Hello People in the world who are on the internet and Also, hello to the people who are in the world that aren't on the internet and Hello the people that aren't on the world or in the world. Hi. I'm John It's been a little bit since I posted a video or done anything.  It's fine One of the links they gave us was a cool note Go ahead and punish yourself if you dare challenge accepted Wendy nather Neither I gotta be really really sorry and apologize. I don't know the best way to present for now It's your name. You're really important. Apparently this person has a lot of followers on the Twitter verse on the world And that's cool like that. That's what gives a person value I'm just kidding. I'm sorry. Please don't please don't be upset punish yourself if you dare Let me get the original quote here. It says in my denial of trust attacks talk I mentioned dark patterns. This is a brilliant example of bad UI design user interface design You really can't appreciate how bad it is until you try to use it So we have this link here user in your face calm And there's some retweets here that I really like Initially misread that as denial of thrust attack and I Imagine someone being poked with a fencing foil that bows absurdly instead of penetrating the target It looks like it should take about 16 minutes to try this kind of thing. It looks like it's a bit of a game Maybe 16 minutes is good. I don't know. We're gonna find out see how I do Gonna go in cold. Let's do it User in your face. Hello It says hi doesn't say hello Hi and welcome to user in your face a challenging exploration of user interactions and design patterns to play the game Simply fill in the form as fast and as accurate as possible No Okay Not actually a button. Please click here to go to the next page Not a link. Oh shoot Here was whoa. What are you saying? Next page is not a link Okay here the word here is the actual link user in your face the site using cookies. No If you hit yes, is that a problem for you? Yes, the site uses cookies. Nothing happens not really know that it goes away Oh, so I'm being timed and I have to fill this out choose a password Anything whoa, okay. I have to actually remove the line that's in there outcome. It doesn't hide my password last pass Not that last pass would be able to do anything. It's just trying to suggest like generate a super secure password.  Let me make sure that all right the cut still good. We're still looking fresh What's my email John Hammond 985 hurry up time is ticking. Thanks. Oh, that's not a close button. That's a Minimum that's a expand button. What is lock? How come lock unlock? What the heck copyright close 119 is that is that actually in a closing window? It is okay 985 At oh geez I can't even like tab complete here at Yahoo I have a drop-down menu to choose the domain Yahoo.com. I Do not accept the terms and conditions. Oh, I actually hit I do accept the terms and conditions. Oh Please read our terms and conditions. Oh No, I'm trying to scroll right now. That's really slow. Can I just drag this? No, I can't drag it down like that Okay, we're just gonna like run on the scroll wheel right now except Now I can press the button. Thank you. Time is ticking Close Next oh my password requires at least 10 characters At symbol anything have one capital letter have at least one numeral one Needs one letter of your email And my your password is not unsafe. What does that even mean? My password can have at least one Cyrillic character cool It's whatever if I hit next oh sweet it does it Two out of four. This is me. It's complete your profile. Please upload. I Didn't know I was gonna have to upload stuff in this guys. I don't know if there's stuff. I want to show you in there Download image. What is that? Is this an image? Is that actually trying to load something or is that? Is that a picture or not? I Don't think so. I can't like oh view background image. That's that That's the one that we want. Let's put him on the desktop Desktop avatar placeholder. We'll use that as the actual thank you.  I did it Maybe it did something Circle things still going choose three interests ponies Ponies polos. I like polos. I have to turn all of these off Why is there? Oh god, I can't like mouse that way. I highlighted squares on accident tires closets Select all oh no God I really shouldn't have done the video like this I don't know if you realize it, but you're actually standing on a Hotel trash can that's upside down. We're kind of on its side. So And my phone's going off. This is a good video everybody good quality content Jeesum Ponies polo unselect all oh that actually does it okay windows questions and squares. I like those next First name placeholder John Are we still fresh? The camera angle is getting worse and worse Not that that really matters Not that there's anything quality in the camera right now choose a title mister surname What? John Street John Number number what does number mean street number? Oh, it's it. I can't type in that. I literally cannot no stop stop We're not going to record this video a second time. I'm not going to do it it would ruin the effect Hurry up. Time is ticking. Thank you Lock close number. I cannot type in this To 10 11 it doesn't matter age. I have to drag. Oh god. I Am a hundred and fifty-five I Can be up to 200 years old guys Man, there's a lot of years ahead of me I'm gonna go Something real close to my age. So you guys don't know how old I actually am 200 zip John City John, can I do those things? Is that oh gosh? Please choose a country that squirrel did not put me in the actual thing there Where is my country? That's that's it. There's America. Happy. Happy, July. Happy the day. That's a couple few days into the July box Box what does that have to do with anything? I know the time is ticking.  Hello, oh that brings it up. That brings it higher up. Why does it do that? Higher someone excuse me hypothesis. I did not write hypothesis. I wrote higher higher someone else Send help. Please wait. There are 468 people in line send the bottom. Thanks Take your sweet time there, buddy Okay, why is it start at 1900 and go down to the latest ones? 2017 male whoa, wait a second. Which of these is actually Which of these is actually the one that I'm selecting male or female? Next why is next? Cancel it should not be green next should be green that should be in the other place next Age and birth date don't match. Yeah, but at least I'm in the zip code of John Do I have to actually do this math now? 1919 stop scroll wheel stop send to help bottom. I'm gonna annoy the people in the hotel room beside me you 19 2019 19 next age and birth date do not match I Have to be like when you're older because it has it's not it's not 2018 right? Is that right? Excuse me Can I set my age to zero? So now we'll set 2019 Thank you time is ticking next Are you kidding me? I Have yet to be born to age. Why do I select that? That's oh This is agony.  How can we help you're like worse than clippy? the Microsoft potato product Microsoft office PowerPoint. Oh No, I Can't deal with this. It's just not gonna let me move on am I am I doing something wrong? Gender and title don't match. Okay, mr Okay, so I'm supposed to be male when it's highlighted. It's in white good almost done now Select all the pictures with glasses That's not a picture. That's a glad those are glasses. Okay. That's a picture now. Thank you time. I appreciate you I Was I'm one year old right now glasses glasses Glasses he's all have glasses What a capture is that glass? I mean that's considered to be glasses. Those are multiple pieces of glass Can I scroll down at all? No, okay Glad I can't select those. Oh, there's another scroll bar in here. Oh, no Go away I Literally wait. Oh Oh, they're supposed to be selected above No one did I see did I not see that was that was I wrong? I was wrong That's what most of these videos are all pictures with glasses Okay now those are glass panes stop get out of my life Validate What I have to do more of them select all pictures with a circle What What is your classification of a circle here guys because a lot of things in these pictures could constitute circles I'm pretty sure that's hippo. That's definitely hippo. Let's Google that What in fact the hippos look like?  Thank you. I appreciate that earth.  The earth is circle. That's that has a circle in it Can I just validate and go select all checks like I'll pictures with the bow. How am I gonna ever gonna get this right? There's no way Select all checks To checkmark this guy's checking an airplane I It's a checkered pattern is a checkbox Checking his watch checks there checkbox validate. Oh my gosh I'm never gonna finish this. I don't want to actually take the time to Select all the pictures with a circle You have proof that I'm human You know that I'm 200 years old or zero years old These are being arranged randomly That's awful that has a circle our hippo is supposed to be circles is There is that some is there some reference. I'm not getting right now. I feel like I got a rage quit on this validate There's no way that I can get this do I have to select all of these pictures because they're all in glass. They're all glasses I will do it Thank you. Thank you. I know it's gonna be a long video Don't remind me the comment section will I didn't select that Select all pictures with glasses literally all of these have glasses of Spectacles, you know what I'm wearing what you might be wearing what we're all wearing Maybe not all of us but validate. Oh my gosh, I did it 1226 guys we could have been at like 13 minutes and 37 seconds We could have been leaked Do you think it says something different? Let's go back. We're gonna do it again. We got a some that's that's like it make it last 13 minutes No, I can't actually go back. I Tried to redirect. I didn't want I wanted to enjoy the dancing man. Oh No, I Said it for the bit and I really wanted to enjoy the you are awesome text. It was warm in my heart Alright, thanks for watching guys.  That was user in your face. I Can't select that text. Is that a picture that might be a picture view background image. Oh, it's SVG file It's all white. I zoomed out. I zoomed way out on that Great. That was fun. I hope it was a cool thing. I hope you enjoyed it.  I Need to end this video. I'm sorry


who basically started the President's Council. That's kind of scary just to be standing here and the President walks in behind you, who basically made a campaign promise before he became President to start an all-out fight against waste, fraud, and abuse. And after election early in 1981, Mr. President, you formed the President's Council on Integrity and Efficiency, which is before you today and proceeded to make good on that campaign promise. In your executive order in 1981, you put the Chairman of the President's Council and the Executive Office of the President, and I have been very proud to be in that role since 1982. Since then, IG funding has doubled to $500 million a year, and that hasn't been easy to get. It really has. IGs have been expanded to Department of Defense, Aid, USIA, Rail Retirement Board. We're negotiating the final IG bill with Congress right now, and the results have been dramatic. The recoveries of the funds put to better use have been $104 billion since 1981. Mr. President, that's not just the only story, because if you look right here, you will see what happened when you first came out and been going up steadily every year. That's one of the stories right there. I'll give you that. In 1982, the funds put to better use were $11.5 billion. We didn't even count them when you first came in because there was no system for basically measuring exactly what funds were put to better use as a result of the IG activities. In 1987, you'll see it's $20 billion per year, and we're running at that rate. Now, Mr. President, it's a 40-to-1 return every single year on your investment in the IGs. The $120 billion goal that you gave us to reach by the end of your administration, we're going to beat it. We'll beat it by $4 or $5 billion. On convictions, there have been 23,000 since 1981, but that's been doubling in the amount. In 1987, we did over 4,300. Now, it's not the situation that's gotten worse. We've gotten better at detecting fraud and abuse and dealing with these problems. Many of the examples are given to you in each semi-annual report, and they've been well-publicized. Like in defense, the IG picked up an $8,000 bribe at Navy contractor. The official was fired. The contractor's on trial. In GSA, the IG picked up a medical hardware company that was faked 60 test results on medical equipment. Companies debarred the presence in jail. USDA IG, three brothers, stole $2.5 million from the Women's Infants Children Program. Those three brothers spending 23 years combined in jail. In a future report, we'll cover the largest procurement fraud investigation ever at the Department of Defense, involving 200 DOD Naval Audit and IG personnel and 150 FBI personnel working together. The results speak for themselves, Mr. President, but the key result is that the federal government is in a much, much better shape to manage and defend against waste and fraud than eight years ago. If somebody tried to rip us off today, they'd know, number one, that they'd probably get caught. If they did it anyway, we'd probably catch them. You've many achievements, Mr. President, as part of your legacy. This is certainly one. Every single Inspector General that is in this room is part of your President's Council. I'm proud as chairman to present you with that 10-year report on the Inspector General that covers the activities and accomplishments of your Council. But, Mr. President, we couldn't have done it without you. This will be an important and very successful part of your legacy. Thank you for your leadership and your continued support. Now you see why I came in a little early there. I wanted to hear all that. Well, thank you, Joe, and I'd like to thank you and your Vice Chairman, Dick Couserot, for your outstanding work on the Council on Integrity and Efficiency. And I'm delighted to welcome the members of the Council on Integrity and Efficiency, or as I like to think of you, the waste and fraud busters. Sadly, as we all know, the abuses that you combat aren't just a problem for our government. I remember a story about two men who were partners in a business. One of them was in the hospital. Doctors didn't give him very much longer to live.  I was the one who took the petty cash from the safe. And I was the one who embezzled the pension fund money. And I was the one who burned our factory down and collected on the insurance. And the partner said, yes, I know all that. The first fellow said, you do? He says, sure, who do you think poisoned you? Well, all kidding aside, the sterling work that you and private organizations like Peter Grace's Citizens Against Government Waste have done just proves that we can use the laws we have and the people we have to make a real difference in the way the federal government does its business. You know, one of the best ways to reduce our deficits, and you know those deficits are shrinking as fast as Walter Hudson. That's the fellow in New York who used to weigh 1,200 pounds. He now weighs 500. He used to battle the scourge of government waste and fraud. You've all done that brilliantly. And it's my honor to recognize the winner of the Paul Boucher Award, Larry Mori, of the Department of Health and Human Services. Under his outstanding leadership, the Office of Investigations at the Department of Health and Human Services has seen its conviction rate leap over 400% to its current level of 1,125 convictions in 1988. Doc, you keep this guy. He's good. The runner-up for this year's award is Chris Greer, who is Deputy Assistant Inspector General for Audit at the Department of Housing and Urban Development. And because of his efforts over the past three years, the government recovered $25 million of misspent money. Sam, what I just told Doc goes for you, too. In 1981, I charged this council with going after illegal acts and mismanagement that we could restore public management in our government. And I told you to be as mean as junkyard dogs in pursuing fraud in West. And throughout this administration, Larry, Chris, and all of you have done a great job. You've done just that. And I have to ask you one question. Isn't it a great pleasure to know that you've succeeded with honor? That's the kind of work that our inspectors, and their excellent staffs do. The diligence-paid work that ferrets out waste and fraud and nails the crooks. For example, I was told about one case. You've heard about some here from Joe already investigated by Larry, where a cardiologist ran a genuinely horrifying Medicare scam. He told many of his patients that they had heart trouble and installed pacemakers, even though it wasn't true. He even bragged openly about how he performed 100 of these surgical implants every year, no matter whether his parents or his patients needed them or not. Well, the inspector general brought him to justice. The cardiologist had to pay back the $100,000 he had built from the government. And when that heart doctor heard the judge pronounce a sentence of 10 years, you can bet his heart skipped a beat or two. In another case, an ambulance company owner paid kickbacks to doctors. And when Larry's people discovered this crime, the owner of the country company was so intent on avoiding prosecution that arrangements were made to have the car of a witness blown up. But the IG prevailed and the owner was convicted of both the kickbacks and the bombing. Larry and Chris joined a prestigious group of past award winners, including John Melchner. John was recognized in 1985 for his outstanding work in the inspector's general office of the Defense Department. The recent defense procurement revelations highlight the need for us to stay vigilant. And that's what you're for, the great core of inspector's general. This is some of the most important work done in government because it upholds the law of the land and simultaneously restores the faith of the people in the ability of the executive branch to police itself. You've earned the respect and gratitude of your countrymen and you've set an example for future administrations to follow.  It isn't a case of that everybody was a crook in our administration. It was when we found things that were being wrong of the kind we've described here, we didn't wait for somebody else to do it. We found it out. And you've earned the respect and gratitude of your countrymen. You've set an example for future administrations to follow. Now, I think we have some pictures to take. I thank you all and God bless you all for what you're doing, but first to Larry Morey, the winner. When you... Happy to see you, sir.


Hey everybody, welcome to Swadok Bay. I'm Jessica and today's video is a back to school Amazon haul. You guys, this is a lot. I'm just gonna go ahead and say it and I'm gonna preface it by saying you do not need any of this to homeschool successfully. This is a mixture of things I wanted, things I thought Emily would enjoy, things you know I was excited to add to her homeschool but you really don't need any of it. You can just homeschool with library card and you wouldn't need anything else. So please know that going in but because we don't purchase a lot of curriculum it gives us the ability to purchase a lot of really fun resources for our homeschool and so that's what I'm going to share with you guys today. I'm just gonna start because if I zoomed the camera out right now I am surrounded by stuff. Okay first thing, first I have a what your sixth grader needs to know. I'm going to be honest and a little bit sad because this is the last year that this is created. I've had every one of these since pre-k. I just like being able to reference it. I mean adults really necessarily need it. I also don't love that this copy is in black and white. The previous copies of the years were in color. This is probably dated just a little bit but I like having it as a reference. I like the poetry selections normally. I like some of the English selections. I like that they're essentially readings for all of the different subjects to teach all of the things that your kid should know for that grade. So I just like having it on hand. So that's the first thing that I purchased and then I also purchased this set of books. The how to survive middle school and then they have each of the subjects. So we have how to survive middle school English, how to survive middle school math, how to survive middle school US history, how to survive middle school world history, and then how to survive middle school science. Now these are all approximately about 500 pages and it is what it calls a do it yourself. So for example like here's chapter one and this is the topic of chapter one and then you kind of read you know all of the different things in the chapter and then every so often there is a check your understanding of the things that you're learning um and then normally at the end of the chapter see if I can find one you have something a little bit more but it's basically meant to be a study guide. So I thought that these would make really great reference books for us to have on hand for middle school um as some of the topics get you know maybe a little beyond what Kevin and I just happen you know to know off the top of our head it would be nice to have something on hand that we could reach for to say oh you wanted to know about this well you know here's a great reference for that. So that is why I added those to our our library. Now I do already have I pulled them out to show you the big fat books for middle school. This is the complete middle school study guide and I do have these in um English, math, US history, world history, science and then computer science and steam. I didn't purchase these now I've had these for over a year and we love them for reference as well so it kind of gives us two different reference books now. So if you are only looking for one I think I prefer this series over this series but I also think that they offer a little bit of different things because this one's more like kind of a journal fill in the blank um anyway there's my opinion if you're only gonna purchase one. Okay I also wanted to do some life skills with Emily so I picked up the life skills for tweens which is supposed to help um cook, make friends, self-confidence, healthy, I'm gonna open to the table of contents for you guys just so you can see it in case you're curious. It's supposed to include everything a preteen should know to be a brilliant teenager and then to go along with that I also picked up the life skills for tweens workbook. I don't know that I'll have her do this in its entirety I just thought it would be nice to have the workbooks go along with it in case she wanted to do some of the things. Let's see I also grabbed this writing magic it is by the same author who wrote Ella Enchanted which she really enjoyed that book so I thought she would enjoy learning some writing tips from an author that she's already read books from and enjoyed um and it's just kind of a oh let's see it's kind of like each chapter tells a little bit of a story and then at the end of the chapter it's like writing time imagine a new universe think about how it can differ from our own describe inhabitants of the universe the plant life and one or more of the following an eating place a classroom a bathroom a bedroom a family vacation use this universe in a story and have fun and then make sure you save what you wrote so she kind of like gives you a little bit of background about her writing and how she does it and a few tips and then like a writing prompt but a kind of detailed one so again I thought Emily would enjoy learning from an author she's read from uh Webster's word of the day we have never really done vocabulary because we do so much reading aloud we've never needed to but I thought this would be a really fun kind of short thing just to do some extra vocabulary kind of stretch ourselves so each day of the year there are just some cute illustrations and a new word to learn I'm not sure where this is fitting in yet um probably sometime in our morning basket I would assume but we'll see I also grabbed how many guinea pigs can fit on a plane we absolutely love bedtime math and this is kind of like the next step up from bedtime math it's by the same author um let's see I will show you an example it's answers to your most clever math questions so just a little bit more advanced than the bedtime math books but still fun uh on this day in history so you would just like the word of the day open to a specific date let's see let's just pretend that today's august 20th it's not and then it would tell you multiple things that happened on that day throughout history I thought it would just kind of be a fun way again to just like oh today's august 20th let's look at the things that happened on this day in 1999 and 1922 and 2018 um and just kind of get an idea for like different things in history that maybe we haven't talked about or touched on I really also love that I think this is going to lead to rabbit trails which are some of my favorite things in homeschooling and then to go along with that I did grab school next new homeschool history timeline notebook so it is just like a timeline book of centuries and I thought it would be fun to add just our who was our what was maybe some of the things that we read on on this day in history that only thought were interesting or that appealed to her um she's really loving crash course history um video playlist so if there's something on there that she's like oh I want to add this to there or for example our history unbox subscriptions comes with stickers and it actually comes with a rollout timeline but we've been adding them to our history notebooks as well and unfortunately we had a pink one before but something got spilled on it so we bought this pretty one to start over I also grabbed these scholastic map skills for today you guys I'm going to be honest we didn't need these but they were like five dollars and I somehow got sucked in and so here we are um the ones that I purchased are grade four and grade five grade five is the highest that they go what I liked about them is that for the most part they are focused on the United States and like the directly surrounding areas so like traveling near and far uh is mostly United States but then like some Canada and Mexico and then the Americas and focus is in depth of America and I thought these would be great to add to our car school like just to kind of stick in her car school bucket for when we're traveling it would be a way to get in some geography um without having to take you know like big things with us or like my whole printed traveling the states or traveling the parks although we love those and we'll probably take specific pages but if she was curious about something that maybe I didn't bring these have a lot of different things and they're super thin like I don't even know how to explain them they're literally like 42 pages each so they would take up absolutely no room and they're colorful so I think she will really like that um for logic I grabbed a few new things logic was our one thing last year we absolutely loved it obviously I want to keep that like momentum going so I picked up Hayley Hattie's 15 minute mysteries Emily loves mysteries um case clothes like the you choose book was one of her favorite series that she's read so these are just 15 short stories for young sleuths each story is about five pages um in case you're curious the writing is even pretty big so I would say maybe even younger kids could read this um and then if they don't figure it out immediately there's also a page right behind it that kind of gives a hint and then a super hint and then it tells you where the solution can be found so I have just the 15 stories volume two 15 stories and then this one is history mysteries so I thought those would be a lot of fun I also grabbed the two truths and a lie series so this is two truths and a lie it's alive then we have two truths and a lie forces of nature this is actually the one I went looking for um specifically and then ended up getting all of them and then we have two truths and a lie history so the way these work is for example chapter one in the history one is over a thousand years ago so you have three stories a is mammoth caves mystery walker and there's like three or four pages all about that b is holy molars and then there's three or four pages about that and then c is a curse on all thieving bathers and again there's three or four pages on that now two of those three are true and one is not and so it even tells you in this chapter you write about these things um what do you think and then I'm pretty sure the answers are on the back of the book on which ones are true on which ones are not they are um but I really wanted to use these as an example for Emily because she's growing up in the digital age of the you can't always believe what you read um I mean let's be honest we all know that but I really she's at that age where she wants to believe that people wouldn't intentionally deceive you um and she wants to believe the best in people and so I thought that would be a really good way for me to start teaching her that not everything you read or hear is true and sometimes you have to think for yourself go do extra research really dig into it to figure out not only what is true and what is not but maybe what parts you believe or don't believe so that's kind of like our next level of logic that we're working towards I also grabbed a another logic um what is that called workbook for gritty kids we have not used the first one even though this one says another um because this is for eight to twelve and the other one was too young and it just looks like a fun I mean there's like all kinds of different varying logic type puzzles and just different activities for her to do so it's 200 plus activities on the cover and then also we went ahead and got the next level of mind vendors which is level five this is hands down our absolute favorite for logic we have used I think all of the levels right now she actually is not all the way done with level four but she'll finish it a couple months into sixth grade more than likely so I went ahead and picked up five this is the one that she used the most of all of the ones that I bought last year as far as the workbooks one okay let's see what's next um we're gonna start with books so the first set of books that I'm gonna show you are books that we purchased for her book club this coming year so she is going to continue doing book club on out school with Miss Mary Hannah Wilson she's actually doing two different book clubs again this year she'll be doing the eight to ten year old fiction and the 11 to 13 year old fiction um it will be her last year that she can do that because she's 11 and you can age one year down or one year up but that's the most you can do but she loved some of the books that Mary picked for the younger kids and so she just decided she wanted to do both so there is one class a month for each of those so this is the books that they will be reading in case you're wondering I will go ahead and tell you the majority of them she reads by herself the rule as far as like for me is kind of if I want to read it it's a read aloud if I don't want to really if I don't want to read it and she reads it independently there are a few in here I want to read um so a couple of them will end up being read alouds but maybe not we'll see how busy I am at that time and what else we're reading aloud so anyway for the haul we have framed which is one I want to read the mouse and the motorcycle grounded the girl who stole an elephant a knight divided sweep the story of a girl and her monster which is another one I want to read pi the very very far north I want to read this because we read the first one and I kind of want to know what happens and in significant events in the life of the cactus a rovers story the boy who harnessed the wind I want to read that one with her too the birch bark house mr. limoncello's very first game manatee summer this one is for sure going to be a read aloud because I'm excited for that one el defo and the silver arrow all right so those are the book club books now in addition to the book club books I purchased another handful of books for us to possibly read aloud for Emily to read independently um because normally she goes through the book club books in about a week so that still leaves us two weeks out of the month for reading what I did when I purchased these books is I specifically like I had a set of kind of like parameters they had to be a series of at least three books because Emily tends to want to dig deeper she tends to want to know more she absolutely loves book series like she's obsessed with them she wants to get to know the character and grow with the character and so normally when it's like a single book and there's not any follow-up she's like where's the next book and so I specifically went looking for books that I thought she would like which means they're probably mostly heavy on fantasy not all of them but more than likely because that's her choice of genre um and there's at least three books in the series maybe more than three but there is a minimum of three so I only bought the first ones because she more than likely will not love all of them but this way if she does love them I can just quickly order the second or the third and they'll be here and boom she's still reading so the first one we have is Wild Lore then we have The Serpent's Secret Never After Celia Lee Jenkins Future Author Extraordinaire Hatchet this is one I want to read so we're gonna make that a read aloud The Unwanted Dealing with Dragons The Van Gogh Deception Front Desk The City of Ember Murder is Bad Manners Ranger's Apprentice Ali Cross I think this is the one that she wants to read first because I've been reading a lot of James Patterson's books in fact I just started the Alex Cross series and this is like the kid's spinoff of it so she was like hey wait a minute that's just like yours so she was excited for that one The Conjurer's and then the Explorers Academy The Nebula Secret and this is by National Geographic so she was really excited about it too because she loves anything and everything National Geographic and then we already had one in this series um and this is like a collection of tales so I went ahead and got the other two because I knew she already liked that one and so it is The Unlikely Heroes this is 37 inspiring stories of courage and heart from the animal kingdom and then Unlikely Friendships which is 47 remarkable stories from the animal kingdom and the one we already have is The Unlikely Loves which is 43 heart warming true stories from the animal kingdom so you know anything animals she loves so she was excited that we were more in that series okay first up we have Samoku which is a math game I love that it's small and can travel with us we have Tappel basically with this one you name and like you pick a card that has a category and then you're trying to name answers and you press the letter that it starts with so it's going to be like a quick one for vocabulary um I picked up Math Attack Toe now I wish I had bought this years ago because at the moment the box is coming open but because it has three different levels the beginner level is ages eight plus the intermediate is 10 plus and the advanced is 12 plus um but basically it does addition and subtraction for beginners multiplication for intermediate and advanced mental math for the advanced ones and you can play with all of like somebody could be playing with multiple kids a beginner an intermediate and an advanced all at the same time so I wish we had bought this younger we did it so it is what it is now but we're definitely going to get our use out of it because there's not a ton of advanced math games and I was excited that I found one oh let's see American trivia spy alley the game of suspense and intrigue I told you guys Emily loves all things spy or mystery I picked up a genius star and genius square to add to our logic lineup because these two games can be played single player or two player so I love that they give us the ability for Emily to play by herself to get better at it to get familiar with it then they also give us the ability to play together and the game work just as well either way we have a few games like that but not many and so I was excited to find that these two would work like that and if you have more games that work like that let me know down in the comments because I'm always looking for good one or two player games once it would work for both oh let's see we have three clue escape games this kind of goes along with the logic Emily and Kevin also were obsessed with clue I have always wanted to do an escape room they won't do it with me so this is like a happy medium because they like clue and that's an escape thing so this is going to be family game night they just don't know it yet we have clue robbery at the museum I'm running out of table it also helped that these were on sale when I purchased them they were part of the buy to get one free um and they were like 50 percent off I think then we have clue sabotage on the high seas and clue treachery at the mansion we have mastermind we have actually been playing the mastermind kids for years and years and it works absolutely fine um Emily just said that she was ready for another level um kind of difficulty because that one you know as kitty has like little animals and stuff she loves it but she was ready to step it up a notch so I went ahead and got just the regular mastermind we also have splurt which is a quick game where you're going to name something so you get like a category for example a song title that ends in E and whoever you know can yell at first gets that card paint chip poetry I thought this would be a really fun addition to our poetry two times or anytime we're working on poetry instead of just writing it it would be a fun kind of addition extension activity um along that same alliance is metaphor dice so I thought that would be a fun way to work on figurative language and metaphors other than just trying to write them I grabbed sketch a molly which is from the same creators as creatures which is really fun uh this says draw pass laugh and repeat and it is basically each artist draws a prompt you pass your artwork and then you add hilarious elements any kind of drawing game and our family is always hilarious because Kevin is such an artist and everything he does is so detailed and Emily is really really close to that and I can't even draw a stick figure so we always like bust a gut laughing so hard so I was like yes please and I think it was less than ten dollars um I grabbed fractions wild it's a fraction based game that plays really similar to uno I thought it would just be a great way to get in some fractions math match which is a dice and card game fence it in Kevin asked for this it says grade two plus but we're just going to use it anyway Kevin actually asked for something like this um for their steam uh stem activities that they do he wanted to have a more hands-on fun way besides just like going around the house measuring things for area and perimeter and so this was kind of the answer to that because that's what it does and then he also asked for me to go ahead and get the a mathological liar grade six because they absolutely love this this is the one thing that they do every time they sit down for their steam lesson is they do at least one of these cases because they think they're amazing and then I grabbed florida opley and florida top trumps with the hope that maybe we'll get to a florida study of some kind this year um and then these two are only back to school presents this is word around the disney version see the little mickey ears we love word around and so most of these words kind of have like a disney feel to them and the cards even have some of the disney characters on them she's going to love that and then I also found a disney 100th anniversary spot it and you guys know spot it as her favorite game so she's going to be equally excited about that I grabbed brain quest grade six we will probably throw these in the car throw my purse it'll just be kind of a great way to pass them time when we need something to do okay school supplies so we have my favorite little post-it tabs this is my favorite size my favorite colors everything I can never have enough of those we also got some of the fine line sharpie markers we use these a lot for mail time because I buy blank cards more sprocket paper for our hp sprocket photo printer when it goes on sale I buy the 100 packs some of my favorite highlighters so the mild liners my absolute favorite erasable pens the friction fine liners I get a new pack every year for back to school and every year at Christmas time Kevin always buys me one because these are my favorites and I use them like crazy oh let's see I got Emily a pack of big pencils these are 0.9 millimeters so they're a little bit thicker lead this is what she started using the end of last year and she really liked them so it's a package 24 hopefully they last all school year and then some of the things I'm going to show you next are part of our nature study plan so that we kind of each have our own set of things one of those being the micron pens so one for each of us the water brushes where you put the water in the reservoir so we don't have to carry water with us so again one for each of us this is a pack of three landscape they're from Arteza books let's see it's watercolor paper and they're 8.3 by 5.1 and it was like I said a pack of three there are 76 pages in it so that will be one for each of us of those and then one for each of us of the prismacolor pencils this is the 36 pack we probably could have shared these except Kevin is kind of snobby about his art supplies so he needed his own because he doesn't want anybody touching his stuff and then um Emily tends to use everything like she'll pick up her favorite color and she uses the whole thing like down to stub or nub and I was like well then I want my own so here we are let's you don't really need one for everybody and then I also got the Windsor and Newton one for each of us little like watercolor palettes with the they're small but perfect for traveling it felt like we've had a set of these before and really like them so I went ahead and ordered another set and then luckily there's three in this pack so this is just a three pack of white gel pens so we'll each get one of those I grabbed a pack of vis-a-vis markers these are wet erase and I love using them for like things I don't want to just erase easily I need a new pack so there we go and this is in the school supply but this was like really really fun so I got it it is a puzzle a day that's like I'll see if you can see it on the back um like each day you have to put these little pieces in to show the month and the date and so every day is a different puzzle they had some wooden ones um they were a little bit bigger but I really liked the idea of the acrylic and the fact that it was different colors instead of all the same colors to make it I don't know more visually appealing I'm visual learner Emily's auditory so she probably could care less but I liked but it was pretty okay for nature study a few of the things that I picked up because that's our one thing and I wanted to make sure I had some resources on hand were the pocket full of pine cones book this is really just for me to read personally to kind of help get my mind in the right spot uh watercolor in nature keeping a nature journal how to teach nature journaling and nature drawing and journaling those two Kevin he's going to learn and then teach us and then I don't remember which ones of these we had and which ones I had to purchase I think I purchased two of these five so I'm just going to show you all of them um I picked these up to kind of keep in our nature study bag um just so we have them with us so we have the Florida wildlife and trees Florida wildflowers and trees sorry Florida wildlife Florida birds Florida reptiles and amphibians and then Florida seashore life so it is like a laminated pamphlet full of kind of just information but it felt like this was a lot less daunting and easier to carry around with us and like this you know these big books and so this is what we have plus since they're laminated that means they're waterproof so we don't have to worry about you know if we're like have it spread out and we're water coloring and water gets on it it's not a big deal because they're waterproof and then last I just have a few like hands-on things so some of these things Kevin asked for it for steam Emily was showing interest in DNA so he asked for some sort of DNA kit to do with her so we got the genetics and DNA lab for him tans and cosmos and then they love doing lego so I picked up the clutch lego gadgets this is one of the few that they don't have yet and the next two things I'm going to show you were technically Emily's birthday presents but they're going to be used as steam as well with the two of them so here they are these were these were birthday just so you know not like this is the three and one medieval castle from lego and then we also have the three and one pirate ship from lego so like I said those were birthday gifts but they're technically going to be part of our homeschool and we did get them from amazon so that is it I think yep that's it that's everything that is everything that I purchased from amazon for the upcoming homeschool year I would absolutely love it if you would leave me a comment down below what you have purchased for your homeschool year


In 1492, Christopher Columbus reached the Americas. This is still commemorated today as his voyages revealed two continents new to Europeans. Let's see what his discovery was all about. Christopher Columbus was an Italian-born explorer who explored with the backing from the Spanish monarchs King Ferdinand and Queen Isabella. On August 3rd, 1492, Columbus set sail from Palos in Spain with three ships, the Santa Maria, the Pinta, and the Nina. His aim was to find a western sea route to China, India, and the Spice Islands of Asia. At the time, most educated Europeans did not know that the Pacific Ocean existed. Therefore, Columbus assumed that only the Atlantic lay between Europe and the riches of the East Indies. On October 12th, Columbus reached land. He thought it was an outlying Japanese island, but soon realized that it was an entirely new territory. It was the Bahamas. Later that October, Columbus sited more land. This time, he thought it was mainland China, but again, it was a territory new to Europeans. It was Cuba. The same happened in December, when his expedition thought they had reached Japan. But it was Hispaniola. It was here that Columbus established Spain's first colony in the Americas, with 39 of his men. And so, Columbus became the first European to explore the Americas, since the Vikings established colonies in Greenland and Newfoundland during the 10th century. In March 1493, Columbus returned to Spain in triumph. After this discovery, he crossed the Atlantic several more times. Columbus led a total of four expeditions to the New World, exploring various Caribbean islands, the Gulf of Mexico, and the South and Central American mainland. Columbus never found a western ocean route to the Far East. However, when he died in 1506, he had no idea of the scope of what he did achieve. Nevertheless, the discovery of the Americas opened a whole new world to Europeans, and in the long run, enriched the lives of all involved.


Good afternoon. I'm presenting on behalf of Simone Pinheiro and myself. And our topic is pharmacosurveillance for SGS and TN in the US. Now, as far as we know, and we would be happy to be corrected, this is mostly carried out at the US Food and Drug Administration. So our presentation will focus largely on what takes place at the FDA. The presentation will take the following format. First, I'll list the tools that we currently use. I'll describe them, including their strengths and limitations. I'll summarize and try to identify gaps in surveillance and then close with suggestions for possible improvements. Now, our pharmacosurveillance tools can be divided into pharmacovigilance and pharmacoepidemiology. For pharmacovigilance, our main tool is the FDA Adverse Event Reporting System, or FAIRS. We sometimes use data mining. We also use the medical literature and VGBase. Now, the pharmacoepidemiology tools, we have them at our disposal, the National Electronic Injury Surveillance System, Co-operative Adverse Drug Event Surveillance. Now, that's a mouthful. So happily, we can abbreviate it to NISCADES. We also do pharmacoepidemiology studies, mainly in databases. And we have another subset of pharmacoepidemiology studies called Sentinel, or its pilot program, the Mini-Sentinel Program. Now, I'm going to spend a fair amount of time on FAIRS, because this is the main pharmacovigilance tool at our disposal at FDA. FAIRS is a computerized database which houses spontaneously reported adverse events associated with human drugs and therapeutic biologics. At the moment, we have more than 10 million reports in FAIRS, and we have been collecting data since 1969. For the last two years, we have added approximately a million reports a year. This cartoon demonstrates how case reports get interferes. Patients, consumers, and health care practitioners on a strictly voluntary basis report either directly to the agency or to the manufacturers of the drug products. The manufacturers are then required by law to report them to the FDA, particularly the most serious ones. And the vast majority of our reports come via the manufacturers. Now, the strengths of FAIRS are that it's simple, it's relatively inexpensive, and it's very good at detecting rare, serious adverse events with a short latency period, such as SGSTN. It's hard to detect SGSTN in clinical trials because of the relatively small numbers of subjects that are enrolled in clinical trials. The other strength of FAIRS is that it is inclusive. All ages, all populations, all marketed drugs and therapeutic biologics. Like all passive surveillance systems, the main limitation of FAIRS is that there is substantial under-reporting. So we have no clear numerator, and we do not have a denominator, so we cannot use these data for incidence calculations. Another big limitation is that information is often missing. Reporting also varies with time and with certain activities in the society, such as publicity and litigation. Now, I thought you might be interested to know that in the last five years, only 0.1% of our reports in FAIRS have been for SGS or TN. Now, how do we detect a signal for SGS and TN? The safety evaluators in our office, they are the officers who are tasked with monitoring certain groups of drugs. And they are mostly pharmacists, and they receive alerts from FAIRS on a daily or weekly basis of the severe or serious adverse events that have been reported in association with their drugs, including SGS or TN. I have data mining here in parentheses because we seldom actually use data mining for SGS and TN since a single case is enough to constitute a signal. We have alerts in the medical literature for the drugs on SGS TN, and we get information from other regulatory authorities around the world, and we also use Vigibase. We find Vigibase is especially useful when a drug is recently introduced to the market or is about to come onto the market in the US, but has already been in use elsewhere in the world. Now, I told you that there was a lot of missing information in FAIRS data or in FAIRS case reports. So I'm going to just illustrate with a couple of samples. The first is a report from a nurse practitioner who reported that a female patient of unknown age developed SGS on an unknown date while on drug A. Concomitant medications and comorbidities were unknown, as was the outcome. Follow-up was attempted, but was not successful. So what do we do with a case like this? Well, we did not include it in our case series because we judged it to be unaccessible because there was just not enough information. However, if this patient had come in as an alert into a safety evaluator's inbox, they would have had to do a complete search of the literature and other databases. It would have constituted a signal, although it would not eventually have made it into a case series for review. This is another example, a 52-year-old man who was on drug X for diabetes mellitus. After nine months, he was still not well controlled, so drug Y was added. And 13 days later, he developed a generalized erythematous rash with bilateral conjunctival hyperemia. He visited a dermatologist who diagnosed that he was having SJS and admitted him to hospital, where all his drugs were discontinued and he was treated with systemic steroids and seen by ophthalmology. He was discharged after one month in hospital with all his symptoms resolved. Now, we assess the diagnosis as being likely because it was made by a dermatologist, and we assess the causality of the drug, of drug Y as probable since it occurred in a close temporal association with drug Y, whereas he had been on drug X for a long period of time without any problems. So this is how we assess diagnoses with the limited information that we have in fares. We say that the diagnosis is likely if it's made by a dermatologist, if there is a good clinical description, especially if there's a record of the percentage of the body surface area that is involved in the blistering and detachment. We accept the diagnosis. If the patient was nursed in ICU or a burn unit, if the patient had a biopsy and the biopsy confirmed that the diagnosis was SJS or TN, but we say that it is less likely but still possible if the diagnosis was made by somebody who was not a dermatologist, and there is no supporting information as above. Now, for causality assessment, we use a modification of the WHO Uppsala Monitoring Center in criteria. We say that the causality is probable if there is a reasonable temporal association, an absence of confounding factors such as concomitant drugs or other alternative explanations. If there is a positive de-challenge and re-challenge information, but if there is only a reasonable temporal association but there are confounding factors, then we say that the causality is possible. Now, people have asked, especially our colleagues in academia over the years, why don't we use the all-den criteria? The answer is that we simply do not have enough detail in our reports and fares. These are not prospectively collected data, they're not collected by a registry, so the data is skimpy at best. But we do use similar elements, we use temporal association, we use de-challenge and re-challenge information, we consider whether they're confounding factors and so on. But the differences, as I said in the detail and the assigning of numeric scores to the different elements, also you heard from Dr. Muckin-Haupt that one element of causality is the notoriety of the drug. Well, at FDA, we are often dealing with drugs that are not previously known, we are the first to make the discovery, so to speak, so we cannot use that element in our assessment. Now, I turn to NICE-CADES. NICE-CADES is a collaboration between the Consumer Product Safety Commission, the CDC and FDA. It's an active surveillance for adverse drug events that are treated in emergency departments in the United States. It's based on a national probability sample of about 60 US hospitals, so it's nationally representative. These hospitals have to have a minimum of six beds and a 24-hour emergency department. An adverse drug event in NICE-CADES is defined as an emergency department visit for a condition that the treating physician explicitly attributes to the therapeutic use of a drug. Now, this cartoon demonstrates how NICE-CADES data are collected. The patient visits the emergency department, sees the clinician, gets some tests done and gets a diagnosis and is treated and either sent home or admitted to the hospital. And all of this is recorded in the notes. Within 24 to 48 hours, trained abstractors from NICE who are usually nurses, they come along and they go through all the notes of the previous 24 or 48 hours. They select the ones that have a diagnosis of an ADE and they abstract pertinent information from the notes onto a computerized form, including the verbatim diagnosis that the EDE clinician made. And these forms are transmitted electronically to the Consumer Product Safety Commission where data cleanup is carried out and then the databases transferred again electronically to the CDC where further checks and validation of the data are carried out. And importantly, based on the verbatim diagnosis from the EDE clinician, MedRA codes are assigned. This is just a screenshot of the computerized form that the NICE abstractors use in the EDE to transfer the information. It's based on our FDA MedWatch form. So it's a similar sort of information. Now, when we're searching for SJS-TEN cases in NICE Cades, we start with the PT and then we move up to the HLT which is Buller Skin Conditions. We sometimes have to use the HLT because we get more cases that way. You find that it might have been coded as a Buller's Condition, but something in the narrative will tell you the patient was admitted to a bullen unit and then the penny will drop that, okay, this probably was a case of TEN. Now, the strengths of the NICE Cades are that it's nationally representative so we can calculate incidence rates from this. It also can be used as an additional source of cases to supplement FAIRs when we're building case series. The diagnosis is made by the actual emergency department physician so that it's better than just the ICD-9 codes. The limitations, however, are that the diagnosis is not confirmed. There is also a lag time of about 15 months for the data to be updated from one year to the previous year. So the lag time ranges from about 15 months to two years because we just got, for example, the data from 2013. NICE Cades does not capture all cases of SJS-TEN. Doesn't capture cases that are not caused by drugs. It doesn't capture cases that occur when the patient is already in hospital for something else and it doesn't capture cases that didn't make it to the hospital. Now we move along to the pharmacotherapy studies. Prospective studies are best but this has proven very difficult in our setting in the United States. Partly because SJS and TEN is so rare and partly because our healthcare system is so fragmented. For a cohort study, you would require very large numbers of enrolled subjects which makes it prohibitively expensive and as far as we are aware, we're not aware of any studies that have been done like that. So prospective studies are what we have been doing or what have been carried out in the U.S. Sorry, retrospective studies are what have been carried out in the U.S. And these are carried out on administrative claims data and more recently electronic medical records. The strengths are that it's a real world setting but unfortunately as you have heard from multiple people today, the ICD-9 codes for SJS and TEN, even the ones that are more recently introduced in 2008 do not validate at all well. They have a very poor positive predictive value of whether a case really will be a case. So these are not, they have not shown to be useful. Sentinel is a program which was launched by the FDA in 2008 in its pilot project, Minicentinel. Sentinel takes a form of active surveillance but it does it on a subset of the administrative claims data and electronic medical records which have specially formatted and standardized so that they're ready to go for studies. Also, they've developed research modules, standardized research modules which can do lots of different types of studies from simple feasibility studies to more complex studies that require adjusting for confounding and that sort of thing. So these are ready to go modules. But again, because for SJS and TEN, the diagnosis is based on ICD-9 codes, we haven't been able to use it successfully for SJS and TEN. So in summary, FAIRS is the main pharmacovigilance tool that we use at FDA. But it's limited by the fact that we have a lot of missing data and there's under-reporting. NISCADES is useful, but BOR could be done especially with confirming the diagnosis. Pharmacoepidemiology studies are limited severely by the fact that we don't have a useful algorithm for detecting the diagnosis and the ICD-9 codes do not validate well. MACE should be in your handouts. I haven't had time to speak about it today, but it stands for Molecular Analysis of Side Effects. And it's a research tool that we have at the FDA and Dr. Keith Burkhart, who should be here, he is a research collaborator with the outside group that's testing this tool. And now I have the following suggestions. I think perhaps we might be able to interest people in doing targeted active surveillance, for example, in intensive care units or burn units, where we would be likely to find cases. It would be the most severe cases, of course, but it would be easy to be sure that the phenotype was correct and that we would get, I think we would get a good yield from looking at these patients. Another source would be to follow up cases identified in NICE-CADES and see what happened to these patients after they were hospitalized. I don't think that this would be unduly burdensome because last year we did an analysis of hospitalizations for SJSNT and NICE-CADES between 2004 and 2009. And in all that time, there were only 60 cases admitted to hospital. Which averages seven a year. So I don't think it would be unduly burdensome. It would, however, take a long time for us to get results from that. It would take another seven or eight years. But it would be a start. Another idea would be to have a network of dermatologists who are interested in studying SJSNT or severe acute ages adverse drug reactions in general, modeled after the Dylan group. I don't know why it is that dermatologists haven't become, you know, haven't become fired up by that sort of thing. But perhaps Dr. Katz or somebody can inspire them. And finally, I'd like to acknowledge the help of all my colleagues in the Office of Surveillance and Epidemiology at the FDA. Particularly those in my division, the divisions of Pharmacovigilance 1 and 2. Thank you. Thank you very much, Dr. LeGrenade. Questions and comments? Yes, please Andrea. Sorry, you have a bit of a hike to get over to it, unless you want to just kind of come to the table. No, you really do need to use microphone because we're recording. Never considered implementing a mandatory reporting system. As our medical practitioners are the first line of timely information, we may find that SJSNT and they're not as rare as we think it is. We have, our mandate at the FDA is a regulatory mandate. And whenever we have tried to ask for mandatory studies, we get some pushback. As if it's primarily for research, then we can't do it. It has to have a regulatory component. So that's our problem. That's our limitation. We have 5,000 signatures of victims for mandatory reporting. I think if you took it to Congress, it might help us better. Right, I was like, it's futile, but, you know, I brought it. Okay. Thank you. Great, thank you. And Munir has a comment, and maybe while he's commenting, others could think if there's any country that you're aware of that has mandatory reporting. That's what I'm going to comment on. So the UK has a voluntary reporting system, but Sweden and Spain have mandatory reporting systems, and the reporting rates are no better in Sweden and Spain compared to the UK, for example. In fact, they're worse sometimes. That's not good news. Just a comment I'll make about the sensitivity of the NEISSK for identifying Stevens-Johnson syndrome. The experience I had with the vaccine safety data link suggested that most physicians were completely unaware of the link between vaccines and well-known vaccine side effects like seizures or ITP after MMR vaccination. And it makes me think that the sensitivity or the ability of most physicians in the emergency room to readily diagnose SGS as a secondary result of Tegretol started the two weeks ago might be very low. I'm wondering what you thought about that. That is a possibility. I think what we find, actually, is that physicians tend to call everything erythema-multiforme, any drug rash, or they have erythema-multiforme. So this is why we use hospitalizations when we're trying to weed out the cases, because if they were hospitalized, then they're more likely to have been SGS rather than just EM. But I take your point, yes. Yes. I wanted to ask, have you observed that reporting certain associations to drugs differs whether the drug is an old drug or a new drug? You showed that you had a list with a high frequency of, for example, carbamazepine-induced cases or somebody showed this morning. And I wonder, because usually new drugs have a higher chance to be reported. And so you have rather an over-reporting with new drugs and old reactions than with the 150s rash after the same drug that everybody knows. Have you seen that? Yes, we have. We have, if the highest reporting is in the first two to three years and the drug is on the market, and then it falls off dramatically after that, especially once it gets into the label, they say, oh, everybody knows about that. So they don't bother to report it anymore. So I wanted to ask about the comment Lois made about potentially doing some kind of surveillance in burn units. That's an interesting idea. And there is a subspecialty of burn medicine and burn unit nurses, et cetera. I wonder, Neil, do you have any experience with that? Yeah, Elizabeth showed the data that we did when we surveyed our units about what was being reported. But I spoke at the American Burn Association annual meeting about two years ago at a symposium on SGSTN or TENS, as they call it. And it was really well attended. I learned a lot about burn units. There are some specialized burn units that are just plastic surgeons who look after burns. Every bed is for a burn and that's it. They often will have three or four states that send patients to them. So they're pretty sick people. Most other burn units, especially pediatric ones where you wouldn't see it as common, might be a bed and a pediatric ICU and the doc. There's one doctor who looks after these people and he's the burn doc and there's a burn unit. It's a unit in the sense that it's one thing, but it's not a unit in the sense of being an ICU or something like that. So it was a really interesting mix. But I have to say the doctors and their support staff and physiotherapists and social workers and all the people who might be part of a burn unit were very, very interested in trying to do a better job in all aspects of looking after SGSTN. And we're quite cooperative too in giving us information about what their therapies were and what investigations, how many people used Alden, how many used SCORE 10 and all these various measures. So I think it's a reasonable thing. It should be nice to collate that and then follow up with reaching out to those burn units in North America, Canada and the US because they do see them. The issue that we found because we have very close relations, we have really Ontario has a population, the province that I live in of about 13 million people. We have the only true burn unit. There's four full-time plastic surgeons who look after burn patients there. And I started relationships with them as soon as they moved to our hospital from another hospital, which was then closed. But what we found was the biggest issue was getting a diagnosis because if somebody was sent to them with TENS, they said it was TENS. And we had to go, no. This one was like in Planetus. This was fixed drug eruption. Could be scabies. I mean, it doesn't matter. And if the outside pathology had been read by a non-dermatopathologist, if it was sent in as TENS, then the answer usually was compatible with TENS. Even though it clearly wasn't toxic epidermal necrolysis ever either clinically or pathologically. So it's nice to think about the pathology helping, but it doesn't always, if it isn't read by somebody who at least knows the strengths or limitations of what they're doing. So I think it's a great idea because I know they are committed and I think they really would like to be involved in a meaningful way. I can confirm that experience to some extent. We are closely collaborating with burn units in Germany and there's about 20 burn units that are larger and they all have patients with SJST and not so many per year, maybe one to five. So it's distributed all over the country. The good thing is they are interested and the burn surgeons want to learn. But they are not the ones to make the diagnosis. They usually overestimate the extent of detachment because it's difficult for them to deal with all the little spots that are around. So that has some impact in the validation, some impact in the treatment, in the supportive care and so forth. And we closely work together because they want us to help and make not only the diagnosis but also help with the medication history because usually the patients are sent to them, not on first hand, but some patients have been in one or two hospitals before because these are referral centers, they don't walk in there. So to obtain a history is not easy and they focus on what is their job, do the correct treatment. So you have to keep in mind, you cannot just take from the burn unit what is there, you have to go back and kind of trace back the history, I think. So I wonder in terms of reporting, I wonder if our FDA colleagues are aware of any surveillance programs related to drugs where there is mandatory surveillance that is actually mandated by the CDC since they're also interested in mandatory reporting for public health reasons. Are there any such programs? Not as far as we are aware. This nice case was a sort of breakthrough surveillance system when it started in 2004. So it sounds like there is room to be pushing the idea of mandatory reporting. If there are groups, obviously, as government employees, we can't lobby and that, but if there are groups that can, hopefully they've heard. So Terry, just related to that, I mean, again, I think we heard clearly from FDA that that's probably not within their purview, but this would be something that presumably would be within the purview of CDC who I don't think we have represented here. So I mean, but in terms of mandatory, at least infectious disease reporting, that's under their... Yeah, no, good point. So maybe Josh, you could come to the microphone and thank you very much. Dr. Luger, not very much appreciate it. Yes, I don't think the FDA would know. So our next speaker is Dr. Josh Denney while his slides are coming up. Who is from Vanderbilt University and he will be talking about the potential for electronic phenotyping in SJSTEN.


I think that the real impact that feminist thinking had on, certainly on me, was that it gave me a way to think about materials, gave me a way to think about how to relate materials from my daily life to a kind of political position, to understand what wearing a certain kind of t-shirt might mean as a political act. And so the piece that is in the current show for me is about the way that children are trained in kinds of gender and racial identity from a very early age, not only by their parents but by the society around them, and how that is both sort of funny and frightening simultaneously. The pieces made up of t-shirts that I have found at various thrift stores and then are sewn together into this sort of toddler's bunny suit, they are attached to a wire so it is a little bit of a long leash that the person is on and there are all t-shirts that are really kind of adult in their theme and are sort of referred to a kind of almost heart-drinking kind of rebel rock and roll lifestyle. And I think it is kind of the collision between the sort of roughness of those shirts and then the sort of sweetness of the form is for me the description of a kind of emotional state that is both rebellious and nervous and frightened at the same time. That was one of the things that was most exciting about seeing that those first generations of feminist work was that there were ways of living and being in the world that were liberating, that were people no longer had to apologize for their own existence. And that to me is the crucial lesson of the politics of that time that people tend to think about the notion of the personal as political as a kind of naval gazing or turning inward. But in reality it is about being able to argue for the validity of any of our existence, any one of us as individuals, and the importance and power of occupying the center stage of our own lives. So to me that is a crucial lesson from the work of that time and one that I am really grateful for.