All right. Thanks very much. Well, it's my pleasure to be here this morning. I really want to thank Dr. Tykoti for inviting me. And as always, when I come to this meeting, I see a lot of familiar faces in the crowd, and I'm very happy for that. So thank you for coming this morning. What I want to talk about is what has really happened with regard to removing renal cell carcinoma in kidneys by trying to spare as much kidney tissue as possible. And what I want to do is talk about what is partial nephrectomy? Why is that important for patients with renal cell carcinoma? Why do we do partial nephrectomy? And then talk about how we're now doing it using the robotic approach and why this is better for for patients with this condition. So a little bit about myself, just so you know, actually was at the University of Washington and did my training there. And then I was on faculty for about 10 years. When I started on faculty, there was no robot. There was all laparoscopic surgery. So I went to Germany to learn how to do laparoscopic surgery, came back and brought that back to the University of Washington and did all the first laparoscopic procedure for kidney cancer. And it was head of laparoscopic robotic surgery before I left to go to Swedish in 2005, where I started their program. We've had a very robust program there, do a lot of prostatectomies, but also a lot of partial nephrectomy. And they also trained fellows in robotic surgery as well. So I want to kind of briefly talk about some of the terminology I'm going to be using today because sometimes this is not always clear, but a radical nephrectomy is removing the entire kidney. And that's a very common operation. And that's usually done for very large tumors. A partial nephrectomy though is the idea of removing the tumor and sparing the kidney. And I'm going to show you why that's important for a lot of patients. Another term that you're going to hear is something called nephron sparing surgery. And that's essentially the same thing as a partial nephrectomy. Basically, when you're sparing nephrons, you're doing a partial nephrectomy. So how do we do this? Well, here's a little cartoon. There's a tumor on the kidney. That yellow thing is a tumor. What you do is you identify the tumor. You create a margin around that tumor because the idea here is when you remove the tumor, you want to remove the tumor and a small margin of normal kidney tissue to ensure that you have removed all the kidney tumor.   The kidney is very vascular. In fact, it gets a quarter of the blood flow every minute of your body. So these are extremely vascular organs. And if you cut into them and don't control blood flow, you lose a lot of blood and you can't see. So that compromises the margin. So we clamp the blood vessels temporarily with little clamps, which are called bulldog clamps. We cut out the tumor. So there's a defect left in the kidney when we remove the tumor.  And that's essentially a partial nephrectomy. And the idea here is to save as much kidney tissue as possible, but at the same time get rid of the cancer. And when you weigh getting rid of the cancer with sparing tissue, you always want to err on the side of getting rid of the cancer. So if there's ever a question, you take more tissue to try and have a negative margin. So why do we do partial nephrectomy? That's, I think, a very important question because for a surgeon, removing the entire kidney is much easier than doing a partial nephrectomy. It's technically much easier and it actually has sometimes fewer complications than doing a radical nephrectomy because you don't have a kidney left behind which can bleed and do things that you don't want them to do. So why would we go through all the trouble of a partial nephrectomy? These are guidelines created by two bodies. The AUA is the American Neurological Association and the EAU is the European Association of Urologists. And they've come out with recent recommendations that for tumors, four centimeters or less, so the first category, what we call a T1A tumor, partial nephrectomy should be considered the standard of care. And this is because there are significant advantages for patients when you leave their remaining kidney behind. And in fact, when you look at larger tumors, tumors between four and seven centimeters, partial nephrectomy should be considered for those patients if it's technically feasible, especially in patients who only have one kidney. So obviously if you have one kidney, you don't want to remove that kidney because then the patient's on dialysis and that's an extreme change in their lifestyle. The other reason we do partial nephrectomy is that one of the major questions that was raised is if you remove the tumor and leave that kidney behind, is there a chance that the cancer can come back? And if you look at comparing partial nephrectomy to radical nephrectomy for tumors four centimeters or less, the data overwhelmingly supports doing a partial nephrectomy. There is no increase in cancer recurrence by doing a partial nephrectomy. Another important thing to consider is that 20 to 30 percent of masses that are found randomly that are four centimeters or less are going to be benign tumors. So taking out an entire kidney for a benign tumor is not a good idea. So another reason to do partial nephrectomy in those patients. And then more importantly, the recent findings have shown that maintaining as much kidney tissue later in the life is extremely important for health. This is an important study published in the New England Journal of Medicine. The first author's go was actually showed that the more kidney tissue you have later in the life, the less cardiovascular events you have, cardiovascular events being heart attack, stroke, and other conditions that shorten your life. So it clearly shows that the more kidney tissue you have, the longer you're going to live. And this has been a major driver for doing something that's more technically challenging than doing a radical nephrectomy. So when we talk about nephron spring surgery or partial nephrectomy, there's basically three ways to do that. You can do open, which is the traditional. You can do it laparoscopically, which was an attempt to decrease the pain and the recovery of open partial nephrectomy and then more recently robotic. So open partial nephrectomy is really the standard. This is where the procedure started. This is how we develop the techniques we currently use. The nice thing about open partial nephrectomy is you can cool the kidney. Now, what does that mean? Well, as I showed you, when we put a clamp on that kidney to stop blood flow to the kidney, we're also stopping oxygen flow to the kidney. And that's not good for any organ. So if you can decrease the oxygen consumption by cooling the kidney, and that's what cooling does in all organs, you can actually have a healthier kidney after partial nephrectomy. The other reason that we people do partial nephrectomies open is that for patients with solitary kidneys. It's riskier. They only have one kidney, so you want to make sure you have everything in order when you do that. So some people will choose to do that as an open procedure. But the disadvantage really with open partial nephrectomy is really what patients go through. And these are some patients of mine. These are in the incisions we do. So there's that incision in the front, which you can go underneath the rib cage. And then there's a decision through the ribs on the side. What we call a flank incision. And neither of the incisions are fun. In fact, the flank incisions, even though it looks smaller, is probably the more painful than two because every time that patient takes a breath, those ribs are moving and they feel that incision. So despite the fact that open partial nephrectomy is truly the standard, this is a significant morbidity for the patient. And this can really affect how they recover. Laparoscopic partial nephrectomy was brought on to try and decrease the morbidity of open partial nephrectomy. But what was found, this is extremely difficult. When you remove that tumor and you have that opening there, you have to suture that together. And doing that laparoscopically involves two little sticks. And it's like working in a tissue box with two little toothpicks. And it's extremely difficult to suture. So it was something that really was only done at a few places in the country where there was experience with laparoscopic surgery. And it really was not something that was going to be widely available. So a lot of patients were getting radical nephrectomies because they could do that laparoscopically. So surgeons could do laparoscopic radical nephrectomy because it was easier, but they weren't offering partial nephrectomy. So that means a lot of kidneys are being taken out that didn't need to be taken out. Here's an example of laparoscopic partial nephrectomy in the complexity. This guy named Gil is a very famous guy. He's the guy that developed laparoscopic partial nephrectomy. He was at Cleveland Clinic. He's a guy that I colleague. I worked with him for many years. And he looked at his first 800 cases with laparoscopic partial nephrectomy. And he divided them based on the time that he did them. So the first group was this first 276 cases, the second group, and then the third group. And as I say in the third group, he did something called early unclamping. So what was recognized is that because this was such a difficult procedure, the kidney had to be clamped for a very long time because it took a long time to suture, took a long time to cut the tumor out. So tumors were being clamped for 40, 50 an hour. And the ideal time is really around 30 minutes. So he developed a technique where he took the clamps off early to try and decrease the time the kidney was not getting blood flow, what we call the ischemic time, the warm ischemia time. And here's what he found. The mean warm ischemia time for his first 565 patients was about 31 minutes. That's actually quite long. If you compare an open procedure, it's around 15 minutes or so. And then with early unclamping, he clearly could decrease the warm ischemia time, but there was a cost. His transfusion rate went back up to 15 percent. So when he was coming off early, there was more blood loss. So what this demonstrated is basically the best guy in the world took 30 minutes to do this and he was losing blood when he took the clamps off early. So this was a hard operation and it really was not going anywhere. I can testify to this when I was at the University of Washington. Here's my first 91 patients. And we started this experience in 1999. And you can see my warm ischemia time was 35 minutes. And you can see what time you get better, but it's still, so my first patients were 38 minutes, so my last 10 patients were 26 minutes, but still very difficult operation. So the question was, could we make laparoscopic parfaitomy less challenging? And there was, at the time that we started asking this question, there was a fair amount of experience with the robot using it for prostatectomy. So the DaVinci robot, which is very, people are very familiar with now, is basically a surgeon tool. It doesn't do anything. It's not automated. It's just a very complex scalpel, a very complex sewing machine. And you need a surgeon to do this and you need a surgeon with experience. But this is a multi-armed robot, a surgeon sits at a console, he's not at the bedside, and this robot has more degrees of freedom, more precision, and it actually has 3D vision. So 3D vision is really important because when we did the laparoscopically, we did this with 2D vision. So when you did it in 2D, you're looking at a television monitor and you have no depth, but when you have 3D, you actually have depth. And when you have depth, you can be more precise. And that's something that was a major advantage with the robot. It allowed us to see better. But not only that, it was magnified about 10 to 15 times. So I'm looking at a magnified view in HD and it's with depth. Now, HD sounds kind of cool on your television and it's kind of neat, but when it's, when you're using it medically, it's a great thing. I mean it, that ability to see, it's much more important than watching a movie, all right? So we really enjoy that and really, it really benefits our patients. This degree of freedom concept I think is really important because degrees of freedom are what you can do with an instrument in space. So that instrument on the left is a laparoscopic instrument. That's an old instrument and basically to give you an idea, when a laparoscopic instrument goes to the body, it goes in through what we call a port. And when you put that instrument in, you can go in and out, you can go up and down, you can go side to side and you can rotate. Those are four degrees of freedom. That's what we mean by moving an instrument four degrees of freedom. With the robot, we actually have two more additional degrees of freedom. And those are called pitch and yaw. So not just going up, but then bending your wrist one more degree of freedom up and not just going to the side but bending to the side with more degree of freedom. Because of this thing called the endo wrist, it actually allows us to do more complex maneuvers in tighter spaces and therefore this really facilitated suturing. So this really changed what we did laparoscopically. And the other thing about robotic surgery which is different than laparoscopic surgery is it's intuitive and that's the name of the company that makes the robot. But here's what i'm talking about. So when you put that trocar in through a trocar, when you want to go up, you move your hand down.  That's opposite of what you normally do. When you use a robot, when you move your hand up, the instrument goes up. When you want to go down, you move your hand down. So this is this is easier, I think, for surgeons to grasp in doing an opposite motion. Another feature of the robot is a safety feature called scaling. Scaling means that when you move your instrument on the outside of the body, it scales it down to make it smaller on the inside of the body. And this was a safety measure because that if you weren't at the bedside, the engineers or the robot thought, well I don't want somebody making big movements and hurting something that they can't see. When you scale movement down, though, that has another side benefit. And that is it gets rid of what all surgeons have and that's called a tremor, of what we call an intention tremor. And when you get rid of your intention tremor, you're more precise, you're more fluid, you look better. And so this robot really takes your motions and makes them better. So again, another advantage, probably a probably an unsung advantage is what this means for the surgeon. So when I do a surgery, I'm not standing up at attention for four to six hours and hurting my back and my shoulders. I'm sitting down. So I'm going to operate later into my career probably and I'm also more comfortable when I'm doing surgery. I'm not stressed and strained and worried about myself and I can completely focus on the patient. So that's the robot in a nutshell. It's a great tool. There's a lot of plus plus and minus, but it's changed surgery and it's not going away and it's a huge advance. Cost, irrespective of cost, this is something that's allowed us to do things that we couldn't do before the robot. So we start using the robot in 2006 for partial nephrectomy and I do two different approaches. I'm not going to go into the details of that for this talk, but we use both the transparently and retroparently of the approach. Now this was a study from a friend of mine named Sam Bayani at Wash U in St. Louis when he first started doing robotic surgery he compared them to laparoscopic surgery and what he found was this WIT means warm ischemia time. That's how long the kidney has clamped and almost immediately when he started on the robot he dropped his warm ischemia time six minutes and again this was comparing his his early robotic experience with a very mature laparoscopic experience. We found the same thing when we compared our retro peritoneal laparoscopic partial nephrectomy to robotic we found a 10 minute decline in warm ischemia time. That's significant. That's a big deal for the kidney and if we look further in our experience when I looked at my first 120 partial nephrectomies to my 91 laps again big difference in warm ischemia time almost 20 minute difference in warm ischemia time with experience. So the thing about the robot as you do more you get better and better and better and the warm ischemia time continues to drop. It doesn't it doesn't level off like Dr. Gill did you know at 576 patients he wasn't getting any better and he had to do something to make it better you get better with more experience. Here's an example who have the robot on the left the laparoscopic on the right I'm just showing you what it looks like side by side and look there's there's quite a bit of difference here between the fluidity of the motion and and you can see it's just an easier method of suturing we're bringing a kidney together in both of these these pictures there's a defect in the kidney and we're suturing it that white thing on the right is what we call a bolster and we don't have to use bolsters anymore because with the robot we can suture more precisely and you can see it's just a better way to move and it's much easier and it's much faster it's more it's more efficient so what can we do with the robot versus lap we can do larger tumors we can do larger patients which in our culture is very important now we can do more complex tumors we can do patients with solitary kidneys which was only done open before and we can do patients with bilateral tumors so let me show you some examples so here's a laparoscopic so there's clearly a difference in what we can do with the robot this laparoscopic tumor is a very easy tumor it's basically ready to fall off the kidney and that's what we could do laparoscopically but look at the tumor on the right that tumor is deep in the kidney that is a what we call a completely endophytic tumor that's a tumor that we could not see or even try and do laparoscopically so this is something we do routinely with the robot here's another example a cystic tumor so these are both cystic tumors but the cystic tumor on the left again is very exophytic almost off the kidney the one on the right is very complex very deep and again we can do this routinely with the robot here's another completely endophytic tumor this is on the left kidney and is there a pointer? so right here you can see there's the tumor right there completely covered by kidney tissue we would never ever attempt to do that laparoscopically and this would be a hard case to do open here's that Bosniak III cyst let me show you another case this is a patient with polycystic kidney disease you can see both kidneys have significant cysts and there's a tumor right in the center of the cysts very difficult tumor to do even open but robotically very straightforward tumor location can be very important hyalur tumors the tumors that are around the blood vessels like this one these are very difficult to do and this is on the what we call a posterior hyalur tumor very large again with the robot and a retroperitone approach we can approach this without difficulty here's a very large tumor this is a tumor that's greater than six centimeters right here warm ischemic time 24 minutes four percent loss in renal function with this approach so that's a very good recovery of renal function after partial refractomy here's a completely intra renal tumor this tumor is completely in the center of the kidney and it's very large this is it's almost like somebody described it as a baseball and a catcher's net I mean this is a tumor that even open this would be a radical nephrectomy this patient was very young she was 30 years old we did it as a robotic partial nephrectomy and as I mentioned before some of these are actually benign this is not a kidney cancer this is what's called an oncocytoma if we had taken out this entire kidney for an oncocytoma and a 32 year old female she has the rest of her life with one kidney and whatever can happen to that kidney might happen to that kidney so again we can do this now with the robot another complex tumor 7.2 centimeter hyaluronic tumor and a patient who's quite large this again very complex here's a patient with bilateral renal masses this is a patient I saw about three years ago and you can see there's a large tumor here on the right but that's not her biggest problem her biggest problem is on the left here a much larger tumor and these patients you have to do in what we call a staged fashion you can't do them both at the same time because if you operate on both kidneys at once then they don't really have any renal function because both kidneys have taken are recovering so we do these we did the right one first and it's a transparent neopartic nephrectomy and then the left one is a retroperitoneopartic nephrectomy and she's done well and she has both kidneys now here's a very easy tumor we could do laparoscopically but I'm showing you this is 5 centimeters of perinephric fat that's a big deal because that's very difficult to work in in somebody like that and this is a patient's outline here you can see this is a very obese patient but again robotically this is a very straightforward case BMI is 44 here's another patient we did robotically BMI of 54 so we can do larger patients now and it allows us to do more complex tumors so I want to show you a case of a patient with kidney cancer who I actually did he's kind of a frequent flyer in my practice I saw him in 2006 for that DDP stands for Da Vinci Prostatectomy he had prostate cancer we took out his prostate we were following him and then four years later he developed a tumor on his right kidney and it was a large tumor and it was a very central location so at the time we thought we should do this as a radical nephrectomy so we took out his entire right kidney and in retrospect I was thinking well I wish I would have done that as a partial nephrectomy and this is the situation you get into if you do a radical nephrectomy in somebody you don't know when they're going to come back down the road with a tumor in their other kidney and now you're operating on a solitary kidney and the stakes are much higher when you operate on a solitary kidney so at any rate we did a radical nephrectomy just like a lot of people would do and just like we normally do and then because it was a Furman 3 over 4 a little more complex he had T3A with invasion and sinus fat we did a scan at 6 months and here's a 6 month CT scan so these are all CT scans by the way that's the tumor and this is a solitary left kidney and here's a tumor and it's in a very unfortunate location this is right in the center of the kidney that's not something hanging off the side which would be a very nice easy parts nephrectomy this is something that's quite central and here's what it looks like what we call a coronal view this is another view on CT scan so you can see very much within the what we call the hylum of the kidney so it's 2.2 centimeters in a solitary left kidney his metastatic evaluation was negative and he has a baseline creatinine of 1.2 so we do this using a transparent needle approach with the robot forearms this is just the port configuration we used just to show you so it's basically five ports we have the robotic scope here my assistant's here left arm right arm and fourth arm so five small incisions now when we take the tumor out we put it in a bag and we extract it whole we don't break it up or morsel it because we want that information for pathologic analysis so what we'll do is we'll take one of these incisions and we'll make it a little bit larger for a 2 centimeter tumor you can get it out pretty much through a trocar some of these tumors we're taking out now they're 9 centimeters we have to make them a bit larger but where you put the incision and the fact that there's no retractor on that incision during the operation makes a big difference in their pain so they patients recovery even if you take out a large tumor they recover quite quickly when you've done this robotic approach so I'm going to show you the video of this case this is kind of a full portion of rectomy this is the artery and we're putting our clamp on the artery this is the vein the vein's larger and we're putting it on the vein so this has now we have complete blood control to the kidney and here's the tumor right here right in the central portion of the kidney and we take these robotic scissors as you can see this is using the robot and this we're cutting the tumor away as I showed you here's our margin of resection it's a very small margin because there's some important structures here and you can see you can see that's the most important thing you can see and the vision is amazing and that's what is such a great thing about robotic surgery is that we can do this now there's some very large blood vessels right at the base of where I'm removing so I'm being very careful not to hit that vein there and there's an artery right next to it so there's the tumor freed up and there's a blood vessel you see a little opening right there that's a blood vessel we're going to suture that shut so when we take the clamp off it's not going to bleed so we control this these blood vessels by suture and then shut so that when we take the clamps off we don't get any bleeding afterwards so you you can tie just like you would do with open surgery and then what we're going to do is we're going to close this defect now we have this opening in the kidney there's a little chunk out of the kidney we're going to close that back together so it doesn't bleed so this is using different types of suture there's a needle with suture there and and the robot allows us to bring this together very precisely and that's really what's nice about this so this is my assistant down here that's not a robot that's my assistant there's a human being on the end of that and he's doing a great job of giving me a view of that and what I you can see is I'm bringing the suture together it's it's coming together and I put a little clip on here this little thing's called a clip and that secures the suture and keeps it from sliding and by doing that it holds the suture in place and it brings the kidney back together and then I'm going to close the outer layer of this these are this is a different type of suture but the same idea here is that we put a clip on the suture to to secure it and you can see the tissue coming together quite nicely and this allows us to bring this together and not have to worry about bleeding afterwards the whole time we're doing this the kidney is clamped so we're going to take the clamps off now and this is what it looks like after we're off so no bleeding precisely brought back together and the kidney is nice and perfused I don't usually get applause in the OR so so the kidney was clamped for 21 minutes that's not very long that's good you can see the OR time is not very long it's just about three hours blood loss 200 cc is very acceptable for a partial rectomy this turned out to be a renal cell carcinoma 2.2 centimeters again firmin 3 over 4 the firmin grade is something that we look at very closely to tell how these tumors are going to act in the future with negative margins now this is what happened to the kidney function so the creatinine is a blood test you do that measures your kidney function and his baseline creatinine was 1.2 the higher the number the worse your kidney function the lower the number the better your kidney function you probably are all familiar with that technique that term so his creatinine went up to 1.45 on day 4 but by two weeks he was back down to his baseline and now he's actually down to 1.2 again so it worked quite nicely for him Hyler tumors with the robot are something that has been looked at in the literature these were tumors as I mentioned before that were just done with open surgery but this is a review by Craig Rogers and Henry Ford 11 patients he looked at tumors that were 3.8 centimeters in size on average and the mean warm ischemia time was 28 minutes now this is a again I hate to beat up on Dr. Gill but here he is again this is his series of 25 partial nephrectomies laparoscopically and you can see this is robotic with Rogers lap with Gill 28 versus 36 warm ischemia time length of stay a full day better with the robot and I will tell you in our experience our patients go home on average 1.2 days so the majority of our patients go home on day 1 now after partial nephrectomy and it's a big difference for their recovery this is our early experience what we call imperative indications for partial nephrectomy these are patients who have either solitary kidneys or bilateral tumors they can't get a radical nephrectomy so that imperative means they must have a partial nephrectomy so if you look at this approach the mean tumor size is 3 centimeters the collecting system is a term for the inner portion of the kidney that the urine collects in what we call the plumbing of the kidney when you enter the collecting system that's a deep tumor because that's the deepest portion of the kidney is the collecting system so we were these were deep tumors 60 percent of the time so primary kidneys the mean warmest kidney time was 13 minutes which is quite low the decrease in GFR was 9 minutes and the bilateral patients the mean warmest kidney time was 23 minutes and again a modest decrease in GFR GFR stands for glomerular filtration rate it's another measure of kidney function other than carotene it's actually supposed to be more accurate than carotene because it takes into account the patient's size and men and women have different renal function there were complications we had bleeding complication in one patient in a solitary kidney she lost 1600 cc's of blood her carotene actually went up quite high because of that blood loss but eventually her carotene came back down to baseline no patient required temporary dialysis which is a great thing normally when you work on a solitary kidney those patients go on dialysis temporarily and we didn't lose any kidneys which is another great thing we've also looked at our patients with large tumors tumors greater than four centimeters and we had two conversions to radical nephrectomy the mean tumor size was five centimeters 5.3 centimeters and we used both approaches and if you look at the two groups here so comparing the tumors less than four centimeters the greater than four centimeters we added the collecting system more often with the larger tumors the OR time is larger the blood loss is greater and the wheeling or scheming time is significantly greater but again only by two minutes so again very acceptable outcomes with very large tumors we had complications we had something called pseudo aneurysms which is where a blood vessel opens up after surgery and we treat that by asking the radiology doctors to go into their groin go up to the kidney and they could stop the bleeding of the blood vessel and then we had a couple other things but we had no urine leakage urine leakage is a very common thing after partial nephrectomy because when you cut into the kidney it can leak urine and we just don't see that robotically I'm going to end with one case where I think it's interesting for this group this is the patient I saw about five years ago he's 61 years old at the time he had a 2.4 centimeter tumor found in his left kidney and he had a creatinate of 1.8 so his creatinates that's a pretty high creatinine that means his renal function was compromised he's also large and he's been treated with his HIV and the CD4 count is very stable so that means he's actually doing quite well from an HIV standpoint so he's got a good survival he's not going to go away anytime soon this tumor was found actually in June of 2009 and it was 1 centimeter and so he was followed and then in March not to next year it actually doubled in size so less than a year later it doubled in size and then an ultrasound basically three months later was 2.4 centimeters so this thing was growing faster than it should and so therefore watching this was not necessarily the best idea so here's another CT scan and the axial view you're going to see this tumor right here now what's different about this tumor is it's not nice and round it's got a little tail right here I don't even appreciate that but when I saw this tumor it doesn't have a distinct border it's not a nice tumor that we would normally see there's no nice tumors but it's not nice and round and here's again the coronal view again not a very distinct tumor so we did this as a partial refractomy again using the robot transparent needle approach here's our trail cards I showed you earlier and it took us 12 minutes to get the tumor out and the pathology was quite unusual this is something called collecting duct carcinoma and Dr. Tycote is familiar with this this histologic variant but this is a very aggressive tumor collecting duct carcinoma has a poor response to chemotherapy they're highly aggressive and the mean survival is about 11 months on average so we were concerned about this we talked about this we presented with our tumor board we had a good margin he had no sign of venus act as he's elsewhere his renal function was somewhat compromised so a radical refractomy was not a good was something we could have done but it would have been a problem for him so we actually followed him and he's almost five years out now and he's NED normal renal function HIV status is stable so again this is a rare case where we got away with it but I think if you find these tumors early and they're offered nephron sparing surgery they can do well so in summary the robotic carcinofractomy facilitates nephron sparing surgery it avoids radical nephrectomy which I think is very important for patients who potentially need to be treated for renal cell carcinoma or for any other condition and it avoids open partial refractomy and again that really improves our patients lives thank you very much for your attention


Kia ora koutou, menei. Welcome to our fireside chat with Cip Chan. We were going to have someone introduce us, but we've decided to just kick off ourselves instead, so to introduce myself. Whoa! My name's Courtney Johnston. I'm the director of the Dalsat Museum and Petone Settlers Museum, and I also take care of community arts out in Lower Hutt, so just across the water there, along to supporter, I guess, of NDF. This is the environment that I grew up in as a professional, so it's always so nice to be back. And I think a big part of that growing up and my experience within this community has been shared with Cip, who will be no stranger to most of the people in the room, but I also realise that you will be unfamiliar to a few people, so maybe you could start off by introducing yourself and telling us where you've been and where you are now. Yeah, cool. Thanks. I first came over to this thing in 2006, in fact, when I was talking about social tagging when I was based at the Powerhouse Museum in Sydney, and I think during that period, I was there from mid-99 to 2011. We were doing a lot of work around that shift from museums as authoritative places into these places where social media was a thing, still as a thing, but that shift of authority and that sort of sense of the web or something moving from that period of being about being a published resource into then being a social resource, and then as I left the Powerhouse, the mobile piece had occurred and we'd started to do experiments with AR and I guess it's first iteration then in 2009, and then also then into mobile apps and all of those things. So then in 2011, I get a call and I get on a plane to go and help rebuild this place, the Smithsonian Design Department Museum in New York, the Cooper Hewitt, which was a really interesting experience. That sense of both starting to shift what the building was for and what was in the building. So I started to acquire software and code for the museum's collection, that sort of piece that has design moved from being about furniture and these things into stuff on screens. What does it mean for museums to start collecting code and then sort of taking that notion of collecting code and releasing that code? So a lot of the Powerhouse work was about the open access piece as well and so in collecting digital-born pieces as my Java tries to update, you have this sort of notion that what does it mean to collect and then release pieces and that GitHub repository thing that we did with Planetary with Aaron Cope was really important, but really the main work was about really building this experience around the museum itself. So as some people may have heard, we created a pen which does this in the museum. As you walk around the museum now in New York, you're given this pen that allows you to collect all of the things in the museum to take home, which is kind of an interesting repurposing of the museum, I guess a little bit more like a public library using the physicality of the museum as a place to browse and then to use that as a way to get access to all the digital resources as well as all the things you create too, so that notion of giving a utility value to the museum visit and reimagining things like the wallpaper collection that had been digitised and giving those things that, when I came into that sort of museum, a very small amount of that collection had been digitised shortly after I left it. It had all been done, so you renovate the building, but if you're renovating the building and digitising all the stuff, how might you make the building work better for a world when all of the things are on the web? So from there, I've then moved to Melbourne. I'm at the Australian Centre for the Moving Image now. So of course, my visa gets cancelled without prejudice, which I think is awesome. And so I'm here now, right? So this is the National Museum of TV, film, video games, digital culture, and it's a very different scale of proposition now, which is exciting. We are the most visited museum of this type in the world. We have a lot of visitors, 2.4 or 5 million visitors a year. So there's a different scale issue there and I think coming into the role I am there, which is all about experience, that sense of how do you work with the media? How do you work with... I'll just jump to this. What is the purpose of that museum when all the things in that museum are actually better experienced on your couch or in bed? Like if you're doing... If it's about film, then arguably there is a reality about seeing a film in a cinema that is different from seeing it on your couch, but for a lot of people, that's not their experience now. Similarly, when we're showing VR works, you end up with... This is Lynette Warworth's collisions work that we have on at the moment. That is a museum gallery experience. It's kind of an interesting one because it's people sitting in chairs with headsets on. And that's a gallery experience. It's a free experience, but it's a gallery experience. That takes up our smaller gallery for three months. So this is an exhibit that, you know, 15 people can see each 30 minutes. One of the... You use the word experience and one of the things that's been noticeable in your move, because you've talked about it, is your selection, I think, of the title Chief Experience Officer. And it's been interesting to see that Shelly Bernstein, as she's moved from Brooklyn Museum to the Barnes Foundation, has adopted the same title. And we were talking just before about brand and museums and the meaningfulness of that. So what's behind that brand for you? Yeah, look, I think it's a realisation that, you know, I think out of the powerhouse experience, really began to realise that the context of people engaging with collections and the museum's knowledge changed the way and the impact that it had. We used to, you know, I remember probably in 2006, 2007, I would have been saying that virtual visitors, as we used to call them, were as important as physical visitors. They're differently important. The context in which people engage in material is different. And I think that's become really the case with mobile. We know that mobile hasn't taken away time from our screens. It's added more time to our screens. I was reading a report from Pew, I think, last week, that, you know, now what Americans spend something like eight hours a day on a screen. So they've not reduced their desktop time at work. They've just added on mobile time and then they've added on Netflix time at home. So it's all now screen mediated, but the context is so different that how we absorb and learn from our screens has changed. So the experience part has become incredibly important. And Cooper, you're it too. Building a physical device changed the way people behaved in the museum. And I knew that from the Science Museum work at the Powerhouse, but that thing of giving people a thing that meant they put their phones away or used their phones in a different way but gave them sort of an additional magic power or super power was kind of interesting. And it just became this sort of thing that actually what's missing in museums is that usually experienced designers are brought in to design an exhibit.  And then the promise of digital as well is not just reduced to the building. I mean, you and I are old enough to remember the promise of the web as a global thing. That really was that mid-2000s, early-2000s or even the 90s view of the web as this global resource. And I think it's almost become balkanised in recent times just well as a balkanisation of politics as well. But, you know, I don't want to lose sight of that. So that notion of a CXO role instead of a digital role was an important shift because it would also assert that digital was folded into just the operations of the museum. And the mission is digital and physical because it's the mission of the museum. One of the things that you and I have talked about quite a lot over the last couple of years, which I find fascinating, you've held these kind of change-making leadership positions both within the Australian system, which is arguably publicly funded, and within the American system, which is substantially privately funded. How is that... How's moving between those environments affected you as a museum person and how have the expectations upon you differed in those two environments? Yeah, look, I think it's been interesting. I think in Australia, in New Zealand, in the UK, there is a general consensus that the public museums are there for the public. And I think in America, that's not the case. And I think, you know, the V&A had that beautiful piece from Neon Circus, which was this, which was really about communicating that all of the things in the museum belong to the public. And actually, it was the museum's responsibility to assert that and make it possible for the public, the citizens, to engage with the museum in new ways, but also to claim it. And I think in the US, that's not the case. There's a non-profit tax kind of status that is about educationalness. So the education piece becomes the reason you get the tax exemptions. It's not that. And so the purpose of the collection is very different. The purpose of the museum and the type of educational role the museum takes, I found was perhaps a bit more paternalistic. Than we might have moved out of in Australia and New Zealand. I think New Zealand and Australia actually are about a decade ahead of the US in terms of museum practice and about a decade behind in terms of access to capital to fund that change. The UK probably sits in the middle there. But I think there's definitely a different sense of professionalisation in Australia and New Zealand. I mean, we had the new sort of museology in the 80s came through both our countries well before the US. And of course the US has amazing collections. I mean, in the art museum world, the art market as well is so important, but also brings a whole different set of donors and the purpose, the cultural capital that's garnered through that is difficult to underpick, particularly in a society that doesn't want to talk about class and barely wants to talk about race. And I think in Australia and New Zealand, we're much more upfront about that, which is a good thing. It doesn't mean we've resolved it at all. When we first got invited to do this session, one of the things that was happening at the time was that some of the prominent US digital innovators, particularly the New York Public Library and the Met, were either shedding well-known and influential staff or shutting down operations. And it's hard to tell whether that was being done because the change that they were hoping to affect had taken place. And so you no longer need your skunkworks and such because it's become widespread change. Or if it was because the change that they were hoping to affect wasn't happening and therefore these things were seen as failures and they were being shut down. So I'm interested in your opinion on what might be driving that. A couple of high-profile flagship initiatives that have been shut down, people have been let go quite publicly, what's your gut feeling on why that's happening and is that a faint signal for our sector? Yeah, I think it is. The funding environment in the US around the world as well has changed. I think one of the things with being largely philanthropically driven is that the consistency of funding that we expect in Australia and New Zealand, even though it may be reducing or its make-up may shift, there is a sense that if you're a government-supported museum, you're not chasing grants each year to fund your operations. And I think in the US, that isn't the case. The certainty of financial security isn't there. You're also dealing with managing a much larger series of stakeholders and boards. So I remember at Coop at Hewitt, we had a board of 40 individuals. And that's not unusual at all. That's not big. That's not big. I remember visiting LACMA in June last year and their board table has something like 70 seats. And it's so long that each seat has a little microphone built into the marble so people can hear each other. Like the UN. Yeah, it's like the UN. So that sense that you're managing the director's role is to manage or the senior leadership's role is to manage 40, 60, 80 people who may have very differing opinions and different pet hates and pet projects that their personal money will go into supporting. That's very different to dealing with a ministerial change. Party politics will generally deliver a predictable series of policy initiatives that have an electoral cycle role. That's not the case if it's private money. But I do think also there was another thing going on or there is another thing going on in the US which is a two-sided piece. One is that digital is done. And I think you definitely get the feel with some of those initiatives being shuttered that in some cases there was a sense that we did enough to secure the funding and resources we need to do. The other things that we really care about, the digital was a way to be seen to be showing innovation. Kind of like a loss leader almost. Yeah, it's a repositioning piece but wasn't necessarily about a structural change. And I think in the other cases though the structural change was what was desired and the ability to fold initiatives that had occurred on the side and been successful into the organisational change that is required in very large organisations. All these places and working in the Smithsonian as well. These are big places that org change takes five, seven, eight years. Possibly beyond the director's term as well. So there's that piece. And I think that there's a sense that often the work that goes on, the really exciting work that you and I and others get really excited about, unless you can fold that into the core operations of the museum within 12 to 18 months, it's not actually successful. And that was something I guess my team and particularly Aaron Cope and I were very aware of at Cooper Hewitt which was about if we were going to make this change we had to make it all of the way through the museum. And so from the security guards, through the conservators, through the curators, the way exhibits were done was the only, we had to change that as much as deliver the bright shiny thing. And that's very difficult if you can't also juggle the desires of the director which may also change and their ability to manage the board and your ability to manage the board. I think there's a lot of lessons for us locally and I think part of the shift that Ross Parry and others have spoken about of going to a post kind of digital phase in museums is about making that transition. And you start to see directors now particularly talking about the mission more than digital. And so if digital people can't align themselves with the mission and articulate that really well I think that's a warning sign. You've mentioned your team a couple of times now and a few people like Aaron who are familiar to long-time India for 10 days. And one of the reasons that I hold you and Shelley in such a steam is the generosity with which you have shared your work over time and encouraged your teams to do the same thing. I mean, we have open-source documentation in our sector and a big part of it is due to you guys and it's not easy to prioritise that time or to prioritise your team's time to document and share thoroughly what you're doing for the benefit of all the rest of us. So what got you started doing that and how have you maintained it? Yeah, I mean I guess for me it started off really as this was, you know, can you imagine a time before Slack or anyway, around that time when blogging was still a thing. We had an internal, you know, I know, right? Did I say that now? Before Wikipedia, no, it's not that old. But no, no, there was this sort of moment in the mid-2000s when I started at the Powerhouse from my team, a blog that was really just a way of us talking within the museum. And that blog, we opened it up to the public but of course no one would see it. Myself and Peter Marni who ran the media teaching labs he's now head of education at the Powerhouse. Peter Marni and I were having a discussion in one of the posts about media teaching. This was when there was a place called the Soundhouse there and what happened was suddenly this comment came in from a teacher who had found it through a Google search and it was a really interesting comment and we just engaged with that comment and from that point on that became just a public facing thing and that started to change what we wrote about and then it became mainly me writing about unfortunately. And then the Powerhouse started up another whole other suite of public facing blogs but I think it was that use of writing as a reflective practice that I think for me has become incredibly important and now certainly at Cooper Hewitt and now at Destran Centre for the Moving Image it's that sense of I guess part of my management style is to get people to have reflective practice and to write what they're doing so whenever a project goes live or whenever we make a learning we allocate time to that because I think if you don't write those things down you don't get to look at them you don't have to concretise those thoughts in that moment which can often lead to new things like oh right I'm expressing it like that right okay now that's what I'm going to use for this but then you can look back on it to in a year, two years time and go that idea that failed then is ready now it's that piece that you don't necessarily realise but that extra two hours it takes is totally worth it but reflective practice is super important it's a little bit like keeping a diary which I don't do but I know people can do that but it's a public facing one because I think one of the things that my former bosses at the powerhouse very early on Kevin kind of assumption who's now director at the Maritime Museum Tim Hart who's now at Museum Victoria in a senior leadership role Mitraba who was my first boss at the powerhouse they all instill this sort of sense that when you're working in the museums or library sector you're not doing it for one institution you're doing it for the sector as a whole and I think in Australia and New Zealand that is very much the case in the US that isn't the case because of the way you're competing for people on your board so you know Courtney's on the board of X so we can't get her to be on our board so who else can we get and there's a competition piece which is unhelpful and I know there's been initiatives I remember in 2006 in fact here when Susan kind of remember Chun was out here speaking about the tagging initiatives of the Steve kind of project the difficulties of getting that to work across multiple museums when it was a very clearly a beneficial piece of work that was such a struggle and I don't think in Australia and New Zealand of course there's struggles around collaboration but there is more it gets back to that public service piece it is the thing that I after make especially after the experience of doing a whirlwind travel around the states that was what I just came back and was so thankful for was that sense of being a public service and that that gives you your mandate to be generous and that when you're more privately supported it's a lot harder to be generous because it's no longer to your benefit in a way or short term benefit so I think it isn't the longer term but maybe directors and boards aren't around for long enough to realise that to see what happens when you give it away the other thing I mean hands up here who's done who's been around for as long as I have and it has been to one of Seb's web analytics workshops back in the long time people so you've like for at least a decade you've been travelling really extensively doing talks like this and maybe not so much now but previously running an awful lot of workshops what's driven you to commit to that kind of I mean you said it at lunchtime you're like you just get up at 3am and do your work so that you can go to the conference later on in the day that you've been invited to speak at what's driven you to commit to that kind of schedule and how have you balanced that with your day job Yeah I mean I think it's become I mean I remember in 2007 at the powerhouse it became a thing where I began to go out on the road a lot more we had a lot of success with the collection site in fact that collection site I hear is being replaced finally in January we say that will have been around for 11 years which is kind of amazing that's a long time on the web but yeah it was about carrying the brand of the museum out and I think I'd always done this as a piece for the museum so on arariums and revenues earned from that I would always flow back as a budget item and I think that was an important piece of it and I think for Cooper Hewitt it was very much acknowledged that this was about getting Cooper Hewitt on the map this was like earned media you know a lot of the digital humanities conferences and other things I would go and speak at were about putting Cooper Hewitt into the digital humanities world and backing it up with actual products and services that meant it made sense to be there but almost you know I learned over the time at the powerhouse that when we do digital projects we never spend enough money on marketing and promotion and in fact it's about generating meaningful buzz around your things but it's also about demonstrating that your organisation is outward facing and I think this comes through to both the last question about reflective practice and this one is that institutions need to be looking out to the world particularly in Australia and New Zealand we need to get out there because people don't look down here we're far away so this was very much about carrying the brand of the museum out so powerhouse Cooper Hewitt was very good in that term but it was difficult at times because we had both me and Aaron going out and that was hard and it was a very difficult high pressure time to do it but it was incredibly important because it was about putting the institution on a map a series of maps in fact and now at the Australian Centre for the Moving Image this is about signalling that that museum is now Australia's national museum of this stuff and we speak to the world we don't just bring exhibitions in we have exhibits touring around the world now in Europe and America that we make and this is about not just touring exhibits but taking the ideas the competencies and the knowledge of the museum out and contributing back at a global scale if we're talking about film museums or museums and video games we need to be creating a network of museums globally around this stuff and that only happens by having people go out I think that's it's a budget priority and it's one that I would defend all the time it's like what are we going to cut well the travel has to stay because the travel gets you all this other stuff So everyone should start we can relabel our marketing budget and travel and spreading the word budget I would not say that it's just professional development I think it is that but it's carrying the brand and it's about shifting the brand to being one which is about connectivity outwards which is carrying that web that web philosophy the web is a web of people and people need to get out and the value of my team going out me going out others going out is that we bring ideas back to and I think that's a really important way to validate what your museum is doing because even we would send curators out and getting them to report back on what they did I had one of our developers go out to America and did a really long 8 or 9000 word post of his American museum visits really great way of him reflecting back on what he'd seen and who he'd spoken to but also communicating to all the staff we have now connections with all of these places and this is what we're doing and putting us on the map even though we're in Melbourne but you're in the network network that's global In preparation for the session again I read the recent interview you did with Sampert where you talk about the importance again when your when your day is crammed remembering that we work in the creative sector and the important word there is creative like if you get too dragged into spending all of your energy on the operational side of things you could be running a ferry shipping service or a supermarket or it could be anything the reason that we're all drawn into this is that creative side of things and you talked about not having the headphone time which is the time where you can sit and immerse yourself in doing something without writing emails or being in meetings and things like that. How do you keep yourself fresh? I think it's increasingly hard I think there's that piece that you have to keep reminding yourself in this sex sector that we're incredibly lucky to work with the people and for the organisations we do even on the worst day it's not the worst possible work day anyone could have by any means. I don't say no people but few people few people and honestly it's a real luxury that we have and I think we need to acknowledge that and be aware of the privilege that we have of working in this field with all the people we do and try to not make it crap for other people too. That's also the piece I remember that this sector is fond of meetings and one of the things that was really interesting in that you know what I mean right but it was interesting in New York that we were working with a strategy firm when it was coming crunch kind of time to deliver the pen this was a we were making a physical device that was being manufactured in 10 factories in type type type type Taiwan co-design with a firm in Spain and all of this crazy stuff all within a very period of months before launch and there was this really important line that stuck with me from this strategy firm which was you should aim for consent rather than consensus and so that sort of sense that you go into meetings with an idea that you're going to have consent to try a thing rather than spend 2 hours coming to a consensus decision a 20 minute meeting that leads to a consent to try a thing to get to the next stage is better so you know I think hopefully my team maybe might disagree at times around this I've got better at shrinking the number of shrinking the length of meetings and shrinking the number of meetings and across an organisation I think that's incredibly important that people need to be trusted to get on with stuff and you need to give people the tools and the inspiration that's the role of leadership is to inspire people to do new things and get out of their way and to keep other people out of their way as well out of their way as well I mean in order to generate a curiosity amongst visitors I mean I have a thing on here I can put up with museums are curiosity machines and we should be there to try to make those curiosity machines better and there's ways that we can improve our own processes to deliver on that mission better and I think the headphone time is now it happens at different hours of the day and I have to be I've got kids so I have to make sure there's good family time and those things and under plugging from all of this stuff is really the real challenge now I think getting that balance right is something we all struggle with so I don't have an elegant segue for this question so I'm not even going to try it but because you guys are kind of getting a little bit of what I guess Seb and I ping between each other every so often and one of the ones that maybe the last year or so I've been occasionally agast I'll send Seb a DM and I'll be like I'm seeing this it's visit a research but it feels more like surveillance starting to creep through and I don't and it kind of sounds funny but I don't think it's funny anymore since about two weeks ago I don't think it's funny anymore and I feel like our data ethics aren't where they need to be yet where are you sitting on that look it's tough I mean the big data piece is reality everything is collecting more data all of the time our own systems that we choose to install are doing that and we're not communicating that to our publics very well if at all I think the exploratorium has done some really good work around this about making visible things about cooking collection on their website beacons in their physical spaces these kinds of things but we should be doing more of that and I think one of the nice things that science museums have been able to do better than others is to couch you in terms of the education role of the museum is to talk about surveillance capitalism and to talk about the surveilling nature of technology we as a profession shouldn't get away from that but I'm always pleased that libraries have always held up privacy as a mantra from the beginning and that borrower records are an important private thing and museums could learn a lot from how libraries deal with this because it's part of the shift from delivering experiences to delivering services and experiences delivering services does mean data collection usually it does mean personalisation and often we're not in control of the system design all of the way through but we can minimise its effects and we can develop internal policies that stop bad things from happening I remember some of the public libraries in the US setting up tour tour nodes for example and running all their public Wi-Fi through tours so people browsing were as anonymised as they could could be when they're in the public library space and so museums could also be doing that but it's always a discussion with the marketing department and the development team who want to gather people's information because that potential leads for leads for things donations or ticket sales all this sort of stuff but it's about managing that well and having an ethics that carries through to policy and that it's not fixed that you have to keep evolving that because I remember you telling me about cell phone towers being installed and cell phone tracking coming into New Zealand museums I was kind of shocked but I think that's becoming the normal the sort of new normal and it's only because the public isn't aware of what that might lead to and you know there's a trade there's a utility vs privacy sort of transaction that we make in our own personal lives but when you're in a space that is like the magic circle that a museum creates when you step into that magic circle you should need to understand what the rules are or the rules need to be legible to you you know the magic circle is an important privileged space but if you don't get told the rules then it's very one sided power kind of relationship and I think the lessons of the last 20 years in museums has been that shifting of power from the institution to the community we owe it to our communities to do that same shift of power around data that's kind of what I try to ask myself whenever I'm making these decisions it's sort of how does the public benefit from what we're doing for them or to them and if I can't see a quite near term benefit then my need to because often to say no don't ask that question if you're not going to act on that question don't ask that question if you don't need that information don't take that information if you don't need to track how many times someone's walked past your building by picking up their cell phone next thing is of course now we're in a new age with the shift in US and global politics is that it's not just do you collect it but who might come and collect it from you through subpoena or other means and so I think libraries are very good at that and defending that and I think as I say museums need to learn a lot from libraries around that stuff that's the libraries totally I think that's all we have time for if you could join me in thinking Seb for his ongoing curiosity how's our fire going down there I never got to see the fire did you put any mallows on it excellent that's so you that's awesome I think we should open source that and get everybody one back in the office thank you both of you friends of NDF back in front of us so thank you very much


How is natural gas being utilized in the United States? Natural gas utilization in the U.S. and beyond for the most part is going towards power generation and it has been for a number of years now. We do see that increasing. There is a large array of new plants that are coming online or have recently come online or are planned for the near future. So we see new pipeline connections going to those locations and we anticipate more of that same development on that scale going forward. Along with that we also see a number of other uses that are increasing for natural gas. Transportation would be a good example. We see more natural gas going into transportation mainly with heavy trucks but to some degree even with light duty trucks. There is some in a passenger car standpoint from a passenger car standpoint but actually very little in that case. Beyond all that we also see natural gas going to other forms of transportation. Inland marine application for instance like tugboats in Pittsburgh. We also see natural gas being used for near shore operations. So container ships for instance that are moving goods up and down along the coast or other near shore operations in marine type settings. So that's becoming much more common than it was and we see the infrastructure to supply that fuel to that type of transportation mode being more common. We also have the use of natural gas going towards rail. So we have a company GE for instance that is now making a new generation of locomotive to move goods that are moving by rail throughout the country and one of the bigger constraints there is an infrastructure to supply the fuel source. Just in the past it was diesel or electric. Now you would have to build a new grid for a fuel delivery to be able to deliver in that case LNG into that setting. Beyond all those things and thinking beyond transportation we also see communities now that are going through a conversion process and moving away from fuel oil or coal and moving towards natural gas as more natural gas or the natural gas grid is expanding in closer proximity to them and they can convert their residential or even in some cases like industrial capacity over towards natural gas. And along with that or tied to that we have virtual deliveries or virtual pipelines as they're often referred to where natural gas is compressed at the pipeline, put into special containers that are put on trucks and then delivered into those other settings where natural gas can displace coal or most commonly diesel or fuel oil at a factory setting or into a community where they didn't have that opportunity in the past. So we see a variety of different pathways that natural gas is finding its way into locations where it may not have been or may not have been to the level that it is now. So ultimately you have more capacity at the upstream side with production and you have more downstream utilization whether it's in power generation or transportation or other industrial or residential uses of natural gas that did not have them in the past.


As engines of economic opportunity and innovation, the unprecedented growth in global cities mean they also emit a growing share of global greenhouse gases and face a mounting health crisis driven by local air pollution. While a small subset of cities have responded to these challenges with renewed leadership and commitment, most are restrained by a lack of relevant quantitative information about their atmospheric emissions. The scientific community has made profound advances characterizing atmospheric pollution in new detail and greater accuracy from a combination of space and ground measurements and modeling systems. This new capability, however, remains disconnected from urban decision makers in desperate need of better information. I propose to close this gap between need and capability by building a global information network that leverages these new scientific capabilities in collaboration with a suite of pilot cities across five continents, transforming the ability of local actors to simultaneously tackle the dual crises of local health and global climate change.


a fiery horse with a speed of light, a cloud of dust, and a hearty high old silver, the lone ranger. The armed guards who rode beside them faced many dangers on the rough trails of the early western United States. Outlaws and renegade Indians filled every trip with a threat of sudden death. And it was not until the masked rider of the planes brought law and order to the lawless frontier that travel became safe. He returned with us now to those thrilling days of yesteryear. From out of the past, from the thundering hoofbeats of the Great Horse Silver, the lone ranger rides again. The famous masked rider of justice raced into the secret camp he shared with his faithful Indian companion, Tonto. Oh, hold this over. Oh boy. Oh. Tell them quick, settle up. They're trouble. The stage was held up. Oh, that man. Here's the couch. The driver was murdered and the passengers robbed. Oh, do it. Now one knows. The passengers were too frightened to tell clear stories. Some claimed the bandit was the lone. Others claimed there were two outlaws. One of the women swears she saw an entire gang. Where happened? Just this side of Bald Rock. We go there now? Right. The stage just reached town. When I left, the sheriff was getting ready to ride out with a posse. But I want to get there before the posse spoils any signs that might have been left on the scene. Ready, Kimosabe? Me ready. Then come on, hurry. Come on, Silver. Come on, old fellow. Come on. The sheriff and his posse were not yet in sight, and the masked man and Tonto reached the place where the holdup had occurred. They looked for any clues that the bandit or bandits might have left behind, and finally stopped beside a clump of trees about a dozen yards from the trail. Oh, Silver. Oh, God. This must be where they hid until the stage came into sight, Tyler. It's the only place that would give them cover. That's right. We can be sure that there were two of them. You find any sign of any more than that? No, at all. I... Look here. What you find? Look at the bark on this tree, Kimosabe. This is where they waited. The horse is rubbed up against this trunk. Ah. The sorrow horse. See the color of the hair that was caught in the bark? Amishi. Two bandits. One of them riding a sorrow horse. When the holdup was finished, they rode off toward the south. Ah. They must have planned to reach the desert and lose their trail there. Ah. I think...listen. Many horse come. The posse. Ah. Into the saddle, Tyler. We'd better be getting out of here before they come inside. They'll be thinking we did it. Ah. Now where go? Those fellows were heading for the desert. I'm afraid they've got too much of a start on us to catch them before they can reach it. Ah. But at least we'll make sure that's the way they went. Come on, sir. Get them on, sir. Come on, fellows. Hurry. Several miles to the north of Black Gulch, Tom Martin, Bart Hurley, and Bart's young son Bobby made their home in a small cabin. Bart and Tom worked to claim nearby. And they were not only partners, but friends of long standing, although Bart was some 20 years older than Tom. On the evening of the holdup, the two men were alone in the cabin. Bart seemed nervous, and Tom wondered what was wrong with him. Say, Bart. Well? Come here a minute, huh? What do you want? You in trouble some kind, Bart. Huh? What gave you that fool notion? Well, guys, the way you've been mooning around since you got back from town, anybody else would think the same. Well, I ain't. Shucks, you needn't snap at me. I just asked because we're partners. You know, Doggone, well, if there was trouble, I'd do what I could, don't you? Huh. I get it. The grub I fixed tonight ain't set in so good with you, huh? Well, ain't nobody to blame but yourself. You ought to know, but this time, I ain't no cook. I ain't in trouble and I ain't feelin' bad. Now, we should quit being so nosy and just leave me alone. Hey, now, Bart. I'm sick and tired of you asking me full questions all the time. Don't you leave a fellow bee? You have to keep pickin' at me when you know I want to be left alone. Oh, say, Bart, gee, I'm sorry.  Ah, forget it. But I... Well, sounds like we're gonna have company. Somebody just rode up. You don't figure it's Bobby and he's got homesick vits and them friends it is, do you? Say, by thunder, Bart, there is something wrong with you.  Oh, I... No, Bobby wouldn't knock. Come in. Oh, howdy, Sheriff. Step in. Evening. Sit down. Well, you was right, Bart. I looked where you told me and I found a part of it anyhow. You did? What do you talk about? Yeah. Don't know where the rest of it is, but I'll make him talk. Say, I'd like... Sure, you'll find it. Hey, now, hold on a second. There's some kind of a secret between you? Ain't nobody supposed to talk to me. Recognize this, Tom? Huh? Take a close look. Oh, watch, huh? Nope. Never seen it before. Ain't seen this neither, I suppose. Well, doggone, a wallet. Somebody lose that somewhere? Ain't there a name in it? You ought to know. Uh-huh. Tom, there's no use you're trying to look innocent. I got you dead to rights. Hice your hands. Why? Be quick about it before I bless you to glory.  Yeah? Well, that ain't going to prevent me jailing you. What in thunder fur? For holding up the stage today, killing the driver and robbing the passengers. This here's part of the loot. What's that? And you'll hang? Are you sure there's justice in this county? You're clean loco. Bart, did you hear what he's accusing me of? You ever hear anything so crazy? Bart, say something. You know I never held up no stage. I was at the mine all day long. Tell the sheriff so. Bart, what's the matter? Tom, there's no use bluffing. What's the matter? And it's for trying to get Bart to give you an alibi. It ain't no use. It was him that turned you in. What? He told how you sneaked away from the mine today and come back without explaining where you'd been. He told how he followed you afterwards and seen you hide some of your loot where I found this. Bart's a law-abiding fella. And even though you're partners, he had to let me know. Tom, the game's up. Bart. Hold out your hands and I'll put these cuffs on them. Bart, answer me. Hold out your hands like I say.  I ain't going to try and get away. But neither am I leaving with you till Bart explains this. Bart. You scared to look me in the eye? Well, I am. You rotten low-down coyote. Yeah, quit that kind of talk. Yeah, well, make me. He knows his lion. Look at him, Sheriff. Just look at him. He ain't even got the gumption to look this way. You and him have been friends for a long time. Sure, it's hard for him to look at you. Anybody'd be bussed up to find out they've been friends with a crook. You've got anybody else's word against me but his? Nope. And with this evidence, I don't need it. Besides, in this case, one man's word will go long ways. Everybody knows that Bart had never turned the endless and he was out and out guilty. Guilty. Bart, the Sheriff's going to take me to jail. All right. I didn't want to turn you in, Tom. But when I heard about you killing the stage driver. You pole cat. It was just my duty. So you framed me. Well, Bart, while I'm in jail, I want you to be thinking some things over. I wish you could. I want you to sit here and recollect how I sat beside your bed and took Carol. You're for 60 hours straight without a wink of sleep. That time the doc said you was dying. Listen, Tom. And then I want you to remember how I went in the mine alone after Bobby. That time the shaft caved in.  All right, Tom.  Come on. Get moving. We've got a ways to go. The next day, Tonto brought word to the Lone Ranger of Tom Martin's arrest. Tonto, what time last night was Tom arrested? It was three hours after sundown. Tonto, don't you see what that means? What that? Tom's telling the truth. Bart is lying. Tom couldn't possibly be one of the guilty men. Why do you say that? We follow their trail. We saw where they'd entered the desert. We made sure they had not turned back again. That right? And how could Tom, if he'd been one of the bandits, cross the desert, circle town, and be back at his cabin again by the time the sheriff found him there? Oh, you don't think of that. The sheriff didn't know any better because he and his men missed the bandits' trail. I don't know how that wallet and watch got where the sheriff found it, but I do know absolutely that the bandits crossed the desert, and therefore Tom could not be one of them. Why, Bart, not tell truth? That's a strange part of this, and the worst part for Tom. It's so well known that he and Bart had been the best of friends for years that anyone who didn't have the facts we possess would never suspect Bart had framed Tom. That's right. But Bart, him not bandits either. No, if Tom isn't, he isn't. The same facts apply to both of them. Oh. But I'll wager Bart knows who the bandits are, and we're going to get to the bottom of this. Here, Silver, call Scout Tutor. Here, Scout. Did you say Bart was in town? Him at the cafe. That's where we're heading. Come on, Silver. Get him out, Scout.  As Tonto had told the masked man, Bart Hurley was in the cafe at Black Gulch. For more than an hour, he sat alone at a table. Finally two rough-looking men entered the place, and when they saw Bart, they went to his table and sat down. Bart seemed to have been expecting the men. Howdy, Bart. Hi, fellas. Listen. Careful. But I got to know.  You start to talking about what you shouldn't, and there's no telling who might hear enough to begin getting suspicious. Act like we were just friends. Try to smile a little.  You think I can help how I look? You don't talk? Oh, go easy on him, Spike. I reckon this is pretty hard for the fella to take, but he's got sense. He knows what's good for him. He ain't spilling anything. Bart, look while there's nobody around. You find that Walton watch where we left it for you You plant that where it'd be found? Sure I did. Didn't you heard none of the talk? Just that you turned Tom in. I went there after the posse'd left. I picked him up and hustled back to the claim and buried him by some brush. And I told the sheriff that's where I'd seen Tom hiding something. That was a right slick idea, yours, Red. He'd give us the chance to lose anybody following by crossing the desert, while still fixing it so there'd be evidence to use against Bart's partner. Keep your full voice down. Sure, Red, sure. I'm being careful. What I want to know, fellas, is what you're doing with... Bart, you know just what we want you to know when we want you to. But you gotta tell me... So far you've done all right. But this won't be finished until Tom's had his trial and been hanged, and me and Spike will be safe. And we'll keep our part of the bargain. You'd better. We will. So between now and then, you watch your step. Don't say anything but what you've told the sheriff already. Stick to that same story at the trial. And after that, your worries will be over. Well, I... What kind of thunder is this? Everybody covered. This isn't a hold-up. The first man who reaches for a gun gets blasted. Bart! What in blazes? He's coming here. Why, he... Bart, I want you. What are you? Come along. Let go! Hey, let's leave! You can't... Follow me, tunnel. Let me go. No one's to leave the cafe. They've been looking for anyone who sticks his head outside the store before we're gone. Sorry, tunnel. Get to the saddle with him.  Come on, Silver! I am Silver! Oh, boy! The curtain falls on the first act of our Lone Ranger drama. Before the next exciting scenes, please permit us to pause for just a few moments. Now to continue our story. After they had returned to camp, the Lone Ranger shot question after question at Bart Hurley. At the end of an hour, the prospect had reached the limit of his endurance. Bart, why did you lie? I didn't. When did you get that evidence? You planted against Tom. I didn't plant it. He put it there himself. I seen him do it. You lie. No, no. What's behind it? I swear I told the truth.  Are you afraid of someone? Did you want revenge? And Tom done something to you that you hated him for? He was my best friend. Exactly. And you betrayed him. Stop it! Stop it! You've sold him out. He's going to hang. Maybe he won't. Maybe they'll let him go. With your story against him, not a chance. He'll die. You will be his murderer just the same as if you shot him in the back. Stop it! I can't stand it. Stop it, please, please! Not until you've told me the truth. No, no. Then you admit you haven't. I didn't say that. I didn't mean it. And what do you mean? I don't know. I don't know. He'll get me all mixed up. You're twisting things. Please. When I finish with you, Tom will start. When he's finished, I'll try my hand again. You won't get any rest. You'll not get a chance to think of more lies. You'll tell the truth that we have defeated out of you. Stop it. Stop it. Why did you betray your friend? No, no. Why? That's better. Now, off with it. You got me half-crazy. Out with it? I had to do it. Had to send your friend to jail for murder? I had no choice. Why not? My boy. Yes? I just told him. He hit him away. He said I'd never see him again if I didn't do what they told me. Well, that's why you did it. It is. You can't blame me. I've been half-crazy. I wish I was dead. But I think more atonement than I do myself. It was just been me I had to consider. I'd never done it. Who forced you into this? I can't tell you.  Who was it? Well, no. You can't make me tell that. There's no known what they do. They found out I... Well, it is necessary, Bart. I'll have to confess I've tricked you. What? I've known more about this from the very first than I'll let you know. You won't tell me their names. I'll tell them to you. You mean to say you knew all the time that Red... Red Morgan and his partner, Spike Jenks. Those are the men. You were with them at the cafe. You fooled me. You didn't know. You made me tell. Under the circumstances, Bart, I was justified. I tell you. But I... Bart, listen to me. You don't know who Tato and I are. And it doesn't matter. As long as you believe that we're on your side. I realize the situation you're in and we'll help you. With your boy there prisoner, I don't know that anyone could blame you for what you've done. Nobody could. But Tom can't be permitted to pay for your son's release. I won't testify against them crooks. I won't. Even you can't make me. And I don't intend to try. Huh? Go back to town. Explain this in any way you think best. Say that I mistook you for someone else or that I'm an old enemy of yours and you made your escape. Tell any story you wish. But don't let anyone know what's really happened here. As if I would. Do that, Bart, and I'll make you a promise. Yeah? Your boy will be returned safely. Tom will be cleared. And Red and Spike will be justice without harm to anyone but them. You mean that? I do. Stranger, if that comes about, I'll thank you on my knees. I give you my word. I'll thank you on my knees. Potto obeyed the Masked Man's orders and took Bart to the edge of town. The miner hurried to the sheriff's office at once. Why, golly, we've been looking everywhere for you. That mask... It was just a mistake, sheriff. He thought I'd done something to a friend of his that I hadn't. When he learned the truth, he let me go. But, sheriff... Forget about him for now, sheriff. Do me a favor, will you? Why, sure. What do you want? Let me talk to Tom. Just for a couple of minutes. Don't forget, sheriff, in spite of what's happened, I can't forget that him and me were partners for a good many years. That's all right, I guess. Can't guarantee he'll be glad to see you, of course. You know where he's locked up. Just walk on back. Thanks. What if he tries to make trouble? No, you won't. Tom. Who are you? You. Tom, I want to talk to you. Get out of here.  Tom, wait. I never want to see you again as long as you live. And I hope every day of your life you remember and suffer for what you've done to me. Tom, won't you listen for just a second? Make it short, then, Vamuse. Here, a trial is coming up day after tomorrow. That ain't news. Sure, but I want to help you. You help me? That's a good one. What have you been feeding on, local weed? Tom, I meant just what I said. I know you've been saving all your cash, hoping someday to have enough to buy yourself a little ranch some ways and settle down on it. Well, I don't want you to touch it. Leave it in the bank. You need a good lawyer, but I'll pay what he costs. Huh? And I can't do no less than that, Tom. I'll pay any amount. And it wouldn't surprise me none of a real slick lawyer like Clemens over to Cactus City could get you off. Get out. But I do.  I wouldn't touch a penny of your cash, even if I knew it would get me free. I wouldn't let you pay for anything if it was all that stood between me and being hung inside the next minute. Tom, listen to me.  I'd be ashamed. If your cash got me out of here, I'd feel like I'd done something so low down me and I'd never be able to look anybody in the eye again. I'd plum-hate myself.  And either you get out of here right now. I'll call the sheriff and have him throw you out. All right, Tom. I'll go. I'm sorry it has to be this way. Sorry that I can tell you. Goodbye, Tom. Poor cat.  It's tough. I can tell me how you feel. Thanks, Sheriff. I sure hate to have to find out to the pardon of mine that a spike here was a crook and a killer. I reckon I'd be feeling mighty bad. Fred, what are you and Spike doing here? Well, just come to ask the sheriff how the case was going, whether he found anything more, than Martin or so. Well, Sheriff, see you some other time. Sure. Come and Bart. What do you want? Sure he is. Right whereby you drink over the cafe. You look as though you need it. You can tell us all about that mask fella. Come along. Huh? Good day, Sheriff. Goodbye. Goodbye, Sheriff. Bye, Sheriff. Bart, I have to hand it to you. Huh? What for? Sheriff, you've got more sense we ever figured you had. Gosh, you should join up with us regularly. You've got a hand on your shoulder. You sure have. I don't savvy this. What's so funny? Well, you're offering to pay for a lawyer for Tom. That's a good one. You don't mean I think that I... Thank you for just about the smartest move you ever made. And we're giving you credit for it. Tom's got friends in town, sure. But who's going to suspicion you'd lie in court again when you still feel friendly enough towards him to pay for a lawyer? Bart, what made you think of a move like that? Hold on a second. What do you mean? I'm going to tell you, fella, something. Yeah? You've got me where I can't make a move. But there's such a thing as friendship, whether you know it or not. Tom hates me. Well, I don't blame him. If I was in his boots, I'd do the same. But don't get no wrong notions. What are you talking about? I didn't offer Tom the use of my cash just to be smart. I meant every word I said to him in there. He could have everything I've got. Even every last fella in town was like you and thought there was a trick behind it. I have to take your orders, yeah. But I'll be dog-gone if I have to be like you. I'll tell you that now. Hey, you talking kind of big? I'll get mealy mouth with us. We know what you was up to. Why, you! Oh! What the? You hit me! And if you want more, get up on your feet again. You! And you've got a notion you're going to scare me. Just recollect this. You got my boy. But any time I want all I have to do is open my mouth and you'll find yourselves in jail. The courtroom was crowded when Tom Martin was brought from the jail to face trial. The case had aroused a tremendous amount of interest and the elderly judge had difficulty in keeping order.  Quiet! One by one those passengers who were on the stage when his driver was killed took the stand to tell their stories. The sheriff told at last a Bart's visit to his office, accusing Tom that length Bart himself was called to the witness chair. He was pale and nervous and his eyes avoided those of the man he was there to accuse, Tom Martin. Bart, I'm going to ask you a number of questions. And when you answer, I want you to remember that you've sworn to tell the truth, the whole truth and nothing but the truth. I will. Good. Now then, you say that on the day of the hold up, Tom Martin left the mind without explaining his absence and was gone for the greater part of the day? Oh, I... Well... There, you see?  He don't dare. Just look at him! Silence in this courtroom! Sheriff, see that the prisoner doesn't make another disturbance. It's despicable.   Maybe now we can go on with this. Bart, I'm still waiting for you to answer my question. Well, it was like this. On that day, I... Bart, tell the truth! Bobby, come on in here! Bobby! The Masked Man's found him! I will tell the truth! Sheriff, grab them fellas right there, resin spike. Grab them.  They made me lie about Tom by holding Bobby prisoner! You squealers! You won't get us! Drop those guns right, Masked Man! I don't see Bobby. Where is he? Wait, did you hear the sheriff drop those guns? You're the one that found the kid, and I'll take you first of all! I've dropped my iron! Now tell where the boy is! Hey, you mean to say you ain't found him? I didn't claim that I did. You thought I was speaking to him and jumped at the conclusion. He was free. I had to do it, Bart. It was the only way to get the truth out of you, here in front of witnesses. Will you make them fellas talk? Leave him! They got Bart. Young man, get away! Don't let him get us! We'll talk. He's in the bankers' house. We hid in there because the bankers out of town. We knew nobody would dare go in it. Keep him back. The boy's all right. We ain't armed him. Tonto, that's just behind the courthouse. Go after him. Bring him here. Sheriff, you've got to let Tom go. You can't hold him now.  Tom is free to go anytime. You can scarcely punish Bart for what he did, Sheriff. With the safety of a boy of yours that had been involved, I think you might have done the same. I ain't got no notion of punishing him. My golly, you think I ain't got no heart at all? Bart, hey, here, Tom. Why didn't you tell me what had happened to Bobby? Why didn't you let me know why you had to do this? Did you think I couldn't understand? Tom, I just didn't feel I could take the chance. Sure, I'd recognize Sally. And you're forgiving me for what I've done? Shucks ain't nothing to forgive. Or still, partners? Sure thing you know. All right. There comes Bobby in the engine. Go on, Bart. I know how you feel, partner. There's Bobby. Bobby. Bobby, son. If Bobby testifies again right in spite, and says there, as far as locked him up, we got the skunks dead to rights. Hey, now where's the mask, man, in the engine? Oh, they've cleared out. Bart, where's the mask? That's them. I promised to thank them, and they wouldn't wait. There is a copyrighted feature of the Lone Ranger Incorporated.