Hello, and thank you for joining us and watching the short preview of the blended learning essentials course for vocational education and training My name is Maron Deepwell. I'm the chief executive of the Association for Learning Technology But I'm here today representing the consortium that put together the course and delivers this course this year Now I'm going to show you a preview of the course tell you a little bit what the course is about how you can participate And what we hope you will get out of the course Now as I mentioned, I'm here representing a consortium Who has delivered this course? That's far too a lot of people, but we'll start with giving you a bit of an overview of who this course is for so We are aiming this course at anyone who is working in further education, skills, training, vocational education, workplace Learning, lifelong learning or adult education and this course is freely delivered online on a future-learn platform And is designed to help you understand the benefits of blended learning and how to make more effective use of technology to support your learners We are running this course preview to give you a chance to connect and sign up for the next run of the course So there's two parts to the course The first one is called blended learning essentials getting started and the next run starts on the 4th of July And also blended learning essentials embedding practice part two of the course starts on the 3rd of October If you're joining the session live, you can ask questions on Twitter or also on the YouTube page using the hashtags FLBLE1 or FLBLE2 At the end of the video we're going to repeat this information So hopefully it will spark your interest and you'll sign up and join the course Now as I mentioned, the consortium I represent leads and funds this course It's funded by the UFI Charitable Trust And is delivered by a consortium led by Diana Laurelard and Neil Morris from the UCL Institute of Education and the University of Leeds respectively But we also have a lot of other partners As mentioned, I'm from the Association for Learning Technology and a number of colleges and other associations are also involved in delivering the course One of the things that makes a real difference with this course is that all of the content and case studies, all of the videos were filmed and produced with and at providers who work across the sector So that it's specifically for your context that you're working in and delivering learning in Now first up before we go and have a look at the actual course and how to participate I'm going to give you a short overview of the contents of the course As I mentioned, it has two parts, part one getting started and part two embedding practice The course aims for part one are to use a range of effective blended learning practices and pedagogies to improve your learners experience and detainment Second, to understand how many free and affordable technologies now available can enhance teaching and learning And finally, to approach new technologies with confidence, designing a pedagogic approach to make the best use of these tools And indeed, as you will find when you participate in the course, most of the tools and technologies that we're looking at and we're showing you how to use are openly available Now part two of the course looks at embedding practice So the course aims here are to integrate new technology into courses and learning and training opportunities To propose ways in which new technologies can help to address the key challenges in the vocational education and training sector Looking at technology as a solution Something that is a problem in itself And finally, to develop your own skills further and to contribute to the sector's community knowledge of the optimal blended learning Now to go a little bit into more depth into part one getting started You can see on the screen an overview of the five weeks And for each week, there is a specific topic and a number of activities It's a very interactive course At the end of the video, we're going to look at how you're going to be able to participate But I just want to highlight a few of the topics for the different weeks So week one really starts at the beginning Posing the question, why should we focus on blended learning? Week two, we're looking at preparing for blended learning So that's where we look at some of the principles of blended learning Assessing one's readiness to get started And looking at case studies of effective blended learning in practice In week three, so that's the middle of the first part of the course We're getting to grips with systems, tools and resources Whether that's a virtual learning environment, a VLE or online tools or open educational resources They're all covered in week three Week four focuses on designing blended learning We're looking at the design process, including assessment and feedback And also flipping the learning in the classroom Finally, week five, the last week of this part of the course We're thinking about teaching for your learner's futures Really focusing on developing learner's digital literacy And improving access to learning But also providing flexibility and inclusion Part two of the course then looks at embedding this practice more deeply Again, each week has a separate topic, a number of activities And as well, lots of things to get involved in So week one, we're looking at learning from experience Technology doesn't always go right, particularly not first time So we're looking at lessons we can learn from our experiences Building new activities to test with learners, provide feedback And improving learning outcomes In week two, we're asking the question What can technology do for the most difficult challenges? That's reaching more learners more flexibly Looking at delivery across an institution, whether that's training, college or adult learning We're thinking about supporting independent learning And reducing the costs of innovation Finally, in week three, we're looking into the future And planning for a challenging future So that involves matching your innovation to the needs of your organisation Supporting your colleagues in increasing their use of blended learning And working collaboratively to keep improving I also want to talk a little bit about why we as a consortium think Blended learning essential is important And on the screen now, you can see a few statements, inspiration So if you're looking at introducing this course as a way to provide free and flexible CPD Within your organisation or for yourself You might find inspiration here You might also be able to share the screen with your line managers Or other senior management within your organisation But for example, one of the lead educators, Diana Laurelard Says that it could be a real boost for innovation in the sector Because the course supports teachers and trainers in learning together About blended learning as they experience it themselves One of the other lead educators, Neil Morris Says that this project and the freely available open courses Are hugely important for teachers and trainers To help them make most effective use of digital technologies To improve their learner's success And the trust who funds all these courses Wants to catalyze change in the vocational world And engaging the professionals who deliver the teaching Is a fundamental step in achieving this And we hope that you will find that these courses play a role In helping you, for example, with challenges like This technology, which plays a role in the area-based reviews But also reviewing where your institution is And what the organisation is in terms of digital literacy Increasingly essential for teachers, trainers, managers, directors and governors But also supporting colleagues and yourself Developing the kinds of skills that you need to deliver effective blended learning Now over 30,000 individuals have registered for these courses And here is a preview of what they look like When you actually sign up and get into it So these are some screenshots of videos That are part of the course one week in embedding practice And you can see that both learners and teachers From across different parts of the sector Have contributed to these videos that were all shot In these kinds of authentic As well as a range of videos There's also a lot of activities to go along with it This is an example of an activity Or going beyond reflection to data And that's an activity where you consider the use of data And helping us design effective blended learning As well as a lot of videos, there's a lot of other types of resources Including a lot of reading material, a wiki, a grocery And also ways like quizzes and tests To help you test how much you've understood of any given topic So this is an example question of a quiz Where you can then get feedback on what the correct answer is And why from one of our lead educators And there's a range of other types of activities If this is the first time that you are participating In an online course, don't worry There's a lot of guidance out there and on the website And within the course on how to participate But you'll also be able to really expand your horizons In terms of reading materials and finding resources Very practical tools that you can use straight away In your learning context Each week, as you can see on the screen now Has a very clear structure And you'll be able to watch welcome videos That guide you through the week, read summaries But also importantly, comments and discussion With other participants And as I mentioned before, all of the case studies were filmed By teachers and trainers across the sector In the context that they're delivering the blended learning in So for example, this particular video shows How you can use digital technology to change teaching learning And this is an example, including learners That gives you a very hands-on idea Of how one particular practitioner translates that into practice There's also a number of tools like this one For example, Padlet that we're using throughout the course Not just to demonstrate how you can use it in learning But also for you to actually engage in the course And a lot of these tools are openly available and free to use So you can get started to experiment straight away The course can be a really helpful, safe space In which to experiment, try out different things And not have to worry what happens when things go wrong You can also share some feedback with colleagues Or other course participants who've tried to use the same tool Now, you might also want to know Not just what the course is about, but what it's like to participate So the next part of the session is going to look at How you participate in the course To begin with, you will be able to sign up for the course online On the Future Learn website And the course will then appear under an area on the website Called My Courses You can complete a profile and interact with other participants As much as you want And we recommend that the time commitment for this course Is about four hours per week But it is flexible and the course content remains live After the course ends I think what we found with the participants That have already completed previous runs of the course Is that some weeks you might have more time to devote To the course than on others And that the course content remains available to you Even after the week is passed Means that you can catch up or go back to things And look up things at any point after the course ends There's also a lot of resources to help you Get to grips with learning online yourself It is definitely a challenge to learn about How to deliver blended learning online If you're not a very confident online learner Or indeed if this is the first open online course That you're experiencing So there is help materials on the Future Learn website And also within the course Helping you prepare to learn Giving you tips on how to listen and reflect Assimilating what you learn And then putting it into your practice context Ideas about making notes For example summarizing key points Forming your ideas and questions And also importantly How to communicate with others on the course Whether that's about sharing your understanding Or questions Also participating in some of the live Q&A sessions There are a range of resources available on the course They're very easy to access and easy to understand That includes videos, audio and articles You can review these items on your own time And follow up by short quizzes To help cement your knowledge The discussion with other participants is a key part And a very unique feature of this course Together practitioners from across different job roles From across the sector to all help talk about the same topics And it's a great way also to build your own learning network We mentioned the quizzes They're not scored and you have unlimited attempts to complete them So you'll get some hints and feedback along the way And there's also tests and assignments At the end of the session We're going to look at some of the pathways to accreditation If you're interested in getting formal accreditation for the course But one element of the course that I haven't touched on thus far Is the digital champions So these courses are supported by dedicated digital champions Who are practitioners from across the sector And they help you connect teaching and learning professionals Who understand the practical everyday challenges Of using blended learning in your particular context Currently have about 50, 70 digital champions Who are actively involved in running the courses And they participate in the course as participants They help facilitate discussion They also help answer any questions that you may have Point you to resources you may have not discovered And they also share on a more informal basis Than the course content can Their own experiences, own tips for tools And any hints that they might have come across that might find useful And they're a really key part of keeping this course As interactive as possible Now I mentioned there are a number of pathways to accreditation And I think one of the challenges given this course Is for such a broad audience Is to provide meaningful pathways to accreditation For every participant So the approach that we have taken as a consortium Is to provide different type of pathways For different types of accreditation options First and available to all participants Are future loan statements of participation These can be purchased via the future loan websites At the end of the course And there are a new standalone way of getting credit For having taken part in completing in the course You can also get pathways to accreditation Via professional bodies So the association that I represent is one of those But also the Society for Education and Training For example we have mapped this course To accreditation frameworks including the ALT C-mold framework And QTLS framework And also there's paths to accreditation for further study So whether that's why one of our partner organizations Like the UCL Institute for Education Or the University of Leeds There is a number of different options available And not to forget the course is also CPD certified So within the course information And on the course home pages You'll be able to see how many hours of CPD Are accredited for each part of the course And completing the course And how that relates to your CPD requirement We hope very much that this will give you a range Of options to go on And use this course as a building block For future accreditation options But also if you just want to dip in and out And use the course as it really fits within your context Make it more flexible, maybe be very active in one week And just audit or have a look at some of the others This course is really here to fit around your requirements And meet your needs And whether those involve formal accreditation or not The course should still be able to meet your requirements Now we're nearly at the end of our session And I hope you've enjoyed this little preview of the course And now it's time to sign up We hope you join us and a growing community Of 30,000 registered participants As I mentioned in the beginning Part 1 starts on the 4th of July So time to register now And if you have any questions Or would like to join into the conversation now You can do that via the YouTube comments Or on Twitter Using the hashtag at FLBLE1 If you want to sign up for the whole run of the course Part 2 is already open for registration And will start on the 3rd of October Both courses together bring you all the course content That we've just had a preview of But as I mentioned it's a flexible course You can dip in and out, you can sign up for both And then review content of the course When you need to even after the course has ended On behalf of my colleagues Across the consortium of partners Who have designed and are delivering these courses I'd like to thank you for joining us For this session today


Effective border security is an essential part of combating transnational crime. Interpol's border management program contributes an important layer of security at each stage of passenger travel. In 2018 Interpol coordinated an average of one border operation each week, mainly in countries which do not have the capabilities to search millions of passenger records and travel documents against Interpol databases. These operations discovered dozens of international fugitives, terrorists and other serious criminals who would otherwise never have been identified. They also highlighted the vulnerabilities which exist when countries do not use Interpol databases to systematically screen all passengers and documents during border controls. Every second around 200 searches are conducted against Interpol databases. Last year alone our databases were searched some 5.4 billion times, resulting in more than 1.1 million hits against records. Information gathered during the booking, check-in and border control when leaving or entering a country can be quickly checked against Interpol's databases in order to identify wanted individuals and suspected goods.


What is going on guys welcome back to the channel and I appreciate you being here. Today I am back with another Destiny 2 video and today I'm going to cover some newly dropped info on exotic master works and how these things are going to work and how they are going to be found and they sound absolutely cool as heck but before we go any further guys if you do enjoy the video leave a like at the end truly helps me and my channel out and I do appreciate that support. Okay so watching the latest PlayStation access video they speak of five things coming to Warmind that video can be found linked within the video description if you do want to check it out. They speak of their time at the community summit at the Bungie Studios in Seattle and how they heard Bungie talk about exotic master works and how these things will work as well as how they are obtained. So firstly they talk about the examples Bungie put forward to how these exotic master works will work. They speak of the vigilance wing exotic master work version being full auto. Damn is that how you are dropping it Bungie sounds mean as heck for sure. They then speak of the crimson and the exotic master work version having max range. Wow so these master works don't seem to be working the same way the Legendary variants do. These ones are game changers now the way these are found are even extra special. They've mentioned Bungie talking about wanting to bring back mystery to the game much like how we had to work together as a community to solve the case of earning the outbreak crime. That kind of mystery that's what they want back. So the master works will drop in the world anywhere in the world but only from doing certain feats you won't be aware of. They speak of us coming together heads thinking together to work out how these are earned and it won't be easy. The exotic master works will only drop also if you already own that said exotic so that's pretty cool too and to think every exotic will have a master works version so that is a lot of figuring out so expect to find clues here and there as well as many other things the mystery awaits us people but guys it doesn't end there once you've actually figured out what to do to get an exotic master work you then have to find out how to unlock it. They said it's going to be a long tail for each master work which I do like the sound of so once you figure out the mystery in finding a master work you then have to do a certain set number of challenges I'm guessing to unlock and use that master work that is absolutely epic. Now to think a plan on making the vigilance wing full auto the crimson max out on range imagine the changes to other exotics in the game it's going to be nuts and I guess we will actually eventually be able to say exotics feel like actual exotics which is a great great thing and we haven't had many instances where we can actually say that. I look forward to earning these new additions in the Exotic Master Works come May 8th with Warmind DLC too so I think I'll have to quickly add a not long post in the video explaining all there is to know about the escalation protocol and the loot obtainable from it there is an armor set for each class as well as a number of weapons at the time of making that video I didn't actually know what the weapons were called but now I do the weapons are all called Ikelos but all bearing individual initials so the sniper rifle is called the Ikelos SR the hand cannon is called the Ikelos HC the shotgun is called the Ikelos SG and so forth you guys get the drift these weapons look incredible no matter the name and I cannot wait to start earning them as well as the armor sets which also look amazing and again I cannot wait to start grinding come May 8th because Destiny 2 has been far from a game I've been grinding lately it feels like absolute months since I've played it even though I played Iron Banner last week which is pretty cool too but it should be fun people it should be fun and on that note I am out if you guys enjoyed the video leaving a like truly helps me out if you are new around here and enjoy daily Destiny videos be sure to subscribe and hopefully people I will see you on that next one


Good morning. My name is as well. I'm also in the tropical immunology group and my thesis focuses on two cell responses to SARS-CoV-2 causative agent of COVID-19 and innovative assays for their measurement. And so in the context of viral infection, T cells play a number of important roles. For example, CD8 T cells can directly kill infected cells and CD4 T cells can provide help to arrange other immune cells. For example, that help these cells to produce antibody responses. And in the context of COVID, we know that these functions performed by T cells have an important role in protection against severe disease, as explained by Ali. And there's also some evidence to suggest that they can protect against infection, which is an area that I focused on in my first year. However, there are a number of questions that still remain about T cell responses in COVID-19. And this is partly due to the nature of the assays or techniques that we use to measure T cell responses. So various methods exist, but many are complex and resource intensive. And this means that they're difficult to apply at scale. And particularly, this means that T cells have been less well studied than antibody responses in COVID. So assays that are based on whole blood stimulation, skip out the steps and complexities associated with isolating and freezing and storing cells. So these might be more feasible to apply at scale than some standard assays. So one of the aims of my default is to develop a scalable whole blood T cell assay. And this is a target product profile highlighting some of the features that we would like this assay to have such as a low sample volume and low equipment and power requirements so that it could be deployed across a range of settings. So to run you through the pipeline for this T cell assay development, I'll start with literature review and analysis of some existing transcriptomics data as well as producing some of my own proteomics data to decide on a selection of candidate biomarkers, which might be indicative of T cell responses. I'll then compare the measurement of those biomarkers after whole blood stimulation to our reference standards in our laboratory, including any sport and flow cytometry techniques mentioned by Ali and Azana. And then once we've decided on a specific biomarker or set of biomarkers, I'll optimize features of the assay that mentioned previously such as sample volume, as well as reagent costs and processing steps. And then I'll validate the assay using samples from a larger cohort of healthcare workers vaccinated and infected with COVID-19.


Looks like everyone is here, so we will call to order the Green Mountain Care Board's March 22nd, 2023 board meeting this morning's meeting will be followed up by meeting this afternoon and this morning we are just. Discussing and potentially voting on the modification of UVM MC's fiscal year 2017. Enforcement action, and so I'll turn it over to Sarah Lindberg and Russ McCracken. Good morning. It is actually morning for once. I will ask probably Russ to take the lead here, but we, as a reminder, very briefly, this is an issue that we brought before you related to. The fiscal year 17 actuals being above the budgeted amounts, not for largely due to the utilization being higher than expected, and UVM wasn't the only facility to experience that. And so the. We'll let Russ get into all the details, so you don't have to hear it twice, but take it away. Russ, good morning. Can everybody hear me and see my screen? Great. And before I start, I will say, I think maybe this meeting was set up with a waiting room for outside folks. I've seen some admit things pop up. We have been admitting everybody. It is a public meeting. I don't, well, I think clean that up. Logistical thing in the future, but everybody who's who's come up in the waiting room has been admitted here. So, I'm going to start this is a bit of a recap and. There's not a lot of new information on these slides, but just to frame the discussion again for the board. The board met to consider this question on February 22nd at March 8th. We came before you with a staff recommendation to modify what the board did and with respect to F Y 17, which was an action taken by the board in April of 2018. Our staff recommendation was to revise that enforcement action to make the use of the remaining funds, which is approximately $18 million more flexible and addressing the current mental health needs. The staff recommendation was to order to develop a proposal and consultation with a Vermont Department of Health. Outlining the planned use of funds to address the mental health needs to come back with that proposal by May 31st. And the restriction would no longer be for only additional inpatient capacity would be for additional capacity for mental health services in the state, not limited to inpatient. I have some updates, slight updates on that proposal that I'll get to. We've had a public comment period open since February 22nd. We've received a lot of great public comments. I'll summarize those in a later slide. The Vermont Department of Mental Health is supportive of this change and broadening the proposal to broaden the restrictions on the use of funds, so that it's able to be deployed to increase mental health capacity without the inpatient limitation. Sarah reviewed this in more detail at the last meeting, but we had some follow up questions to the University of Vermont health network, which said that the funds have been maintained at unrestricted investments, which is included in their days cash on hand calculations for the hospital. Um, the returns that were provided by the health network. Uh, showed about a 21.2% cumulative return, which is about 4.1% annualized. And we also noted and discussed a little bit more. There's an inflation index if you look from April, 2018 to January, 2023 shows about a 20.1% inflation. Here, we've looked at this before, so I don't want to read through it again. This is the action that the board took in 2018. Provisionally allowing you to self restrict $21 million in surplus funds with the condition that those funds be used solely for investments that measurably increase in patient mental health capacity in Vermont. Um, the proposal we're looking at here is to modify that this by taking out the inpatient. Part of this cap of this use restriction. The order just as a reminder to the board also says that if the GMCB determines that insufficient progress has been made, it may order. The UBMC use all our portion of the $21 million to benefit rate payers through a commercial rate reduction. The finding that insufficient progress has been made is something the board did do over the summer of spring and summer of 2022. Following a presentation from a UBM health network that they were not able to move forward at the current time on the planned inpatient. Expand in inpatient psych project at CVMC. So, to date, or at least as of yesterday, when I put the slides together, the board has received 14 written public comments regarding the potential modification. Of the enforcement action, additionally, comment letter, letter from UBM health network was received. These, as I said, the last meeting, these are summaries and they don't do justice to the sort of breadth and the quality of the public comments that we've received. But the general themes were an urgent need for additional mental health services. Urgent need for additional inpatient capacity, including to address the issue of mental health patients being boarded in emergency departments. I need to prioritize inpatient beds, especially for children and adolescents. The continued disparity and reimbursements for mental health services versus other health care reimbursement amounts. Some value in providing flex, excuse me, the value of the flexibility in providing mental health services outside of an inpatient setting to reduce hospitalizations. And providing better options that are available 24, 7, then going to an emergency department. And then, important note at the end, the comment from the health care advocate during the last meeting to clarify what we intended in the motion language with the phrase in consultation with the image. And to include some required input from community members. So, the public comments received 7 really explicitly supported retaining the scope of the self restricted funds and 6 were more explicit about expanding the scope of the funds that in as the staff had proposed. So, what we're coming to you now with is a bit of an update on the staff recommendation, although kind of fundamentally, I think it's very much in line with what we had proposed before. It's to revise that why 17 enforcement action to make the use of funds. More flexible in addressing the current mental health needs by allowing the funds to be used to increase mental health capacity, not limited inpatient capacity. And then the 2nd part of this is to order UVM health network to develop a proposal that reflects and incorporates priorities from the Vermont Department of Mental Health. And contributions from community members identified by DMH, outlining the planned use of funds to address the mental health needs in Vermont. And for the board to determine that sufficient progress is being made on this, the proposal will need to be submitted to the board by May 31st. DMH will need to provide the board with confirmation that DMH is satisfied. The proposal adequately reflects its contributions and the proposal has to explain the impact on the issue of mental health patients being boarded in emergency departments. So a couple of additions in the staff recommendation and I put, we put together some motion language reflecting that staff recommendation for the board's consideration. And that was all I had prepared as a presentation to set this up again. Mr. Chair, so I will, unless Sarah wants to add anything, I will turn it back to you for board questions, comments. And discussion. Great. Thank you both. I'm just going to take a second to read the motion language before we open up to comment. Okay, great. Thank you both very much. I'll turn to board comment. If any board members have any questions or comments, please go ahead. We can start with Dr. Dr. Merman. Good morning. Thanks, Chair Foster. Thanks Russ for the presentation and Russ and Sarah for all the hard work and the team for all the hard work on this. I first want to continue to express all of our shared concerns about access to mental health treatment in Vermont, whether it be inpatient or outpatient. And all the other services related to the care of patients with struggling with mental health challenging conditions. This really needs to be improved. I do think this reconsideration of this prior budget enforcement action has brought a lot of these issues since in my short time on the board right to the top of the agenda. And I think it's been really, really helpful for this to have occurred to encourage all of the really helpful public comments that we have received. I think most of us read every single one of these and consider them very carefully. So I think this has been a really good thing to have occurred at this time to reinvigorate the conversation about challenges of capacity for mental health treatment of mental health conditions and access to inpatient care and access to outpatient care. And other services. You know, I've mentioned before as an emergency physician, you know, essentially at this point every clinical shift we we take care of patients who are being evaluated for mental health crises or are boarding in our departments awaiting treatment therapeutic treatment for a mental health crisis. And it's it's come to the point where at this point, I don't think very many, many of us feel at all surprised when somebody has been boarding in our departments for at least 48 hours. I mean that doesn't even seem shocking at this point. In fact, that's starting to seem like a reasonable amount of time for someone to await transfer to a treatment facility. And and actually we're getting to the point where sometimes weeks don't seem all that uncommon children waiting a week or two for an inpatient psychiatric bed in our departments. It doesn't feel nobody feels good about it and we all know that it's much harder on the patients than it is on us but it but watching it happen is is is really is really challenging and and tragic. And it just seems like it's the wrong the wrong way to care for these patients night and I think everybody in the state is in agreement with that every public comment. Every hospital. Nobody thinks this is the ideal way to care for these patients and the patients themselves are the ones that are they're most affected by this. And there's not clearly and I think the public comment speaks to this very eloquently there's not a single solution for each one of these scenarios. I mean from my perspective it's clear that more inpatient capacity would be beneficial because there's patients that just need need that level of service now an ideal world with improved outpatient treatment could we prevent those patients from having to come to the emergency department. And I think many yes but I don't I don't know if if at least in the near future. I do think we need more inpatient capacity the ED is just a really not a good place for these patients to to language it's not the solution. We don't have opportunities for therapy there's rare opportunities of any opportunities to see natural light sleep cycles are impossibly hard to maintain. There's other instances of dysregulated patients are very high acuity medical trauma patients that are near these patients there can be stress that's associated with those situations. It's just not the place to be waiting for treatment. It's not treatment. So as a new board member trying to understand and actually having not been through the hospital budget process yet trying to understand the subtle derivation of the normal process of of managing a hospital. Margin budget process with a margin or net patient revenue was over the allocated amount in 2017 has been a bit of a deep dive trying to understand what occurred. So looking back this appears to have been a very unique situation taken by the board as far as I can tell. There were no other circumstances when a similar situation occurred where the net patient revenue or margin levels were above the allocated amount and the money that that was not returned at least in a large part to commercial rate payers through a commercial rate reduction. So it appears to me that in 2017 as continues now there was a crisis and patients boarding in the emergency department awaiting mental health treatment and there seemed to be an opportunity and an appetite to try to rapidly improve this this crisis and it it's hard to tell. Looking through the presentations and the records what actually occurred but it seems to me to be reasonable that there was some communication between the board and and people at UVM. To that that there was a that there was potentially a solution that this could that this could work out quickly. And and I think that there was all the best intentions of this occurring as a rapid improvement to addressing the in patients mental health capacity challenges in Vermont. But it if this unexpectedly high margin was dealt with in the same manner as any other unexpectedly high margin was in 2017 and this money was returned to commercial rate payers in Vermont by a rate reduction. Well we would not be here today talking about this but it it also would have reduced the commercial. Rate reimbursement to UVM by approximately by twenty one million dollars in the subsequent year and a rate reduction of approximately 3% is what it looks like back then from looking through slides that it was about $7 million per percent at that time for UVM budget. And if that 3% rate reduction or twenty one million dollar rate reduction occurred in twenty eighteen. It may have actually continued through twenty nineteen twenty twenty twenty twenty one twenty twenty two. It continues because the rate would have been lowered and the and that rate would have been down and that that would have that's a large amount of money. Now that may not have been what happened. It's it's hard to to reinvent the past and predicted forward. The board could have said OK well UVM took a rate reduction coming into twenty seventeen because of twenty sixteenths performance. And so maybe the board wouldn't have thought that a whole 3% rate reduction was the appropriate amount. Maybe they would have been a one and a half percent rate reduction or maybe in twenty eighteen. UVM would have asked for a commercial rate increase from from what it would need in twenty eighteen plus what it needs in twenty seventeen. So it's not necessary that it would have been twenty one million dollars a year for each of the last five or six years. But but at the very least they're not having a commercial rate reduction in twenty seventeen for UVM was financially very good for UVM. Well financially good to very good for UVM depending on what would have occurred again. It's all hypothetical but it clearly was was better to take to try to figure out this solution for the hospital. And at the time it looks much better for Vermont to try to figure out the solution because we needed to deal rapidly with this mental health boarding crisis. Now we all know what has happened since then and that did not pan out. But that's my best understanding of what occurred then and what the potential the potential ramifications of this of this money work. Additionally there was this money that that Russ had described about the earnings associated with investing this twenty one million dollars. So the twenty one million dollars was appropriately put into the I believe the general funds at the Medical Center or the Health Network along with other money like funded depreciation. There is I think some things like endowment are put in there as well and this money is invested in that. That's the smart thing to do. And this money the twenty one million dollars has earned money at this point. And so to me it would seem that this approximately four million dollars that the twenty one million dollars has earned because it had not been used for the initial intent. And it had really not been used. I think with the intent was for this to be used fairly quickly although it wasn't really defined in the enforcement action. I think that four million dollars seems reasonable to me that that be added to this twenty one million dollars for use to improve mental health capacity whether inpatient or outpatient in Vermont. The other pot of money that I'm trying to understand what happened to is the three million dollars that was spent designing the new hospital complex and parking garage at CVMC. I think the intent was again the best intent for this to be used to increase mental health capacity. There was going to be some beds shifted from the current capacity at CVMC to this new facility and then some beds added to that. But unfortunately because of a twenty because of a net operating loss of approximately twenty million dollars a year this this project has been put on an indefinite hold. So you know strictly speaking with the language that says this should be used I think to I don't have in front of me measurably increase inpatient mental health capacity in Vermont. This three million dollars did not do that. So so I do I do think we should consider whether or not that three million dollars should be used for measurably improving mental health treatment capacity in Vermont. So again thank you very much Russ and Sarah I really do think this is an incredibly important topic for us to spend more time on. I really would look forward to speaking with DMH to understand our state's priorities on how to improve mental health treatment capacity and treatment in Vermont. I think this is a great opportunity to rethink about how to use this money in a an effective way and in a rapid way to try to to try to alleviate the problems. So look forward to hearing other people's comments. Thanks so much and back to you to our foster. Thank you Dr. Merman. Jessica Holmes Miss Holmes. Sure questions or comments. Thank you. I think I'll be I'm going to focus on the motion. But I actually you know I want to thank the team Russ and Sarah for thinking about this and putting together some you know motion language for us to consider and also like my colleague Dave. The I also want to thank the members of the public for taking the time to really submit some really thoughtful comments very very much appreciated again read all of them and really appreciate them very much. I would say that I support this motion with the language that's been suggested for increasing the flexibility. I really think it's important that the language says to increase capacity of mental health services. That's you know but giving the flexibility to not limit it to inpatient capacity but again still focused on increasing capacity. I think you know as as Dr. Merman just outlined we have we have a mental health crisis we have it today. We need to deploy these resources today. I think the deadline of May 31st seems reasonable so that a proposal must be submitted. We need to know where this money is going to go and how it's going to increase mental health services in the state with that flexibility added. It was good to hear and I appreciate that DMH is involved and supportive of this motion to increase the flexibility and that they will be involved in developing that proposal and incorporating DMH's priorities into that proposal and we will receive confirmation that DMH in fact is satisfied that was important to me and I'm glad to see it in the language here. Also you know I think important that that the proposal reflect communication from stakeholders you know that the public comment that we received was really helpful. One of the things I think we should do is submit you know in case that public comment was not read by the Department of Mental Health and UVM Health Network I think we should share that public comment with the folks that are developing this proposal. And to me I think that third bullet item is really important that the proposal include an analysis and explanation of how this investment of resources is going to impact the patients who are boarding in EDs. And I wonder actually given some of the public comment we received about adolescent borders in particular in the need for better treatment paths for our children and adolescents. I wonder whether my one minor thought as I'm looking at this language is whether we want to just specify that we want to understand how this proposal will impact mental health patients being boarded in EDs separately adults and children. So we understand if there's going to be an impact in reducing adolescent borders or is it just going to address adult borders. I think that would be helpful to understand. Given the priorities for getting treatments for particularly children and adolescents it would be helpful to understand that and hopefully however these dollars are allocated will alleviate some of that. The issue among children and adolescents. But again I for me the really important thing is we're not the experts DMH is the are the experts here with a full view of the system and how best to create impact with these dollars. So to me that was a really important component of this motion so I support the motion and I appreciate all the hard work that's been done here. Great. Thank you very much. Member Holmes. Member Walsh. Sure. Thank you chair. Thank you Sarah. Thank you Russ. Thank you Jess. And thank you Dave. I really appreciated your thorough walk through the dollars and the three million that it seems hard to say that that went toward mental health care and the four million earned in interest. I think those are really key points that I'd like to come back to. In regards to the motion here I think it's an improvement from what we saw a couple weeks ago. I'm not quite there yet to go with it the way that it is worded. I read I've reread every one of the public comments last night and this morning. You know and I think Russ did a nice job saying that we can't summarize them in a slide. Right there. They're profound. I think we we say that seven were in favor of keeping the focus on inpatient care. Six supporting you know widening the scope. But you know one of the one of the letters was from the emergency department directors across the state. I think that was 11 people. They described our current situation. These are their words as inhumane and unethical and Dr. Merman does a nice job. But in an emergency departments calm emergency department doctors calm demeanor. Right describing kids being kept inside unable to go outdoors for weeks. If you were not in a severe mental health crisis when you came in you would be in one by the end of that time. Any one of us this situation has languished. It was discussed in 2017. It's only worse now. The suffering is worse. The situation as a whole is worse. Another another item from that letter. 30 patients in boarding in the E.D. for a day or more. On any given day there are 30 patients in Vermont. Who are in an emergency department for at least 24 hours. Sometimes weeks. For every 24 hours that one of those patients in the emergency department. Six concerns have been raised. in the emergency department, six non six patients without mental health disorders are diverted. So the simple math would be that at least 180 patients a day are diverted, but but that's inaccurate. That number is way too low because some of those 30 patients have been there for multiple days or weeks. And this figure from Dr. Smith and colleagues is that for every 24 hours, one person is in the ED six are diverted. So this isn't a problem that's only affecting people who are suffering from mental health issue. This is a public safety issue. Our emergency departments are clogged. So I don't know how to create more urgency around this other than saying words like inhumane and unethical and public health emergency. We've been told there's been a lack of action because this is doing something about this would not be profitable. I don't know if that's true. But as an excuse, it falls woefully short of the mission of a nonprofit system. The part about this motion that I appreciate the most is the proposal to include analysis and explanation of how the proposal will impact the issue of mental health patients. I could imagine extending that to say that it would need to include an assessment of inpatient capacity need. The best evidence that I could find two weeks ago was that we need a few more beds. Not a lot, but a few. And because they're deemed not profitable, I worry they will never be made. So I think we need to keep some focus in our language on assessing what the need is and right sizing our capacity. We have some measures of. Boarding doctor Smith and colleagues advocated for having ongoing assessment of boarding numbers, quote unquote. I think we should add that to this motion. And I'd suggest wording like this to the third bullet that there is work in consultation with the emergency department directors to develop a parsimonious set of boarding measures that includes, but is not limited to the number of patients boarding for more than 24 hours, more than 36, more than five days. And that we stratify that by gender, the proportion male female by race and ethnicity is very much likely an equity issue under scoring all of this as well. And the age distribution and average, and that those numbers be updated weekly and provided to us. And we post them on our website. If we can do that, I can support the motion. The way that it's written right now, I can't.  Thank you very much. Member lunch. Thank you. And I echo everyone else's thanks to the staff and the public and my colleagues. I just wanted to say one thing in response to Dave's sort of summary. I would say I would use the term. I'm not sure I would use the term quickly that there is an expectation that inpatient capacity could be expanded quickly because of course anything that involves construction quickly might be three to five years, which is not, I think, quick in most people's time frame. So I would just caveat sort of that with at least my own personal expectation on the timeframe for increase in inpatient capacity. Most of my questions are actually for our legal team and involve legal advice. So I think once chair Foster once everyone has finished their questions, I would like to make a motion to go into executive session for legal advice. I can do that now. But if you'd prefer to ask your questions, happy to wait. I think I'll make my comments and questions because they may be relevant as well to any potential legal advice. And then the other question I have for you member lunges, would you prefer that if the motion carries for executive session for the purposes of obtaining legal advice that it come after the HCA in public comment or before? I don't have a preference. So I'm happy to do it after so that we can have the full information that might be best. I think that's my inclination. So we'll do that. Okay. Did you have any other questions or comments or just the executive session? Just the executive session. Thank you. Great. Great. Thank you. All right. So I don't have a whole lot beyond what my fellow colleagues said. The one thing I wanted to note was that back in 2017, this was a crisis and it's today a crisis as we all know, and it's likely a much worse crisis. So, you know, the board took opportunity to create a solution to a problem and that took some boldness and it was a good idea. It was a huge problem and there was a creative solution that the board took. And if it had come to be, it would have been a huge positive for all the points that Dr. Merman made. It would have helped patients get the right care in the right setting. It would have helped ED doctors, staff, nurses who are dealing with a huge number of borders. It would have helped the hospitals with their costs. It would have helped for monitors with the cost of affording health care. So had it come to be, I think it would have been a huge, huge, huge benefit to the state. And so I'm glad that the board took that opportunity to try and come up with a solution to a very important problem. Unfortunately, it didn't come to pass. And the proposal that UVM put together wasn't financially feasible. And then, of course, we had a pandemic and now we have hospitals with severe financial challenges. The board and UVM or nobody could have predicted all of those confluence of things happening. To Dr. Merman's point about the $3 million being used for improving, measurably improving mental health capacity, I don't think it's clear that that $3 million was. It was never built. So, of course, it didn't help in that regard. And then second, we pulled or received in response to requests of ours some of the documents relating to the architectural planning. And I want to just share one or two of those and raise a question about them. In UVM's letter, it didn't explain or identify that some of this money may have been used $3 million for things other than strictly inpatient mental health. And so I wanted to raise the question if anyone knew the answer, perhaps someone from UVM is on so that we have a better, clearer understanding. Mr. McCracken, do you have that document 3A? Could you share that? Yes, hold on a minute. And if possible, blow up project scope. So this document is the UVM Health Network CVMC EDE4H fee proposal that was executed. The date is June 18, 2019. And the project scope here indicates that CVMC wished to construct 107,000 square feet of new building to house a new 40 bed inpatient psychiatric hospital and relocate replace the emergency department in new construction. The new building will be three stories plus mechanical space in the basement level and rooftop. The building will be designed to accommodate three additional floors of medical, surgical, inpatient nursing units in the future. There's additional option being considered for based on space for the emergency department. It's anticipated that the new building will connect to the existing hospital on the ground floor and first floor levels only. The inpatient psychiatric hospital requires secure exterior space for patients. And so from the project scope from this document at least, it looks as though it wasn't strictly relating to inpatient psych. It looks like it included some work to the ED that maybe was desirable or maybe was needed to do the inpatient psych. The second document, Russ, is the PIC project workbook. And here we see the total cost for the project. According to this document of 157,786,167 dollars. And if you go to the medical equipment page, and you just scroll down to the bottom of that page, you see that there's equipment for OBGYN, Covery, all sorts of equipment that I'm not sure would relate specifically to inpatient psych. And Russ, if you go to the design drawings, the CVMC SD drawings, selected pages. Is that sharing? Oh, great. Thank you. And you can just scroll down from my review of this. It looks, again, to be quite broader than inpatient psych. It's quite an extensive building. So the 157 million dollar estimate to my eye based on these documents appears to be quite a bit broader than inpatient psych, which potentially I don't know the answer because I wasn't here, but was one of the reasons why it wasn't affordable. And if anyone knows the answer, I'd be curious what it is, whether or not that 3 million that was spent was just for inpatient psych development, or if that included some of the work that related to some of these other things that are depicted in these documents. I can speak to it at a pretty high level. So this was understood that the project was more expansive than inpatient psych, specifically part of that has to do with the complexities of reimbursement as governed by the IMD, which is connected with capacity at the hospital at large. Some of it had to do with stakeholder input about how to kind of make this all work in a cohesive way. And so, you know, I think that that was kind of part of the vision there. And just to be clear, I've never heard that the construction cost was the prohibitive part. It was the ongoing operating loss that was prohibited given their financial change in status. The $21 million that Dr. Berman referenced. That was the estimate at the time. I do believe that, you know, given the precedent that particularly our Medicaid program has set in its work in expanding beds at the Brattleboro Retreat, that's probably, you know, could be navigated in partnership with them, potentially. But that is, you know, the cost that was cited as prohibitive, not the construction cost per se. Great. So in any event, some certain was $21 million and it didn't come to be. And that's where we are. And we have an order from 2017 that is our guiding document in terms of how the board can address this issue today. So I have no other comments other than I would support Member Walsh's addition to the potential motion. I think getting the information to understand what the boarding situation is is only beneficial. I don't know if it's particularly burdensome, but I think it would be beneficial. I support the need for that data. Sorry to interrupt, Chair Foster. I just don't know that it's appropriate places in an enforcement action for one hospital if we're asking from data across the system. That just seems a little tricky from where I'm sitting. Oh, and I'm sorry. It wasn't clear to me actually if the suggestion was across the system or just at UVM. Across the system. Great. I have nothing else unless any other board members have any other questions or comments. Can I make a comment regarding Member Walsh's suggested motion language, including the demographic data? If we were to do this, I think we should just be very careful about the specifics of the demographic data being reported on a public website. There are You could potentially have identifiable people. So I think we just want to be very mindful that it would need to be vague enough to not potentially identify specific individuals. Understood. It's a good concern. Could I ask a follow up question as well? Sarah, do you happen to know what DMH is already collecting on this issue? I do have that in the back of my mind. I know there's some robust information that they do have. I don't know specifically on boarding. I'm happy to follow up on that. I think it's really important to understand that. And again, just welcome their expertise on what might be missing and if there's anything we can leverage to get more if it's helpful. Yeah, it appeared to me that there is some data because the physicians in their letter cited 30 patients of at least 24 hours. But acknowledge that some are considerably longer. So I think that one data point isn't sufficient. But there seem to be numbers somewhere and it's a statewide concern. I understand that putting the onus on one facility may not appear to be fair. But it's a public health crisis. We should find ways to work together. I just don't know that we even need that mechanism to do that. You know what I'm saying? I'm not sure, but I'm open, right? It's I'm open to learning more and it's the suggested language was in consultation with the emergency department directors, DMH and UVM and have that part of the reporting requirement and have that operational by the end of May. The numbers don't have to be created. They're there. It's pulling them together. Any other member comments or questions? Great. Okay, I'll turn to the health care advocate. Morning, Jeff Oster. Morning, everyone. Thank you for the really high quality conversation discussion this morning. The HCA supportive of the revised or amended language that was presented and thanks, Sarah and Russ for all the work and incorporating a lot of really high quality feedback, I think for members of the public. I think that's reflected in the motion. And we also support member Walsh, your proposal. I think any kind of stratified system level analysis is going to be valuable here, particularly for assessing health equity. And we also second member Merman's concern around doing this in a really sensitive way. It's responsive to me. A lot of this information is identifiable and sensitive, particularly when you look at race ethnicity. And so I think that there is a way to do this in a thoughtful way. I'm not sure if that's I defer to legal about how to incorporate that into a motion that is not my expertise. But I think the intent and the quality of discussion is in a really good direction. So we're supportive of it. Thank you. Thank you. And I'll open up to public comment via the raise your hand function. Mr. Hoffman. Good morning. Go ahead. Good morning. First, I think the public would thank the board for taking the level of detail and granularity in its analysis of this urgent crisis in a way that to this day has been remiss. The fact that this sat year after year without any type of persistent follow up. It should be memorialized that this won't again occur, particularly in matters of urgent public health crisis. It's very likely that in the last number of years, actual lives were lost because this crisis wasn't attended to individuals who sat for days and weeks in E.R.'s ended up going on to take their lives as a result of not receiving the caroling. I can recall in 2018 sitting in a board meeting with LaMoyle health partners, rather 2019, I was about to leave the organization to return to my home state of Pennsylvania, and telling them excitedly about the news I was reading that there was going to be an imminent building of an inpatient facility, and that we wouldn't have to run across the street to Copley to try and de-escalate somebody who is dramatically decompensating and worrying that after they had been given some benadryl to calm them down and shipped out in a couple days that they wouldn't be found dead somewhere in our community. Since then, many folks that I worked with tragically have expired in that area. Vermont is a uniquely heavily regulated state, and this is the model your constituents through their legislators have chosen for years now, and it's incumbent on you all to make it work. If this were a private sector paradigm, you all would essentially be the board of trustees, and in this situation, UVMHN with 21 million on their books would be directed to invest, reinvest those funds in a project, and you would be following up quarterly to see what the progress was that was made on that. And while that money was sitting in an interest-bearing account, you would be monitoring that it was earning its best return possible with the lowest amount of risk. I would suggest that the motion as it stands contains no language around what becomes of the earned interest, nor does the motion address what becomes of the 3 million that was not exactly invested as the spirit and letter of the statute required. So I think that when you all go into executive session, it would be wise to discuss if and how that language should be added. And then a final point that it was incumbent on this group when they said our plan is not feasible to come back and say, what is feasible? No CEO would approach its board of directors and say, sorry, it doesn't work. And then the board of directors says, I guess that's too bad. It won't work out. No, you push back and you say, okay, let's get back at the table. We need 36 beds in this state. How are we going to figure out to get 36 beds as quickly as possible? If Elon Musk can build a million square foot factory in 18 months, can we build a 100,000 square foot stopgap boarding facility inpatient facility to get these people the care they need quickly? How do we do that most quickly and urgently? And that just wasn't there. And it needs to be. And this can't be five years from now, we're finally going to have those beds that I was telling people in LaMoya County that we would eventually have. This needs to be how are we going to get there in the next 24 months to solve this crisis before we lose however many more dozens of people to suicide? Thank you. Thank you very much for your comment. Mr. Dave Ham Davis, good morning. How are you? Please go ahead. Thank you. The the I think that it's been a huge the nature of this problem has been laid out an enormous detail. Many times I had a transcript made of one of your one of your recent meetings that was 15 pages single space. And so the thing I the thing that I think needs to be addressed and I don't hear from anybody really that everybody everybody recognizes the problem is really huge here. But the question really is is is where's the money going to come from to support the where's the money going to come from to support the operations of these inpatient beds? And unless you have that, okay, then you really don't have anything irrespective of how much you belabor the problem of well, it's terrible for these people to be waiting.  It's the worst thing ever. It's illegal. It's immoral, etc. Somebody is needs going to have that the job here is going to be is going to be to find the money to make the operation work. And I think it's the only way to get that to do that is to get it through UVM. The reality is that they got the one bid you've had for actually doing something came from Bennington that they obviously just that's not obviously just not going to work. And so anyway, I just think that the as regulators that they that's the job you need to be looking at. Thank you. Thank you for your comment. Any other public comment? Mr. Davis, your hand appears raised, but I think it was just left out. I'm sorry, Mr. Chairman. I'm challenged. No, no, so am I. Thank you. Thank you. Sorry. I just want to make sure if you had another one, you got the opportunity. Great. Member Lange, if you have a motion. I do. I actually have to. The first motion is that I move that we find that premature general public knowledge regarding legal advice of our council about the board's hospital budget enforcement authority in this action would clearly place the board at a substantial disadvantage in any appeal or other challenge that arose out of our decision. So that's a motion that we have a finding, which is a requirement under the Public Records Act for executive session is that there's a finding that premature general knowledge regarding the matter would put us at a disadvantage. Open meeting on right. Yes, thank you. Thank you, Sarah. I second the motion and I would ask if there's a vote that Mr. McCracken take the vote. Is there discussion or are you ready for a vote? Do any board members have any discussion on Miss Lange's motion? No discussion, Mr. McCracken. Okay, so I'll take a roll called vote. Board member Holmes. Yes. Board member Merman. Yes. Board member Lange. Yes. Board member Walsh. Yes. And Chair Foster. Yes. Okay, so the second motion then is that I would move that we enter into executive session to consider confidential attorney client communications regarding the board's enforcement authority for hospital budgets under the provisions of Title I, Section 313A1F of Vermont Statute attendance at the executive session would be board members, the board's legal team executive director and staff working on the hospital budgets. I second the motion. Is there any discussion of the motion? Hearing none, Mr. McCracken, would you take the vote? Yep. Board member Holmes. Yes. Board member Lange. Yes. Board member Merman. Yes. Board member Walsh. Yes. And Chair Foster. Yes. So typically I'm not sure if we've done this with everyone yet. So I would just say that typically what happens is that the board members and staff will exit this meeting and we have an executive session calendar invite that we will use for the executive session. And then we usually try to give an estimate of when we might reconvene for the general public, which is a little bit tricky, but I would say probably 10 to 15 minutes would be my estimate, rest of you. What do you think? Yeah, it's always a little bit hard to gauge the scope of the executive session is narrow and limited to what was covered in the motion. Hopefully 15 minutes would be sufficient. Okay, it's 1130 so we can reconvene the hearing and thanks for your patience and many thanks to Russ for handling a number of naughty legal questions quite deftly. Thanks very much, Russ. We're lucky to have your guidance on these issues. So we've obtained some legal advice and Russ, if you could pull up the motion language, I think that would be helpful. And prior to the break, there had been some discussion about potential additions to this language or modifications. If any members have any additions or modifications they'd like to make, please, please go ahead. This is this is Tom. I'd like to to amend the third bullet slightly to include analysis and explanation of how the proposal will affect in patient capacity in patient care for patients with mental health concerns and will impact the issue of mental health patients or patients with mental health concerns being boarded in EDs. And the fourth bullet that I spoke about earlier would be to work in consultation with the Department of Mental Health and ED directors to develop a set of boarding measures as recommended by the ED directors in their public comment. And that include but not be limited to the number of patients boarding longer than 24 hours, longer than 36, and longer than five days. And the analysis to include the gender distribution, race, ethnicity distribution, the age distribution and mean and that these be reported to the board weekly and that whatever we can display publicly, we do. And just for process, what we'll do, I think, because this will take a little drafting, we'll receive any suggestions from members and we can work on the drafting prior to an actual vote, but we can get it drafted before we so we all can see and read it and then have a vote later. And I think what I'll do is I'll put this meeting into recess after any suggestions from members and we'll reconvene this meeting at one o'clock in connection right before our next meeting. Thank you, Member Walsh. Do you have any other suggestions or do the other members? I would just throw out an alternative to the amendment made by Member Walsh just for contemplation. The saying what's currently written, the proposal must include an analysis showing that the investment will reduce the frequency and length of time, adults, adolescents and children experiencing mental health episodes are boarded in EDs in Vermont. So that's just another way to think about it. I think thank you, Jess. That's an improvement over what I'd said. The one piece that I was trying to loop in that I did not hear was the effect on inpatient capacity. I remain concerned that without some directive and follow through the evidence that I reviewed suggest we are under capacity slightly and we do not have a history. The state does not have a history of addressing that. I don't want to lose sight of that. The evidence telling us there's a need for more beds. So I would like something worked in about that. Can I offer a comment on that? Robin pointed out that it does take three to five years often for construction projects and health care. So the rapidly getting inpatient capacity out of this is likely unlikely. That said, I mean, definitely during COVID, we really saw how health care facilities can be repurposed really rapidly. And so I think actually maybe the initial intent was to try to repurpose a facility as opposed to build a facility. That is a possibility. My hesitancy in including inpatient capacity at this time and this redetermination of the enforcement is that I feel that and I agree with you, Tom, that there probably is a need for more inpatient capacity. But if but I wouldn't want it to delay other projects that could decrease e-boarding and improve access to care for patients who need mental health treatment. So I don't know if this is the appropriate time to sort of discuss the subtleties of these, but I guess in my in my view, I think that having flexibility for DMH and the community partners and UVM health network who are are more directly represented from the network who are more directly attuned to these subtleties and what can happen quickly and what can happen effectively, maybe better than to prescribe inpatient capacity at this time. Yeah. Thanks, Dave. I tried with my my wording. I'm not very artful, but I tried that it's an assessment of the need for capacity that we have in the proposal so that we're not losing sight of it. Not that they're proposing an inpatient facility. Sorry. Sorry, I miss and miss the the assessment word on that and not rewarding. I apologize. Thanks. I have one addition which would be and when it would be that these funds on a prospective basis be held in an interest bearing account and that any proceeds from such interest should be applied toward the purpose of the amendment, which is to increase mental health capacity. And I can I can help with some clear language, but ultimately my intent is that if this project doesn't happen for two years or three years or four years that the money is held in a low risk interest bearing account so that it grows in the future. Do any other members have any other suggestions? Great. OK. I'll put this meeting in recess and we'll take it back up at 1 PM. Oh, sorry.  Thank you. I just wanted to clarify and make sure that the public knows that we will start the meeting at 1 PM. As you said, Mr. Chair, using the will the public will use the link that's available on the press release. And because we have two invitations going, my concern is if we're putting this meeting in recess, recess, folks might pop onto this meeting. What we'll do to make sure that we don't lose anyone is we'll monitor this meeting at 1 o'clock. But for board members, please use your 1 PM invitation. Thank you.


A film in three minutes. Strange days. If you could re-experience your most precious memories, what would they be? Perhaps your first kiss? Or the day you proposed? Or maybe the birth of your child? Now what if you lived in a future where you could also relive other people's memories, such as their first robbery, or first assault, or first murder? Would you flee at the thought of knowing what they felt like? Or would the temptation to stare into this dark, cerebral abyss be too great? Because in the world of Catherine Bigelow's 1995 sci-fi thriller Strange Days, such possibilities can become reality. Set in a dystopian version of Los Angeles at the turn of the century, the story follows Lenny Nero, a former LAPD vice squad officer who now makes a living selling illegal squid or superconducting quantum interface device recordings on the black market. These recordings enable users to experience full sensory feedback from pre-recorded memories and physical sensations of other people, making them highly addictive. But when Lenny receives a mysterious recording showing a friend of his ex-girlfriend being murdered, his life is quickly turned upside down, exposing him to a conspiracy that reaches the upper echelons of the LAPD and wider society, forcing him and his bodyguard slash best friend Mace, played by Angela Bassett, to try and uncover the true identity of the killer. Produced by James Cameron, Bigelow's ex-husband, Strange Days incorporated new cinematography techniques in order to create the first-person perspective squid recordings offer. Cameron's production company, Lightstorm Entertainment, created a special lightweight 35mm camera that could be fitted onto a portable steady camera to approximate the angle and distance of the human eye, adding tremendous intensity and realism to the several memory sequences in the film. The decision not to use any early CGI when visualising these scenes was a wise one and prevents the film from dating as badly as other 90s movies that dealt with similar themes on virtual reality. Paying tribute to the cyberpunk genre first coined by William Gibson, the film's atmosphere borrows heavily from works such as Blade Runner, presenting us with a richly lit neon LA that is on the brink of societal collapse, which was in turn inspired by the then recent LA riots of 1992. Undercurrent themes of racism, drug addiction and what it means to have a private life in an age of increasingly accessible voyeuristic technology elevate the film from other science fiction pieces released before the Matrix and have helped to cement Strange Days' reputation as a cult film. Despite a poor box office performance that almost derailed Bigelow's career, Strange Days' reputation has only grown in the years since release. Her pull-no-punches direction when dealing with some of the film's more graphic sequences, as well as the unorthodox casting of finds in the lead role, make the film stand apart from other sci-fi escapisms released during that decade. The film's warning about not becoming obsessed with the past is one that anyone with a smartphone can relate to, which of course in these Strange Days is most of us.


There's a deep sense of satisfaction and sort of peace and, you know... If I could do a couple of somewisers a day, that would be brilliant. I would really make my day. In the end you realise you're sharing the same world. People ask me this all the time and I, you know, people say, why are you interested in birds? And it's like asking me why I'm right-handed. It is an obsession and I think it's the excitement and the rush that you get from seeing an individual bird, especially if you're going for it. Trying to eliminate birds just for fun, I think, is something that doesn't seem well with my conscience. There's this something that is noxious in Philippine culture. The way young boys are raised, we call it the slingshot culture. That's what I would like to eliminate. And that these young boys are taught the joys of hunting birds, whatever kind of bird. With slingshots, a terrible way to raise boys or children. With the way we're losing endemic species in the Philippines, for example, or we're losing birds. They say that birds are pests, especially in the rice fields, but there's a balancing mechanism by nature that actually is at work. One of the attitudes towards birds in rice fields is that if it flaps, you're scared away. Thinking that all birds eat rice and will cause damage to rice fields, when that's just not true. It needs to be much, you need to look at it much more on a species level to understand what birds will eat rice and when they eat rice and when they're just in there for other reasons. The majority of birds seen in rice fields from my research are insectivorous, so they're solely going to the rice field because they're attracting invertebrates to eat. You don't really know how wild a bird is until you've held it in your hand or when you've held a wild wader or a parrot in your hand or a barbit which twists its head around and tries to bite your finger on. That's a wild animal. You can really see the dinosaur in that when you've got it in your hand. You do have this extraordinary combination of a beautiful bird and that just feathers are amazing things. Feathers are just quite incredible structures with interesting calls sometimes.  Plus this extraordinary biology and the history of the animals. The whole aesthetic is just fantastic. It really impresses lots of buttons for me. The biggest rumour and the biggest myth that I hopefully will dispel at the end of my PhD would be that not all birds eat rice and that to spend so much time and effort in scaring away all birds not only doesn't help the ecosystem but it also is a waste of resources. When push comes to shove, I'm a bird and that's the thing that defines me more than anything else. It's something that does not really remind me of the stress and the rigors of my job but it also teaches me a lot of things and values that I use in my job like patience, like the power of observation, the power of sympathy and empathy the value of interacting with your environment whether it's in an environment of people or an environment of non-people.


Are you tired of watching boring old press releases? Then you've come to the right place, the right channel, the number one channel for CEO interviews and company overviews. Welcome to Rich TV Live, subscribe to our channel and make sure to hit the like button. On our videos to help with the YouTube algorithm for more information and in-depth discussions and analysis join our trading club at richpigsdaily.com and don't forget to subscribe and hit the bell for notifications to get alerted when our next CEO interview is released so you can discover the next 10-bagger. Hi, how's everybody doing today? I'm your host, Rich. Here we have Rich TV Live with our very special guest, Hamutal Yitzak, the CEO of Else Nutrition. How are you doing today, Hamutal? Hi, I'm doing very well, I'm very happy to be back and thank you for having me. Always a pleasure. I'm a big fan of Else Nutrition. Not only have you done extremely well as a stock, but the company is doing great work, especially for toddlers and infants and children. Now, for a little recap, Else Nutrition is a food and nutrition company that has developed clean and plant-based products for infants, children and adults. Since we last spoke, what's new with Else Nutrition? So, yeah, it's quite difficult to recap everything in two sentences because being a lot, it's been a while, I think we've last spoke in November, so it was just a couple months after our launch of the toddler nutrition. So since then, we've seen very fast growth on our e-com and platforms as well as started selling on the retail space and there we see very nice growth, but it's just the beginning. We started on February and we've expanded our team in Israel as well in North America quite dramatically. We have a very, very strong team in so many spaces and we're building a new team in North America for expansion and marketing with HCPs and all kinds of stuff is happening. We're trying to locate a new capacity for production in Europe as well in the States. So many things are happening concurrently, working very hard on the clinical side. So I suggest we dive into the details and speak and get into its question so I can really provide more information. Great. Hamid Tall, Else just announced some impressive first quarter results at the end of May. Can you tell us about the company's progress in Q1? Sure. So the revenue growth that we reported in Q1 are based on the fast growth on our online sales as well as the first large orders that we got from distributors that serve the retail space. So we've seen, for example, we've seen over 1.1 million Canadian dollars, which represents about 90% growth over the revenues of the fourth quarter in 2020. And we've seen an increase of about 300% versus the revenues of our first quarter in 2020. And it was the first quarter to recognize the formula revenues from the retail market. And with the formula revenues specifically, we've seen 150% growth and quarter over a quarter of about 900,000 Canadian versus 350% in the fourth quarter of 2020. We've also seen an increase in the number of orders of 66% from Amazon. And then average basket increase of 15% quarter over quarter. So these are the major numbers from Q1. I love that. Everything is growing. Everything. Every number is growing. All your numbers are growing. So that's really, really good news for investors and for the company. Now the company has also grown its online sales. You touched on a little bit there. Can you tell us a little bit more about your online sales? Sure. So it started its U.S. online sales in August 2020, as you remember. It was first introduced on our e-store. And later in September, it was introduced on Amazon.com. And I think two months after that, on November, we were already ranked best seller on Amazon as infant and toddler nutrition new releases, which is quite exciting. And so the initial online sales on these two channels, our e-store and Amazon, demonstrate a very, very good trajectory of growth. We're growing over 20% month over month. And we're also expected to accelerate this because we are introducing more products into the virtual shelf and into the shelf in general. Just seen our previous launch a few days ago of the Kids Institution Drink, and there will be many more. And just one more figure, the Amazon sales are actually doubling every three months. This is also quite exciting. Super exciting growth. I love to see growth. We love to see revenue. That is always the biggest catalyst for any company. With the plant-based industry growing so rapidly. Can you tell us where you see ELS nutrition one year from now? I think in a year's time, there will be so many different things with a case of ELS. I mean, we definitely will see many new retailers listings and launches. We are currently in discussions with dozens of retailers that represent around 5000 additional doors. Currently, we're listed on 900 doors since February, and we're selling already in 600 of them. But I think that towards the next, I mean, in a year's time, we'll be seeing thousands of doors for ELS. We'll also be looking at Canada, I mean, looking in terms of bringing a product that's compliant to the Canadian regulation, and currently we're just shipping to Canada, not compliant to the regulation so we can't sell in Canada, and there'll be many new product launches in terms of new product lines. Some of them will be catering babies from six months already. That means a very long-term life value of each client because loyalty is the name of the game here, and there will be penetration to new geographies, which we're working on. One of them is Europe as well, and we're working on China. That will be, I think, in the second part of the next year. I think there will be results coming from the clinical study, so we will be able to have claims on certain products, which are clinical claims, and all sorts of things. Yeah. That sounds great. It sounds like you guys are on the right track, and obviously the plant-based industry has grown so much. When we started talking a couple of years ago, almost two years ago to the day now, I remember it was like the beginning of the plant-based industry. Now there's so many other companies getting into the plant-based industry, and you guys are almost veterans now of the plant-based industry. So it's exciting to see the evolution. Now at the beginning of spring this year, ELSE Nutrition Sign deals with two massive U.S. distributors. Can you tell us more about ELSE Nutrition's growing presence in the United States and what these milestones mean for the company, and are there any other strategic partnerships you'd like to highlight? Sure. So first of all, we did onboard and already are shipping products through those two major distributors, the largest in North America, UNFI and KG. Great. And together, both of them are covering almost the entire retail market in the U.S., which is about 60-thousand doors, which are potential doors for ELSE expansion. That's incredible. And they already opened 14 of their distribution centers for ELSE, which is quite amazing, considering the very short time that we are operating together. So I think that means a lot for ELSE in terms of trust, in terms of the fact that these two major distributors actually, it means credibility. It means trust in the product, trust in the company, trust in our capabilities to support the supply chain, to grow.  We're selected amongst thousands of brands into a very, very unique and exclusive program with them. So that means a lot to us. And so the retail sales started very early February and sprouts farmers market, which is the competitor of Whole Foods with 350 doors. And then we extended into several additional natural food and grocery retailers and independent stores. So as I said, we have big wine, railies, and natural grocers. It was 160 doors. And AFS, which represents 300 potential doors. And many, many more. So currently we're listed on 900, as I said, and already selling to 600. And that is ongoing on an ungrown trajectory for growth all the time. Wow. And are there any other strategic partnerships that you'd like to highlight at this point that you maybe are working on or you guys are planning to put together? So there are. We are currently negotiating at least two strategic partnerships, very major ones, but we're negotiating. So I really cannot disclose that at this moment, but stay tuned. And one more thing that I maybe forgot to mention that we are also international. I mean, we have been listed and already started selling on iHerb, which is a major international platform, online platform that serves actually consumers from 180 countries. Wow. So potentially we're available all over the world for every month that wants to purchase the brand. It's just a matter of awareness and marketing. And we intend to be very active on that platform as well. Very good. Wow. You guys have really grown and it's exciting to watch the evolution. You really recently announced, and this was the news that we were looking at today. We were talking about and we're breaking on Rich TV Live today. You recently announced the launch of a second product, a nutrition shake for kids. Age three and up. What has been the market response so far? And do you have any other products coming down the pipeline this year? Sure. So, I mean, to be honest, the kids nutrition drink was just announced today officially in a PR, but so it was soft launched a few days ago. And it's a very short time to tell what's the market response. But for as far as we see now that the velocity was quite impressive. And we see from reviews, from the few reviews that we have seen from consumers that they are quite happy with our taste and solubility. Even I mean, despite the fact that our sugar levels are very low compared to our leading competitors and that's something we're very proud of. I mean, having a great taste with a very low level of sugar. So we see great responses for now. But let's let's be patient and look for more valid and solid responses and from the market. Do you have any other products coming down the pipeline this year that you guys are working on? So for sure. So as I as I already mentioned, there are several product lines that are coming into the market this year already already. Some of them are already produced, but are in different stages of packaging or ready to go to live to the market. And I'm talking about a series for six months, babies, whether it is a complementary nutrition product with high proteins. And I'm talking about liquid product that will be by the end of the year or the beginning of the next one. And and we're talking about different products for different territories. Because, as you said, as I said, regulation is different in every country. So you have to adapt and you have to create a different, a slightly different product for each each country. But mainly these are the major product lines that will be available very soon on top of the kids nutrition that has just been launched. And there will be many skews additionally with different flavors and all different kinds of additives and, you know, immune boosting and all these kinds of additives that we add on a natural basis to those products. So there'll be multiple skews for us. Wow. It's been a wild year so far already into June or six months into the year. We're halfway through the year almost. What can we look forward to for else nutrition? I know you guys have been super busy. Can we look forward to anything in the next coming months for the rest of this year? Yeah, so I think I think whatever I've already described here is a lot to wait for. I mean, we're looking at new territories, new product lines, I mean, expansion, expansion, expansion, all in so many facets and aspects. And we're looking at new claims, as I said, clinical claims, which will also accelerate growth and attractiveness of our products with new customers and new audiences all over the world. And what I can tell you about something new that's really, really happening and I'm not sure I've mentioned that is that parents are actually speaking about amazing things that our product is doing to their babies. And they've actually tried everything that's in the market, I mean, cow's milk or soy, which is whatever it is in the market. There's nothing else and nothing helps in cases of allergenicity or intolerance or all kinds of irritations. And they're speaking about healing effects of our product for their babies. And they're so thankful. So we see great future for that company just because of that. And that's the most important thing that I have to say for our investors and for our customers that actually creates the basis for success for a brand. Because you see that the product really provides and really, really creates, makes a difference, makes a difference and changes lives for so many families. I agree 100 percent as a father myself. I wish this product was around when my children were babies. My kids are teenagers now. So not as much of a focus with this product for teenagers as it is for toddlers. But your products are also for adults as well, right? So your products are pretty much covering everybody now from infants and babies all the way to adults. Yeah, yeah, we haven't launched adult products, but we are working on that to get there. And when when company decides that it's the right time to currently we're trying to focus on on the young, young child nutrition. But definitely we are working to create additional, you know, lines for adults. That's great. That would make the same difference for them. I'm sure that I think that's a great idea. Now, there's going to be investors all over the world that are going to see this interview that are going to ask questions. What's the best way for them to get in contact with you? Well, I think I'm very responsive on email. So it'd be the best way to get me and so yeah. And and else care are info emails. We have a great team very responsive as well. So you can also get in touch with them and they'll forward it to me. Thank you so much for your time today. The CEO of Else Nutrition, Hamutel Yitzak. Keep up all the great work. Every time I speak with you, there's more big news. There's new markets, there's new products, revenue is really grown. Congratulations to getting over that seven figure mark. And I know that the numbers will only continue to grow. Thank you for your time today, Hamutel. Thank you so much, Great. And looking forward for the next one soon. Thank you so much for your time today, Hamutel. Now, for those of you guys that are watching, remember, Rich TV Live is strictly for information and education purposes. Please do your due diligence, due to research before you invest in any companies that we talk about. And in saying that, if you like the video, smash the like button, comment down below, share the video everywhere and subscribe. Else Nutrition has been one of our biggest winners. About two years ago, we started talking with Hamutel when it was at 30 cents. Today, the stock is trading well over two dollars in Canada. It's also trading the United States. So it's been a huge success. It's been as high as five dollars. So it's been a very big success for our community. So I still believe that this is a company that has a lot of growth potential. And I still believe is undervalued, under-appreciated, under-exposed and has an incredible future. So if you guys agree with me or you like to comment on the video, please do so. Otherwise, thank you guys for watching. Hamutel, keep up all the great work. Look forward to seeing you again soon.