labor and management to work together. Saturn will truly be America's answer to worldwide competition. And eventually Saturn will mean dramatic changes in all our GM facility construction company. The supervisor of Orian Township, Joanne Van Tassel, productive manufacturer and beaver of the U.S. federal deficit. We owe a celebration of jobs for our people. Welcome. To introduce our dedication speaker, the President of the United States of America, the Honorable Ronald Reagan. Mr. President. Thank you. Thank you very much. Thank you, Roger. Governor Blanchard, Senators Levin and Regal, Representative, Congressman Bill Broomfield, the state and local officials, Jim McDonald, Les Richards, and ladies and gentlemen. I have seen so much that I told Roger just a little while ago, I can't wait for the next summit conference. I've got so much to tell some of our friends from around the world, but also I had the privilege of driving a prototype car just a little while ago. Roger was brave enough to get in the other seat and I reminded him that for three and a half years I've been sitting in the backseat. But fortunately, I have to tell you, it literally drove itself. Well, yesterday we celebrated Independence Day when all Americans come together with good cheer and revelry commemorate our freedom. Today we herald another step forward that will ensure that America remains the free and prosperous land that God intended it to be. I've always believed that with freedom, hard work, and the profit motive, there's nothing that Americans can't do. Well, this plant represents the can-do spirit for which your industry in America have always been known. It took great courage for all of you to make this kind of an investment. In a time of great uncertainty, General Motors proved that they had faith in our country and faith in our country's economy. Since 1979, more than 50 billion dollars has been spent by your industry, scrapping old plants, building new ones, developing technology, and retraining employees, and over 23 billion of that 50 was spent by General Motors right here in America. President Dwight Eisenhower, who dedicated the GM high tech center, which I just visited once said, the future will belong not to the faint-hearted, but to those who believe in it and prepare for it. Well, you're preparing for our future, for a better future. So let our competitors take note today. The American automobile industry is back, back with pride, back with teamwork, and back with performance that can and will make us number one. This plant is a result of the bold leadership of your industry and an admirable commitment to the future of America. And I think your plant symbolizes a new spirit of cooperation between management and labor. That cooperation reflects the determination of this industry not just to survive, but to triumph. And we know that the UAW put its full support behind this endeavor. Keeping faith with that goodwill, I understand that General Motors chose this site over three less costly locations, permitting them to put laid-off General Motors employees back to work. You're showing just how much can be accomplished when management and labor speak with each other instead of at each other, when management and labor work together instead of against each other. I'd like to take this opportunity to congratulate the UAW and the entire American labor movement. During these last few years of severe economic stress, organized labor has played a responsible and constructive role in rebuilding American industry. You've demonstrated when the chips are down what people can do working together, freely, rather than at the dictates of some central planner or bureaucratic mandate of government. I happen to believe the last thing your industry needs is the federal government bringing in outsiders to tell you how to run your business and how much to pay your workers. And let me just share with you a conviction that I feel deep in my bones. If we Americans keep working together to improve quality, keep investing in America's technology to become more productive and hold down costs, then yes, we can outcompete, outperform and outsoil the pants off anybody anywhere in the world. Earlier today, I was at the tech center taking a look at your Saturn project. The energy and creativity out there confirm my belief that mankind is on the edge of a new era of opportunity and progress. Putting technology to work for us, which is what your Saturn project is all about, will ensure that when the future gets here, Americans will be leading the way. Space age technology is being put to use to make certain America remains on the cutting edge of progress, new products and new jobs. The confidence and positive outlook experienced here today or evidenced here today is the kind of optimism and pride in our way of life, cropping up in cities and towns in every part of our country. It's a far cry from the gloom and doom of just four years ago. Sometimes it's hard to remember that only a short time ago people were counting America out. They were claiming that we were a nation in decline, that our best days were behind us. Inflation was running in double digits, robbing working people and the elderly of the value of their savings. Economic stagnation was throwing more and more people out of work and destroying any chance for the poor to better their lot. The auto industry like the rest of the country was on the edge of catastrophe. In 1980 alone, the big three lost four billion dollars and then came the recession, the culmination of years of too much taxing, spending and regulating by those who claimed they could spend your earnings better than you could. Well, we've been determined to chart a new beginning for America and I know that it hasn't been easy that recession was deeper and longer than predicted, but these problems had been building up for 20 years. We were determined to find a real economic cure, not just resort as had so often in the past to another political quick fix. There have been eight recessions since World War II and seven of those were treated with quick fixes. There's no compassion in snake oil cures. We weathered that storm together and now the sun is shining on a strong economy and on an American automobile industry that is moving forward again. We want to work to get control of federal spending that had been increasing 17 percent a year. We've cut that in half. Taxes had more than doubled just between 1975 and 1981, leaving working people paying taxes at a rate that only a short time before had been reserved for the extremely well-to-do. This ever-increasing tax load was driving money away from the private sector that could have been spent buying new cars or investing in new plants and equipment. With a 25 percent across the board tax cut, we've prevented the people from being mauled by tax increases, and we've indexed the rates so that ordinary people won't be pushed by inflation into higher and higher tax brackets. We immediately moved to reduce the regulatory burden which bound the hands of our most productive citizens with federal red tape. And I'm proud to say we made a special effort on behalf of the auto industry, saving you hundreds of millions of dollars at a time when every dollar counted. It took time to put our program in place and time to take effect, and the same was true for all the auto industry. And I salute all of you who kept your faith when things were especially tough, and I know they were tough. But by working together, by believing in each other, we've turned the situation around. In the last 19 months, we've enjoyed economic expansion even beyond our own expectations. In the first quarter of this year, the economy grew at the astonishing rate of 9.7 percent. Second quarter growth appears to have been solid, not quite 9.7, but still higher than anyone had expected. And inflation ran at only 3.6 percent in the first three months of the year. For the first time in over a decade, we're enjoying a strong economy, falling on employment, and low inflation all at the same time, and we're determined to keep it that way. Those selling the old no-win notion that you can't have growth without high inflation have been proven wrong. Having a degree in economics myself, I feel free to talk about too many economists have a watch chain with a 5-beta kappa key at one end of the chain and no watch on the other end. They were wrong when they said that inflation and interest rates couldn't come down. They were wrong when they said recovery wouldn't come. Wrong when they said expansion couldn't last. And I think if they keep running down America, they're going to be wrong again. What we're seeing is that things are getting better. Across America, businesses are showing a profit. Late-off workers are being rehired, and new employees are being brought on board. Over six million new jobs have been created in the last 18 months. Now, Europe calls this, in fact, to my face at the last summit meeting, the American miracle. Well, last year the auto industry had a good year. General Motors has been reopening plants and putting on second shifts all over the country. And I'm told that in the last 18 months you've brought 90,000 men and women back onto the payroll. And this expansion isn't just confined to big business. Over 600,000 new businesses were incorporated last year, and most of these were small businesses. The mom and pop store, the entrepreneur kind of business. John Nasbit, futurist and author of Megatrends, said earlier this year that 1984 has arrived just in time to witness an explosion of bottom-up entrepreneurialism and the dawn of an era that may offer our best hope yet. Well, we have every reason to be confident. Our country has recaptured the pride and community spirit that was for so long an essential part of our national character. You folks here at GM have much of which to be proud in this account. You not only build cars, you're making this country the decent place that we wanted to be. Orion Employees alone donated almost $86,000 to the United Way last year. You also gave your whole heart to support these last two years to the GM UAW Christmas Care and Share Program, feeding the needy through donations of canned foodstuffs and cash. Orion Employees serve on the boards of many community and organizations including the YMCA, the Pontiac Urban League, and the United Way. I especially want to congratulate Michelle Roberts, production technician in Tail Light Assembly. She works tirelessly for the United Way and also recruits volunteers from your ranks for worthy community projects. Mr. Roberts, or Ms. Roberts I should say citizenship is an example to all of us. And Herman Lafayette, he's helped over a thousand young adults in the junior achievement program. He's also worked as a counselor at a local half-way house for former prisoners. Your company deserves some recognition on this count. General Motors Annual Award for Excellence in Community Activities is the kind of program of which any corporation should be proud. It highlights the public service of employees like Kenneth Mayo, who's a city councilman of Western, and Wallace Holland, a former GM employee who's now the mayor of Pontiac. I think Americans, all of us, have come to a better appreciation of the values that bind us together. We're seeing a new respect for family and neighborhood. Remember when it was fashionable to claim that God is dead? Well, today I think we're seeing that he's alive and well in the hearts of our people and we're grateful to him for the many blessings that he's showered upon us. We're rededicating ourselves to the values that define our character, that make us a good and worthy people, and that can and will keep America strong and secure and free. Our forefathers left us a wondrous land of liberty, and now it's up to us. This dedication today, the cooperation and the hard work behind it, the community spirit and the heartfelt patriotism of everyone who works here, are part of a rebirth of freedom. This generation of Americans is meeting the test. We intend to pass on a country as prosperous and free as the one that was given to us. And I can't tell you how much I appreciate you are letting me join you here today. Yes, thank you. Good luck.  Thank you, Mr. President. I think that the audience reaction speaks far more than ever. I could say but I will say that please keep up what you're doing because it's working. Today General Motors reported our June car and truck sales. They're the best since 1978 and it brings the six-month sales to a new high for us. It's 25 percent ahead of where we were last year and it's our best year since 1979. And now, now I'd like to ask you to help me unveil the dedication plaque for our plant. Mr. President, you've seen a lot of new technology here today, so we have something of a presentation we'd like to make to you now over here on your right.  They do that because it's always on the go, it never gets tired, it says little and does much. So we felt it was the perfect candidate to present to you this model of our GM concept car of the future. It's a replica of the car that's out at the entrance to the General Motors Technical Center and I hope that you will accept this model. We'll walk over there now. Roger, that fellow that's leaving isn't a candidate for anything, is he? Well thank you all very much for coming. This brings our dedication ceremonies to an end. I know that you and I are all delighted to have the president here today. I'd last for one more round of applause as the president departs and please stay in your places until he's left.


The Sweden government announced a new package of military aid to Ukraine on Thursday, January the 19th that will include armoured infantry fighting vehicles and the Archer Artillery System. The package is worth 4.3 billion Swedish crowns, 419 million dollars, and will also include light portable NLAW anti-tank weapons, mine clearing equipment and assault rifles. Sweden will send about 50 of its tracked and armoured Type 90 infantry fighting vehicles. It can be used to transport up to 8 infantry soldiers and is equipped with a 40mm automatic cannon. The government did not specify how many Archer systems it would supply. Sweden has 48 Archer systems, which is a vehicle-mounted self-propelled gun howitzer made by Boffers BAE that Ukraine has long expressed an interest in adding to its arsenal as it seeks to repel Russian forces. Ahead of the package presented on Thursday, Sweden had announced around 5 billion Swedish crowns of military aid to Ukraine as well as several installments of humanitarian supplies.


When I come to things that you guys have seen on tests, this is something that you brought up after class yesterday. Like, hey, more or something. He said, it would have been more advantageous if I'd have spent a little time on when I was talking about the Chittokagashi syndrome and Prater-Willi and those syndromes as a sort of a review to you guys and like all the characteristics of Albinism where I glossed over them thinking, oh, this isn't, you know, this isn't ERGs. Let's move on to the, or Albinism, let's move on to the next thing. So if you see something you've seen, raise your paw. Before I do visually evoke potentials, I'm gonna spend just five or 10 minutes on EOGs because it's something you need to know about even though they're used very rarely. I would say I don't do more than two a month and all of these are on potential best patients so you need to know about it. And as genetics gets more and more common, it will become less and less useful. There's a real good paper that just came out, oh, maybe a month ago. In fact, it doesn't even have page numbers because it's an e-publication and it'll be in Retina. First off, there's named Khan and they looked at 120-something best patients and oh, the exceptions are incredible about the, you know, the locus they found for some that like, oh, this isn't best but it is best, or it looks like best, that kind of a thing. I'll be adding that to my chapter on web vision when I redo it in the next few months. So EOGs are not the same as electoretina grams even though they're both generated in the retina, the sources of the generation are different. The source of the generation of the EOG is an interaction between the pigment epithelium. The pigment epithelium is the main actual generator of the potential but the light rise of the EOG when a person is exposed to the light after being in the dark for 10 or 15 minutes, the light rise is dependent upon interaction between the pigment epithelium and the mid retina. So both of them have to be intact. It's not an evoked potential like electoretina gram is. There's a standing potential about two to five millivolts between the retinal pigment epithelium and the mid retina that is cornea positive at the outside of the eye. Here's a graphic that shows this. So you can think of the eye as a little battery with the cornea positive in the retinal area negative at the back. So if you place electrodes near the inner and outer canthus like so and then a person wiggles their eyes left and right, this will produce a potential swing that will give you that voltage. Before I go any further, a little bit of, to me, interesting history, being older than dirt, I knew the guy that named this was named Elwyn Marg. Unusual name, he named the EOG in 1951 but it wasn't introduced as a clinical test until 1962 by Jeffrey Arden in London. And so the ratio I'm gonna talk about is called the Arden ratio. Is that something that they refer to in your books as Arden, he's still alive by the way. And he authors one of the chapters in web vision. He'd be at least 85. And those of you that know Helga Kolb's name, the editor of web vision, Helga Kolb was a co-author when she was 21 years old on the first clinical EOG paper in 1962 with Arden, small world. So if you place electrodes on the face like so, they're usually always recorded bilaterally and my experience of having done them for 40 years, I've never seen a difference between the eyes. This is Gail McNeil. Gail used to be, what are the texts, the texts that's orthoptic texts, tech here, years and years ago. But she has a lot of money and last time I saw her, a chauffeur was dropping off a dance. She now lives in this, I think Scottsdale. But she's a model for all my contact lenses. So a Gansfeld like so is used like for recording ERGs. Patient puts their chin in the chin rest and usually use a forehead bar to keep their head stationary and you pre-train them to not move their head and only move their eyes and to look at the LEDs when they alternate left and right. So they're inside the globe, the right one comes on, then the left one comes on, then the right one comes on, then the left one comes on. 10 second sample is taken about each minute depending on the program you're using but it's very close to 10 seconds each minute for a period of 10 to 15 minutes in the dark. So you get a baseline, here's 10 seconds of eyes swinging back and forth every couple of seconds just in room lighting. And then after you're put in the dark, everybody, the voltage goes down a little bit. Everybody, whether you have pathology and you're retina at all, everybody in the dark, the voltage goes down maybe 20%. And then when you turn the lights on, it approximately doubles in size for most people. That approximately is any ratio greater than about 1.8, so almost double or greater is normal. Ratios of 1.7 or below are considered abnormal. That is comparing the low in the dark, excuse me, the low in the dark between how big in the light, that's the ardent ratio. So it's usually a number of like 2.3, 2.4. A young adolescent female will give you ratios of three or four. This thing will be twice as big as that. The young, the adolescent female has the biggest electrophysiology in all electrophysiology. Women are just better, you guys can attest to that. Ratio of the amplitudes of how big is that voltage across the eye when you compare the low in the dark to the greatest rise. So the low in the dark is hit after about eight to 10 minutes and similarly, the high in the light is hit about between eight and 12 minutes, usually before 10 minutes. So if you've tracked it and printed out, here are two eyes of a normal person I tested in the last year here. So in the dark, the voltage goes down like so and then stays stable after about eight or nine minutes and if you would carry this out for even 15 minutes. Some programs go a full 15 minutes, the one we use just goes 12. 12 minutes in the dark and then you turn the lights on, the first testing, nothing happens and then it shoots up like this and as soon as they peek out and start to come down you can end the test cause you're, that's it. You don't need to keep running them in time, you're not gonna get any gain. So what happens here, if you kept testing them this would just come back down to this baseline over the next five or 10 minutes. So there's the two eyes in an individual. This is a best disease patient tested here in the last six months. So you get the same phenomena, if it goes down a little in the dark and then you turn the light on and you don't get a light rise, usually any greater than 1.5, some of them are as low as 1.1 like they hardly increase at all. So best disease in adult vetelepharm dystrophy are associated with normal ERG but abnormal EOG, it's the only disease and that's what makes it peculiar.  Yes, Ferguson? Yeah, you're using a globe, yeah. Right, I don't know of a way to do focal EOGs and I've never seen that question addressed in the literature, you could try searching for it. I've never run across the answer to that accidentally. In best disease in the textbooks, it's considered an absolute, it's not an absolute. There are no absolutes in the universe and they say if you throw your body into a brick wall for infinity, sometime the molecules will all match and you'll pass through. But in general, best disease especially at the younger stage when you're making the diagnosis is normal ERG, abnormal EOG. When they get older and the disease progresses, you will also start to see abnormalities in the ERG. In adult vetelepharm dystrophy, even though they look, just you can't tell them apart in the progression when you look at the OCT progression that I'm gonna show you in a couple of minutes. You can't tell them apart but the number of adult vetelepharm dystrophies that show the normal ERG and abnormal is spotty. It's not consistent. These are the only two I know of that are characteristic for that, for almost all retinal disorders, abnormal ERG and abnormal EOG. So in the early days, 50 years ago, they tried various things, which is better, in the early days, it was thought that drug toxicities were maybe a little more sensitive using detecting drug toxic, a little more sensitive with EOGs but that would fit because you get things like the accumulation of drugs and the pigment epithelium and stuff but still the ERG because it has so many other parameters where you're looking at rods and cones and light and dark and everything is the more sensitive test. So an EOG, except for research purposes, is pretty much a waste of time unless you're working with adult vetelepharm dystrophies or best and I can see even just in a handful of years that this will be all genetic when the speed of the genetic feedback comes and stuff. So as you guys are familiar, both diseases are due to a buildup of lipofusion and a breakdown of the retinal pigment between the outer retina and the retinal pigment epithelium and I'm gonna run through that there's just so much variability which you guys have probably already seen as you pass through retina. This is a rare one here just a few months ago, a five year old, this was the fundus. I've never seen anyone this young and a confirmed best at five years old and he was just classic. Some others, this is the classic sunny side egg looking. Veteleformin means egg-like, a yellow egg-like. You only catch them at this phase if you're lucky. Usually they're past this phase and you get them in the scrambled egg category but let me run through a few here. Here's the progression. This is actually an adult veteleform but the sequence I've been told does not differ between best if you know otherwise, tell me. So here's a progression a couple of years ago, 2011 of a woman, I think she was about 50 and passing through the sunny side egg stage and then the breakdown to the scrambled egg stage. Scrambled egg stage, more bests. I show you these just to appreciate that it's so much as dependent upon when you get to see them at diagnostic stages. I've seen undiagnosed bests that are 40 years old, not adult veteleform dystrophy, that undiagnosed that they have a history, like a phone book and they had never been correctly diagnosed and people have been looking at them since they were teenagers, autofluorescence. So adult veteleform dystrophy, the difference is not much. The difference is age of onset but the progression is usually quite similar. Dominantly inherited juvenile onset, abnormal EOG, EOG normal or mildly abnormal, so it varies quite a bit. I think in the last year of the maybe dozen or so that I've tested, one of the adults was abnormal. Now, do you remember any coming through that were tested? Potential adult veteleform dystrophies that you guys also got an EOG? We haven't done it. Yeah, well, no, I know there's not. One every couple of weeks is the most I see. I don't remember. In this paper I mentioned that came out, it's an E publication right now in Retina but should appear any month now. First author, Kahn, KAHN, they looked over 120 and they found recessively inherited, everything's possible. So more is discussed in web vision and keep that in mind for a resource. Trying to get something to go away here. Ah, no, go away. God, it's so easy. Now I get into Photoshop. Let's try this. Okay, let's talk about visually evoked potential. They gave that little handout. That waveform is the classic waveform of the most commonly used visually evoked potential. That is the pattern reversal visually evoked potential. It's important that you choose the right stimulus depending on the pathology you're looking for. For example, I'll address this in a few minutes. You cannot use pattern reversal with any patient that has nystagmus because the pattern reversal because of the quote apparent movement to pattern reversal, it just exacerbates their nystagmus and so they can't focus and you will be guaranteed an abnormal visually evoked potential. I remember a patient that was sent from Cal, that was worked up in California that ended up a degree patient and the history was optic nerve disease, abnormal visually evoked potential.  And it wasn't optic nerve disease. It was nystagmus. So the 10, 20 international electrode placements system you may or may not have been exposed to when you pass through neurology. It's the agreed upon international system of where electrodes should be placed for EEGs. And the south view of the northbound human, the occipital pole, these electrode locations are used to record visually evoked potential. It's not in my opinion, not necessary to do anything but the central unless you're looking for albinism. Why I'll get into in the next couple of minutes. There, even the majority probably of labs put an array across the back of the head thinking they're gonna lateralize pathology. Not, these three locations are most commonly used in both neurology and ophthalmology for tapping the information from the occipital pole. The Indian is the bump going up the back of the head, the large bump. The placement of these electrodes is 10% of that distance to the nasion, the bridge of the nose here. And in anybody in this room, it'll be about three to four centimeters. So you don't have to get out the tape measure to do it. Feel the back of the head, go up what you think is about three or four centimeters. And I adjust that based on the size of the head. You know, if it's a nine-year-old, I don't go up more than three centimeters. If it's a Samoan football player, and he's got a head the size of a basketball, I go up four centimeters or more. This is the reason to me, the main reason that you can't lateralize pathology. These are sections of functional MRIs. This person was viewing a checked pattern that appeared three times a second. And this is the areas of excitation in the functional MRIs, with the red being the greatest excitation, and the purple and blue being the least in excitation. First of all, note the asymmetry. Particularly look at these slices. The asymmetry of the hot area. Sometimes the hot area is buried down three or four centimeters between the walls and that. This is why, in my opinion, you cannot lateralize pathology. You can lateralize pathology best based on your other information. Visual fields, if you have scanning information, history of the individual. This is an interesting, this is a paper, this is interesting. This is the functional areas for combining MRI and EEG, showing the hottest areas in the brain in different planes. When you get to the walls that face each other between the hemispheres, down in between the hemispheres, if you have good symmetry, you not only cannot lateralize, you get cancellation, electrical cancellation across the walls, and you will actually get false lateralization. That what you, what you appears from the visually evoked potential information across the head might give you opposite of what you're expecting because of the electrical interaction. As soon as those fields leave the occipital pole and get down into the sulci, forget it. But the visually evoked potential is really good at telling you are the pathways working normally between the retina and the visual pole. These are the multifocal visually evoked potentials. You can see in this a little bit polarity reversal. If you look at the upper and lower fields and these potentials, they almost reverse in polarity. Look at this one versus this one. That's the electrical phenomenon I'm talking about. All evoked potentials, auditory, somatosensory and visual come from EEG. The EEG was first described in 1929 by a German named Hans Berger. And within just a couple of years, it was being recorded routinely both in Europe and the United States and Canada. And one of the things that if you would observe an EEG, like when they're doing photic driving to check for epilepsy, you can see, you can see when there's a flash of light presented, you can see the evoked potential like this one. You don't always see it because it depends on which way the EEG is going. If the EEG happens to be coming down when the evoked potential is supposed to be coming up, you won't see it. That's why it takes an average of across time to pull the EEG, pull out of the EEG the visually evoked potential. So all evoked potentials, a stimulus is presented such as a flash of light or a pattern appearing or disappearing on a screen or an auditory click in the ear or somatosensory stimulation of the medial or peripheral tibial nerve. And then a computer grabs the set time after that stimulus, such as these windows and adds one to the next to the next to the next to the next. In the case of a visually evoked potential in a child that has a thin skull in just five flashes, you can see the visually evoked potential. Whereas in an adult with a thicker skull, it might take 20 or so before you start to see it and then it smooths out over the next minute. These stimuli are all used even today other than this mirror system that I'll talk about historically. But in the beginning, a strobe flash was used and in the beginning and the beginning went up until the mid sixties, EEG recording was used. So you had the EEG recording on paper and then from the amplifiers that was put into a little computer that was dedicated to be able to average. And these started to appear in the early 1960s, which is when I got into it. And computers that did the whole thing didn't come out until the seventies. And still they weren't programmable. They had no keyboards or anything like that. They just, the earliest computers, and they were wonderful. Not all of these choices. It had start, stop, print. Loved it. So in the beginning, a strobe flash was used such as photic driving in EEG, the old grass stimulators, what I started with like this. And then pattern flash appeared. Then pattern reversal was invented in the mid 1970s by a guy named Martin Halliday at Queen Square in London.  And he had one that produced a check of one pattern and then the other one produced the check opposite. And by using the camera shutters, he could make it appear to reverse by back projecting it onto a screen. It was really neat. And they put into the TVs didn't come until early 1980s. So in the beginning, the strobe flash was used. Then beginning the late 1960s, people started putting patterns on top of the flash. It was a pattern flash. It didn't reverse. And then the pattern reversal came up. So you'd see this, and then this, and then this, and then this. And so this is what is still used today, pattern reversal produced on a television screen. Martin Halliday's old slide system produced sharper, bigger evoked potentials because you can change a pattern much quicker with a camera shutter than you can with a TV screen. Because a TV screen is based on the line frequency. So 16.66 milliseconds is as fast as you could change it. Whereas Halliday's system could change it in like a thousandth of a second. It was neat. Normal pattern reversal VEP looks like this, like the handout. Probably anyone in this room would give you this kind of a form. And that's the great thing about pattern reversal. You get the same potential from every body that's normal. Whereas any other stimulation, flash, pattern flash, pattern onset, all of those, you get more reflection of the individual idiosyncrasies of the individual. Development of the visually evoked potential. At 22 weeks, you get very sparse embryonic 22 weeks. Early cones. And then more development postnatal five days. And then the development when you get old with the cone packing. Cone packing yields up to 2020 vision measured by VEPs by six months of age. Preferential looking indicates 2060 by six months of age. So physiologically, it seems like the system is capable of 2020 vision within six months. But perceptually, there's a little lag behind. The main difference in visually evoked potentials is the myelination of the optic pathways. This was a patient I recorded during one of the exams under anesthesia over at primary a few months ago. So the visually evoked potential of an infant, baby, only a few months old, will be very slow. So this is the quote P100 out here at about 240 milliseconds. And what happens over the next five years as the system myelinates, this P100 just marches back to left of the middle of the screen. So it just goes, it just month by month by month, it would just come back faster and faster. So that by school age, by kindergarten or first grade, the VEP just looks like that of an adult. Did you, can you? Yeah, so like the question that we always get on tasks is for you to sweep VEP? Yeah, sweep the sinusoidal VEPs, yeah. Can you talk about that? Sweep VEPs are produced at a fast rate. So it gives you a sinusoidal waveform. I know there's at least one company that's out there. All they wanna do is sell you. They don't care if it helps patients. Their sales pitch is, this is what you can bill for. Run it on everybody and bill. So we don't have. We don't, I don't do it, yeah. It can be used, there's nothing wrong with it, but it, you can get information from it, but it's more obscure than the information. What kind of questions do they ask you? They always say to add in things is to use sweep VEPs. Yeah, they do that. But you can do the same thing with the pattern, but that doesn't get you out of the fact you have to answer the question. What do they wanna know? Yes, no? Can you? Yes, you can. The visually evoked potential, either the sweep or the transient, where transient means that the rate is no more than about three per second. So the evoked potential can completely recover before the next one is presented. Whereas sweep is usually at a fast rate and you can do that, but it can't do any better job than you can do or a good pediatric ophthalmologist can do at estimating it, estimating the visual acuity. Yeah, Ferguson? So it's true. Uh-huh, yeah. The, the location of the generators is not known that well, those first slides that I showed you and there's tremendous inner, individually. The P100 is generated from about all of my hand here like this. Yeah, beginning from below, below the Indian up to the top of the head. And then the negativity is just the preceding and following voltage swing that takes place. And they don't know the origin of them like they do for ERGs where we know the A wave comes in the rods and cones and the B wave comes from the mid-retina and the C wave comes from the pigment epithelium. And I think the D wave is the off-response of on and off bipolar cells. They don't know that about VEPs. VEPs are best to estimate and quantify the integrity of the pathways. I don't know if this is answering your question, but. Well, it sort of does peak at 75 milliseconds. Right. And at 75 milliseconds, it's probably. 90 or something. And then the P100 peak, which I'll show you in MS, is if it's delayed two standard deviations, which is about six milliseconds. So if you get beyond about 112 in a person over age of seven or so, if you get past 112, then it probably is reflecting true pathology. Latency, no, but also amplitude. Yeah, amplitude is usually reflects more, usually. There are no absolutes. Usually reflects pressure on the pathways like hydrocephalus, pituitary tumor, or such. So the analogy I use when I'm explaining to parents is the optic nerve is like a water hose going from the faucet, your eyeball, around the house to a sprinkler in the backyard that's your occipital pole. And the question is, is somebody along the line getting cute and stepping on the hose? And that's what tumors usually do. So you get a reduction in amplitude and that can be quantified. I'm gonna show, let me progress and I'll show you a series that might answer those questions. So if you look at P100s in groups that included, doesn't have the numbers in these groups, but there were about 10 or 20 in each of these age groups and you get just this progression that the biggest difference, look at the standard deviation, the biggest difference when you get over 65 is not really the mean times, but the standard deviation because the two times in life that things vary the most in visually evoked potentials and well, not so much in ERGs, but in visually evoked potentials is the variation in maturation those first three or four years and then after 50 or 60. And there's even greater variation in how people age. You've all seen this as patients, I once, I've made a lot of mistakes assuming the relationship between patients between individuals that I see and one time there were a couple and they were about the same age but their wife looked so bad from her illness he looked like at least his mother, at least his mother and I made that assumption. And the woman told her husband to hit me. But you know you see people who are 60, 70, 80 years old some of them look like 60, 70, 80 and some look like 90, 100, 110. Here's a scattergram of those peak 100. So the biggest variation is in the development, preschool age, this only goes back to about six. And then things tighten up through young adulthood and then again when you get over 70 the spread gets at least as big and this probably the spread will get even bigger in this group when you get to 80, 90, 100. Well it's yeah and over general health, yeah it's not really demyelination as much as it is just aging cell loss breakdown of your body. Something that most of you are probably 28 by now, close or close, the studies of hundreds of people indicate you are at peak here in your adolescence as far as speed things stay the same but by age 28 you start dying as far as visual function. It's all over at 28. From then on it's just a slide. Merry Christmas. Okay, besides pattern reversal pattern onset offset is the stimulus of choice in any patient with nystagmus because of the fact pattern reversal exacerbates nystagmus. So if your patient comes in with any etiology of nystagmus pattern onset which is pattern comes blank screen pattern comes on pattern goes off pattern comes on pattern goes off. So this is what the stimulus is like. So you use this for whether it's idiopathic nystagmus or an albino pattern onset VPs are best for poor fixation, poor acuity. Eye movement disorders, nystagmus, malingering and deliberate de-focusing which is not an issue in adults. We lose the ability to deliberately de-focus. You don't get many children that are malingerers that know enough to deliberately de-focus so I probably should drop that one but I leave it so I can point out that adults can't deliberately de-focus. Again, this is progression. This is upside down the P100s but it shows the progression from this number of people in each group with the average age of this. So even though it goes down a little bit in amplitude there's no statistical difference till at least 55 or 60 and that's mostly due to variation. How are we doing on time? Oh, good. Okay, sweep VPs that stimulate lines or bars of different widths and also by using different sizes of checks either way you can estimate acuity. The biggest fastest VEP will be produced by the image, the patient, the smallest image a person can see sharply. So for all of you with your best corrected vision it would be a small check like a quarter inch check at a meter. That would be the biggest one. If you're 2050, 2100 or worse it might be closer to a three quarter inch check and on and on. So by using multiple check sizes or multiple sweep stimulation of different widths of lines you can estimate acuity. But again I emphasize even though it's a question a good pediatric ophthalmologist can do as good or better with their testing. Most of you as you rotate through PEADS you're gonna see exams under anesthesia. This is one taken next door at primary with the goggles I use which inside as an array of 15 LEDs made to be bright enough to go through closed lids. They're quite irritating when I use them in clinic. Little kids don't like it at all. Oops, looks like so inside. There's really neat, a company is supposed to give me one but they've been dragging their feet and dragging their feet. Hopefully I'll get it. It has a head on it smaller than a softball between a baseball and a softball and it has a cup system around it similar to this kind of a thing but oval. So it's made to place over the eye so you can monocularly stimulate and you can produce any of the colors like you do in a full field ERG and dark adapt and use dim blue and dim red and everything. So I'm hoping to get one of those that I'll start using in the OR so we can do a little bit more, a better job at rod and cone isolation in the exams under anesthesia. Whereas this you have no choice but these red LEDs. Okay, let's talk about optic neuritis in a series of different kinds of patients and what happens in the visually rock potentials. The classic optic neuritis patient is one eye showing demyelination first, the other eye usually comes along at a later date but not necessarily no absolutes but usually one nerve precedes the other so you get slowing of the quote P100 and not much amplitude change at all. This is the diagnostic stage when you're seeing the MS patient for the first time who's 25 or 30 or 35 years old. As people progress you'll get amplitude loss and also if you would follow that patient and do VEPs every two or three or four or five years for the rest of their life you would see with the demyelination as the demyelination proceeds you would see that P100 go 110, 120, 125, 130, 135 so that the 60 year old classic MS patients that P100 might be 160 and once you get a lot of demyelination roughly in years these are not, these are just thrown out at you, I don't know what this study says, like 40, 50 years old beyond you'll start seeing significant amplitude loss. Yes? Usually, yeah, yeah, usually. Although 99% of decisions are made about either the amplitude or the speed of the P100 peak in the pattern reversal. Here's just some more, here's bilateral pretty symmetrical but both slow. Later stage, optic neuritis patient starting to lose some amplitude. If you show me the visually evoked potential of a MS patient with optic neuritis versus a neurofibromatosis type one patient they look the same. You get the same slowing but for different reasons. Roughly similar to you lose your B wave and ERG from both classic congenital stationary night blindness and retinal schesis but the reason is complete or the etiology is completely different. Essentially all neurofibromatosis type one patients have slow VEPs by school age whether or not they develop the gliomas. So something else is going on metabolically producing a slow VEP look that looks like optic neuritis. So this is a neurofibromatosis patient, slow. Just same as what a MS optic neuritis patient would look like. Okay, this is initial VEP on a child. Pretty happy. This is two, three years later. This patient had bilateral gliomas. Four years later. This is the procedure mostly from compression produced by the gliomas. Sorgazan. Standard deviation is about six or seven depending on the lab. Why it varies is people use different brightnesses of televisions. They place the patient different distances. There's no standard. Some people place the patients just half a meter away some a meter away, rarely more than a meter. And the field is different. So that some use just some use a 14 inch quote TV. Some use a 27 inch TV. When you change parameters like that different people use different room lighting. It will affect the standard deviation. So about six or seven. So 112 or so is pretty definitive that it's pathology if you get slowing to that. Of course you don't know what that person was when they got out of high school. I would like that on everybody. Then there's no question because many women their normal P100 is 95. And so a number of 104 or 105, 106, 107 that would be considered well slow but still, I bet if you knew what their VEPs were like when they were 18 and not now that you were tested as a potential MS patient when they're 30 but we don't have that. Okay let's move through. So I'm just gonna go through some different disorders so you can see some of the applications of visually low potentials. Pale nerves, what the VEP is useful for it's not that you can't make the diagnosis of a pale nerve it will quantitate the degree of dysfunction for you. How bad is it? Cause some nerves can look terrible and still have pretty good function and vice versa. Some can be borderline and be quite dysfunctional. Orbital mass, both sides affected. One side no VEP at all. Do I have the follow up? Here's that same patient after decompression. So you get a much better on the basically unaffected side and the return of some kind of VEP there. So you can follow progression. Some of the neurosurgeons will send me patients prior to say pituitary adenoma surgery. Some don't and so you see the progression. Some I only see afterwards so I don't know what the baseline was before. Neuroblastoma, orbital fracture left. Pale optic nerve, pale optic nerve again. Yes yeah I know pale optic nerve but this again quantitate the degree of dysfunction. The Thambutile nerve toxicity. This was about a 30 something year old patient of Dr. Katz. Slowing like so you couldn't tell these from optic neuritis but you know from the history what's going on. So these are symptomatic all evoked potentials are symptomatic but not diagnostic. You have to, they have to be considered within the rest of your exam history scanning et cetera. Meningeal tuberculosis again slowing again. You can't tell these from optic neuritis or neurofibromatosis. The Cardi syndrome. I don't know why, why do we see so many Cardi syndromes here? Cause it's such a rare disorder. We see in a Cardi, I see a Cardi just with Hoffman every six months or so. Is it in the water or something?  It's thought to be a rare dominant mutation of the X chromosome and thought lethal to normal XY males. Some Klinefelters males will have it. But it's so rare that you don't have to worry about that. So they show this leucane cune. This was a series taken in the OR, not really sharp but done hand held by Scott Larson when he was here. And here's the VEP on this one. One eye, what makes such a, cause the expression is bilateral but it can be quite variable. So if the expression affects the optic nerve head or central macular area, that's when you'll get the real bad VEPs. Multifocal VEPs. Multifocal VEPs give you a evoked potential as if you divided the optic nerve into 100 over 100 channels. So you might pick up abnormalities that aren't apparent from just the gross overall optic nerve. Our system that hopefully we're gonna get in the next week or so will be like this and what will be new for us is currently, those of you, most of you I think have seen a multifocal, you get that external view of the eye. The new system we're supposed to get by pushing the arrow keys, it'll give you the fundus view. And the advantage of that will be those patients that have AMD or central macular scatomas, instead of them trying to fixate on an X the size of a pencil and hope that they can see the middle somewhere or interpolate the middle somewhere, will be able to focus the pattern onto their fovea and just tell them to stay still. Most systems, only one company has that, the guy who invented multifocal VEPs and ERGs. Most systems have a system like this where the patient looks at a wide screen and has a chin rest for both multifocal ERGs, which is this pattern is a multifocal ERG, multifocal ERGs and multifocal VEPs. The pattern for the VEP is not this hexagon pattern that blinks off and on, but a dart board that all of these blink off and on. And you end up with, these are normal multifocals. The red is the right, the blue is the left. This, the following series starts off with a severe episode of acute optic neuritis, which essentially obliterates all of the right VEPs followed by recovery. So the red is right, the blue are the good ones, the red are the poor during the acute phase. Next, over a period of two months, the amplitude recovered, but the time, the latency, peak latency remained. And then three months later, on the lower field, even the latency recovered, but it remained slower in the upper field. The schemic optic neuropathy, oops, shows the differences in this area.  They require four electrodes on the occipital pole that hopefully stay the same in their, how connected they are and everything and digging down through hair and placing those up to the nightmare. I just like run for my car when I hear them even talking about order, you know, multi-focal. Any questions? Oh, I'm glad you mentioned that. The question is, you know, what is the variation in amplitude? Because of the asymmetry of the brain and that one of those first slides I showed you of those functional MRIs, amplitude can't be considered definitively abnormal unless it's about 50% or greater because the back of the brain does not look like the drawings. The back of the brain looks like this. So the asymmetry in the occipital pole just anatomy is greater than the left and right of a face and you've all seen those where you take the half of a face of a person and replicate it and you're like, that's Tom Cruise that you don't recognize. So because of the natural asymmetry built into the idiosyncrasies of our anatomy, it's about 50% now. Yeah? I'm not sure if I understand. You're right. An after-matter. What's the mechanism that bullets with one side of the brain? The mass having a pressure effect even on the other nerve even though it was unilateral mainly, it would have pressure, for instance, in pituitary tumors in doing these for 40 years, actually 50 now, 50 years. I've only ever seen one that the VPs look symmetrical because there's always, there's some lateralization usually to the pressure. So if you have a mass on one side, just the spread of the pressure usually reaches the other nerve if it's a significant mass. And for the one side of the yellow, was that? I don't remember. Oh yeah, on the one, the bad one? The very first one. I don't remember. But you often see unilateral gliomas in these patients. Merry Christmas.


Welcome back everyone to theCUBE's live coverage of MY's here at the Marriott Marquis in Washington, DC. I'm your host, Rebecca Knight, along with my co-host and analyst, Rob Streche. We are joined by Taylor Lehman. He is the Director Office of the Chief Information Security Officer at Google Cloud, and Monica Shokrai, the Head of Business Risk and Insurance at Google Cloud. Welcome, Taylor and Monica. Thanks for having us. Thanks for having us. So Taylor, I'm going to start with you. You were a former CISO at Athena Health and Tufts Medical Center, and your role now at Google Cloud is helping healthcare organizations and life science companies through the same challenges that you faced in working in the industry yourself. So tell our viewers a little bit more about what are the kinds of cyber threats that are facing healthcare organizations right now? It's constantly evolving. It's probably best handled by thinking about healthcare as a number of sub-sectors, like you kind of mentioned in your intro. So you've got hospital systems who are being attacked, largely because digital extortion, ransomware events create tremendous leverage. They threaten people's safety, and attackers know that and use it to their advantage to compel payment. And there's also a ton of legacy infrastructure in these places that make them sort of target rich in a sense. You've got health insurance companies. They operate mainly like banks, they process claims, they move a lot of money. Very highly targeted for not just the medical information, but also the financial data that they typically have that they keep alongside that. You've got like med tech companies, farm tech companies. These are like a sort of a facet of life sciences where they're developing drugs and devices to keep people healthy. Intellectual property is super valuable, not just for competitors to acquire, but nation states want it to basically treat and keep their own societies healthy. And you've got pharmaceutical companies and others who are just using science to build new treatments for people. So there's a variety of organizations that make up the healthcare industry and the threats and the opportunities are different for each depending on how you look at it. And how susceptible do you think the industry is as a whole from a healthcare perspective? Is there a reason why? Is it just the legacy of the applications and that layer that's really been pulling them back and why they need to really focus on this? I think, you know, when folks realize that you could extort business and get paid for it. And focusing specifically on hospitals for a moment. You know, people did a bit of a value equation and said how bad can I make it for an entity and how low is the bar to achieve that outcome? And I think people pretty much figured out hospital systems, things go bad, people get hurt and tons of legacy technology everywhere that's hard to manage by organizations that aren't really being reimbursed at a rate and pace that allows them to refresh their infrastructure. So you have a couple of really unique, interesting factors that go into why healthcare is an interesting target and why it's so vulnerable. I think if you step back and kind of take a macro view, these are also systems that are really important to the safety of entire society. So if you start messing with them, you not only compel the individual organizations to participate, but you also affect the broader society around you and that's also unacceptable. So there's some interesting sort of intersections between societal risk, risk to these organizations going down what it could mean on an individual basis but then also when you really think about how a number of those threats play out, you kind of cause in a sense of catastrophic outcomes for entire communities, cities and towns and Tusk Medical Center right where I worked, not only a large, noteworthy academic health system, it was also a community hospital system that served people not just like coming in from out of town to get treated, but it served a very large portion of the Boston area. If that went down, which in recent years when we had things like the marathon bombing and things like that that just showed us how much we rely on these organizations, it really paints a scary picture when you think about the ramifications of a cyber attack just knowing what happens when these organizations get stressed in the first place. Because they are so vulnerable and they come at a time when people are very vulnerable in their lives. So Monica, how can cyber insurance protect healthcare providers from these financial losses? Absolutely, so cyber insurance is part of a holistic risk management program. Not only from a security perspective or you're trying to reduce the risk from a frequency perspective, but if something happens, cyber insurance can help you reduce that severity. Particularly because cyber insurance programs come with an incident response panel, a panel of providers that will help you respond quickly, they'll help you negotiate claims, et cetera. And so from that perspective, we see it as a holistic risk management strategy. But what I think is more interesting about cyber insurance is that insurance is one of the only industries that can start to better prioritize using risk and losses, what controls and what metrics make more of an impact to customers. And so over time, if we can get the insurance industry to a place where they're bringing in the right metrics, they can help customers improve their security and improve that feedback loop and that's something that we're very interested in. So it makes sense that there'd be a lot of education that has to go on for the insurance, having been in an insurance industry, Manulife Financial and John Hancock, where I ran part of the IT there. It's one of these where they themselves are trying to get a handle on this. And do you see that as part of what you're bringing to them is a lot of education as part of the program? Yes, absolutely. So we have a program called the risk protection program, which I think you're touching upon. And within that program, what we're doing is we're helping our customers get access to cyber insurance. The way that we're doing that is that if you look at the cyber insurance industry today, there's 40 page PDFs with a lot of manual questions that CSOs are being asked to respond to. And a lot of times the questions aren't simply a yes or no question. That's easy for the CSO to answer. So what we thought is a couple of years ago, we pulled back and said cloud providers have a very unique role to play in this space where we can provide scans that have inside out metrics indicative of risk that customers can send directly to insurers so that they can better utilize metrics to understand risk. When you pull back from that, we're also a leader in the security space, Google as a whole, in addition to Google Cloud, right? And how can we take that IP and our understanding of security and help the insurance industry better understand their risk? And so as part of this program, there is education and thought leadership working with insurers. Right now it's Munich Green Alliance that we're working with so that they can better understand the metrics that we're providing. So you're having these dialogues with these CSOs and Taylor as a former CSO yourself, what are you hearing from these people? What is keeping them up at night? What are their biggest concerns right now? I want to take that one to both of you. And I think it's really obviously confidentiality of sensitive data, critical, paired with availability of systems, increasingly critical when you combine the two where you've got folks ransoming data, X-filling data, it keeps, and then exposing sensitive information publicly. It creates a really interesting set of problems and challenges that CSOs have to really think about. It's not just like keep it locked down but I got to keep it online. I also have to minimize it so I don't find myself in a place where I don't want to be. In healthcare, we touched a little bit about this but availability of systems is probably the most important outcome that a CSO can achieve and any threats to a system going down need to be at the top of the list. In the last year we've started to see more and more targeting of healthcare organizations not just with ransomware events but insider threat is something that we're starting to see clearly quite a bit. We're starting to see symbolic DDoS attacks like Kilnette earlier this year where hospital systems were being just attacked from other places in the world just because people knew the availability was such a critical thing and really wasn't clear what the outcomes they were hoping for but you're starting to see more and more of that. I mean we hadn't seen really relevant DDoS activity since, I want to say almost a decade ago and I can think of an example at Boston Children's Hospital where we had a significant event but really hasn't been a thing we've had to deal with. Now it's becoming increasingly more common and it's being combined with other types of attacks. So I'd say obviously ransomware continues to be an issue making sure you've got strong hygiene internally are always a priority there. Ensuring insider risk is understood and covered protecting yourself against DDoS attacks which I think are going to continue and then of course we've got advanced actors now doing really interesting things that we're seeing and I'm sure we'll be briefed about later today around like acquiring intellectual property capturing data on interesting people that they're targeting, scientists, researchers, et cetera. And so it's almost like kind of who knows what's next? It's a data rich environment and healthcare data has a lot of value but I'd say yeah, I mean it's, those are the priorities, those are the threats that we're seeing from the board. Yeah, I, oh sorry, go ahead. I was just going to add from a risk management perspective speaking to CISOs, one of their biggest concerns is how do I, is all the toil that they're faced with from a day-to-day perspective and how do I figure out what to prioritize, what to do first if I have a limited amount of time? Where do I focus? And that's an area where we're trying to help them from an insurance perspective as well. Yeah, I mean that makes total sense because both industries are really data heavy industries plus there's proprietary information in both, there's very confidential information in both, I mean from actuarial tables, that's the IP of an insurance company all the way through, you know, patient records, X-rays and all of that stuff. How do you see this really pushing those industries? I mean it makes sense, the insurance side of de-risking themselves. Are you seeing a good uptick in people saying yeah, these insurance regulations or not regulations but requirements are changing the behavior of the companies? I think they are and it's probably more recent within the evolution of cyber insurance. So once, a couple years ago when ransomware really uptick that caused the industry to basically skyrocket their premiums doubling and tripping premiums year over year and that got to a place where cyber insurance became a little bit more relevant in the day to day of a CISO and an organization because it suddenly was costing a lot more. As part of that process, the different requirements that they were asking customers to implement became top priorities because a customer wanted to make sure that they were insured. So I do think that the industry is starting to influence what people prioritize from a cyber security perspective. I would add, I think, and this is kind of happening at the same time as cloud adoption is becoming more where CISOs and security leaders, you mentioned total reduction is a key priority to address threats but we're seeing this sort of shift to leveraging service providers and insurance organizations, basically people who do business with adopt this sort of shared fate concept where it's more than just, hey, we're going to acquire technology tools, people to help solve problems. It's more like we're going to look to our providers to partner with us to more effectively manage sort of the entire spectrum of risk, including insurance. So like an example would be coming onto Google Cloud, the platform itself has a variety of platform controls built in, they're ambient, you can't avoid them. They're there, they're on by default. That brings you up to a certain bar and then when you actually start to measure your risk and incorporate financial tools like insurance, you can actually do real risk transference, which wasn't really available before. Like people would buy an insurance policy and be like, oh please, I hope I don't ever have to use this thing, right? And of course we were catching up earlier before, it certainly doesn't cover the long tail effects of certain outcomes like people getting hurt, safety issues, cyber insurance and patient safety don't necessarily go together exactly but for me, what the opportunity is now that we're having people moving on cloud and becoming more data driven with their security programs, they're able to effectively transfer risk and with organizations like Google and the risk protection program, you can actually transfer it in a way where it's a responsible transfer but you know that those risks in a sense are covered through effective use of a platform. So you're starting to see the shift in the connection between, hey how do I leverage my providers, what I have a little bit more and then start to do more interesting things that you can only really do if you have a modern technology platform, to be honest with you. So. I like the way you talked about the shared fate aspect in the sense of, because as Taylor was saying, these are organizations that are also community goods, I mean Tufts Medical Center is providing valuable services to so many different kinds of populations within a community. How are they viewing the reputational risk of these kinds of ransomware attacks and security breaches? I think it depends on why it happens, right? Sometimes it's just bad luck, sometimes it's negligence. I think it really matters more, not just necessarily the outcome or the impact but it's how you handle it post in terms of being transparent and communicating effectively and helping take the necessary steps to recover, rebuild trust with customers, make sure the investments are in the right places. The reputational risk is real. It shouldn't be the reason why organizations are compelled to be good at cyber, right? Should be more on what is the customer outcome we want and why does that matter? More than it does what is my personal reputation but I do think it compels to a certain organization to do the right thing but really reputational risk is managed post event. In my experience, I see it better managed by being as ready as you possibly can be than having a clear strategy to engage your stakeholders coming out of it. I don't know, anything you would add? It's not something you can insure. Yeah, it's not insurable, unfortunately. We get asked about it a lot in terms of quantifying risk. How do you quantify reputational risk and impact but it's not something that's covered under the policy. On the shared fate point, I was going to talk a little bit more about one of the things that we're seeing within the industry, Appbay is an insurance company. They came out with a report that essentially said for their customer base, if you use workspace, the chance of a claim, of a loss, is down 40% compared to other email providers. So when you think about the power that the insurance industry can bring to helping customers make decisions on what risk-adjusted decisions on what technology they're going to provide helps overall where a customer might not know the difference between different technology providers. So that's something that we're interested in working with them on. And I think that level of precision and risk measurement and then how you treat it is going to get better and better and better as people adopt more modern stacks, looking at data that comes off the system to inform them of risk, pairing it with intelligence, coming out of places like Mandion to sort of create a better understanding of the risk, the effective control, and then if transference is a great option, making that almost click, click, click and you're done, right? I see that definitely as a trend that's going to continue to occur. Yeah, I agree. Well, looking into your crystal balls, what do you see? I mean, you mentioned that as a trend. Is there any other themes that you're seeing emerging, particularly as we are here at MYS? From an insurance perspective, I think the theme is better inside out metrics over time. I think more and more insurers are going to start adopting that. What you're seeing, they're already adopting, it's a lot of outside in scans and the two industries merging, but that trend will continue. There's a term insurer sec that's emerging of the combination of the two industries and I think it only accelerates. Yeah, I would just say I'm hopeful for the future. I think things are generally going to, they're going to be difficult but we're going to continue to see improvement as more and more organizations sort of understand the threats they face and then put controls in place and programs like insurance in place. I think on the insurance side, the thing that I'm most looking forward to is seeing the adoption of more quantitative mechanisms to measure risk in real time, not just like, oh, I'm going to model a scenario, it's going to take me 30 days to pull the data together, run a Monte Carlo analysis and basically like for this one really precisely defined risk, my exposure is X. I think we're going to see that feedback loop get shorter and shorter and shorter and in more and more real time so that we can make risk-based decisions and like I said, even on a precise scale, be able to have more options in how we treat those risks. That don't involve, hey, I got to go rack $20 million of new equipment, new firewalls, whatever, to get it in, like especially with code now being the way cloud is provisioned, they've seen the combination of more precise risk measurement and the ability to move quickly with less toil. I think it just means the, I'm personally excited, more healthcare companies get on cloud, start using intelligence-driven approaches, start measuring risk faster, means we're going to have safer and safer health systems. Well, that's an optimistic note to end on. Thank you so much, Taylor and Monica, for joining us. Thank you so much. I'm Rebecca Knight, stay tuned for more of theCUBE's live coverage here on theCUBE for Rob Strecce. Great.


The proposed research has successfully identified auriferous, uriniferous marbles in the Barameya Dagbar district of the eastern desert of Egypt using remote sensing and machine learning algorithms. The results indicate that the marbles are spatially associated with aphialites and are likely to be of magmatic origin. Furthermore, the research suggests that the marbles may contain both gold and uranium, which could potentially be economically viable deposits. This article was authored by Ali Shebel and Mohamed Hamdi.


I'm Dr. Lisa Aronson-Fontes. I'm going to speak about how to help a person you know who is being harmfully controlled in their intimate relationship. Stay in touch. Don't allow the person to become isolated. Call, email, text, stop by. Let the person know your concerns in a gentle, non-judgmental way. Ask what you can do to help, but do not take over. Ask what would make their life easier and give them strength. Maybe they need a place to stay, babysitting. Maybe they need help taking care of pets or money. Don't commit to more than you can actually take on. Avoid telling the victim what to do.  Listen to what the person wants to say, but don't ask too many questions. Allow the person to express a range of feelings without criticism. Hate, anger, shame, fear, even love for the abuser, these are all apt to pop up. Encourage the person to seek professional support. A domestic violence advocate is an expert at helping in this situation, even if there's no physical violence. Be careful about giving advice. Advocates who work with controlling and abusive relationships every day will be able to offer the best advice about safety. For example, many well-meaning people tell their friends to obtain a restraining order, but for some victims this leads to increased violence. Interested in learning more? Please check out my book, Invisible Chains, Overcoming Coercive Control in Your Intimate Relationship, and look for my other videos on coercive control. Thank you.


What is going on guys, welcome back to the channel and I appreciate you being here today. I want to showcase to you my amazing Hunter. Now this is something I've been working on since basically the games come out, obviously you've got to get to that top level first. Once I got to the top level I thought it would be quite impressive to try and get a top level fully maxed out, blue armour and weapons, 335 Guardian and that is exactly what I've done and I think it looks pretty good. I really do now showcase to you guys exactly what we've got here. We have the Philly piece B I think that says, which is a sub machine gun. I have my Sam Wasp and I also have my Stampede, 335. Obviously you get these drop at 330s and you just apply a mod to them as per usual you kind of fuse into blues so trying to get 330s drop is pretty hard and I actually just got my chest piece dropped from the Iron Banner, literally just got it dropped from the Iron Banner so now I'm rocking and playing Iron Banner with all blue gear and it's so fun it really is. I get quite a few messages you can believe that. So armour wise I've got War Mantis Helmet, Mobility and Recovery, I've got the Outlanders groups but I also do have the War Mantis Gauntlet to swap out which I don't think they look quite as good. They look alright I suppose we're going enough blue on them so yeah switch and swap. I've got the War Mantis Chest, I haven't got War Mantis Leg Armours which I'd like, I've got the Shadow Spectre Leg Armours after we resilience and recovery and I have the War Mantis Coloak. I just think it looks pretty cool now this is something I would love for them to introduce into the game. I would love to say a feature, I know many of RPGs out there in the world do offer such but I would love to be able to say I've got my Nuka Head Raider, I would love to be able to make my Nuka Head Raider look like this. So any armour I get I can have my Guardian looking like any Guardian I want him to look like but still have the perks of an Exotic, still have the perks of a Legendary. I just think some of the old school, the blue, the green even the white armours looks great I really do and I've got a lot of my, the armour I've started the game with like it's I think it's the one I closed up it's sort of like all messed up and ripped and torn. I love the look of that gear, I just don't wear it because it offers me no, it offers me nothing. So yeah, I would love to be able to say sort of like an Infusion feature I would love to be able to wear that but still have the acting perks of an Exotic or a Legendary. I just think it's sort of limited there that would be a great, great feature for them to introduce. I think it really would do I ever see it happening probably not but then insane that the amount of changes that are common to the game because you obviously feel pressured by the amount of negativity surrounding the game, the content creators, streamers, everybody's basically hating on the game for the way it is. So they're making decent changes, they're speeding up the whole experience of PvP and PvE as we know from the recent roadmap, they're doing a lot of big changes. So yeah, could something like this come in the future? You just never know. Now I am Bannu's here at the minute and I want to show you guys my progression at the minute. Now it's currently Saturday and I have been grinding Iron Banner. Now I mostly play solo, now I put on my Iron Banner gear firstly. As you can see here I've got every piece, I've got every arm piece and it looks beautiful as it was standard but it's just getting the ornaments to grind these real people. Now you've got to get 25 wins for the helmet, I've got 15 out of 25. This is from playing more or less every day, I haven't been playing hardcore every day but I've been playing quite a lot every day.  So I will eventually get there, hopefully I'll get there before this weekly reset, I ain't going to count on it but if at the end of the day if I don't I'll just wait until the next Iron Banner event. The gauntlets, I believe, what are needed for these? Milestones complete. This obviously is jump on every day, doing a milestone is this simple. So yeah, and then we have the legs which I think I have done, this was, well, you have to get so many kills, it was a bar of 100% so I did that, I'm not sure exactly how many kills it was but yeah, looking quite good and the cloak, all I've got to do is just open five packages, I haven't quite done yet, I'm stacking up my Iron Banner tokens for the time being, I'm going to open them, I'm going to open them on my titan because my titan is still missing a few armor pieces whereas my hunter is not. But yes guys, just also onto the positive video, showcasing to you guys my epic blue geared, blue, oh not the wrong one, my blue geared armor people and it just looks, I think it looks great, I really do and I'd love to be able to rock this plane red, love to be able to rock this plane PVP, doing whatever I want looking like that the way I want it to look but still have the benefits of the other, well what, the other armor offers, that would be amazing, it really would. But yes guys, hope you enjoyed the video and I ain't the first to do this because I saw someone post on Twitter about three or four days back but still, I still think it's quite an achievement worth sharing with you guys but yes, I hope you enjoyed the video, thanks as always for stopping by and hopefully people, I will see you on that next one.


Hello, my name is Sergio. I want to show you very shortly a small website I did in order to aggregate some information from the GitHub API. So yeah, once upon a time this page didn't exist or it was very different. It still exists now, but still I think that for a very specific purpose, the site I did a slightly better job. So the thing is I like to contribute to open source. I contribute less than I would like, but still I'm very proud of each little thing I've done. I think everyone contributing to open source should be very proud because it's great. So I wanted a place where in only one place I could just show my contributions or the contributions of any person to open source. So yeah, I created it and yeah, it's very simple. It shows for a user, for example this is Vicent. It shows all the repositories in GitHub to which this person has contributed and how much. That's pretty much it. It's very simple and very small. From a technology point of view, just for if you are curious, it uses Sinatra and Ruby, GitHub API. It also uses the GitHub hooks. So any change there in the repo gets sent to the application to update the numbers and everything. It uses CouchDB to store the data locally and it's MapReduce views because basically the idea is that in GitHub API for each repo you can get a list of contributions. The idea is just simply take this data and turn it upside down. So for each user you want to know all the repos he has contributed and yeah, that's it. Open source as you can see there. So yeah, it's there in GitHub. You can have a look. You can help. And actually, tomorrow probably I would be working in a couple of issues and if you are curious about it or want to help, look for me and I'll show you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you.