributable risk in rural regions to say smoking versus hypertension and some of the other risk factors? Well, Yan Fangu, his cohort, which includes rural areas of Muka, M-U-C-A cohort, his hypertension is the strongest risk factor. Triple risk of hypertension is higher than the other risks in rural areas. Just to follow up on, I remember 10, 15 years ago, WHO was predicting lung cancer, essentially, the graph that you showed, skyrocketed in time. Is smoking as prevalent in the rural areas as one would expect in the big cities? It's very prevalent. It's prevalent among males, about 70% of adult males, and only maybe less than 10%, 5% of females. In some very remote regions, the women also smoke. They smoke pipes, but most of the women in rural China don't smoke. Is there a gender difference in hypertension, heart disease? Yes. Yes. It's more in high rate. This is prevalence of hypertension. These are different studies, so they're not exactly comparable and there's all types of biases involved, but if you look at the results of the different studies starting in 1959, the earliest studies in Chinese statistics of prevalence of hypertension in rural Chinese adults were as only about 5%, they didn't consider an important problem at all, going through the present where it's as high as 35%. In our study at NUNON, it was 30% in middle aged elderly adults in Liaoning province in the northeast of China. It's for about 45% of adults in rural areas have hypertension. So there's a very rapid increase in prevalence of hypertension in countries like... So Bob, one other issue about that. So with an uncontrolled hypertension, a big issue, are you seeing proportionately more strokes versus coronary disease in rural China than, for example, in urban China where coronary disease seems to be going up and maybe stroke not quite as much because they're controlling blood pressure a little bit better in urban areas? Well, I'm not sure that's true, Nathan. I think strokes are... death from strokes, stroke mortality is still higher than coronary disease mortality everywhere in China. Stroke mortality is very high. It's one of the mysteries, really. The difference is so great that it makes a lot of sense. There might be differences in genetic differences. Yeah, much more than in estates. Stroke is a much bigger deal. Also in Japan, stroke mortality is high, which pans are all at least in the whole country, Korea also. In China, it's the only large country where there's an excess of stroke mortality over heart disease mortality. All over the city and countries. When I see more strokes, I see more strokes than heart attacks. Michael went with us. Remember, we didn't see any heart attack. But we see strokes. What was your definition of hypertension? It's a WHO definition. It's either a history of hypertension or a systolic blood pressure of at least 140, or a diastolic of at least 90. And do you see the prevalence of the degree of hypertension as it dropped off at the higher levels? Or do you see a kind of a continuous, I mean, a similarity of very high blood pressure versus just breaking up? I think, you mean compared to other places? I don't know. The question is that we see fewer people with very high blood pressure? Yeah, we see. Most of the people with hypertension have blood pressures in 240 systolic people, 140, 160, and diastolic between, say, 90 and 100, most of them. But we see also some with very high blood pressure. I see a lady with 260 over 140, and she just walked in and I measured it three times and it was that high. And she wanted to go home and she said, no, no, wait here. We have to give you some medicine. So you're giving her medicine, but how aggressively are you revaling or maybe secondary causes? Secondary hypertension versus primary hypertension. Secondary hypertension is a known cause, like needle artery stenosis or hypothyroidism. You know, in China, like everywhere else, most hypertension is essential hypertension. If we have young women, and we do a physical examination, we have young women, we've seen young women who seem very nervous, tachycardic, fast heart rate, and we'll check out somebody like that for hypothyroidism. We've seen some of those. In fact, some of them are so obvious that hypothyroidism actually treated them because it's not easy to get thyroid function tests. You have to send them far away, but we've actually treated them with tapasol or lithosol and adiablocker. But most of them are in one case of a coartation of the aorta in an adult. It's just very interesting how you want to get into it now. Because you're doing echocardiographs. Not in any particular sense, right? Yeah, but in some cases. We have echocardiographs in the end. So we're a small organization, China, California, Hardwatch, and what are we doing in China? Our mission is to, one, establish transnational education exchange to allow American students to study in developing areas of China, even on problems, research hypertension and heart disease in China, train rural healthcare workers, and get free clinical care. And I'm going to talk about each one of those in terms of our accomplishments. In education exchange, we have an intern program, which Michael Berniani, who's here, participated in. We are doing research. We have one publication in the period literature and international literature, which Ashkan Akashay is the primary author. He is a medical student at UCI. He and my colleagues in China, and Dr. Wang here, wrote this paper. It was published in the 2009. I'm going to show briefly something about that paper in the next 10 minutes. And we are teaching village doctors in training courses, which we hold now every year. And we have several clinical programs, but I think the most remarkable, especially for me, because I never expected to do this, and I am not a pediatric cardiologist, is our Grants for Kids program. Last year, we helped give 14 children a new chance of life, who never could have undergone surgeries or procedures if we hadn't been there to help them. This is Ashkan Akashay in Yunnan, and his paper was published in American Journal of Hypertension last year. Left in Turkino Mass of Blood Pressure and Untreated Hypertensives in rural Yunnan. Just briefly going through this in a formalistic type method, the methods that we used to do this was we randomly chose 10 villages, villages from different townships, and we randomly chose subjects, residents of those villages between the ages of 50 and 70 years from each village. We had a total of 490 men and women. Of those 490, 344 were available to participate. So the 490 were chosen from a list, but we didn't find all of them. Some of them had gone to the city to for a blue-blinded lame or some of them were too sick to come in and we did not consent. So we ended up with a sample size of 344 which individuals who participated between 50 and 70 equal numbers of men and women. We took histories for risk factors, smoking, alcohol use, medication use, and we measured blood pressure 3 times, measured height and weight to get body mass index. We did cardiac ultrasound using a small portable ultrasound machine in order to measure the interventricular septal wall thickness, that's the wall that separates the right and left ventricle and the left ventricular posterior wall, that's the opposite wall of the left ventricle and also the diameter of the ventricle of the left ventricle diastole. Using those three measurements one can use a formula to calculate the mass of the left ventricle which is a fairly accurate formula has been used in many epidemiological studies internationally. So in order to reduce variability I was very nervous that we weren't going to get good measurements. In order to calculate variability and reduce variability we did four measurements of each one of these so we had four separate left ventricular masses for each one of the 344 participants. This is me doing an ultrasound in a subject's home. We did some of these in the home, some of them in community centers, some of them in clinics. This is the small machine that we used to do the measurements on. This is a a picture, you can't see it very well, but this is the interseptal of the septal thickness.  The septal thickness in this one was 1.8 centimeters, 18 millimeters. The posterior wall thickness was 16 millimeters, and the internal diameter of the left ventricle was 46 millimeters. Using those three measurements, you can calculate left ventricular mass and you use the formula called the DEVARU formula named after professor DEVARU who is a cardiologist at Cornell University and that's the formula. Everyone has to remember this, don't you? The professor is going to ask you next week, what's the DEVARU formula? Did you also get left atrial dimensions? I was curious. Yes, you did. I'm putting it on here, but we have to use that data. Yeah, that would be... Well, it's the next paper. Maybe someone wants to look at the left atrial dimensions and see how they're related to blood pressure. So we took the average of the blood pressure measurements, the average of the fluorescence of left ventricular mass and we calculated the left ventricular mass index which is left ventricular mass divided by the body surface area. This is just how we got down to 344. Okay. And in our results of the 344, 48 percent in men body mass index was 22.6 and 38 percent of smokers, most all of those were men. Now high cholesterol and diabetes we did not measure. We did not take blood specimens. We did self-reported. And in rural areas people never get tested. So basically we asked them, do you have high cholesterol and they would say yes or no. Now in many cases think they really don't know. So these data are a little bit questionable, frankly. There's a problem with them. It would have been nicer to do finger sticks or some kind of measurement but we didn't have that available when we started to study. Blood pressure, mean blood pressure was 130, diastolic blood pressure mean was 75 and mean left ventricular mass was 138 grams. And this is the relationship between systolic blood pressure and left ventricular mass. As the blood pressure increases, the left ventricular mass increases, this is a significant relationship of an R-squared of 0.22 and a slope of 0.4 for the systolic blood pressure. So remember slope is 0.4 whereas for the diastolic blood pressure slope is 0.7 there was a stronger relationship with diastolic blood pressure. So left ventricular mass the size of the left ventricle had a stronger relationship with diastolic than with systolic blood pressure. Which is kind of an interesting finding because it's not what we found in studies in the United States like the cardiac study, right Nathan? Yeah but I thought the electric R was higher for systolic. Yeah the R is higher but the slope is R is 0.2. R-squared is 0.2 and the R-squared is 0.18 so there's a little higher. But the slope here for the diastolic is 0.7 it's almost twice. So the relationship is a stronger steeper relationship. How much time do you spend with each subject? To do this 30 minutes to do the historical information about blood pressure and do the ultrasound and we do it in teams, we rotate so we'll have three teams, one team actually sometimes four teams we'll have one team doing intake in history and registration, consent one team is doing blood pressure then we have usually the medical student who doesn't speak Chinese the measure is hiding away and I one other student will be doing the ultrasound here and you've been able to get the undergraduate student Yes, we train them we train the students on the first two days when they arrive in Yunnan we train them to measure blood pressure and also we certify them and test them to make sure they're doing it accurately. Okay so this is just another way of looking at these data the relationship between blood pressure, a category normal, mild, moderate, severe hypertension, systolic and diastolic these relationships with left ventricular mass there's a constant increase in mass as you increase your category the severe hypertension being much higher than the normal particularly when you look at diastolic the mass is the highest severe diastolic hypertension it would be very interesting someday to plot the systolic versus diastolic on separate axes to see if there's any sort of J-shaped thing going on like with the diastolic Yes Okay and when we did multivariable analysis adjusting for age and body mass index and gender we also found the relationships significant relationships between left ventricular mass and blood pressure with a stronger relationship coefficient 0.7 as opposed to 0.38 for diastolic 0.7 for systolic 0.38 these are the beta coefficients in the multivariable analysis most of you know how this works multivariable analysis this is when you adjust for covariates you still see a strong relationship with diastolic so we concluded in our paper that the high prevalence of untreated hypertension there was a high percentage of problems in rural U-9 30% of our subjects had hypertension there was a strong relationship between blood pressure and left ventricular mass and the untreated diastolic blood pressure may have a greater effect on left ventricular mass all of the subjects that we studied were untreated if they were taking treatment for hypertension that was an inclusion criteria because there most people are not treated now when we finished the study we saw 50 points you mean you didn't treat them? of course we treated them we did the survey and then immediately we put them on medication and also gave them appropriate advice on life about the lifestyle of modification but all of the participants when we saw them were not receiving treatment for the blood all the participants had high blood pressure none of them were receiving treatment so we believed that untreated diastolic blood pressure may have a greater effect and the reason they weren't receiving it was because they hadn't seen anybody or that they had no contact most of them didn't know they had no contact with healthcare no one measured their blood pressure they didn't know some of them had been taking medication and they just stopped because they didn't know they had to continue to take it there's also an unfortunate tendency of some physicians see physicians in China are fee-for-service providers they're not paid by the state and even no doctors are fee-for-service providers so there's a temptation in another factory they get a percentage on medications when they prescribe medications they get a cut on that so there's a tendency to get expensive medications because they get more money so rather than give high-procure fives out which is very cheap they'll give an ARB which is expensive but once they give one prescription for two weeks then the farmer can't buy it anymore so it's finished it doesn't take medication for the last two weeks when you say you gave recommendations about lifestyle changes mostly reducing self-intake mostly reducing self-intake but also smoking cessation reducing alcohol intake most of the men also drinking is primarily also a male vice did you find the next I'm thinking the training of physicians there is kind of like a negative consequence for them if they do what would be better I'm going to talk about training physicians just a couple of minutes that's our second program we're going to talk about well let me just the third program the student internship program these were one of our groups of student interns some of these Daisy Shen these are UCI students Ben Zakariah some of you may know these are UCI students this was one group of student interns last year Carol Thompson is a nurse from Hogue Hospital she volunteered to help us and Dr. Poon Kimble Poon is a cardiologist from Los Angeles who volunteered county director at SCI wonderful lady very dedicated to her her citizens she's the director of Yangbi County near Dali City and this is Mr. Lee her assistant this is Dr. Poon examining a little girl and this is one of our students Alina Khan a Columbia student examining a child this is Anastasia Colasola she's Russian but she lives in England and she's the young girl who recently brought to me because she is working on this project for her university looking at distance from the village distance from the city and this is another one of our students who has a child of eyes in Arizona when we leave a township at the end of the internship I have our students write a report in English and then translate it into Chinese and this is the report from one of our villages which we give to the local health department and we tell them how many people have high blood pressure how many have severe high blood pressure how many are treated how many are not treated our hypertension training seminar is getting back to Dr. Chun's question we started these in 2008 the first training seminar was in Kunming Professor Law was on the faculty this is another faculty member Joy Beckman who was a cardiac nurse at the Harvard UCLA Medical Center Joy is a Chinese born American or American born Chinese born I guess CVS she was born in China but now she lives in America and she's training village doctors here to measure each other's blood pressure this lady in the fancy costume is a honey this was our training seminar in Kunming in 2008 in April 2008 we trained 160 village doctors in 2009 we had two training two trainings one in Zhongdian in Northwestern Inan we trained 40 village doctors and one in Longling in Southwestern we trained 130 village doctors and in 2010 April we're going to have three in April and we hope to reach at least 300 village doctors and we tend to we want to repeat that in October so we have two sessions three two different times three training seminars each time one in 2010 will be in Pu'an which is another state another prefecture we invite renowned international and national lecturers does anyone recognize this if you're Chinese you might recognize this he is Hu Daiyi he's been most famous cardiologist in China he lectured at the first Kunming seminar and he's attending our internship mission in April and we also have local faculty who trained from Kunming who trained our village doctors some of these local faculty are doctors at Kunming Medical College some of them are missionary doctors this is Dr. Lu Cheng who is a he's a professor at Singapore University but he is a missionary doctor now working with a Christian group and he's an excellent teacher he trains village doctors as his work there he helps us train village doctors using very innovative methods of training very simple methods that they can understand how to diagnose and treat hypertension this is practical training how to measure blood pressure taking an exam giving the exams before the session and after the session to see what improvement we can see and then we award certificates and this is our graduating class now you have questions this is a good time oh just the conflicts with the financial conflicts training the village doctors well you have to understand the village doctors are farmers and they are not rich, they are poor they are a little bit better off than the other farmers but not much so we have to understand their financial needs and what we are trying to train them to do is most important thing is hypertension is a long term disease you have to treat it for a long time so that means when you find a patient with hypertension a patient for life every time they come back for a visit you make money every time you prescribe in medicine you are going to make money but if you prescribe in medicine which is so expensive that they can't take the medicine they are not going to come back so we try to say this is the right way for your villagers, for your patients and that also can work out well for you we do a little calculation to show you and we think it has some effect we are hoping it has some effect now there are healthcare reforms on the table in China I don't have the date on that now which are going to discourage prescribing expensive medications for problems like hypertension there are reforms that the Chinese government is now beginning to enact so basically given your focus on generics which I think have a very important treatment to have some of the manufacturers of the generic drugs that have been interested in perhaps partnering I love to do that that makes a lot of sense to have a manufacturer who wants to for example ARBs they are going generic in China next year or this year so we would like to get maybe a local company once again on the EDL on the essential drug list in China it would be a big great for them it would make sense for them perhaps to help us but I only have so much time in my day I can't do it so you have to do that application we are actually Jason Ehring who has who is very involved with the generic drug market in China right he is on our board in medicine so most of the medicine is it western medicine or is it like medicine in China first of all there is western medicine and then there is Chinese medicine in traditional Chinese medicine we don't describe traditional Chinese medicine I there are I just want to give you another talk some of them have some degree of effectiveness particularly the way they are used in the country traditional Chinese medicine they are not effective at all and almost everyone I see who is on traditional Chinese medicine are more virtuous than I although I know there are some of them particularly Danshan Danshan has been shown to be effective but I don't describe it now the western medicines are manufactured in China international multinational corporations like but they are manufactured in China do they have a large supply from how do the villagers access yes they are all on this essential drug list there are large supplies and they are available to the local doctors and to the pharmacists in local pharmacies so what you are saying isn't the issue it is mainly trying to get the people to screen and educate their doctors I am curious what kind of formal education they have they have three months very good question they have three months of treatment three months of training after high school so we all have to be literate in Mandarin theoretically although I met quite a few who are really not literate in Mandarin surprising but there are some but they are supposed to be literate in Mandarin they are both graduated from high school and then they have three months of training after that some of them have a little more training maybe six or nine months of training and during that training they receive little or no training about chronic diseases like hypertension yes with the people going on to the provinces and we train them what kind of follow through do you have after you have trained them because you are just saying that you did mention this is a long term treatment ok that is another project maybe you could volunteer and stuff like that what I have been wanting to do I almost did it last year but we just have too many things to do is we would do the training seminar before the training seminar I would go into say three or four villages where I knew there was a good chance that that doctor was going to come to the training seminar I would go in and measure 30 blood pressures in that village and then a few months after the seminar we go back to the same village and measure 30 blood pressures and see if the blood pressure went down or not but we just have it other than pre and post exams which are not very good follow up we have not done that type of even the medium term follow up but it is certainly an excellent idea we really kind of need a grant for that or if there is some way to even survey the doctors who participated in these training courses like one year later asking them what they are doing I will tell you they are doing good things we are not going to tell you I didn't pay any attention to you they are going to tell us the best way is to go in and see how the blood pressure is changing I would give this internet access I would give this internet access non-existent in many places I mean in some town centers in town centers usually there is one computer in the administrative office or two maybe in very large towns there may be an internet bar in the villages there is no computer access those doctors don't have computer access do you think over the next 10 years you might need to change these positions no well I don't know hard to say in 10 years internet is spreading there but not rapidly certainly couldn't do it now let me talk about our last program here our clinical care program I am just going to talk about the children because we do also do clinical care for adults Yunnan province has about 50,000 children with congenital heart disease and that's based on one study done by a professor at Kuiming Medical College she's a surgeon she did a prevalence survey a large part of the province and just extrapolated from her prevalence survey that's about how many kids have congenital heart disease in Yunnan province 50,000 the local hospitals I think there are four or five in Kuiming and one or two in Dali do about 2,000 procedures either surgical or non-surgical procedures to correct congenital heart defects so you can see that the numbers don't match up you take a long time of 2,000 a year to reach 50,000 the kids keep being born so obviously what's happening to the others in United States we don't see older children or adults with uncorrected congenital heart disease we see them rarely because they're usually almost all corrected when they're small or they die if they can't be corrected or we either don't survive or they're correct but in China they don't get corrected and they live into adulthood miserable lives suffering all their lives or they die at an early age and the parents can do nothing and the problem is knowledge one and two money the local medical community doesn't have the knowledge to do the screening and diagnosis and even if they can screen and diagnose there's nothing they can do about it because the families don't have the money so we started a program for children in 2008 and in 2008 we supported a successful surgical or percutaneous intervention treatment of five children that was the beginning and our goal at the beginning of 2009 was to double that number to 10 that was our stated goal we stated it at our fundraiser not too far from here Irvine Valley College we're going to try to do 10 in 2009 with the help of generous help of equipment donations from AGA Corporation which makes medical devices to fix the children's hearts and Sotocyte Corporation makes ultrasound and collaborations with Chinese foundations like the Red Cross Foundation at the Wash-off Foundation we didn't do 10, we did 14 children and this is one of the things we had zero mortality in 2009 in zero serious morbidity all the kids went home and were followed up six months later and they're all doing well and I want to show you a picture of each one of these kids in two years I'm going to be there so many kids that I'm going to have to click this for an hour so still we have thousands of kids that need help this is the fundraising part of the talk but you know I'm not expecting any money just to show you why do we ask the $2,000 from the students family we plan to expand this and this year we hope to do 25 to 30 kids we hope to help we've already done three one is a little girl with cleft palate who had severe heart disease she had patent doctoric arteriosus ventricle supple defect and atrial supple defect we've corrected all three defects we have an effective medication to treat her pulmonary artery high blood pressure, hypertension it's another type of hypertension she's now getting discharged from the hospital in Chengdu she's going home in a couple of days back to Kunming and she has cleft lip, cleft palate six months we're going to refer her to an oral surgeon who will also do a charitable charitable funded surgery to give her a beautiful smile and all the boys will love her we have two other little children who while last month in January underwent procedures at Kunming's St. John's cardiology hospital St. John's heart disease hospital it's nothing to do with religion it's the name of the hospital St. John's heart disease hospital in Kunming that's what we do with the percutaneous procedures the surgery is we do either again on hospital in Kunming at the Chengdu Military Hospital because we know the doctors there and one of those two hospitals are these Chinese doctors through the fall Chinese doctors through the fall Chinese doctors that's it thank you very much this should be on here applause there are different procedures but I wanted to give sort of a ballpark cost for the cardiac repair in other words related to what we fund that's a good question to do a percutaneous procedure simple surgical supplement effect closure 20,000 R&B 3,000 dollars between 15,000 and 20,000 so it's about 2 to 3,000 dollars to do surgery like a little girl in Chengdu that's much more expensive now what we've done is we kind of multiply our ability to help these kids because now we have support from other foundations like the little girl in Chengdu Chinese health from the hardware students have to pay for her we have the Kua Sha Foundation which is a large foundation in Beijing the way they work is they match a child with a donor so they have a child that needs help and they go out and hunt for a donor a wealthy person in China and they found a donor for the civil girl so they paid for the surgery but we work with them and some of those groups are matching donations that I'm actually trying to count they'll make because another organization is called the Children's Hope Foundation they're a Christian based foundation they used to be based in US but now they're totally in China and what they do is every time we find a child that needs help they give us I think 7,000 R&B 7,000 that's a good part of them it can be almost half they give 7,000 to support that kid's surgery and then you support the balance yeah we support it yeah yes do you choose them? which kids with the general heart defects get treatment? how do we choose them? we have two types of screen what is medical? I have to approve them otherwise I approve whether or not we're going to support we may recommend it but I will approve whether they're going to support and what is medical screening? I have to feel that if there's a good chance that this child's heart can be fixed and that there's not a high mortality I told you about the child who went to Beijing for surgery and came back and died two weeks later I don't want that ever to happen again I mean it probably will eventually but I want to reduce the possibility of that happening because it would have been better just not to try than how that happened the second one is an economic one the family hasn't shown us proof of poverty their documents they have to produce Pin Kun Jung Min and Shou Yun Jung Min these are proof of income and proof of poverty which they they can they have to produce now of course families may cheat they may get a friend to sign off on these documents but we can't do anything about that we don't go beyond asking for those documents I did some a preliminary study and a lot of minority people in China are illiterate so when you ask them to produce documents like that do you have assistance? many are illiterate so how can they produce documents the local governments are always involved so we don't we never the local government is always involved so the local we communicate with the local government the local government knows this and they help with that if the families don't remember that you turned down in the last year several applicants for these type of work about five three of them for medical reasons they were just too complicated I just didn't want to take a chance at and two of them because they didn't have they admitted their incomes were high and they were in a range where I thought it would be they probably could raise the money so I referred them to local how closely do you follow through their procedures and what kind of commitment is there how closely do you follow the procedures I mean after the procedures done well before, during and after as far as like do you determine which hospital they go to which doctor they see for their treatment and then afterwards how long is the commitment of the organization well I have to approve in order to approve the grant I have to know which hospital they're going to if I don't like the hospital I think it's not a good hospital I wouldn't approve the grant and they can go to any hospital they want but then they're going to have to find their own life so that's number one in terms of follow-up afterwards the hospitals have been doing that and they do that with six month follow-up visits now there are some of them that don't do the six month follow-up visits and that's troublesome for me I don't know what happens when they go back to the village we have had no reports of problems but there could be problems that we don't know about and once again that's because we're small and we just don't have the funding now I've recently hired a nurse and I'm hoping that she's a young woman she's 26 years old and I'm hoping she will we can get her to go to some of these places like the cost of follow-up care if there's a complication or something like that is there a commitment for that to the families? we don't have any, we don't make a commitment but if we have if there's a problem we've always covered it we had one child, didn't have surgery it was on medication and did poorly and we had to take, recover the cost of that child being admitted to an intensive care unit when you're home yes I know you didn't mean to show this slide but I think two years ago in the US the Institute of Medicine recommended that the food and drug administrations start regulating salt in American diet in FDA said we have too many problems we won't follow up on this and I just what is the equivalent do you have support for the educational component of prevention to talk to people about salt intake and is there support from the Chinese government agencies that we have no support for the Chinese government to do that, we do advise people about reducing salt intake but as you probably know advice about dietary changes you know, it goes in one ear and out the other ear and I don't think they we tell everybody who is smoking to stop smoking and when I do that I tell them you have to stop smoking you have high blood pressure because you're smoking and everybody, all the guys in the room laugh they're addicted, they know they can't stop smoking that's the salt data China this is from the industry salt production in China it's surpassed the United States yes what kind of conditions do you work with like do you have an infrastructure in place do you have toilets running water is that way yeah we have I personally own an apartment which I lease for zero money to the China California hard watch as a clinic we have a living room set up as a clinic we have the sleeping area slept as residents for the students when the students come, like if you come to do an internship you're a practicum, stay there and we also use it as an office space we have rented a similar residence or facility in Bali city we're opening up a satellite clinic in Bali city I want to hire a doctor to run the satellite so we have that what else we have an ultrasound machine two of them we have ECG machine we have other simple medical equipment that's it, that's all we have what is the estimated cash out of the volunteer going into this program how much would it cost you to volunteer yeah fly food I would volunteer if you are willing to stay at our residence in Kunming it's free we offer that to volunteers there's plenty of places to stay if you don't want to stay at the residence you have to pay for your own apartment and that will be a few hundred dollars a month and food maybe also maybe two hundred dollars a month for food airfare airfare airfare, no we don't cover airfare are you a physician no I'm not because if you're a physician we really want to get the air to help us then we pay we've done that to a couple of people not that we don't want you not that we don't want you it's a long journey but there's a donation and the airfare that essentially everyone has to pay or it's a different thing student interpreters or during practice they have to pay their own expenses and they also request a donation which is on the website volunteers with medical experience doctors nurses we don't pay your airfare you don't have to give a donation you know just as long as you're acceptable and we need we'll take that if you're a pediatric cardiologist if you have any special skills or often adult cardiologists we'll also pay the airfare up to twelve hundred dollars since you are a 501 to receive these folks can write us off their taxes yes I'm looking at the intentions on the website I notice the donations vary depends on the length of the internship the two week internship is fourteen hundred the three week is two thousand the five week is twenty five hundred but the five week is filled up we don't have any more places in June and July we have places in May, August, September and October June and July is filled with those of us that say may want to do this as a practical site I'm in a magic program is it possible to change the duration of our internship? yes yes yes I already talked to I just talked to me about it we'll arrange something if you're in a practical world we'll arrange a reasonable we'll make it reasonable thank you so much thank you


Spray drones are fairly new less than five years since the first model was being commercialized but they have been adapting to the agriculture and evolving very fast. In the last two to three years we have seen a lot of adoption in row crop agriculture and also in specialty crop forestry spraying and all the other jobs. Spray drone has several unique benefits over the traditional ground sprayer. The first one particularly for Alabama is we constantly get too much rain and it remains too wet for too long. For spray drones because they do not touch the ground so even though the field can be very muddy they are still able to carry out the operation and conduct spraying. And also the other big benefit is it is very precise and you avoid a lot of the erosion and the compaction issue you know just imagine when you drive big row crop sprayer in the crop field it's a lot of weight on top of the field and then you cause a lot of physical damage on the crop so it avoid a lot of those issues as well. It is very important to keep in mind if you are interested in flying spraying drones particularly there are several exemptions you need to obtain from the FAA and also you need to follow state and the local regulations pesticide laws to obtain proper certificates and the permit so you can spray or spread pesticide or other chemicals with the drones. I wouldn't be too surprised to see the spray drone numbers and the spray drone numbers triple or even increased by five fold after three to five years which means a lot of new operators and of farmers start to using the technology so I think there are lots of opportunities for us as land-growing institution and extension system there's still a lot of trial research and educational effort that we need to continue and the more educational products that we need to generate to support our operators and farmers.