Now, you guys are not sissy. You know how to do the snow really well. So I am here to talk a little bit about one of the things. Let me just step back for a moment. It's my understanding that we are not, in these three webinars, we're not going to review old stuff. We're not going to talk about the definition of the characteristics or what's up there, any of that. You guys have that. And so I am delighted to say we're going to just move forward with some information that was agreed upon. And hope that it will spring some questions or some thoughts. Now, I have a question, Roy, about if people have questions, is there a way to do that? Because my screen doesn't show anything except my slide. Yeah, so folks have the ability to put a hand up and then be recognized. And we also have a chat function where people can put comments into the chat.  I just had a comment through somebody who asked if it was possible for you to turn your microphone up. Yes. Is that better? That sounded a little bit better to me, yeah. OK. OK. And if that's still a problem, please let me know. And perhaps I can do something to help improve that. All right. So I'm going to start with a CVI update, things to consider. And so one of the first things I want to start with is just welcome. And I think to myself, what can I share with you today that broadens your understanding of CVI? You folks have the basics for sure, your experience, you know a lot about CVI. You know that you're all practitioners as well. So many of you have a deep understanding and years of experience. Some of the challenges among the experience. This is what people have told me. See if this rings a bell with you. That they sometimes have trouble interpreting the range scoring, like they are in the plus full program. They may have trouble conducting specific parts of the range and they have questions about just specific parts. Applying the results of the CVI range to individual students. So now that I have a score, I'm not sure what that looks like in that child's day-to-day life. Selecting appropriate materials and environments for two students of CVI. Some of the challenges are also managing the needs of individuals who are in phase three. This is a common, common difficulty that has been reported almost universally. That people seem to learn about CVI from my perspective in a certain order. They learn phase one, phase two, and then the hardest and sort of laugh to really get that high level of skill is in phase three. A challenge may be facilitating improvements in functional vision. Integrating accommodations into routines across therapies and instruction. It may be a challenge to think about CVI and communication needs and meeting parent expectations. That's always a very big issue. In this hour, I'm going to talk to you a little bit about some of those challenges, but I'm also going to talk about some research that's going on and I want to talk about the CVI range endorsement. So I'm going to pass on the video because I'm worried that it's not going to play right. So you just saw a screen that was going to have a video, but I want to maybe try another one in a moment. One of the difficulties is that we're not all in the same place. So everybody has a role. Everybody has a place. It isn't like this picture where somebody's going to not get a seat at the table. The novice in CVI has a role and the expert has a role. And we all really need to work together in this process because no two people really aren't exactly the same place in understanding CVI. So your professions, meaning those of you who might not be vision people, your professions are diverse, students are diverse, and the goals are shared, but the goals are shared. So I was going to show some images of a child with CVI so just so that we all remember and maybe for those who are not novices or those who are really well advanced, I always want to remind people that when you look at a child with CVI, you have no idea. You have no idea when you encounter a child who may have CVI based on what they look like. This is a child who looks like a typically developing five-year-old who has CVI. And here he's trying to really discriminate the very fine internal details of these images to find the ones that are the same or different. This should be a child in phase three. OK, so look at this with all of these faces. Is that so? Is that funny? Can you show me a face that looks like that over here maybe not the same color, but a face that looks like that at the same face as that? OK, I'm going to move on. These are also students with CVI, of course. I'm just trying to emphasize the diversity of this group of children. So this is a child working on a lightbox. So I just want to stop for a moment and say, are the videos working for people? Roy, has anybody put their hand up to say the videos are not working for them? The videos are working just fine for us. So I'm assuming that they should be OK out there, yeah. Somebody just responded, videos are good. There's another child. She doesn't like Elmo at all. It's like a real issue with her. What I want to say about those little video clips is that each one of those children has a different score on the CVI range. Each one of those, so you saw a child in phase one, a child in phase two, a couple kids in phase two, and a child in phase three. And that's what part of what makes all of this so challenging is that these children are so, so, so diverse. And we have to know, I don't know what that means. Oh dear, something is different. We have to know how to really address the needs of all of those kids all along the continuum. If most of you are a tenorant teachers, this is the old news for you, right? You do this all the time anyway. So those characteristics, the characteristics are the things that really bind the children with CVI together. They might look different, some walk, some talk, some are, I know, children with CVI who are gifted readers, and yet what is it that binds them together? It is the fact that the characteristics, those ten characteristics remain active with that child. There are two other criteria you guys know what those are as well. So the level of the characteristics, of course, determines the course of our support. And unfortunately, and I'm just sort of gonna do this as an intro to our three lectures because the CVI range is really the centerpiece, I think, of all of our work with children with CVI. At least it is in my opinion. Unfortunately, the scoring of the range is not always performed uniformly. Unfortunately, accommodations and CVI direct instruction are not always applied accurately. That's really a problem. The child's level of functional vision doesn't change if we don't get that right. So I'm gonna breach behind me right now and I'm gonna pull out a folder that has a document in it that I brought with me home from a clinic yesterday, CVI Clinic, PDF review. I wanna read to you something that was in, that demonstrates this point.  And it says that the vision support teacher observed this child over two sessions. The purpose of the observations were to conduct the across CVI characteristics method. This score provides an overview or composite perspective of the overall extent of the impact that CVI is interfering with this use of vision. Her score place sure is range three to four, meaning that she functions more with a more consistent visual response. Now, if you know what was wrong with that, those statements I read, then good for you. Because when I read this and I had a parent sitting right in front of me, my thought was, wow, what am I supposed to do with that? Because we know that the CVI range is rating one and rating two. It incorporates observation interview and direct assessment. It is, you have to have two scores, one from rating one and one for rating two. How this person got two scores, three to four, from doing one method, but not even really doing it, in my opinion, places this child at risk, okay? So that concern, that whole concern, has led to the Roman Perkins or Perkins Roman, I see it both ways, CVI range endorsement. If Roy, if you could tell me if you're still there, how many people, people that are present have heard of the endorsement, the CVI range endorsement. People could just take a moment and let me know. Just go ahead, folks, and use your up hand. And I'll just quickly go through and cop those. I am seeing so six. Okay, out of, you said there's about 30 people present. We have 40. 40. Yeah. Let me take a moment and explain to people what this is. I think it's a really important piece of information, that the Roman Perkins CVI range endorsement is, I'm gonna go back for a minute. So when I see things, oh, I see somebody. Somebody has your camera on. Krista, I see you. Look at, do you, does everybody see her? Uh, who's got their camera on? Please turn that off. It's okay. It's off now, I think. And so when I would encounter documents like that, when I saw IEPs, and I saw record reviews, and I saw assessment materials, I wonder how you do that. And I see that somebody has actually made a really good attempt to address the child CVI needs, but they have completely missed the boat on doing the CVI range. Parents would ask me, they would always, they would say to me, well, how do I know if my vision person knows CVI? How do I know if they know how to do the range? So for that parent, you know, she doesn't know, she actually was so pleased that her teacher did the CVI range, though she did not do the CVI range. She did something, but it wasn't the range. And so it occurred to me that I had a responsibility since this is my test, I have a responsibility to make sure that we identify people that can do it well. And so the endorsement was really born from this need to acknowledge the students of people who really know how to do the range. It is a way to really thank people for the additional work like you guys are doing right now.  I'm hearing lots of voices. And it's a way to acknowledge the additional work completed by individuals who have been motivated to improve their skills and knowledge relative to CVI. Some of you folks are these people for sure. And so, you know, thank you. Thank you so much for the work you've done, the passion you've had, and the way you've followed up on the needs of kids with CVI. The endorsement is a way to establish a level of competence that can be recognized by parents, administrators, and educational teams. And so if somebody is CVI range endorsed, it doesn't mean like they're necessarily the best teacher in the world. It means that these are people that are maybe, maybe they are the best teacher in the world. Maybe they're somewhere in between, but they are people who know how to administer the range and understand the principles that are contained in it. It's a way to provide competent support to individuals with CVI. So when a parent has somebody who's CVI range endorsed on their team, they don't have to ask the question, do you know how to do this test? Do you know what this test means? Do you know where to take the information from this test next? They've already proven that. So just like many of you have certificates in braille competencies, without the certificate, you're probably just as competent. But the certificate is a way to send a message to people that I don't really need to explain myself. It's, you see that I've completed this. People, let's look at PT. There's neurodevelopmental therapy, NDT, right? So people can't just say they're NDT trained. They have to actually pass a threshold of test. They have to demonstrate competence in that. So this is a way to do that. I also want to say, and most of you know, I am a teacher of the vision impaired. I am an ONM specialist. And so maybe a lot of you know that I also taught in higher ed for 17 years. And I know that the competencies that you're expected to learn are designed by the Council for Exceptional Children in the United States. I don't know what it is in Canada. And university people like me, I had to teach what I was told to teach. You must teach X number of hours of braille instruction. You must teach X number of hours of anatomy and physiology of the eye and so forth. But in that list of expectations for university people, there is little to nothing about TBI. And what's the problem there? The problem is TBI is the leading cause of visual impairment in children. And so everyone who knows me knows that my mentor and my great, the person that I admire so deeply is Dr. James Jan from Vancouver. And he once told me that for every one child with TBI, for every one child with ocular visual impairment on a case load, there should be about 2.5 with TBI. That's how many kids there are with TBI. And that was a while ago. So, again, range score is important. Well, I'm gonna go back to this. I wanna say a little bit more about the endorsement. So, let me just say a little bit more about the endorsement. So, this is what's contained in that. So, Perkin School for the Blind put their hand up and said, we would like to partner with you. I wrote a proposal. I asked for letters of support. And in seven days, I had this flood of letters from universities, from schools to the blind, from itinerant teachers, from parents, from administrators in special education settings, from, you name it. And I collected those up and took them to a few places and said, would you be willing to sponsor this endorsement? And it was Dave Power at Perkin School for the Blind who said, I think this is important. Yes, we'll do the work. This is what's involved. The whole thing can be done online. A person who wants to be endorsed just goes online to Perkins.org, Perkin's e-learning. And in Perkin's e-learning, there is a link to the endorsement. And you write in some information about your experience with students with CVI.  So, if you once met a child with CVI on the street, that's not enough. If you once were in a special ed classroom and you saw a child with CVI, that's not enough. You have to have worked with kids with CVI. You had to have assessed kids. And so, once that's clear, you take a test of knowledge and it's a multiple choice test and it's not meant to be overly difficult. It's a basic test. Then you do score two videos. And the videos are me conducting a CVI range in a controlled and well videoed setting. I do the interview. There are observations of the child and then you watch the direct assessment as well. Then you score it. And you have to get within 1.5 points of my score. If you do that with both videos, then you're good. If not, they give you another chance or two. I also have office hours to answer questions. And finally, you have to have letters of reference. The letters of reference have one, at least one has to be from a parent. So, when that collection of things are sent, all this is done online, then you can become endorsed and your name goes into a directory. So that parents and administrators and everyone who's looking for an endorsed person knows where to find them. There are people in Canada who are endorsed and I think it's a really, really important movement. And I think that at least I can speak for parents maybe on the East Coast of the United States where there's a lot of emphasis on CVI, more so than other parts of the United States perhaps. There are parents who are not finding an AP without an endorsed person being somewhere on the team. They don't have to be their child's direct CVI but they have to be available for consultation. And I think that's an interesting turn of events. I'd love to know at this point what your questions or comments are about the endorsement and truly just have at it because believe me, I've been in rooms where people have asked some very direct questions and I want you to. So what are your questions or thoughts about it at this point? Is there anything Roy? I'm just seeing, it's a marvelous thing, what a good idea. So far that's what I got. Another good idea. Christine, you have to be a teacher of the visually impaired. Could you be like an OT or PT to get the endorsement? You can be from any professional background, educational professional background or therapeutic. So OT, PT, speech, yes. And there are people from those fields who are endorsed. They never can substitute for the teacher of the visually impaired. So every child who needs a TBI gets one. But that endorsed person can be part of the team to help with some technical stuff around doing the range and so forth. Yes, they can be from any field. There's a very practical question, Christine, that says, is there a cost for the endorsement? There is a cost. It costs $125 for five years. A cost, it lasts, so it's $25 a year. And I know in some places, administrators are paying for it for their teachers as an option for in-service, instead of in-service, they sometimes pay for this or sometimes just pay for it outright. So, and sometimes teachers are paying it on their own. But the cost is literally just to manage the websites and to pay the people that do it. I should tell you, I think it's very important that you know, I don't make a penny from this, nor do I review any of the applications. My job is to do office hours in case you have questions, but we want to make sure there's no even hint of any conflict of interest. So I'm completely out of it. I just do the office hours part. Perfect, thanks, Christine.  And I want to go, I really want to, I'd like to share with you some, share my screen on this one now. And I want to share with you some data that have been collected around, forgive me for this scanning through. So here are some, I wanted to, part of the purpose of today's meeting is to talk about some research activity. So here's, I wanted to talk about this. So I just want to remind people if you don't know that the interview instrument in the range. So you know the, the CBA range is part interview, part observation, part direct assessment. The 25 questions used in the interview portion were actually my doctoral dissertation in 1996. And what we found was that these 25 questions, such as, does your child have a favorite color? When you offer something to your child, do they seem to respond better in a certain way? Meaning to the right or the left or up or down? If you take your child, if you offer your child a new object and one they know well, what would they prefer looking at? Those are all scored based on how the parent responds. We either say, yes, that's the CBI like answer or no, not really. This weekend clinic, I had a child come in who did not have CBI and the questions in the interview were so confusing to the parent.  Is there a color that can just, you know, really draw your child's attention? And the parent looked at me like I grew a second head. That's how they do look at you when you ask these questions of parents with who don't have CBI. This was asked of parents who had, or the child either had an eye disorder or CBI. And what we found was that the children, the parents of the children with eye disorders answered the questions extraordinarily differently than those in CBI. We also found that I also then had to take the same question. So we knew it was sensitive to CBI, but not ocular. And asked parents of infants who had had some kind of brain injury, did the parents of kids who, you know, will leave in the NICU or had a history of a brain disorder or condition? They were interviewed with these same questions. And at the same time that the interview was happening, a teacher of the visually impaired who was trained, had was with that baby in another room and actually conducted the CBI range with that child. And then we paired what the parent said with what the child did. And we found that the significance, meaning to what degree could this have been chanced at the match of what the parent said is what the child did, it was significant with the p-value of .0001, meaning it's almost impossible to be chanced. That's a really good thing. So that means these questions really do get at the heart of CBI. In 2010, there was an article published by Dr. Sandra Newcomb in which she looked at the entire test and she wanted to see if it was reliable and valid, whether it had internal consistency. She looked at test retest. She really just tore the test apart basically to see what the psychometric properties are of the CBI range. Believe me, I lost a lot of sleep during this period of time. I thought, well, I could knit the rest of my life, that would be all right. Because I really thought if they find it to be a very weak test, you know, that's not good for kids. So what we found was that, I'll just go back, was that there was a very high degree, very, very high degree, 0.90, 0.95 of inter-rater reliability. So if two people conducted the range at the same time, they got very similar scores. If you tested a child on day one, you went back within two weeks or so and retested the child, they got the same score. And the questions that you ask in rating one agree with the responses that you get in rating two. So the internal consistency was strong as well. Those are all good things, too. I want to tell you some of you know Jane Aaron. She is a retired professor from University of Arizona, very esteemed professor in vision. And she, she, I was at a meeting where she was talking about assessment. She was doing the presentation. And to my surprise, she said that there was only one test in all of visual impairment, that that was a reliable and valid instrument and it's the CBI range. So it is the functional vision assessment for children CBI. And I hope that you can feel confident that it actually does what it's supposed to do. I was surprised actually at the outcome. I'm very pleased. So I want to share with you, maybe some of you years ago even saw the data that I collected from our clinic called Pediatric View at the Western Pennsylvania Hospital. It is a clinic where I evaluate children who have CBI or suspected to have CBI. In our clinic, we also have the benefit of having a neonatologist present to review medical records, to look at MRIs, to answer medical questions about, you know, conditions or seizures or, you know, that kind of thing. And we, we, you know, published that, that was published in 2010. Well, I've continued to collect data and a second set now has emerged and this will work on publishing this. And I wanted to share this with you as well. And these are the data that were collected on the children that we see at Pediatric View. Now no names are used, all of the information is coded. And what I'm really curious about is what, what is the profile of a child with CBI? What do we know about kids with CBI? So it's important to know that these are, these data are collected from a group that cannot be considered a random sample because parents who come to Pediatric View and Pittsburgh, they are self-selected volunteers. They are not, nobody makes them do this. And we know from research practices that volunteers are essentially different than randomly selected people. However, given the fact that these people were highly motivated and that they were seeking information, we think that it's interesting to see what the outcomes can be when someone is so, so ready to take this on. Okay, so there were 431, they're called patients because we're at a hospital. That's always a conflict for me as an educator, but that's the way it is. And I think, I think we might have one of the largest data banks of children with CBI that includes both medical and educational data. These children span three months of age to 21 years of age. The families came from 31 states in the United States and 11 countries outside the US. This just shows you the top 10 states in the US by volume. And those states that are closest to Pennsylvania and Pennsylvania itself are obviously the greatest number. But if we look at a different map, you can see that they also come from places all over the world. And if I updated this map, there would be more stars on it. I wanna tell you that I don't see this as a good thing. I see this as an unfortunate thing. My wish is that there are enough CBI range-endorsed people that parents no longer travel these great distances for a two-hour assessment. And that's what they get for me, a two-hour assessment. That's just not right. I think that's just not right. And so, this is meant to show, to me, this reflects the great desperation and the great hope that parents have that something more can be done to help their child's functional vision. Any comments so far? Just at any point where if there's a hand up, let me know. So what are the ages of these patients at the time of the diagnosis? So we keep data on when did the child become, that when were they diagnosed with CBI by a neurologist or an ophthalmologist? Those children who were birthed to 12 months, they were 130. Greater than 12 months, between 12 months and two years, there were 50. Between two years and three years, 19. Greater than three years, there were 56. And how about this last one? 176 of those individuals came to pediatric field. Seeking a diagnosis. And those were 176 who had CBI. So that's troublesome to me. And I think it suggests that there are children, many children, almost half, right? Who are not, who have CBI and are not, there's CBI's not being addressed. We have a lot of work to do. So again, look at your own case loads and think about how many kids in CBI you serve and wonder to yourself and if you can, how many others are out there. It kind of gives one pause. 380 of these individuals having neurologist. I bet that's not a surprise. 421 have been examined by eye care specialists. And additional specialists include orthopedic people, surgical people, psychiatric people. 392 of the 431 have a diagnosis. I wanna go back to something here. 429 of the 431 have a diagnosis of cerebral palsy of some type. So doesn't mean all kids with CBI have cerebral palsy, but it means quite a few do. I've often wondered if we could screen all kids with CP for CBI, what would we find? These are the therapies that this group of children get. And remember, they come from all over the place. So that is pretty generalizable. That's pretty random example in that they come from lots of different areas. 322 have a PT in early intervention, school age or both. So most of the kids are getting the greatest service that they get, the greatest number of children get PT. 311 get OT, almost as many get OT in early intervention, school age or both. 195 have a speech therapist in early intervention, school age or both. 210 have a teacher of the vision impaired. And that's less than half. 56 have orientation and mobility in early intervention, school age or both. And 12 had a teacher of the hearing impaired. There were 19 with a diagnosis of hearing impairment. I would love to know what your thoughts are about this number in blue. The 210 who have a teacher of the vision impaired. So these kids come to pediatric view, the parents bring them to pediatric view. And when I ask them the question, tell me the services your child's receiving. And they say they're getting PT, OT and speech. And then I ask the question, are they being seen by a teacher of the vision impaired? I hear often, about half the time, well, no, because they don't qualify or no, because they don't have anybody in our area or no, because they said they don't work with kids at MCBI or they don't understand TBI. How about when somebody says, I don't understand TBI, how would a parent feel? But anyway, what are your thoughts about that? Do you feel like that it's better in Calgary than these numbers reflect? Well, from my point of view, I'm not really certain. Of course, we've got, we're dealing with fewer kids. I think more and more our TBI's are, their caseloads are becoming a little bit more full with students who have TBI. I welcome some comments from other teachers of the vision impaired who are on board here. We've got about 16 or 17. They're all being shy, Christine. Okay, let's acknowledge together that we still, you know, we still have some work to do. Okay, I just got one comment here from one of our TBI's that says two thirds of their caseload have TBI. Okay, then I'm not talking to you. You're already there, you are there. I'm not, this is not for you. You are really there, my gosh, two thirds. Thank you for what you do, thank you. Okay, so then when we look at the, what are the vision conditions that these children have in addition to TBI? Many of the children have scubism. Many, many, many of the children have an eye that turns in or turns out. A great number of them have some optic nerve disorder like a paleoptic disc or a small amount of optic atrophy or hyperplasia, but it's not enough to explain their functional use of vision. So I would even say, you know, when you see optic nerve atrophy in a child who's, you know, complex especially, just maybe think about doing a TBI range because there are a lot of, that's a co-existing thing very often. 32 of nystagmus, 102 had a refractive error with most of them being far sighted and that's very unusual as well because most, you know, most glasses are prescribed for the pediatric population as near sighted. So that's another discussion for another time, but that's an interesting one. Additional diagnosis include seven that had ROP that only reached stage two or possibly threshold but no, meaning stage three, but no surgery, coloboma, glaucoma, ptosis, cataract retinal scarring, those were some of the additional ones. So this shows again the number, if you just look at this pie chart and we look at the number of kids and children who have scubismus, you see how common that will be. Almost, you just look for it. So it's so interesting to me too and maybe the vision people are aware of this as much as I am that, you know, people will, what they see is the easiest and most tangible things for them to want to reach out to. And unfortunately, you can't see CVI, just can't really look inside their brain and see it, but when you see that stir business, that's something that, you know, eye doctors and sometimes even vision people will really latch onto and say, well, that's sort of their primary issue. It's just, no, it's one of those coexisting things, but in all of these cases, these were children who had very mild or unilateral or it could not, their condition that you see listed there could not explain their CVI in all those cases. Now, obviously, there are children with glaucoma who are blind, you know, or have very low vision, but that's not these children, okay? One of my most surprising slides, this is one of the most surprising, was that 303 of these children were born full term. 128 of them were premies. This is not, CVI is not a condition of prematurity. When people say, well, there's so many kids in CVI because we have so many premature children. Uh-uh, not really. There are some children who have, end up with PBL or who have grade three or four IVH that, you know, have that certainly were premies, but by far more of the children are full term.  Those children are very much at risk, very much at risk. So keep your eye on those children. Some of them have had trauma, some of them have had near-missed. Those children are, represent this larger number. The major, what we found in this data set were that the major conditions and causes of CVI are first HIE or asphyxia, stroke, PBL, or any type of white matter damage, trauma, infection, structural brain disorders like hypocephalus, chromosomal disorders, we're gonna see more and more of those as the tests get more sensitive. Metabolic disorders, intraventricular hemorrhage, there are four who have, there are a lot more kids that have infantile spasms, but there were four who the only thing we could find in their medical history was infantile spasms. So they were included as that being the primary cause, but generally that's not the primary cause. Three had tumor and one was a child who was withdrawing from fetus exposure and noxious substances that child was withdrawing from drugs. This is a controversial one because most, drug exposure in UDRO is not associated with CVI anywhere really, but I think there are people that would take issue with that when I once said that they should list something like this that people in Alaska, they told me, you're crazy, it's definitely a cause of CVI. So stay tuned on that one. Okay, so this just shows the bar graph of how of these causes. And you can see that asphyxia is, it always has been and it still is the primary cause. Structural brain disorders and chromosomal disorders almost could be sisters because chromosomal disorders often cause brain, the structural brain differences. So be aware that those things they're kind of partners some of the time. Christine's got another, an interesting question that has just come up. Is there any evidence for connection to fetal alcohol spectrum disorder? Not that we know, but again, remember those Alaska people, they told me, yes, there is, it's me. What do you guys think? Yeah, I'm not sure. Karen, you asked the question, I'll put you on the spot, have you any thoughts? She says that she just had the question posed in the past, so we'll carry on. Thank you, 113 of them had seizures in the newborn period, in other words, by the end of the first month of life and 162 have ongoing seizures which all sound familiar to everybody. The children who were taking medications 271, the most common were those medications that were to control seizures. The age of diagnosis of CBI, the average age was, I'm sorry, the average age of diagnosis in children with congenital CBI was three years, two months. The range was one month to 19 years and the medium age was four. That's another problem that needs to be fixed because if the greatest period of plasticity, visual plasticity is an interesting, then we really should do everything we can to take advantage of that for sure. So you see the challenges we've had here. I'm almost done with this and I have one more thing I wanna show you, so I'm gonna rush through this. The CBI range scores at the time of the first pediatric view appointment, regardless of age, this is probably the most important two slides. 299 of the 431 children scored in phase one or 69%, and that's regardless of age. So whether they were 15 or 15 months old. At the time of the first pediatric view appointment, 121 scored in phase two, which is above three to seven, which means they have more functional vision. And at the time of the first pediatric view appointment, 11 scored in phase three, almost no one at that first appointment. So when I first meet the child there of any age, I can pretty much say it's money in the bank that they're gonna be in phase one because 70% of the time pretty much they're in phase one. Some of the time they actually are in phase two because somebody really helped them get to that point and only rarely do I meet a child on that first appointment who's in phase three. At the time of the last pediatric view appointment, regardless of age, the opposite happened. 21 were in phase one, 120 were in phase two or 27.8% and 290 or 67.2% were in phase three. And so what we, something happens, something happens when that family comes and they, we assess the child and we talk about what the child needs and I write a report and I hope that it's helpful, that parent is on, they change what they do with the child. The team probably changes what they do with the child. I don't know, but the information they gather creates a need for them to do something differently and the child's functional vision improves pretty dramatically. We also know it takes about 2.7 years. I should go back to this one, it takes about 2.7 years. I'm so sorry, 3.7 years on average for a child to get from phase one to phase three. But that's only after that first solid CBI range assessment and the modifications and adaptations and specialized instruction that flows from that. So we can, I always tell parents, well, it is out there. Is today your first CBI range or did someone already do one with your child and the clock starts from when that first official CBI range was conducted with the assumption it was done correctly. Okay, so we're still to worry about these 176 children who are undiagnosed to the person's appointment because it's naive to think that we found all these children or that they are not lost in classes for kids with autism or significant multiple disabilities. So we want to, I want to skip all this now because I want to, I want to get to the last part. I want to show you that the research part, let me see if that is, close your eyes for a minute so you don't get vision. Christine, while you're doing that, got a couple of questions that have come in. One of them is, can you expect that every child who gets appropriate intervention will learn to use their vision? That is, they'll move through the levels. It has a really significant brain injury. They're non-verbal, they have seizures. What I just showed you, that's the profile. That's who these children are. And so they may not be those kids who go on to read or read print, but they are children who can be in phase three and use complex communication devices because they've got so much more functional vision. The child who doesn't, there are two reasons I have found that a child doesn't improve their functional vision as measured by the range. One is the child has a debilitating condition that is degenerative.  The second is, if a child doesn't have enough opportunities to use their vision, because opportunity is the key to this. And so maybe in one of the future ones, I can't remember what we're doing. We can talk about ways to make this come alive every day for a child, even if you're not there to do, create a CVI schedule that gives this child opportunity to use their vision at that assessed level all day long. And it runs without you having to necessarily be there, but it's a plan that takes a little bit of time and effort to get organized. It's a way to put what you've learned from the CVI range into action based on what the child's schedule already is. So there's no more vision time of, it's really about accommodations. So the last thing I wanna show you, and we just have seven more minutes, is how early did these characteristics emerge? And so I identify, I've been working on an infant screening, and I'm gonna go through it quite fairly quickly. I want to identify babies because of that 176 number. I wanna try to identify babies who are most at risk with CVI. So we know that there is this very serious screening for kids with ROP. Why is there not a screening for kids with CVI when it's the most common cause? And so this is what I'm working on, that the screening is used to identify babies with high-risk behaviors, CVI behaviors, which is based on things that I learned from the nurses in the NICU who would, when they would say, you need to come see this baby, Christine Roman, and I would say, well, tell me why? And they would describe to me things, they saw the baby doing, and I thought, oh, we can probably do something with that. So we ask two questions and observe three behaviors. First, we ask, does the child look at your face? Because parents, you have to ask a parent, and if the parent says anything short of yes, and newborns look right at their parents' faces, so if the child doesn't look at the face, or the parent says, well, I think it's getting better, that's a positive for CVI. If the parent says, well, not yet, that's a positive for CVI. We ask, do you have concerns about the way your baby sees? Because I've learned that retrospectively, parents will tell me, boy, those first couple years, I didn't know if she could see at all. So I want to get at that. And I want to ask, not in what the parent says to me, well, the doctor said, and then I'll say again, but I want to know what you think. And if they say, I think my baby seems fine, that's a negative for CVF. They say, well, I think it's improving, or I'm not sure that's a positive.  And you can see the characteristics of CVI that accompany those behaviors. So it's a very short thing to do. We're doing it at our hospital. We just finished our data collection, and Dartmouth Hospital is also doing it in New Hampshire. All right, so I wanted to show you two quick videos. The first video shows a baby who's 31 weeks gestation, but in the video it's 36 weeks, has no eye disease, no ROP, has a normal MRI and normal brain, and no neurologic problems. Their neurologic exam was normal. They blink when they're touching the nose, they look at their mom's face, and they close their eyes to bright light. This will give you a sense. There's some things in here that are not part of screening, ignore those. This is your baby, you'll see how he blinks. Okay, that's a good thing, right? All right, let's go to the next one. So he closes his eyes. Now, the light that we're using for the research is a standardized light in its red. It's not this light anymore, but you see how he does that. Oh, I hate that. And babies are photophobic, they should do that. And here's his baby looking at his mom. And even though he gets stressed and starts to hiccup, he's got eye-to-eye contact with his mom. Isn't that a beautiful thing? So he's stressed, because that's why he's hiccuping, but okay, now I want to compare this. Now I'm gonna skip to the last one. This is the baby who has a positive screening and who will be followed. Who will be followed for possible CDI. We saw this 42 weeks at the time of the video. He has enlarged ventricles and white matter damage. He does not blink when touching the virgin nose. He does not defend himself to bright light. He does not look at faces. He also has some other visual behaviors that are concerning. And here he is. He's also in a dark room. You can't do this in a dark room. There's very standardized conditions now, but just get a sense of what this is. Isn't that striking? All right, one more minute. And no blink, and no blink. And so that baby, that last baby, that last video shows he doesn't look at faces either. He demonstrated all of the, so at nine months of age, this is what I just say, at nine months of age, between nine and 12 months of age, the children who score positive, like they look like they might have CDI down the road, we reassess those children between nine and 12 months using the CDI range. If the child has a CDI profile on the CDI range, it shows they have the characteristics. And they've had a positive screening. We have enough evidence to say the screening seems to be picking up kids with CDI. We have had, in our, we've had 53, since 2015, 53 infant screens. One minute. Somebody, somebody needs to mute. 53 additional infants were screened and 28 had positive for CDI profiles and seven ultimately were diagnosed with CDI. Those were seven children who were diagnosed with CDI by between nine and 12 months of age. And they were then able to get interventions very, very quickly. So there's a whole protocol and we're working it through. We're hoping that we can get enough data to write a much bigger grant and do this on a bigger level. And if any of you are interested in, you know, you know, hospitals that want to participate, let me know. So I'm gonna stop right there. All right, so anybody, do you have any last minute questions? It's 629 and, you know, you can tell I used to teach graduate students because I never go over because that's like the kiss of death if you talk, if you lecture longer than the class is. So I'm very prompted about that. But are there any, is there any question anybody has at this point? There's, Christine, there's one question in the chat that I think went to everybody. So you can read it, it's fairly lengthy. What sort of significance does it show if the child blinks to a puff of air but not with a tap on the bridge of the nose nor hand pass? What was the first part if they blinked to a what? A puff of air. A puff of air. A puff of air. I don't think it might mean that they're closing your eyes because it feels intrusive to them. They don't blink to the touch or the threat. Then I would, it wouldn't, I mean, on the range, it just wouldn't mean anything. It would suggest to me that the child probably is gonna be able to blink to the touch fairly soon. But I don't assess that piece, you know? It's not the same when somebody, you know, when air is blowing on your face versus when something visually is approaching you. So it's interesting, but it's not, I know I can't correlate it with those other two responses. But thank you. Great, great, thank you, Christine. Well, we are past the time and we respect your time as well. I guess it's getting close to dinner time for you. So thank you very much for that very informative hour. We're all excited about next month's webinar. So we'll see you in about a month and do have a fantastic Christmas holiday break. And same to everyone else. And to the folks who are on the next meeting, you guys can just stay on while everybody else checks out. Okay, thank you. Okay, take care. Bye-bye.


In video games, the combo short for combination is a set of actions performed in sequence, usually with strict timing limitations, that yield the significant benefit or advantage. The term originates from fighting games where it is based upon the concept of a striking combination. It has been since applied more generally to a wide variety of genres, such as puzzle games, shoot and ups, and sports games. Those are commonly used as an essential gameplay element, but can also serve as a high score or attack-powered modifier, or simply as a way to exhibit a flamboyant playing style. In fighting games, combo specifically indicates a timed sequence of moves which produce a cohesive series of hits, each of which leaves the opponent unable or almost unable to block or otherwise avoid the following hits. In the sequence.1 in some cases, each additional hit has an increasing negative modifier. In order to balance gameplay, it is shown in Capcom's Street Fighter ID series.2.


You got an HTML. Yeah, yeah. Let's stop it. Yeah. Test. Test. All right. That's good. Thank you. We'll be starting. The source to name this cloud, our presenter this morning, is Joe Gouin. Yeah. And the IT industry is serving the companies and just seems to be a little like Oracle. He's also been contributing to it. Just raise your hand and I'll try to get a microphone to you. We're going to make sure we record it. So, please go ahead. Okay. Thank you. So, this is Dalat. So, my name is Chen Fengwen from LightHeartCommonG based in Beijing. So, today I want to present one topic of how open source enables cloud computing in China. So, this is the agenda today. So, first I will review the status of cloud computing in China. Secondly, we are integrated to insight into how open source technology interacts with the cloud computing in China. So, this is the agenda I want to share with you today is how Chinese companies benefit from the open cloud technology by engagement. And in the university, they contribute the code to the open source community. The final part, we are talking about looking for the future and the challenge ahead of us. So, this is the IT market 2017 worldwide line script. You can see here, the channel totally at the market will hit to 2,045 billion US dollars. So, specific to the sort of industry in China, this year it will reach to 140 billion US dollars. And on each year, there is 100,000 graduate programmers. And now there are 170 billion internet users, accountable more than 46, near 46 of the total population. And in terms of the cloud aggregate market in China, you can see that the market will grow at least 30% year on year in the coming three or five years. And in the 2020, the total value will be hit 140 yuan. So, this perceived the public cloud market, so the public cloud market will grow at least 40% year on year in the coming five years. So, much like other countries, the cloud in China also one company play a dominant role. So, this is Alibaba cloud. It is almost accounted for half of the total market size. Just a big game, followed by Tencent cloud and the China Telecom cloud. So, in China, there are various cities that not only produce the cloud technology based on the open source, but also they consume the open source cloud technology. So, this city is three representative cities. The first one is Shanghai. Shanghai is China finance and market center. So, in Shanghai, whether it is the finance or stock or even insurance industry, the heavily widely used cloud technology based on the open source. The second city is Beijing. Beijing is the high court of university or research center. And also it's the intervention center. So, here a lot of cloud technology based on the source are developed here. And also whether it's the individual or the enterprise user that consumes the open source technology in cloud. The third one is Hongzhou. Hongzhou is the high court of Alibaba cloud. So, it is the newly emerging cloud technology center. So, if you have been travel to the China, you should could be by question by the three cities. Actually, if we carefully examine the region, behind that, you can see all these four cities is backing up by the open source cloud technology. First is the Douglas Shield bicycle. It's used to have technology. So, our technology now is open source. The second is the Alipay or WeChat Pay. It kind of, in Monday there are millions or thousands of transactions. Those transactions should be powered by the cloud technology back end. And China high speed railway. Actually, the China railway used the OpenStack set up the private cloud. On this private cloud, they built up their own antique cell system. And it's online shopping. Whether it's JD.com or Alibaba. They have not only the public cloud provider, they also use the public cloud technology enables the online cell system, online shopping. So, from here, we can see that today China is society nearly powered by open source technology. So, the second part is that before we talk about how open source technology works with the cloud in China. We just have a quick review of the open source journey in China. And, roughly, until now, I was 20 years old in open source technology in China. The first phase started from in 1998 to the third phase. So, during these phases, people just want to learn the open source. Even just these propagates the open source technology by transferring the book to the Chinese. So, at that time, in the people mind, open source is just equal to enix. So, the second phase started from 2004 until 2006. So, during the period, some people just want to create some open source elements. Such as China also has promotion union. So, one of the brain ideas, they put out that they create a sign of something like single tank. The single tank tried to bring out some ideas and organize some open source community events to promote open source technology in China. And, the third phase is starting from 2007 to 2011. Some power companies such as Huawei or Lenovo, they actively consume open source technology. But, however, they still contribute way more to the open source community. So, the fourth phase started from 2012 until today or even in the future. So, open source technology, since this phase is booming, whether from individual or from government or from enterprise, they have a set of common sense and the open source, they are a little needed. In this period, they have biological direction. So, companies in China not only consume the open source technology, but also contribution back. Some power companies such as Huawei, Alibaba by Dutensant, they contribute much back to the open source community. So, a lot of events or promotion activities hold up in each year. Even for the individuals, we can see on GitHub, there are many of them from China. So, we will examine the open source technology succeeding across the world. So, open source is an extremely important law. So, certain models also apply in China. So, let's take a look at the open source system in China. First is divided laws. Now, on the GitHub, there are 220,000 active GitHub contribution from China. And also, as I mentioned, a lot of local organizations set up, they work with the international community such as Lin's Foundation, CINCIF, and Apache Foundation to try to promote open source technology in China. For the user, use point of view, in China, the largest population in China, individuals or enterprise users, and in their daily activity, they just consume a lot of open source technology. So, the open source technology or solution or products can be developed by their R&D development team or can be bought from vendors. So, vendors are also very important law. They suggest that they provide a certain service product to the local customer. So, they offer a certain service product to the local customer. So, they offer a certain service product to the local customer. So, how is open source software usage in cloud instance in China? So, the green part shows that currently, using open source software in their cloud industry is count 93, and applying use of open source is count 10%. So, together, they are more than 90%, they want to use open source technology in their cloud industry. So, how does it implement? So, at least 90% is just used in host development. That means they set up the R&D center to develop a solution or product based on open source cloud technology. 16% also is used open source provider. That means they buy from the solution, from the third party vendor such as Red Hat and other companies. And the majority is used both two ways, in hosting or buy from the provider. So, cloud deployment, we have a sense of way that how many virtualizing server deployment. So, most of the majority focus on just 100, 11,000 virtualizing server also. And for the container deployment, so, most of the companies that use the content technology just for the office automation and elastic scaling. And for the server deployment, most use the technology for the file storage and the block storage. So, there are various industry in China. Different industries have different maturity model and they have different deployment about open source cloud technology. So, the X-axis indicates the development stage. They have from the integration to transformation, to innovation. The Y-axis indicates the compound annual growth rate. So, you can see that the manufacturing industry, education and government, those stay in the integration stage. So, the attitude to the cloud is to try to use the OpenStack or some kind of OpenStack test of some private cloud and the care about added insecurity. For the second stage, for energy, transportation, health care, there actually is already set up for stack cloud technology whether it's a pass or it's the eyes or some kind of test. They try to emerge some cut-edge technology based on life-saving data. And for the innovation stage, there is the telecom, details, and other industry. So, this industry has a lot of emerging technology based on the underlying cloud. I'm sorry, what was the FSI? What is FSI? I think it's a foreign service way in Moscow. Oh, okay, very good. Yeah. So, this examines the four cloud stacks in China, really powered by OpenStack. So, from the bottom line, they use the underlying operation in the centers or U-BAN tool for the virtualized laser-ized layer. They use the KMMC, it's a hypervisor. They use the OpenStack as the virtualized managed layer. For the content technology, they use the KMMC as the orchestrating tools. The underlying environment is Docker. For the mid-layer or pass layer, they use OpenSource, MyCircle, MongoDB, some kind of things. On the operating layer, they use the IoT OpenSource. They use the Jenkins pipeline. They use TensorFlow for Spark or Hattubu. They use TensorFlow for AI. So, from the bottom to the top, you can sample the four cloud stacks that are just generally related to the cloud technology. So, we can do the third part. So, if we all organize, OpenSource technology is very successful in the cloud industry. So, if we finally find out the reason behind that, we can find out what we are doing today is just circle around the key element. One is project. The other one is solution. The other one is value. So, these three key elements are something like innovation skills. They work together to just spin the innovation and move the OpenSource technology forward. So, in TensorFlow project today, we have a incredible number of projects on GitHub, even millions of them. So, the most important one I think that we try to need to how projects can incorporate, include the solution. Those solutions really address the customer needs and really resolve the real-life issues. So, you can see many companies just work with the international community to bring partners together to select some projects with meeting these criteria. So, furthermore, if the project cannot bring the value to the company which contribution heavily, it's not a good project. So, the good project with solution could be bring some benefit. Let the company to own the money, then can bring money back and put more community source on the project and make the whole project move forward. So, in terms of engagement in OpenSource, the first thing in coming is the code contribution. Yeah, that's important part. But beyond that, we also needed to put code into some valuable project, not just a common project because if the project cannot really resolve the customer issues, no one buy that code is waste. So, in China, a lot of companies just try to in order to achieve this, a lot of companies in China want to be a member of the project, try to be a technical leader or could be a strategic interest group leader or even be the board member of the foundation, some kind of a thing. So, just talking about code contribution, I just give one example. So, for current project, we can see that this long-buy country, from China side, is the long-term force. And for membership, you can see that the top level of the leader foundation, they are two companies from China, it's around five ways and it's ten cents. The gold member is Alibaba Cloud, Baidu. The top level is the planning membership, we are Alibaba Cloud, we are Fawei, we are JD.com. And the gold member from CNC, is ATE. So, also, in the OpenStack from the direct board, we are three members from Chinese company. So, project contribution, this company contributed a lot of project on the OpenStack community, so I don't want to go through that each day, so you can just get the bronze. So, now, kind of the final part is the look for the future. So, OpenStack technology is special in cloud. It's like a train, it will start in China, so it cannot be stopped. So, if you think I had three or five years later, we can see some trains here. Number one is Cloud Olivia. So, you can see that today in China whether it's individual or enterprise users, you cannot live without OpenStack technology. So, when you are in daily life, you buy things online, the back of technology is the cloud from the OpenStack technology. So, you can see in the current future some kind of represent technology such as OpenStack technology, Kubernetes, KVM, and IoT. Those OpenStack technology will be widely, more widely be adopted in China. The second one is cost in my local focus. So, I can give one example that Huawei hope China Mobile, the largest mobile operator in China to set up a private cloud based on OpenStack. They set up a solar cluster but they want to have the same kind of plan to manage the solar cluster. At a lot of times, OpenStack don't have this solution. So, Huawei companies just hope that China Mobile resolve the issue to build the cloud back to the upstream. So, in the future, you can see that the industry adopt the cloud will spread from mobile internet industry to the traditional industry such as China Railway some kind of things from non-PCM critical to the machine critical such in finance or bank systems and kind of things. And number four is the local companies try to set up open source ecosystem. They try to set up strong partnership. I can give one example. By the company the open source Apollo auto driving platform is the intelligence driving car system and it's almost cost more than 30 billion I think US dollars. So, they open source that and they try to bring partnership from international or from local car producers. So, challenges that has security. So, if we ask what's the number one concern when adopt cloud technology. So, number one should be security. They still have some concern about this for when they adopt open source cloud technology. So, open source governance I can give you some here. Tencent which has the largest VChat right the owner VChat they try to open source a lot of technology but the code includes some kind of proprietary software and the same open source so they try to make them to handle that to open source that So, it's kind of take time for open source governance mentally and education in China in the college we actually have open source courses and Linux send out some open science and kind of things. So, it's take time to educated from the high school students or the college students or the kids so it's time for that So, make it to open source technology smoothly. We know that in China a lot of enterprise still use the legacy infrastructure. So, it's not easy for the legacy infrastructure to the open source support infrastructure. Cooperation among the community and the with the extended organization. We know that we are a lot of local community and the Internet community to try to have more events or activity hold up in China and they also want to work with some Internet standard organization such on the 5G they work with the International Telecom Union, same kind of things work out NFV Spark, same kind of all this. So, in the future I think they need more same kind of information. Okay, that's it. Yeah, question? So, the longer I work in open source and have an opportunity to work with other people across the world I realize that the the basic cultural norms within a country or a group or anything really dictate sometimes interest in working in open source I think when you mentioned some of the on the last slide you mentioned some of the challenges do you think that and I asked this with all good intentions but do you think that the general cultural feeling within China is one that can operate in this meritocracy as Chris talked about in his keynote is it are people comfortable with the interactions they receive or the feedbacks they receive, positive or negative do you know what I mean? Go back a little this company is how the largest in China largest we chat we chat no one year ago they are not actually pass based on need confidence but this year we have some need confidence in just one step it becomes a top member of before that year they don't need to consider open source any technology now there opens a lot of projects only one in one year one year that's great where the funds enterprise or individual they actually know that open source they are needed they are learning nearly something so I couldn't mind knowing that even in four or five way more than five hundred they need to work on open stack yeah so I just saw that in second position this one this kind of things if you have travel simply in China you are this four things those things could be all power by open source technology so I think from the human many sides they little little by little accept open source their need thank you to follow on to his question and something that I was thinking about during the presentation because this is all very exciting of course my question here then is are there clear or open signals coming from governmental levels proposing to communities and others that open source may be a good solution for handling some of your problems do they do they openly adopt the ideas that hey open source is good for people and they promote that or is it something that like here comes from the grass roots as it were from contributors those community is founded by government so a lot of the events of communities actually the money is found by the government to promote open source technology so we go back to your question we know that China, US treated better one of the key concern is the IP issue right intellectual property so China government realize like how can we resolve that right open source don't have IP issue in most cases so why not we use government source so they encourage local enterprise to just participate in activity more in the upcoming future I think so so as you say then the Chinese government and developers see this as a way of sort of removing themselves of the burden of say restricted IP and opening up to a more fruitful development and implementation for government for problems that need to be resolved giving them new tools to do certain things and getting them away from the restrictions of proprietary technologies so is it would you consider then an overall positive outlook on the part of the government toward open source and where they want to go with it so they look at it as an overall positive thing absolutely they look at it in a very positive yeah, attitude yeah you can see one single is why there's so many companies in China as the membership very high level sorry so this company China is 72 years yeah, not 5 years only 72 years in the needs foundation in the 2007 we have another example is the more than 15 companies from China join the needs foundation in one year so in one of the slides you mentioned that ISVs play a role between the users and the vendors as we my question is that how important do you think a role of ISVs such as Red Hat and Microsoft is to encouraging more Chinese companies to be involved in open source like you said in the last 2 years you've seen companies become platinum members and open source so can companies like Red Hat push other companies a certain example that you know I think you should open source so you can see that for ISV for example Red Hat they just use the way to set up strong partnership with local provider Huawei or Alibaba we have set up cooperation partnership on the open source technology how to let customers trust our solution or products that's the one way another is that we have some cooperation project with college or university we have some intern each year we have different university we try to learn to at the beginning knowledge we have tried to Chinese marketing that have some advice they try to cooperate with us not in Beijing they have send us some people to talk about open source technology in the college students so it takes time and I mean it cannot be achieved in my life so yeah are there possibly also security concerns with regard to the adoption or expansion of the use of open source technologies that is when you're locked into proprietary solutions you're stuck at fixing things at the pace of whoever is making that product with open source products if you have a good sustaining base of engineers and developers you can respond to security challenges perhaps a bit more adeptly and more reflexively is that a possible consideration in this or is that not well known I mean they are concerned about security from many perspective what we learn is about data privacy because now the system is quite complex there are different layers that incorporate a lot of code so when they use that some companies don't have some export technology to handle this security policy so that's why we need SV for that we guarantee that we have longer support whether it's the bug fix or the security point of view so I think for many large enterprise they still trust software from SV thank you


Hi everybody, welcome back to Navigating the Road to Cyber Resiliency, the summit made possible by Dell Technologies. This is the power analyst panel. I've been looking forward to this. Rob Streche with theCUBE Research, Christoph Bertrand is here, he's the practice director and senior analyst at ESG and Zius Caravalla of ZK Research, principal at that company. Great to see you guys. Thanks for coming on. Welcome to our Palo Alto studio. Great to be here. Great, yeah. So we're going to talk about the state of cybersecurity. Christoph, you gave us some data. It's from a survey, 600N, so it's a big number. All right, so you guys don't mess around, you do your surveys, set it up for us. When was the survey? Give us the basic overview. Essentially, a few months ago, we decided to survey again, the market for ransomware preparedness.  So it's not a vendor survey to be clear. Around the world, primarily North America and Western Europe. And what we did was essentially a state of the market. We built in a little maturity model and asked a lot of questions about what's going on when it comes to ransomware preparedness. And we loosely followed the NIST model to cover all of the angles. So I partnered with one of my colleagues on the cybersecurity practice and by coming together with the various angles who are able to really determine what's going on. And because it's the second time we've done this, we also have some historical perspective. We got a little time series data in there and ZSU and I have talked about this for a while. I don't know if you guys heard Gil Hecht just now, but I mean, he was talking about how ransomware has evolved from, okay, we used to be, we're just going to encrypt and then we're going to extort you. Now, they're like exfiltrating, right? So you've seen that evolution of ransomware, haven't you? Oh yeah, it's gotten a lot more advanced, right? They're able to get a lot more data now. I think the way, you know, work from home and all these other trends has opened up the attack surface so it's much bigger. So they're able to, the bad guys are able to get in now and low and slow, you know, is the way they work and so they're able to access a lot more data than they have in the past. And I also think the type of data they're going after has changed as well, where it used to be financial data, credit cards, that's not as valuable anymore, right?  It's a lot of medical records, HR records, things like that, that's really what pays the big bucks cause that gives you an insight as to the person's personality and things like that. So you're going after reputation, right? And so Andrew, bring up the first slide. This is one from the ESG study. 89% rank ransomware as a top five threat to the viability of the organization. You see 52% say it's one of the top three threats to the organization's viability. I don't know Rob, what the other two would be if it's not, there it is. Yeah, no, I mean, I think this is, I think again, the way that, and I'll let Christophe talk to it, I think the way that really this plays out is that it shows how people don't have this solved yet in a big way. And what was it that you were seeing in this as well, in the data? Well, so a few things. Number one, the fact that this is an existential question. It's not an IT question, it's not a cyber ops or a response question. It's a business level, business viability question. First thing, so it's a big deal. The other thing we saw in the data is the fact that it seems to be a never ending problem and people are struggling today to even protect their mission critical applications against ransomware. People have, I think, realized and are agreeing that it's a very different animal. We used to talk about DR and, you know, you can see the hurricane come and you can fail over, you can, that's easy, right? Compared to something that can happen at any time and really change the workflows for recovery. So the biggest issue is recoverability in a timely fashion. And you can only do that if you've really thought through all of the possibilities and have all the right technologies in place. Yeah, and we'll bring that slide up again, if you would, because I want to get, I want to look at that, Zia, look at the right hand side here. 25% basically say that they can, they can confidently recover more than 80% of their mission critical applications. So there's automatic, already a 20% gap there, but only 25%. 75% say they can't cover more than 80%. I actually don't believe that number in actuality is 25%. You think it's way lower? I think it's lower than that. I believe you're right. I think organizations are in preparedness, because you don't know until you don't know, right? And that's the problem. And I think one of the other challenges is the cyber side of it is different than the recovery side, which tends to be more backup and recovery, right? Do you have good practices? Are you airgapping your data? Do you know where to recover to? If you recover to infected, right? If you're not always cleaning your data and inspecting your data and you recover and that data is infected, then you're just in a position that you're going to get hit with ransom again. And so there's a lot of, there's a lot that goes into both sides of that and somewhere along the line, the world of backup and recovery and cyber need to come together in order to create kind of a single resilient cyber chain here, because I think the two worlds are largely separate right now. So you're a product guy, Rob, but this is not just a product problem, is it? It's not. And I don't think, there's the processes and the people that go along with this. And I think some of the guests that we've already had on have talked about that. That's a big problem, I think. And I think it is a big piece of it where the partners have to be involved, the companies that sell the technology. And I think we've heard some of that about how Dell is really bringing that to bear with through their partners and through their consulting services. I think that's a huge piece of it is that it's got to be a full-on press because what Zeus was saying and Kristoff, I think you start to look at the attack surface constantly growing and how can you really confidently say that you can, 80% of the time you can recover 80% of your mission critical applications. I think that is without testing it. Right. The other side of this too is the cloud, right? People have gotten pretty good at backing up their on-prem data. There's a bit of a misconception in the industry that if you're in the cloud, the cloud provider will help you with that there. You look at AWS, GCP Azure, they all have shared responsibility, right? And so one of the big emerging markets right now is moving to SaaS backups and cloud backups, right? So that's a part of it, I think that's largely been left out of it, but that data is just as likely to get breached as any other data. So it's like the cloud's like the first line of defense, right, Kristoff? But to Zeus's point, those guys made to a great job of security but you as the customer still have work to do. Still your data, right? It's always your data. And by the way, you talk about SaaS, what about SaaS data itself? So it becomes very complicated. I think the key is about the first line of defense is having that plan that really integrates essentially the people, the processes and the technology across and beyond traditional boundaries. Whether you're talking about security, posture management, whether you're talking about cyber, just response. By the time the cyber guy is called the backup guys, well, it's kind of too late. So you never want to be in that position and you want also to be really, really strong in preparedness. Have air-gapped, immutable backup solutions in place so that you can recover quickly. Have training in place and have the ability to really test the recovery. You mentioned that earlier, Rob, and I think that's the fundamental thing that has to change. Practice makes perfect.  Typically when it happens, when you get hit. And I think that's where technologies like ML and AI embedded in the various processes can actually help with automating some of these processes at scale. And maybe, you know, it used to be a lot of companies wouldn't test their DR because it was too dangerous. They were afraid to lose all their data. You know, they have this, we've been having conversations about synthetic data. We can actually create synthetic data and then test against that. That's another sort of new trend. I wonder, Andrew, can you bring up the second slide here, please? If you could, of course I, here we go. So, more is expected from data protection solution providers. Christophe, what is this telling us? Set this up for us. What are we looking at here? Well, you know, essentially, if you are selecting a data protection solution, you're going to have some RFP, some expectations and you're looking to the earlier points that were made at the breadth and depth of expertise and technologies. You can't do it alone. And really what this is saying is, it used to be that you were focused on supporting platform A, B, or C, or cloud A, B, or C. Now, it's about partnering with a much different ecosystem. So, a lot of it is also about the ecosystem integration and about having the right partners, the right alliances, the right API integrations in place. So, all of this will take time, obviously, but this is where having a full view or 360 view of the problem is critical. So, you can use models like NIST, for example, to prepare and there are new versions of it coming out. There's also regulation that helps maybe provide some incentives, but it's really a governance question that has to be based on understanding the ecosystem and really your data lifecycle. If you can take a look at it from this prism, this perspective, you get to a point where in a sense it doesn't really matter what hits you, you have a recovery process that will work or at least you've done enough that you can really shield your data from being affected or extorted or excerpts rated. I want to double click on this. Bring that same data up again, if you would. So, you've got cloud security, network security, DLP, endpoint vendors, manage the MDR, manage MSSP, which is taken on. This is the security problem, right? This is it right here, right? You've got to work with all the XDR, you've got to work with all these guys. I mean, elaborate, Z. This is the problem with security. We have too many tools. Every time there's a new threat, we roll on another tool and then you get to a point where you just can't keep policies straight and all the management's different and so you don't have consistency across them, right? And I was talking with Cesar earlier this year who said he finally understands that trying to roll up best to breed everywhere doesn't lead to best in class threat protection, right? And so I think there has been a big pivot this year trying to move more from a cyber side anyways to platforms that doesn't really address the data backup side and the recovery piece of it because that's a whole separate discipline. But I do think the more we can consolidate down the number of vendors we have and you look at NDR, XDR, endpoint, if we're managing those separately then all we're doing is we have silos of information, silos of policy and nobody wins with that. You and I have talked about this, Cesar, where you really shouldn't even try, companies shouldn't try to be best to breed and have a big broad portfolio. In fact, maybe best to breed means you have a broad portfolio but each individual component is not necessarily the best to breed. It actually works together and is integrated. As somebody who's worked on this challenge you would start ups who have to be best to breed but you've worked with big companies. How do you think about, how should companies think about addressing that problem? Yeah, I mean, I think companies need to look at that list and say how do I partner up? As Christophe was saying, what are the right APIs? What are the right integration points? Because on average, ransomware is in your environment for like 300 days or something like that. And when you start to look at the extent for ransomware and other things is how are you going to respond and going through it? I would take a little bit of a bone to pick because in the early 2000s when I ran storage in DR for our financial services we tested our DR twice a year. And that was with capabilities that were far less from what is provided by the vendors today. Well, you had to in financial services, right? That was a requirement. More or less had to. The one industry. But it wasn't twice a year you had to do it. So you start to look at it and go, testing makes perfect but it also gives you an opportunity to use some of those other tools to then go back and look at that data protection, look at what you've backed up. Is it the right data? Have you, do you have stuff that's sitting there that may not be a good place to go and restore back to? And I think that's probably what you're seeing in some of that data. I came out of that industry too and the one big takeaway I have from that is in the world of backup and recovery everyone's an expert in backup no one's an expert in recovery. Yeah, you have to have that. You have to have that. Backup's one thing. Recovery is everything. It is. But you have to have that clean. Even if you test there's always things you forget. So I think this is a very good point. It's not the, as I said before, it's not the hurricane is coming and you know exactly how you're going to shut down gracefully and how you're going to restart fell over to the cloud, whatever. Doesn't matter how you do it. This is where, when people are running with their hair on fire, okay? Not a good thing. So what you're looking at is really the ability to have multiple paths to resolution and that's why it's very, very difficult to do at scale and that's why you need to integrate the teams and really revisit all the processes and this is why I like to say that DR is dead. Now it's cyber DR, cyber resiliency. That's the new standard. It's a lot more complex. IT professionals agree. They think DR is a different or cyber recovery is a different animal. It's a multi-headed beast and what it does that it fundamentally changes a number of things. On the end user side, how you organize, how you train, what technologies you buy and we can talk about too many, not too many. That's a complex conversation and then on the vendor side, it changes the nature of how you look at your market, your personas, who you talk to, with whom you partner. So all of this has to work in unison which means that it's going to take a while to resolve because the cyber attackers are not waiting. Even on the data side though, think of what's happened in the world, right? We have hot storage, cold storage, job deck storage, we have stuff in Kubernetes now, right? Stuff in the cloud, stuff on-prem. That world itself, like when you and I were doing it, I don't know how long ago, but it was pretty easy. Like, well, not easy. It was straightforward. Well, it was straightforward. Not easy, but, and now to Kristoff's point, you don't have the warning of the storm coming. All of a sudden, your data is locked and you got to make a decision, do I pay the ransom or not? If you pay the ransom, there's no guarantee you're getting the data back, but at least there's a shot at it. And if you don't have that path to recovery, I mean, your company could be crippled. But I think also what it goes to is the fact and you're talking, okay, so I have Kubernetes, I still have to go to where the data lives and I still need to protect the data, air gap the data as we've been talking about most of this day and be able to bring it back to a safe place, a clean place. And I think that's part of it is that the attacks have gotten so sophisticated, it's how do you know what's a good place to actually go recover? And to Kristoff's point about hair on fire, I've been in those situations where things have gone bump in the middle of the night and you have to recover to somewhere else and everybody, all hands on deck and you gotta look at, okay, do you have the processes? Do you have the people? Do you have the partners? Because I think those are the three P's that go into it that are going to be that and who are those partners and who are they gonna really help you because it's so complex to know, am I recovering to a known good? Am I recovering to a known good place? And can I get up and running so that financial services can keep running because I can't be out for more than 48 hours or if I'm at, in a lot of companies nowadays, you have to, if you're out for 24 hours, your company could be down and gone. That's how rapid this stuff happens. Yeah, bring that next slide up. I think this sort of speaks to it, which is 52%, I just kind of screwed up the order before 89% ranked ransomware as the top five threat. You're right, it could take you out, right? Absolutely, and I think that's what I was saying. That's why for the first time ever, when you talk about storage or backup and recovery, you can actually walk into the boardroom and they'll listen to you. Never happened to me before. I've been in this business for a couple of minutes. So I think that shows you the nature of the problem. But it's also an incentive, right? It's an opportunity to change as other investments are made across the infrastructure. So yeah, we talked about storage, we talked about, we could talk about any component if you think about the reward and sort of the stick and carrot here. Clearly this is the stick, ransomware is. But the carrot is, whatever you do will be an opportunity to improve your environment and very likely it will allow you to then be even more digitally sound if that makes sense as you move forward. So of course it's not ideal to think that you have to improve because otherwise you'll die. But at the same time, what better incentive for executives to really embrace technology even further and support the efforts to fix the problem. The scary part too is if you get hit once, you're statistically much more likely to get hit again. It's not like lightning. No, it's not like lightning. It's the opposite, yeah. Because say, whoa, there's an infrastructure that's not resilient, let's keep hammering it. I do think one of the things that's missing here too is from a lot of the investments in this do need to come from business leader down. I was talking with the CIO, one of the city organizations down South, I won't say which one. And she said they knew it was coming because the state had got hit, some schools had got hit and it was just a matter of time before they got hit and she tried to get funding for it at a city level and it kept getting pushed, kept getting pushed, they got hit. There were no city services available for an entire week while they tried, while they recovered all their systems.  You don't really think about it until you get hit and it's the thing that might happen but might not happen. But this is where I think, you know, this has to be considered part of, you know, critical infrastructure for all companies and I don't think a lot of business leaders think of it that way. Our last guest today is Dr. Tony Bryson who is the CISO of the town of Gilbert in Arizona but it's actually the size of a city.  Yeah, but I think it goes back to something you also said earlier where it's, because it's become a boardroom discussion because I could end up as somebody in the Wall Street Journal because I get read it out to the SEC by the attackers and the hackers.  Dezeus' point, I think government, especially in the small government side, it has to lean on their partners. I mean, I think that's the big thing and probably what we'll hear later on today is that you gotta look for those partners that are gonna help you get across to de-risk what you have. What's the right organizational regime and is it evolving? In other words, I always felt like the backup and recovery function was part of the infrastructure team. Should it be, is that the case and should it be part of the SECOPS team? What do you guys think about that? It's an open question. I think depending on who you ask, you'll get different answers. I think at the end of the day, it doesn't really matter, it's very academic. What matters is that you really combine the recovery operations from a cyber standpoint which means that every part of the infrastructure can send signals to different people and then when the time comes to declare a problem and start the recovery, you know what to do. Now whether it's SECOPS that's doing it or some other entity, who cares, right? I think we'll see, the market will decide but for sure what I'm seeing is that for any data protection decision that's being made now, there is a veto power from the security organization from the CISO. So CISOs have become probably the most important executive in many organizations based on the data we've seen. And I think, you know, and as far as the backup and recovery guys well there and guys, they're IT ops, they're cloud ops. There's no more backup and recovery PhD. The problem with having standalone SECOPS teams though is this change has been a foot for a long time where security needs to become distributed across all IT organizations. Right, we've been talking about the coming together in networking and security for a while, you know, DevOps and security. The thing with security is it's changed. It's no longer a game of signatures where you're trying to roll out reactively a patch to a security system that'll take care of a known threat. It's using analytics and the data that you have which spans applications, security, networking, right? And compute and storage, using that data to try and infer breaches. And because of that, security now almost becomes a distributed function across all of IT versus a standalone. Yeah, I think it goes back. Last word, why don't we go around the horn? You start and we'll go clockwise.  It's an organizational top-down mantra that there's none of this shift left, shift right kind of thing. It's everybody has to be involved because the signals are very specific to, exactly, you're not looking for signatures anymore, you're looking for different signals. And those signals can be very minute signals within application performance data and things of that nature. So that brings in observability. And I think that's going to be really a key is drawing it across organizationally in through, if you call it platform engineering and bringing that through the entire organization. Right. And Kristoff, thank you for bringing some quality survey data from ESG to the session today. Really appreciate that. What's your last word? Well, we looked, as I said, at the market in terms of maturity. Here's the sobering news. We ranked organizations and had four stages and the leaders, stage one are only a fraction of the market, less than 20%. So there's a- It's good and bad, guys. Yeah, and the VCs, I guess. Yeah. Exactly. See us? I think this is a fight, fire with fire. The bad guys are using the cloud to leverage in AI. They're leveraging machine learning and they're able to create such sophisticated attacks today that you cannot fight back with traditional old school security methods. And so I don't care how good a security engineer you are, you cannot manually look at data and infer what it's saying anymore. You have to embrace AI because the bad guys are and you're never going to be able to catch up otherwise. Guys, it's such a pleasure working with top analysts like yourselves. Thank you so much for spending some time with us today. Really appreciate it. Okay, keep it right there. You're watching Navigating the Road to Cyber Resiliency, the summit, which is made possible by Dell Technologies. We have so much more to learn today so don't go anywhere. Rob Emsley is up next, the sort of visionary behind this whole program. Keep it right there.


Hey guys, it's Adana. I have a really quick announcement for you. If you're trying to get into PA school, I want to help you. That's why I'm offering a 60 minute consultation session with me personally via the phone or video chat, why I will help you personally develop a plan to help get you into PA school. For the video with the full details and how we're going to get that done, go ahead and head to the description box below because there'll be a link there or it will be pinned to the first comment on this video. Or you can always just go on to my website at adanathepa.com and schedule your appointment today. Hope you enjoy the rest of this video.  It's Adana coming in from the other side with another video for you guys. So you guys, I have this video on my heart to make for you all because I know that a lot of you have this question, how to get your healthcare experience because a lot of places are requiring like 500, 1000, 2000 hours of healthcare experience prior to getting into PA school. And although that sounds like a lot, which I mean, it is honestly, like if we want to be honest about things, you know, that's what over a year of work. But hey, you can do it. And this video is going to tell you exactly how you can do it. So that is what I'm going to be talking about today, how to get your healthcare experience. I know that I already made a video on my personal kind of road to healthcare experience. So I'm like a big proponent, you guys, of making things easy. You know, like I want like the quick, easy route, but also I'm still getting like the required information and like quality information. So my like my main thing is always going to be go ahead and get your CNA license or GNA license, whatever they call it in your state, or what whichever one you want to work with. Go ahead and do that. I went ahead and did that. I did it a little later on in life, I guess you could say, but it worked. And I'm pretty sure that it helped me out. I feel like that is the fastest way. Yes, there are other ways that you can do it. I know that the community college that I went to to take some of my prerequisites that I needed to retake because they were already too old over they offer different things like surgical tech. There was like something called a PCA or something like that, radiology tech, micro, what do they call it? Like it's basically like a hematologist or you know, like a medical laboratory science tech. So things like that they offer those two year certificate or degree programs where you can have a specialty and then you can get working. You can go to the hospital and work as a surgical tech. You can go to the lab at an urgent care or just at like lab core and work as a medical laboratory tech. So there are different options that you can take that take a little bit longer, but I'm all about like, what's the fastest way that I can do that? And to me, that's being a CNA or going ahead and taking the test and becoming a GNA because it only takes you guys like there are programs that will allow you to do it with in four to eight weeks, literally a month to two months out of your life. And you have your certificate, you're certified, you're able to go and now find a job and get those healthcare experience hours. I know my program was six weeks, but I did see some programs for four weeks, but it just wasn't feasible for me because I still have to work. So if you still have to work or if you still have to go to school, it might be better for you to do one of those programs that are a little bit longer, one of the eight week programs that you can do in the evening and just kind of knock it out right then and there. And then over the summer, you can work or if you're in school, you can work at night if you're able to do that because not everybody can pull, you know, like those 12, 16 hour in school for eight hours and then I'm working for seven or I'm working for eight, not everyone can do that. So work at your pace, but I definitely, I definitely suggest go ahead and become a CNA or an MA that will allow you the opportunity to get working sooner. And then you can even kind of move up in the ladder, like maybe you're at your job for two or three years and you've now, your scope of practice is even larger because your provider is allowing you to do more at their practice and that is going to look really good longevity and then a broadened scope of practice looks great. But if you do have time, definitely go ahead and do like an EMS or be an EMT. They take longer, but your critical thinking skills are going to be off the chart. You're already going to be like pretty familiar with body systems and how things work and what an MI might look like in an elderly patient as opposed to an MI in a young female because it looks different. So you're going to have like a wealth of knowledge already going into PA school. So those are really some good options for you to get your health care experience. But if you're trying to get something in quick, easy, the whatever, what does my teacher say? The quick and dirty, like you just try to get in there, get it done and then start working. Definitely go ahead and try and Google just go online four to eight weeks. You can see if you want to do the four weeks, six week or eight week program, you can get it done and you can start working and you'll be well on your way to getting that 500 to 2000 hours that some schools require. All right, so I hope that was helpful for you guys. If I didn't really answer the question in a way that you felt comfortable, go ahead and shoot me an email. If you have more questions, I will definitely get to it. I am in school, you guys disclaimer. I'm still in school, so I may not get to it immediately, but I really try and get to you guys's comments within like two weeks max. So your emails, comments, all of that stuff. If I don't get back to you within two weeks, my bad, I'm at full, I'm a work on it. Okay, but I definitely try to do that within two weeks. So just hit me up on Instagram at adana, the PA or you can send me an email and I will be sure to get back to you. Thank you guys so much for watching. Really, really appreciate you guys. And I will talk to you guys later. All right.