Good morning. Good afternoon. Good evening to everyone. Apologies, I'm accidentally advancing the slides instead of just unmuting myself. Richard, if you could help me, just skip back to my first slide. That'd be great. My name is Andre Chow. I'm the vice president and general manager of the digital surgery business here at Medtronic. With digital surgery, we really focus on using digital technologies, data, AI, to really expand access to high quality surgical care. And it gives me a really great pleasure today to introduce you to the first of three webinars, which we'll be doing over the next few months. And today we're going to be focusing on the issue of surgical video and really how to use it best to improve your surgical practice, help your surgical teams, and so on. You can see the agenda. They're there in front of you will be going over some some high level concepts before kind of diving a little bit deeper into the evolution of recording surgical video and, you know, some specific points around how video can be used to improve your practice. As Richard mentioned, please submit any questions using the Q&A function, which should be there in your Zoom window, and we'll make sure to save some time at the end to kind of go over those. It gives me great pleasure to introduce our guest speaker today, Dr. Sanjay Perky-Yasla, who I've known for many, many years. He is a consultant general surgeon with a specialist interest in bariatric and upper gastrointestinal surgery. And he works at Imperial College surgery and cancer division, as well as the one Wellbeck digestive surgery, and King Edward the seventh hospital in London. Welcome Sanjay, real pleasure to have you here. And thank you to Medtronic for inviting me and thanks for everyone who has joined us to listen to our chat today. Great. All right, well, let's let's jump straight into it. So I'm going to try and advance these slides here. So let's start off with a pretty broad question here. Obviously, we're here today to talk about surgical video. And really, Sanjay, I'd really love to kind of, I guess, get your broad opinions, first of all, on what are the sorts of ways in which we can use surgical video to help surgical practice and so on. So I think a lot of surgeons and practitioners have been interested in the video capture element of surgery for probably decades, but up until recently, it's been quite cumbersome. Now previously, I'm sure there are a lot of people listening in who have recorded their laparoscopic or arthroscopic or endoscopic procedures. So you had to then either historically kind of burn them and then put them onto a format where they could edit them to use them for conferences, education, presentations, but also for training. Now from a training perspective, probably about decade and a half ago, when I was training, I started recording the laparoscopic procedures that I was carrying out mainly to see objectively after the cases were done. What did it look like when I was operating retrospectively? And I tried to push some of these videos under the noses of my then trainers to say, hey, what do you think of how I'm doing? And at the time, a lot of surgeons were not really keen to do so. And at the time, because of research and training, all of our patients were consented for image capture anyway. So one of the things I thought that could be helpful would be not just for my own training, but for a peer-to-peer review or even sharing things with patients. And that is an attitude that I think we really need to move towards. And that's kind of how the journey started, really, to try and improve my own performance and see what other people who don't see me working in the OR and who aren't my direct trainers thought of my surgical techniques. So that's where it kind of started from. That's really interesting. And it's fascinating that you've been trying to kind of use this digital media for really for quite a while now. So obviously, you've used it quite a lot in regards to self-improvement and your own training. Where do you kind of see this technology going in the future? Where are the avenues that this could help kind of beyond training? So it really helps in preparedness. And that's probably a term we've heard much more during the pandemic. But it will help us with rehearsal. It certainly helps with onboarding. It helps with academic presentations and training presentations. It helps with explaining things to patients, not just pre-operatively but post-operatively. For example, anti-reflux surgery can explain exactly why you did what you did, the extent of hiatal dissection, the fact that some patients hiatus hernias are under-called or over-called from the diagnostics and why we picked a particular approach during that surgery. There are also contentious issues, but if there are interoperative complications, we found actually using video is a lot easier to explain these to patients and relatives as to why it was a challenging case, why something may have happened pre-operatively. And we found that it helps dialogue amongst other practitioners as well as patients. A lot of places have moved to electronic records. A lot of us feel particularly in our institutions that the operative video is really crucial to electronic records, along with the operative note. And for certain surgeries where there is revisional surgery in the future, it is very valuable to know exactly what was done. But in those cases, sometimes you don't have to watch the whole video, and if you have access to the right segment of the video, then preparing for revisional surgery is very helpful. So all of these different tools have come about and during our journey in the last eight to 10 years with different ways of video capture, as we'll talk about in a second, it's also opened our eyes to other potential patient safety positives. There are swab counts issues with kits during the procedure, ensuring that certain steps of surgery are followed, and it has certainly led to increased standardization in our unit across the board when it comes to deciding which kit we're going to use, and which operative steps we're going to use and it has also meant that, particularly in our specialties, we've all sat down, all surgeons together to kind of decide, can we standardize our approach to different procedures as a unit, and not just from a surgeon to surgeon perspective. So it's really aided collaboration as well. So kind of you can see how you've started to think about using this all the way through from training, through to actually standardization of practice, and collaboration of colleagues as well, it's absolutely fascinating. Before we move on to the next section, I think we've got a little poll that we wanted to do just to get a bit of a benchmark as to how our audience feel about video currently. So hopefully a question will have popped up on your screen at the moment that's going to ask you how often do you record your surgical video with a number of options there so either you record for every elective and emergency case or just for elective cases, or just sometimes really or never. So if you could just take a second just to answer that and then the poll should disappear from your screen. You can get a quick snapshot really of what our audience thinks. And here we go. So it looks like the majority of you only sometimes record your video. And yeah, so that's a nice little snapshot really of where we are. Great. So let's move on to the next slide please Richard. And really Sanjay what I wanted to dive into here was about I guess the experience that most surgeons have today with trying to record surgical video right so you mentioned previously, you know the need to potentially burn DVDs and so on and so forth. Before a lot of surgeons have experienced now with you know integrated operating rooms and you know advanced laparoscopic towers and so on. But do do those devices make accessing your surgical video easy today or are there still problems. I mean things have moved on a lot in the last decade and a half. I'm sure everyone will remember the days where we had to burn everything onto CD. That took a long time that then had to be uploaded onto your hard drive and you know to edit a video. You know even a straightforward laparoscopic callus astectomy or laparoscopic hernia repair is you know minimum of 30 to 45 minutes of footage you'd have to edit that down. It all I mean the data transfer itself took a lot of time. The advent of USBs made it easier. You know encrypted hard drives are very useful but still even with USB threes. It does take a significant amount of time because it is so much data and with the advent of high definition and ultra high definition images that the amount of data on that bundle is even more. And so at the end of each case you know previously you or the end of the day you're downloading this huge amount of data and then you have this issue of where do you put it where do you keep it where is it safe. And so those issues with data safety and encryption were some of the things that we had to discuss. You know at our internal review board equivalent and get through our NHS trusts and other hospital governance boards to make sure that they corresponded with in the UK or the GDPR data. Regulatory issues got them all ticked off but it just means that now that we have a way of uploading this video almost automatically at the end of each case and for standardized procedures where we have worked as part of our research collaboration and research with my PhD students to be able to segment these videos into the major steps that at the end of a procedure you just hit one button and basically it's uploaded into a cloud and several eight minutes later you have a video that you can edit the different steps on know how long each step took and then actually put footnotes if there were problems and then market to see if it's something you want to discuss with your colleagues it's useful for training it's something you want the people who have access to your portfolio to look at and all of these things just takes a matter of minutes at the end of each case and then if something were to happen to that case it's very easy to pick it up and then actually discuss it with the images in your routine monthly by monthly or whatever you know each unit does for their morbidity and mortality meeting so it's really kind of made that whole pathway much less cumbersome it also means that if there's a particular step that is of is the bit that you know you want to take to a conference or you know use for training you can just use that particular step and it means you don't have to go through reams of video trying to find exactly the bit that you need so loads of positives don't have a negative at that moment to share with you I'm afraid. No worries I mean you brought us on nicely to the next next section actually which is around the solution that we've developed. Richard if you wouldn't mind advancing the slide just one. So really the product there that Sanjay was talking about which he's been using now for for over a year is our touch surgery enterprise system, which essentially was developed to to solve the issues of data management and surgical video management. As Sanjay mentioned you know we've all come across colleagues who do take a lot of time burning DVDs or saving files to USB drives, which are often unencrypted and really what we've developed is a very simple almost plug and play system that plugs into any laparoscopic stack. Using our DS one computer that you can see there on the right hand side of the screen, which then essentially connects your operating room with our secure cloud based video management system available on your computer or on your mobile device. So essentially you have all of your videos that at your fingertips minutes after finishing your operation. And also should mention around data security which was one of the one of the concerns that Sanjay brought up the whole system is compliant with a number of different regulations including HIPAA high tech SOC to etc. So it's been designed really from the ground up with privacy in mind. Sanjay now that you've had the chance to kind of use the system now for, for, you know, well over a year and I've seen you've actually uploaded hundreds of videos now onto the system. You know, what, what change in practice has this made for your team or what has this allowed your team to do you think that that can't be done in other places. So it's been useful in areas where we were expecting it to be useful such as for, you know, perioperative training, presenting useful cases m&ms etc. But it was also highlighted the need for a proper onboarding system with surgical trainees so for example I'll be getting a new trainee in April. I've already been sent a link to be able to access my portfolio that portfolio doesn't just have the cases that we've done but the standardization of how those cases are carried out the positioning the kit little links to how to use the kit. In a lot of places, particularly in the UK induction or onboarding revolves around coming to the hospital and understanding the geography of the hospital. And what things you need in your training portfolio and a whole bunch of other things including fire safety and, you know, lifting regulations. But until recently, you know, we weren't actually providing induction of what we do in the operating room so that they can prepare for it. So onboarding is one. The second thing is rehearsal and preparation. There's great evidence out there that cognitive task assessment and analysis, just like athletes thinking through what they will be doing on the big day of their big race is very relevant to surgical brains and surgical decision making this alongside the touch surgery platform allows that both with video and animation now. It also allows our scrub text to prepare if they're new and I'm sure everyone's experience during the pandemic that you work with very different teams and the continuity of teams has broken down. And so that allows others other than the trainees to actually prepare for the case and the kit. It also allows comparison, which some people like some people don't, but we can tell you from standardizing our procedures that actually five or six surgeons. There is very little difference whether the between the different consultants operating or when the registrars or trainees are operating. The system has allowed us to demonstrate that during the pandemic, even with lockdown in the in the times that we were allowed to carry out benign bariatric surgery. You know, out of the 180 cases that we carried out between July and end of November. Last year, 70% were carried out by trainees. So it's a whole host of benefits that some of which we were hoping for and some of which that we have stumbled across. But most importantly, it's been very simple to record cases. You just need to plug the stack in and hit record. And then at the end you just need to hit stop and it can't get any easier than that really, even for someone who, you know, I'm not a social media kind of guy. But using this technology is has been very, very straightforward for me and the whole team. It also led to behavioral change across the unit with my surgical colleagues who all of who in the unit have now agreed, not just in bariatrics but across specialties. Anyone that carries out laparoscopy in our trust across three sites has now, you know, agreed to using this and recording every case when and where possible including emergencies. That's fantastic. So let's jump on to the next slide Richard. And let's dive a little bit deeper into surgical training, which we've touched on a few times so far in this discussion. So could you could you tell us kind of how do you encourage your trainees to use video. And how has it kind of changed the way that they approach learning how to operate. So, as I kind of alluded to there's the onboarding process, which is also part of rehearsal. There is obviously the, not just learning the steps but watching the movements of someone who has carried out these procedures hundreds of times compared to themselves. There is the ability to debrief that picture on the slide is actually myself and Jasmine, who's one of my fellows, looking at the procedure at the end of a case to understand, you know what could have been done better. There is also the ability for peer to peer comparison so trainees can look at their videos with their colleagues and say, you know, this is what you think similarly with other trainers and not just the one in the OR. So there's a whole host of comparators that it allows. And it also allows a portfolio to be built. And we have any portfolio in the UK that's taken into consideration at the end of your training. But I think a system like this will almost allow for almost like a real to be produced, a bit like a real that, you know, actors and other performers may have, when they go for a new job or a new role or an audition, you know, we should have a real for our trainees at the end of their training of all of the lap colis they've done all the herniers they've done. And it also shows you how their movements have changed at the beginning of their placement with us, and their end of their placement with us. And that gives you some objective feedback that you are able to give your trainees, which they really have appreciated. That's great. I mean, so you mentioned almost like creating a greatest hits real for trainees to add to their portfolio. How about the other way around how do you use video to, I guess, look at, you know, mistakes or things that could have been done better. Is that something that's incorporated into your practice? Yeah, so that's part of the debriefing as I call it, but also if there are technically challenging cases, all the trainees and, you know, our colleagues across the unit we know, you know, to specifically kind of highlight these and use these for education. The best example is probably laparoscopic colis mastectomy.  But, you know, the more and more acute lap colis you do, you know, there are challenges that junior surgeons can, you know, fall into easy pitfalls with obscured anatomy, distorted anatomy.  And those are the kind of tips and tricks and visual images that we can share with each other, not just in a unit, but actually, you know, across the surgical community to make surgery safer by sharing those slightly unusual situations that you may find yourself in.  Everyone will tell you that acute lap colis have got much worse. You know, there are some anatomical variants with the acute pathology that has led to a slightly higher use of one instrument in our unit, the endomini retract that allows you to get round tubular structures with a blunt dissection, for example. So these little tips and tricks are really helpful. And actually, I think there's a huge bias in not publishing and talking about problems and complications. And I agree with you, we need to get away with that. We need to share the complications so that they're avoided and we learn from mistakes, not just of our own, but everyone's. Let's pick up on that point a little bit further. So, you know, I know that when I was training, I didn't see my consultants, my bosses, kind of getting together and discussing surgical techniques very often. But you've mentioned that, you know, now that your colleagues record all of their surgical video, there is more collaboration. Can we touch a little bit on that as to how that's done and how that's, you know, affected practice? Well, from a collaborative perspective, to be able to do this, you have to think about standardizing your procedures. If you've got, as we have five or six surgeons carrying out bariatric procedures. And if everyone uses different techniques, different kit, it just gives heterogeneity within the operating room. And that is what can cause potential problems. It also has cost efficiencies. If you all use the same kit, it tends to be cheaper. You can package it in a different way. But also from a training perspective, if you have the same steps, it's a lot easier for a fellow to come to the department. And if they're working with five surgeons, they actually have five times the volume of the same operation if it's done in the same way. And so it's collaborative because it forces standardization. And I think for elective surgery, that's, you know, particularly something like benign upper GI surgery. I think that is the way forward. If you do something well and you do it over and over again, it's easier to train, not just for the trainee. It's easier to train for the scrub tech. It's easier to train for the runner. And actually our anesthetists prefer it as well, because we all operate in the same way. Richard, let's move on to the next slide, please. Sanjay, you mentioned patients. A couple of times as we were talking. Personally, I don't know many surgeons apart from yourself who who actively uses video when when talking to their patients, but I'd love to hear kind of how how this has changed the way you interact and communicate with your patient group. So patients get lots of information through the provider's website through the internet. But when it comes to counseling patients, it's quite useful to have your own surgeries to be able to tell them what you're talking about. It's all well and good explaining an operation and showing some diagrams to patients, but patients quite rightly have become more educated and want to know a bit more about your particular technique. For example, some patients even want to know what kit we use and why. And it's very helpful to have the access to the videos, you know, quickly. And so although we talk through things and now we're virtually consenting patients. So they get there on a platform where we send them the consent form virtually while before we do the consultation both in the NHS and in private practice here. So it is very useful to be able to also talk them through video. And after the surgery as well psychologically, it's very helpful I found to show them either images or bits of the video and if it's their operation even better to say this is what your liver looked like at the time of the sleeve. This is how big the stomach was this is what we've removed this is what was left. You know we had no complications this is what the operative field looked like at the end of the procedure. And we think that you're going to do really well and now we've done our bit over to you to do the hard work. So that's an amazing amount of transparency, I guess that you're having with your patients. And then you also mentioned that you're using video to potentially explain when things haven't gone to plan to patients as well so I'd love to hear a little more about about that experience. Sure. So, you know, everyone any surgeon who has no complications, as my old boss used to say, is either not doing any surgery, or is telling porcupine. So it's really important to share complications and I know that surgeons that will be listening and providers that might be listening in are worried about litigation etc. Why I would say to all of those is actually being transparent and talking about things would probably reduce complaints and we've certainly found that. And I think if you have a complication if you share it with the patient and you explain it to them, along with, you know, the continued input from senior clinicians, even if you have complications. Actually, you there's less risk of failure to failure to rescue, the patient gets sorted out actually, even though they've had a complication, there doesn't have to be a complaint or litigation to follow. Now that might be different in different countries, but I feel that the UK is definitely going towards the direction of North America with regards to litigation. But I think it's very important to consider to be proactive, rather than reactive to complications. So if you do have a problem, share it with your patients share it with the relatives, talk it through with them explain to them why it happened and what the challenges were. And then make sure that you're present and more present than normal during their recovery, and you will work with the patient and their family to get them better.  In fact, the only Jejano Jejano perforation that I've had which occurred three or three and a half weeks after surgery. And the patient needed re-operation is actually one of our biggest advocates of bariatric surgery in my patient cohort. And I know him and his family better than some of my other patients you've done amazingly well with no complication. So, I would just say that, you know, transparency, sharing data with patients. I think it's a positive thing, and we should celebrate what goes on in the or not hiding it, even if they are errors. That's great. That's great to hear. Up on the screen here we've got on the left hand side, one of our, I guess privacy measures that we built into the system, which is our redacted technology and as you can see essentially what it does is automatically blur the screen when the laparoscopes taken out of the body, just to stop accidental pickup of faces and so on and so forth. So, Jamie, thanks for your question. He's asked how is procedural video managed and distributed securely and how is access controlled. That's absolutely vital Jamie and these are steps that are different with regards to regulatory issues, depending on I guess geographically where everyone is we have GDPR guidelines in the UK in based around European law and British law and so I would say to you that it's very important that you get all of your information government governance ethical approval for this and IT infrastructure discussed with anyone who's interested in doing this and the digital surgery team are very open and transparent to provide all the necessary documentation so that all procedural videos are managed in a way that conforms with the regulations wherever you are. The distribution so it is all secured on an encrypted cloud based server of the highest in encryption for healthcare and can only get access to that if the surgeon or the provider wants you to have access. So for example, I will have access to it on my account and I'm allowed to give access to my account to other trainees and other surgeons. If I want to show anonymous and all the videos are anonymized because of the redacted system. So if I want to show a bit of a video to somebody to explain what things are about that has already been cleared from a regulatory perspective by the provider. And we've consented all of the surgeons and trainees that operate so any new trainee that comes to the system comes to the unit gets consent is allowed to consent so far no one has refused to consent for surgeries that they're carrying out to be shared with colleagues to be used in m&ms to be used if in case of complications and also if the patients request images, then we are happy to share those images with the patients. And initially that did cause some pushback from some of my colleagues, but subsequent to, you know, some of the benefits and the fact that so many people in fact all of us are now happy to record things has meant a huge change in kind of institutional behavior and allowed real behavioral change within the system that you are to occur so that, you know, you can go ahead and and use the videos and the ways that I'm describing but it is absolutely imperative that you go through all of the necessary regulatory information governance and encryption procedures. If you are looking to set up a system like this or similar to this in your hospital. Thank you so much. I'm going to step in for for Andre my name is Kristen D'Angelo I lead our marketing for digital surgery. And so I love if we can now move to the next topic I think we have spent a, you know, got a really good understanding of patient experience and addressing some of the concerns that that were brought up in in the q amp a Richard if you could please advance the slide. So, we're really interested now and hearing more about your experience and how this technology can also improve or efficiency. So, can you talk a little bit about the features that you've used and some of the standardization that they you've described Dr put the asset on on really the ways in which you've been able to achieve standardization and improved workflow in your operating room and also explain some of the different snapshots that we have here on the page and how those have assisted in that. Thanks Kristen and thanks for stepping in. So, a lot of the efficiency I think comes from standardization so that's a decision of the unit, you know whether we were going to use video data capture or not, but having standardization does allow a better use of this technology in my opinion, particularly with the integration of the machine learning so, you know, there are all the bariatric procedures I carry out with collaboration with digital surgery now is recognizable to a machine learning system. So it knows all the steps. And it knows when I, you know, when we're not going to when we're not carrying out the next step so if there is a difficult case and we're not carrying that out. There is an option to have that. But from an efficiency perspective it collects all the time stamps in in real time. You can see there on that third image on that on that smartphone. There are little lines above the bar charts those are the average times of each step. Compared to the times that you're carrying out of that step and you'll be able to see that literally at the end of the procedure. That allows you to be able to feed back to your trainee or to yourself. You know this was a pretty straightforward case. This was an average case or was there a problem. Those timestamps are collectible not just for an individual but for the whole team. So technically they are comparable. And that is something that we have looked at and as I alluded to earlier, they haven't been, you know, because of the way that we work we all work pretty similarly and our outcomes and our times are the same. It's also allowed us to understand which by looking at the video and actually analyzing it, you know, are we using which kids are we using, you know, what should be within our car decks and what shouldn't. It's helped, you know, take things in and take things out of our kits and sets. So it's not just helped the surgeon but it's helped the the administrative and the scrub team as well for efficient. That's great to hear. And thank you for those examples. You know, before we head into the Q&A where we'd really like to hear more from from all of you would like to do one more one more poll so you'll see that now flash up on your on your screen here. And we'd like to ask the question of, you know, as we've gone through these three different areas for opportunities of how surgical video can improve practice and and achieve excellence in the operating room. What's your take where do you see the best opportunity for for that improvement. Wonderful. Well, it's great to see just, you know, where there's such strong use and an opportunity to improve surgical training. And certainly in the other areas that we've talked about as well. And certainly, as you've shared, Dr. Koyasa on on just the ways in which you've seen this with your trainees and in your practice. We've certainly been able to supply some some great examples of how that can be made possible with technology like this. So at this point, now we'll move to the question and answer so Richard if you could please advance the slide. And so with that, we're going to put back up the instructions just to remind everyone about how to submit those questions which I believe are on the subsequent slide here. Okay, great. So we will, we'll get started. We've had some great activities so thank you so much for for the questions that have have come in. Can you describe Dr. Perghiasa how long did it take this technology to get approved at your facility can you describe a little bit more about what that process was like for you, who was involved what kind of questions were asked and and what kind of conversations did you did you have along I think that's whoever asked that fantastic question because that is that was the most painful part of this process for us. But one of the reasons it was the most painful is when we started doing this, you know, this product really wasn't out there and we were. We wanted to carry out research to see whether, you know, this sort of technology and process would be useful so there wasn't really any prior system or example to go with. And the second thing that was painful for us is, you know, this is part of the NHS, as well as an academic institution so that meant we had two different governance systems to go through and one is the largest healthcare provider in the world, with lots of issues with information governance and had an issue with being hacked in 2019. So, I would say that those conversations were challenging, we had to plan and although we've been using this system for over a year. All of this actually started in 2017, which is four years ago now. It took about six to eight months to get all the discussions carried out with information governance with the information technology team, the internal review boards, and with the institution executives on one side which was the NHS Trust, and then we had to go through ethics and all of the paperwork for the university because this was an academic enterprise at the time. That did take a very long time to get the parties together, but it did eventually happen. It had to get signed off by the academic leads and the divisional leads at the trust and the university and once we were able to convene that meeting, we were kind of good to go. These things would be very different now that we have gone ahead with this. I know that there are other trusts in the UK that do use this technology that have had a much easier route to doing that because they've spoken to us. And when they're relevant colleagues in their IT and information governance departments contact hours and kind of have a chatter on a kind of professional level, it makes things a lot easier. Wherever you are in the world, I'm not sure if your administrative issues will be as painful as ours. I hope they're not. But to avoid those, you should plan well in advance, and I would say a minimum of four to six months of conversations will need to take place unless you work somewhere very forward thinking. No, thank you. I think that it can be a really difficult process to get started and requires championing like you described. And so does everything that's worth doing and it's disruptive. So thanks for adding that. Yeah, so we've had one question come in that we've talked a lot about training. If we could give an example about how this technology has helped in an example for patient safety. And I know I know Dr. Brigasi you've you've had some great experiences here so maybe we can hear from you on on an example of how you've encountered that and how you use the technology. There's a couple of cases, but one case in particular, which we've we've actually uploaded and is available on the touch surgery platform as a learning tool. It's called the needle in a haystack case. We had a gas an uneventful gastric bypass in a BMI of about 60 something where right towards the end of the procedure where one of the final sutures was being put in the needle broke off the suture and disappeared into the background somewhere. And despite looking it was very it was impossible to find with x-ray laparoscopy. And at the time this happened probably about two, two, two years ago, there were no protocols for what we should do so ringing our head of patient safety. We got three different answers. One was keep the patient asleep, send them to CT scan and then retrieve the needle. Do a laparotomy and have a good look and take it out. And the other one was just leave it in because it's not harming the patient and we'll find it later. None of these three felt comfortable to me as the attending surgeon. And actually at the time of these discussions which had added already 45 minutes to the case. My trainee actually suggested why don't we just rewind the video and watch it in super slow motion which we did. We actually found that the needle had popped off by catching the laparoscopic port which was in the right upper quadrant bouncing off the diaphragm and falling down between the spleen and the kidney. And was actually in retrospect we took it out laparoscopically but we had to mobilize the splenic flexure and take this needle out. There was no harm to the patient. There was an addition of an hour and a half to this procedure which normally takes less than an hour and a half in our unit. So it's double the procedure time. We have a duty of candor criteria in the NHS which is to explain all complications in lay terms to the patient so this was explained to them. We actually showed them the video and said this is what happened. They were nothing but grateful and thankful that they did not have to go and have a CT scan or have a laparotomy. And actually as with 80% of our gastric bypasses in our unit, the patient went home the day later. So even the extra 90 minutes of anesthetic time didn't make a difference to their outcome. And we've obviously followed them up and they've done really well. But this was discussed in our morbidity and mortality meeting and it has now led to a policy of how to deal with these things. And because we record everything, we're able to play these things back. So if you do have an interactive complication, you can play things back and see what the problem is, not just with a broken needle, but with where did the bleeding come from? What was the structure that was damaged? Or if you can't find a swab, you can actually play things back to see when that swab was put in, the laparoscopic tonsil swabs that we use to see when to take it out. So it's really helpful to be able to in real time retrospectively have a look back at the case that you're in if you come across a problem intraoperatively. That's great. And very, very powerful example. So thank you. This next question, Andre, perhaps we could direct this to you. We've had a question come in around how do you handle these huge data files? What is kind of the processing experience like? And what's kind of the workflow is someone kind of turning this on and off and so forth? And then I'll combine that with another question because we've had a lot of great activity on the Q&A. But in the processing of that video, can you talk a little bit more about how patient information is protected as well? Absolutely. So I mean, yes, the question is absolutely right. Surgical video files can be massive. They can be gigabytes at a time. And we are lucky that we live in the era of fast internet broadband speeds and cloud computing. So we're able to manage all of this up on our cloud servers. You know, openly we use Amazon web services to run that. And that gives us the ability to securely store these and process these really as quickly as possible. And as we mentioned previously, literally minutes after the case is finished, you can have access to that video right there on your mobile device. So the use case or the user experience we feel is significantly changed through the use of our system. In regards to, you know, I saw some questions about kind of rights to the video and so on, once it's on our servers, you know, again, just to be clear, you know, we act as a data processor. We are not a data owner. So the data, the original video remains the property of the hospital or surgeon or whoever uploaded it in case that's of a concern. Come on to another question I can see here about the sort of different specialties that the system has been used for. You know, obviously we're, we're focusing this right now on the general surgery space or more specifically the laparoscopic general surgery space. But the question here is about other specialties like orthopedics neurosurgery and cardiac surgery. The answer really is, you know, wherever you are using video or a video camera specifically as part of your operative workflow. And then then you can use this system. Right so, you know, for also I guess that would be arthroscopy. You know neurosurgery with with my microscopes, you know, cardiac surgery potentially with robots. You know anything that uses a camera for minimally invasive type operations and can can use our system today. And they require really is a video video output to connect with our system and up to the cloud. So, hopefully, hopefully that answers that one. So, like we mentioned, our system is designed with kind of data security and privacy from the ground up. Once we have the right agreement in place with a hospital. We are our systems are certified to hold that sort of data as long as we have permission from the hospital. If there is concern about spread of that. We can actually enable the system to completely remove all PII and completely divorce the the video from the actual patient case as well. So, you know, we're able to adapt our installation, depending upon really the the appetite of the hospital on exactly kind of what they what they require. Let's pick a question here. Yeah, here's, here's one that came in. As we excitedly await the metronic robot. Can you explain how the touch surgery platform will work with the robot. Absolutely, you know, working working with the robotic team here at metronic was one of the big reasons why we decided to join last year. The touch surgery enterprise system will be available with every Hugo robot system as it goes on sale around the world. And, you know, I think I can openly say that we are an integral part of the roadmap when it comes to the digital tools that will be enabled as part of the robotic platform. I would say that starts with, you know, video management smart video management cloud based systems and so on and so forth. And then as we get into the future. You know, really we're we're talking about using AI in the future to actually help introduce further safety features of the robot and so on and so forth so so it's going to be pretty closely integrated with it. Well, thank you. And so, I wish we had more time to address more of these, these questions but thank you everyone really for your engagement during during our webinar. I'll hand it over to Andre to wrap things up and Richard if you could please advance the slide. Great well as Kristen said, we're at the top of the hour. Thank you so much for your time and engagement and some some great questions. My apologies I dropped for a few minutes. But thank you Kristen for for picking up the slack for me. Like I mentioned, this is the first of three webinars that we will be doing. So keep your eyes peeled for for the next ones which should come out in the next few weeks or so. And yeah, see you next time. Take care everyone. So, I should also say thank you to Sanjay. I appreciate the time. Thank you Andre. Thanks Kristen and thanks everyone for joining.


And welcome to STEM Chat. This episode is all about Pi and not the Pi you can eat. That's right, because Pi Day is coming up on March 14th, because Pi is 3.14. That's right. And we're going to have lots of fun activities for you to do with your kids to lead up to Pi Day on March 14th. Pi is the ratio of the circumference of a circle to its diameter. There's some fun activities you can do to teach your kids about circles and Pi and circumference and diameter, and they can have so much fun doing it. And one of the things is with sidewalk chalk. And if you don't have a sidewalk or driveway where you can do this stuff, you can totally use butcher paper, a poster board, or even just have your kids draw on paper. I know it's still winter in some places in the country now. Yeah, so I was saying our ground is frozen here. Yeah, I may not work in the snow right now. But the cool thing about this set, I got this on Amazon, is that it actually comes with a chalk compass.  It's super fun. And even if my daughter is older at 12, we were doing this example for the video. We had fun doing it. So it's a pretty cool thing to do. So I would say the first thing you can do, depending on the age of your kids, is to start, start simple. My daughter had a good tip that to use the chalk and make a mark in the center to be the center of the circle, that in case the compass moved as you were using it, you could adjust it back to the right size. So just play around making circles.  And one of the pieces in the box has this sort of like holder thing. So that really helped us keep everything in place. And my husband had to help so I could film this so we can watch the video. This is so neat. I like everyone's moving around to make it. Even more kids, everyone can help out. And the person in the middle has to hold it steady and turn around. But now it's a beautiful, perfect circle. Yeah, it's so fun to do. And so now it's a fun part of decorating. So we thought it'd be fun to do circles within circles and show them intersecting with each other. And then we just had fun coloring. And taking the time to color and just figure out what we wanted the colors to be on the inside. But it just, it was just a fun experience just to be outside and see all the things. It was really curious. My dog Lulu wanted to see what was going on. So she always likes to pose when I do like when I used to work for a craft and pictures to pose. So she's posing hard here. But I think the key to show is that, you know, you're showing them circles. You can actually measure them if you want to. And you can just show them how there's different sized circles. And no matter what size they are, every circle is pie. And it's a nice way to get other people excited about circles, too, because it's out in your driveway and other people can walk in and they're walking by. The garbage man.  So it's still there. So it's great. We've kept it there. That's really nice. I wish we could do this. Our ground is frozen here. So we can't really get out and do an east sidewalk chalk right now. Well, even if it is frozen now, you can do it at home right now. And in the spring, when things get warmer, this is a activity you can do even outside of pie day. I think it's just a great way again to bring in geometry and circles. And in the summer, it's perfect time to like just have an outdoor, you know, drawing activity. Oh, yeah, that's right. Yeah, I really like that working together. That's nice. Totally. Since I have younger kids, we've been having some fun measuring the circumference of things and seeing how it relates to the diameter. So we just find some ribbon or string. The important thing is that it's not stretchy. And we've been wrapping it around different objects that are circular. And then we compare how that relates to the size of the diameter. So here you can see it's like one and then two and then three and a little bit more, which is the point one for, etc. But I have pretty young kids, so we don't really go into the full details of that. But it's kind of fun to play with and measure. Yes. And I know what I think is I think that's great that you're showing this and using really cute like washi tape to do it. And they're having fun and there's no need to go into detail. But as they're older, you can do that. And if you're homeschooling, you can look into the, you know, what are the requirements for math for that particular grade level? And, you know, just start mentioning words as depending on their age level. But I think the key is just to get them aware of circles, especially for your three year old, who is very young. Yes. Yeah. She so she had a lot of one of the things we did before is we went around and searched for things that were circular and did kind of like a hunt. So she had a lot of fun doing that. And then afterward, she said she wanted to try it on squares and rectangles. So we also I'm sorry, not squares and rectangles. After she said she wanted to try it on squares and triangles. And it was actually pretty difficult to find triangles in our home. But we had a lot of fun searching for them. However, I will say she wasn't actually too interested in measuring. I showed it to her once, but then she wound up kind of like freely playing on her own with all of the different circular things. And I figured that's OK as long as she has fun and we're still getting excited about circles and kind of like finding different shapes. Yeah, she's she's tinkering. She's you're she's absorbing that you she did go on the hunt to look for shapes and circles and she wanted to find triangles. And it is getting her excited about other kinds of shapes. So the fact that she's playing around, that's great. Let the kids play, you know, I think it's not being forced learning.  Yeah, it's just a great example of tinkering.  Yeah, yeah, she's been saying that this is how she plays sections. But that's cool. Yeah, she's just having fun playing with the different shapes. A lot of times you see pie as three point one four. But there are a lot of integers that come after the decimal point. As you can see below, the integer is continuing after continue on forever. And that's because pie is an irrational number. It cannot be represented by a fraction and the numbers never repeat in a pattern. Yeah, and this is showing you fire under digits of pie right now. So it's pretty cool to see. And it goes on to infinity. Speaking of irrational numbers, I found while doing research for this episode, an amazing Canadian scientist slash artist. And he does artwork on pie, which really visually helps you see the irrational numbers. The artist's name is Martin Krasinski. He is a Canadian scientist, and I consider him an amazing artist. He's making such amazing mathematical art. We've linked to his website below in the description. Please, if you have time, he just explains in detail how he creates these pieces. So this was his first piece back in 2013. And it really shows how pie is such an irrational number. Every digit from zero to nine is a special color. And you can see there's no patterns to it at all. And this image shows 768 digits of pie. I love this. You can really see how random it is. It's just like random colors everywhere. I think it's easier to understand. Oh, yeah, yeah.  This is 768 digits, and he takes it to, I think, over 2,000 doing lines. So it's like an extended version of this art concept. OK, so the next image is his exploration in circular and spiral artwork with pie. And this shows 13,689 digits of pie. Yeah, and he used tiny circles in a spiral using the Archimedean spiral because it's a dense layout and with the colors, he's using a red, yellow, blue palette called the Brewer palette. So you can actually read about how he calculated everything, but it goes starts from the top and it goes around from the right all around in a spiral. And I had no idea as a designer about the Brewer palette, but it's it's different shades of red, yellow and blue. And it's very useful for perceptual properties and it's commonly used to display quantitative and categorical data. So you can see it's really beautiful.  It really is. And it looks like infinity, even though I guess it's a thousand digit, she said. Thirteen thousand. Oh, 13,000 digits. Yeah. Yeah, so this is amazing. So we're just showing three, but he has a lot more on his side. This is also one of my favorites. It it's a it reminds me of the artist Mondrian. And this is using a tree map to create this visual representation of pie. It's three thousand six hundred and twenty eight digits in a six level tree map. He uses variable line thicknesses, as you can tell, and using Bauhaus prime colors. It's just beautiful.  He actually does artwork on a site. So if you wanted to have some of these pieces, you can you can put it on a site, but it's just breathtakingly beautiful. And so when I was when I contacted Martin to give us permissions to use his artwork in this video, we we had a wonderful conversational exchange about pie. And I love that math is not just art, but it's so poetic. He told me that this tree map version of his artwork actually made it into a music video by Max Cooper. And he had worked on a music video with another musical artist, Aleph, to on the idea of infinity. So this is a quote. Everyone knows that the digits of pie go on forever. But an interesting thing about forever is that there are many kinds of forever. Some are longer than others, though all are forever. This is the idea of various infinities, which the Aleph to video hints at. And I'll link to the music video below. It's beautiful. It's just like an animation of numbers. It goes along really well with the music, and you can think about infinity. That's wonderful. It's so poetic, very poetic. And I just love the idea of math sort of bringing in this artistry and inspiring music, too. It just all comes together. It's true. So you can't have pie day without actual pie, right? And I don't we don't really eat like fruit pies here. I don't really bake fruit pies. Sometimes I do little mini like tarts and stuff. But our favorite pie is the recipe for minis chocolate pie. So we bake that and I had to actually put it in the fridge overnight so that we could decorate it the next day. And I put a sign so my husband wouldn't eat it. Do not eat stem chat pie. And we were my daughter was really inspired by Martin's artwork. And so we thought, you know what, let's do something different and let's make a decoration on the pie based on his artwork. So since it's almost Easter, there's actually the pastel M&M's are out. So we had more colors to work with. And she picked from zero to nine, which colors to have for each digit. And so you can see, actually, this is the pie right here. And you can see at the top right there, that's thirty six digits. So we actually went thirty six digits for the pie. And we just put the pie symbol right in the middle. And here we go. Pie for pie day. Isn't it cute? It's you just like, you know, let kids kind of think out of the box.  I love how colorful it is. It's beautiful. I will say one thing. Thank you for actual baking things. I usually try and do things from, like, you know, scratch and stuff, but I got a frozen pie pie crust. And I was going to make the whipped cream boat in time and I use the spray whipped cream and it melts. So it didn't stand up as fresh whipped cream homemade would be. So just an idea, if you're going to decorate it, I would. And also I would do that last after you do the pie M&M. So that's something we learned on doing this one. And I think you did something too, right? Before. Yes. Yeah, we've we've made a Bing cherry pie that was a pie pie. We make a lot of pies here. This looks so good. Thanks. Yeah, it's pretty good. We put ice cream on it, too. Oh, well, you got to have ice cream with the pie. So that makes sense. I'll mode. I think it just shows, you know what? I think kids can have fun with math, but then you got to have, you know, some fun dessert for pie. Yes, it wouldn't be pie day without a real pie. I mean, not a real pie and edible pie. Exactly. So now's the time we talk about our favorite things. And this time I have a really fun picture book that relates to math. It's called Circumference and the First Roundtable. And it's sort of like a Knights of the Roundtable story. And we all kind of know the round table and circumference and his lady diameter. They work together and they figure out a way because they can't see each other when they're sitting on a long rectangular table to create the round table. So it's a lot of like math puns. This book actually was published a while ago. I don't know what year exactly, but I borrowed this book from the library digital edition. So it's a whole series. So you can check and see if you're not able to go to the library these days to check and see if you can borrow it online and just read it on your tablet or computer. And it's a really fun picture book. And I think people love these kind of medieval night stories. And this is a really clever stories. It's fun. It's funny. I can't wait to check it out with my kids. So I have this style compass that I really like. It's very affordable. It's about two or three dollars. But it's really nice because since you screw it together in the center, the pen or pencil or whatever you choose to put it, it doesn't slide around that much. Sometimes with the cheaper compasses, they're a little bit difficult to use, but this one is really great. Oh, that's cool. And so that's great for younger kids. And the pencil slipping is a big thing, which is why my daughter likes this stab later one. It actually came in a kit. It's got an actual precise wheel on the inside or you press these sides so that the compass will not accidentally go wide open. You can adjust it. And you can also it comes to the lead here, but it comes in a box and you can actually attach on this this attachment to put your own pencil in if you wanted to. And it comes with extra lead. So if you have, I'd say, a child maybe 10 and up, this would probably be maybe starting from fifth grade on. Get a good one because they're going to need it when they go for school. Having a good compass is really important when you're doing math work. Yeah. And I think it's because it's harder to do if it's not a good compass. And so it makes it a lot less fun and then kids get frustrated. Exactly. Exactly. So I'm really excited. So Terri Selting David came out with her second book for the Renegade Tinkering Club, and it's called Renegade Style. So as you know, the story centers are on multiple girls that work together. And this one centers on Amber Rosenberg, who loves fashion and loves sewing. So I love this because the story here is about the environment and she discovers that fast fashion hurts the environment. And what can she do? And the projects are fun. So it starts out with something like, you know, doing some fancy weaving and she comes up with projects on patterns. I love like Terri's illustrative style to do this sort of like comic book style for doing projects. And then she even moves up to doing a stone circuit like bracelet, which my daughter made in her camp before and she was very excited. So she did this. So this is the project here and she shows you how to do it. So there's a lot of really fun projects and a really good story. So check it out and and continue this. The Renegade Girls Stinkering Glove Style. It looks like a lot of fun. OK, so I'm going to give a rock tumbler update. We finally finished tumbling our rocks. This is how they came out. They actually they came up better than I thought they would. But it turns out that even though my kids had a lot of fun making them, they didn't really like them as much. They like the ones that we find like how they naturally look a little bit more instead. So but we might try it again later as they get older. And I think I did learn a lot of things while I was doing it because we made a bunch of mistakes, which is OK. That's how you learn. Yeah, it's really cool that they actually know the difference now between. Oh, you know what? I want it in its natural state rather than, you know, too refined in the tumbler. Yeah, that's true. Well, I think also it's kind of it's like unpredictable. You don't know how they're going to turn out.  So one of the things that we like to do at Easter is to dye different color eggs. I guess we start with eggs that are different colors. They all wind up being different colors in the end. So we use the brown eggs, the white eggs and the blue eggs. There's also like more red, brown eggs and green eggs you can get to. And it's really fun to dye them because you kind of don't know what color they're going to turn out. It's kind of like a surprise. So I think we actually did not expect to like the brown eggs the most. But we really liked how the brown egg colors came out because they were like extra vibrant and bright. And the blue eggs, we thought it was going to make like a super blue egg when we dyed the blue egg, but it looked kind of similar to how the white egg looked in the blue. Oh, that's interesting. I never thought to dye other color eggs. Yeah, it's a lot of fun. Thank you, everyone, for joining us for our episode about pie. I hope you found some fun activities to do with your kids to help celebrate pie day. Yes, and don't forget to follow us on Instagram at STEMChat and we'll see you next time. Bye. Bye.


Can I now turn to you, Iide, with a view from China and on China. Thank you, Chairman. First of all, I have to say I'm not an expert on public health like other members of this panel. I guess because I'm the only Chinese in person at WPC, so organizer want to double my assignment. That's a lot of responsibility on your shoulders. Yeah, but anyway, as a observer, as someone gone through lockdown in China in past three years, I would like to share my view on what's going on in China, what experience and the lesson can learn from China to deal with future X disease or unknown violence. First of all, I guess being trans, trans currency should be the first principle of the unknown virus or X disease in the future. Here I mean the virus origin, gene composition, evolution of a virus, and its possible harm on the human being, et cetera, should be released. All this information should be released to the public, government departments, and the CDC on time. I understand there is a controversy where the Chinese government do enough on this area. Honestly, I'm not positioned to make a judgment on the issue, but the one factor I wanted to raise here, actually the one professor at a Fudan University in Shanghai published the gene composition on the internet. That enables the other company in Western to produce PCR-tasting material to produce a vaccine very soon. Without his release, it's harder to imagine. In a period of time, a vaccine can be produced. Secondly, the action should be taken quickly. I want to use the term yesterday, rapidity of action. That's also very important. When local authorities find the unknown virus, they should immediately report to national CDC while national CDC should immediately report to WHO according the retired procedure. In case of China, I have to say the local government had been a little bit slow to quickly report case to national CDC. That's the lesson I guess we should take it. Third point is physical separation and its extreme form lockdown is effective at the beginning to prevent expansion of virus. At the beginning, it's effective. The earlier it takes, the more effective it would be and the smaller its scope could be.  Wuhan is the capital of Hubei province. That lockdown in early 2020 was a successful example. It helped much less case occurred in China in that year relative to other countries. It also helped China become only one of a large economy which get a positive GDP growth in 2020. The fourth point, first lesson, I guess, the flexibility and the sensibility are necessary to deal with variation of virus. Different measures should be taken to different variation. A past success, successful measure doesn't mean a future success. In China, I guess at the beginning, they did a good job. But starting from this year, I guess Chinese government has been slow to reaction of Omicron. Omicron occurred in China December of last year. It takes several months at least. Chinese government should understand the nature of Omicron. They should not continue to take zero COVID policy until recently. I guess they lift the restriction immediately. I guess in past one or two weeks, that's fortunately for Chinese people. Because in past several months, China went through very tough time. The cost is very high. The economy slowed down. But now the policy has been changed. We will see what happens in the near future. The last point is that awareness public on the virus or X disease are also very important. I came here a little bit earlier due to the availability of flight. I met some staff, a bank of China here in UAE. They told me very interesting case. One staff originally came from Wuhan. In January 2016, 2020, his family including his parents, wife and two kids from Wuhan fly to Dubai. He read some article in youth papers. He knows something happened. But he doesn't know the detail. But he is very smart. He keeps all of his family members at home. Don't go outside. But later on, one by one, some symptoms appear. First of all, he sent his mom to the hospital here. The doctor checked her. No answer. They don't know what's going on here. They came back all midnight. The doctor and the nurse came to their home because they found some PCR test. They found some virus. The whole family be moved to the hospital for quarantine. So he brought it to me. He said, yes, we brought the virus to UAE. But we never infect anyone here in UAE. That's a very good example. Now what happened in China? I guess Chinese government should do more on public understanding what's going on. Otherwise, it will create serious consequences. Might be the wave will occur in China. I guess Chinese government will start to do that. I just stop here. Thank you. Thank you very much. And thank you for emphasizing from the start how China very, very early on made the sequence of the virus available. That if I remember well was on January 2nd, 2020. I mean, within days after the first cases were reported to WHO. That had not been the case with some other viruses in the history. But this issue of sharing sequences is clearly one of the key issues of the ongoing negotiations of a new pandemic treaty at international level. So, you know, within the new field of health diplomacy, there is a subfield of genomic sequence sharing diplomacy nowadays. Maybe... Yeah, I guess you are right. And sorry, maybe could you also say a few words about the current acceptance of the virus by people over the age, let's say of 65 or 70 in China? Yeah, I guess you are right. Several Eastern Asian countries did similar things look down at the beginning of 2020. But now you are right. They transferred to another model, another panel. Interestingly, what happened in Hong Kong? Because Hong Kong has a close relation with the mainland China. But finally, they changed the model. Actually, we as an organization, I have a good contact with the professor of medical school of Hong Kong University. He showed his view to experience what happened in Hong Kong. He said to me, actually, Xinhua news agency asked him to write a report which sent to central governments of China. What I try to say, what happened in other countries have some impact on the changing of Chinese government policy on zero COVID policy. That's my feeling. Thank you very much.


Hey cleaning business owners. This is Derek with cleaning business builders. Although today I'm hanging out in my new business handyman connection I've owned it for a week in a day now. So I'm making lots of changes around here So I'm talking today about work life balance because I'm shooting these videos sort of stream of consciousness of what's going on in my life and Only multiple businesses including a new one work life balance is pretty important And we have a couple sayings at cleaning business builders One of which is what gets measured is what gets done, but I'm also a believer in what gets scheduled is what gets done So I'm going to talk to you about how some of the things I do to achieve work life balance And also kind of tell you a story of a side effect of it of how I accidentally ended up on a date And I'm married by the way, so I shouldn't be dating very bad, but we'll get to that later So one of the things I do to manage all my businesses is Tuesday is meeting day Once a week I step away from the businesses and switch into 100% CEO mode So I have meetings all day long so 8 a.m I meet with my sales team at handyman connection just added that this week and go over what they're selling What's in the pipeline? What can we expect to be coming on board in the next week at 8 30? I meet with the team at cleaning business today our trade publication So Tom Austin and I talk about what are the articles going to be? What's our advertising plan? What type of new products are we going to launch? Now 9 30 I meet with the team over at blue skies services I'm an investor with blue skies and also a consultant to them So I attend their management meeting where we talk about key measures 10 30 to 11 I get a 30 minute break to move around maybe eat something then 11 to 1 Tom Liz and I meet for cleaning business builders where we work on our new products our services things like that From One to 130 I've got a break to eat lunch and then 130 to 230 I meet with the castle keepers team Just like with blue sky services castle keepers is someone I do some consulting with and I'm helping them expand across the country And we've got a conference call to discuss how that's all going to work together from 230 to 330 I've got a conference call in a new acquisition. We're working on can't share yet But we're working on a new market. So that's that call 230 excuse me 330 to 4 I've got a 30 minute break and then 4 to 5 I meet with Randy and Kyle with real world services in Columbus So pretty much Tuesday from 8 a.m. Till 5 p.m. With the exception of an hour and a half I'm scheduled with calls and on those calls. We go over key measures. What are the plans? What's the strategy to make sure everything's staying on track? Now I apply this same scheduling principle to my personal life now. I'm not going to recommend this to everyone I will bet 85 percent of you maybe 90 are going to think this is a crazy system But it works for my wife and I I am happily married have two kids spend a lot of time with them And part of the reason why is our scheduling system So I might need a diagram to explain this But Monday night my wife is responsible for our kids, which means Monday night I'm free to do whatever I want. So Monday is the night that I work out with my trainer Tuesday I take care of the kids on Tuesday night. My wife goes and plays ice hockey Wednesday night My wife takes care of the kids and Wednesday night. I normally go running Thursday night. I take care of the kids again And Becky plays ultimate frisbee and then Friday night is a little bit complicated because we have a rotation And the way the rotation works out is it's four week rotation One week I have my daughter and Becky's got my son the next week we flip The week after that I take both kids the week after that she takes both kids So this ensures that every single week we each get some one-on-one time with one of our kids And then we're not every single week once a month and we normally try to make it something fun I'll go to king's island with them But something where I spend one-on-one time with them and then also Once every month we get a friday off to kind of do whatever we want in my case I normally work in Becky's case. She normally goes and hangs out with her girlfriends Saturday Becky takes care of the kids during the day and Saturday night We have a date night. So we always have a date just the two of us every Saturday Sunday I take care of the kids and then Sunday night is family time we do Family events family dinner and make sure that the whole family is together And there's a few other things in there every Thursday morning I take the kids out to a restaurant For breakfast and we get donuts and eggs and omelets and talk and hang out in the morning So that's how we schedule it and this ensures that every single night Someone's watching the kids Becky and I have time to work out do whatever we're interested in And it avoids a lot of jealousy and arguments with us when we first got married I'd be upset that Becky'd be hanging out with her friends She'd be upset that I was working too much and under this deal on Monday and Wednesday night If I want to work all night, that's cool But I have to be home Tuesdays and Thursdays at 5 p.m. non-negotiable Now I can work out. I can stay at work. I could go hang out with my friends I could do whatever I want, but that's the system that works for us So recently I did a training event in Indianapolis and people were asking me Well, why did you do Indianapolis and the real answer was it was the Friday rotation where I was off from the kids So Indianapolis is close enough that I could drive out Friday night spend the night Teach the class on Saturday got to dinner with everyone on Saturday be home in time for date night Saturday night So that's why I taught the class in Indianapolis. I didn't need to ask permission Now life isn't always that neat. Sometimes there's events or things we have to go to But since we've got an outline Becky and I kind of do swaps So sometimes on date night the discussion towards the beginning we're a little more romantic later on is logistical of Hey, you know, I've got to have a meeting on Thursday night when I'm supposed to watch the kids Can I swap Thursday for Wednesday with you this week and we do that type of stuff? So what gets scheduled what gets done and this makes sure every single month Becky or every single week Becky and I have a date every single week our family spends time together That our kids always have a parent at home that we have time to work out and stay in shape And everything is balanced for us and we have time to do our projects if I want to go to the comic book store Whatever, that's okay. And once a month we get someone on one time with the kids and once a month We get a free day on a Friday night to do whatever we want. Now, how did I end up on a date? Well, part of the reason why is I don't know if you've ever noticed this but I don't wear a wedding ring I'm very uncomfortable with jewelry. Just a little finicky thing with me. I don't like Necklaces watches and I don't like rings. So I lost my wedding ring Several times at which point we decided it was best that I just not get them anymore And about five years ago before we had a second my youngest or my eldest Lindsey was about four years old at the time And we didn't have any kids who lived on our street back then We moved since then but back then we didn't have any kids who lived on our street So Lindsey always seemed a little lonely to me and she was always talking about this kid at school mckinsey And mckinsey was her best friend.  I would love to get the girls together, etc So we went on this play date and on the play date mckinsey's mom keeps asking these questions And she's like, wow, you're really active with Lindsey and I'm like, well, of course I am I take care of her on every monday and wednesday night and every, you know, every sunday and Remember no ring and as the night's going on she starts with, you know, the casual touching and Eventually starts moving to Attempting to pet me which is a little awkward And at that point I start realizing something weird is going on here and mckinsey keeps bringing up her dad And I guess they were divorced or never married and mckinsey's I didn't know that when I set up the play date Mckinsey's mom's like mckinsey stop talking about your daddy now. It's a bad time And that's finally when it dawns on me that I never used the word married with this woman My wife has a name. It's Becky. So especially back then I didn't tend to say my wife I would say, oh, yeah I take care of the of Lindsey on monday and wednesday and Becky takes care of her on tuesday and thursday And I realized I kind of sounded like a divorced guy So, uh, I had accidentally ended up on a date and I actually felt really guilty because this woman was like Wow, what a great guy. He's so involved in his daughter's life and look our kids already love each other And I'm sure she was already starting to imagine all the great things it could be So I kind of freaked out at that point and was like Lindsey, you got to go potty. She's like, no, I don't daddy I'm like, yes, you have to go potty daddy needs time to think so we went to the bathroom Uh, so lindsay could go potty and daddy could think of how to get out of this And I at that point had to figure out how to sneak in the words Wife and married in a way that would let mckinsey's mom back off Without being too embarrassed since it was my fault So if you use this plan, I highly recommend you wear a wedding ring or you at least manage to tell people you're married But that's how I achieve work life balance. It may not work for everybody. It may be a little over structured My mom thinks it's the weirdest system in the world But it works for us and that's what matters in your life And that's what's great about being an entrepreneur is you can develop your life Your systems How you want to and this works for us and I hope it gives you some ideas and uh, hopefully you follow us at cleaning business builders. Thanks


Would you rather pay $650 or $66 for a smart phone? Simple. With the Appalachian Advantage Plan, pay less upfront and then just a few dollars more every month. Better service, bigger savings. That's today's Appalachian Wireless. The Pike County Commonwealth's Attorney's Office claimed another victory this week when a jury found an Elkhorn City man guilty of bringing a large amount of meth into the Pike County Detention Center. The Commonwealth's Attorney Donald Smith says 38-year-old James Rowe was facing charges stemming from an incident in July of last year in which Rowe attempted to smuggle meth into the jail following an arrest. However, this case was about much more than just the drugs alone. We want to send a message about the security of our jails and how important that is to us. And also, we want to send a message about taking a tough stance against persistent phony offenders, which Mr. Rowe was, and that after so many chances they don't deserve any more. The trial, which began on Monday of this week, only lasted two days. However, Rowe, who was out on bail pending the outcome of the trial, decided not to show up on Tuesday. Mr. Rowe did not appear on the second day. Judge Coleman gave him an opportunity to appear, delayed the trial for a few hours, issued a bench warrant. Our local police forces made a really strong effort to bring him in, and they've not been able to do so yet. In fact, he's still at large, and the warrant is still pending. Anyone who knows the whereabouts of James Rowe is asked to contact your local law enforcement agency. Despite Rowe's absence in the courtroom, the jury returned a guilty verdict and recommended a sentence of 20 years.


Live from Las Vegas, Nevada, extracting the signal from the noise. It's theCUBE covering IBM Edge 2015, brought to you by IBM. Hi, everybody, welcome to IBM Edge 2015. This is theCUBE, I'm here with Stu Miniman. My name is Dave Vellante, and theCUBE is a studio. We go out to the events, we extract the signal from the noise, and we bring to you, our audience, a flavor for the event. We talk to the guests, we talk to CIOs, IT practitioners, industry technologists, industry analysts, we've got a number of those folks coming up. We have a packed two-day schedule here. We're at the Sands Convention Center. Las Vegas is the place where all the tech companies go in the spring, they bring their customers in. 6,000 customers here, Stu. And really, the Edge show started in Orlando two years ago. This is our third Edge. It really started as a storage show, and now here we were just talking to Deon Newman, the CMO of the STG group. It's really expanded. The scope really now is not only storage, but system Z, the power, middleware. There's even a little analytics flavor. I saw N. He Cho-Sah is speaking on the main stage. So a lot of IBM clients, a lot of IBM executives, industry ecosystem, and a growing show. Yeah, Dave, as you said, it's our third year doing IBM Edge, and it's grown and matured. It's interesting to watch IBM this year has really been consolidating some of their shows. We were at Interconnect earlier this year, which kind of was cloud and some of the other pieces put together, and this show, as you said, heavy storage, power, Z, middleware, pulling those pieces together. I mean, mainframe, Dave, you did the IBM Z13 launch earlier this year, and it's interesting to see all the pieces going on in the mainframe era. Actually, I got a little Twitter discussion going last night, because what is the hottest technology in tech? Well, it's Docker, and what's another place that you can run Docker? Well, let's take an IBM Z13, run ZLinux on top of it, put containers on top of it. We've come full circle in the IT world. What started with the mainframe is now back on the mainframe, and so a lot of stuff to cover here. Well, mainframe cycles are very long. The R&D cycle in the mainframe is longer than the typical X86 cycle. And we're talking several years. A lot of money goes into R&D. The January announcement of the Z13 was a big boost, in my opinion, for IBM's do, and it's going to help with earnings. People don't talk much about the mainframe, but if you think about what IBM has done in rationalizing its systems business, systems and storage business, storage has been in decline for a number of years. IBM has had challenges turning R&D into productive product. IBM outsourced its storage to a number of companies, NetApp, LSI, and others over the years, and then really in the last decade it's had to kind of scramble and make up for that. And so that is a business that's been in transition. Jamie Thomas took over a year and a half, I think actually a year ago, Ed, or two years ago, I got to get my stances last year. So she's been on for about a year, a little over a year, really pushing toward a software defined world for storage, and then she comes out of the Tivoli Group. IBM jettisoned the X86 business, so it's chasing profits, not revenue now. So it puts pressure on the revenue line, but it should help with the gross margin, and consequently the profit piece. The Z mainframe cycle should be a big boost to IBM, and then of course there's the power, and power is like fighting it out. You know, there's always an alternative, right? There's always going to be a room for a number two, Intel's obviously number one in the enterprise, and power has found a niche in high performance computing, analytics, big data, driving power into little Indian, so that it has binary compatibility with a lot of the applications. The Z is really interesting, Stu, about 25% of the workloads that run on Z run on Linux. And so what IBM has done is they brought the open Linux platform to the mainframe and allowing people to develop modern, Linux-based apps, building apps on top of that Linux platform, and even converting migrating people into that platform. So you'll hear some stories about that. The big thing from a financial perspective, Stu, is mainframes are highly profitable for IBM. They drag not only hardware, they drag software, they drag database, they drag middleware, they drag services, and so I would expect that 2015 should be a strong year for IBM's so-called hardware division, which has really been struggling over the last couple of years. Yeah, and Dave, some of the things I'm looking out at this show, you mentioned last year, IBM took the X86 business and gave it over to Lenovo, so what is the repercussions of that? How does the converged infrastructure and hyper-converged businesses still have play with IBM because Lenovo took over the server business and especially hyper-convergence really sits on that X86 platform. And what about the cloud? Right now, going on this week is the Cloud Foundry Summit in San Francisco.  We've been having a lot of discussions inside the Wikibon offices about Paz and what's happening there. And IBM's a big player there, and if you talk about middleware at this conference, Paz really is that new middleware taking over really the application lifecycle, if you will. So how does all of that fit in with all of the other discussions that we have and storage power and Z? Well, it's interesting too, I was just talking to David Floyer about this and you were in our research meeting on Friday and we were talking about helping our practitioners within the Wikibon community better understand the whole Paz, what it's all about, where it fits. And we're trying to simplify it for people, not only for ourselves, but for our audience. And essentially you've got three classes I was talking to David Floyer about this earlier today and we're just about to publish this. You've got what I call IIS plus. In other words, you're buying infrastructure, you're buying servers, and then you're adding a Paz layer on top of that. So Amazon's the perfect example. You've got another example, which is more of the Cloud Foundry Bluemix approach where you're going into an application development environment of Paz layer, and that essentially defines the infrastructure underneath it. And then you've got a third level, which is what I call SAS minus. So it's like a Salesforce or a service now that essentially has a platform and an application, but they're providing a development platform for the world to then extend those applications. And of course Red Hat's in the mix and everybody wants a piece of that action. Why is that still? Yeah, so I mean Dave, we know the whole reason that infrastructure exists is to deliver those applications. And that whole modernization of applications is one of the biggest challenges we have in IT today. If you look at where we are with applications, applications run your business. And companies are looking for new ways to accelerate how they can get new business value, have business units, leverage the data that we have. So here at the IBM show, we've been talking with the last couple of years, is it's not about storing your data, it's leveraging that data, and it's analytics and new business value that we can create, often with new applications, the cloud native apps, if you will, mobile applications and analytics that leverage that data, which is the whole reason why this whole space exists. Another big story that we're going to hear today this week is Flash. I mean, if you're in the systems and storage business and you're not talking about Flash, then you've had to sleep at the wheel. IBM, as you know, Stu, acquired Texas memory systems. They subsequently, initially were using the sand volume controller to provide the stack for TMS. They've now integrated into the store-wise product line with an all-Flash array. Gartner just published its numbers. IBM was number three, EMC was number one, Pure was number two, IBM was number three, ahead of NetApp, ahead of Atachi, ahead of HP, and others. That's a very fast-growing market. It's growing at 50% a year, and it really is going, we think, going to overtake not only the SSD space and the hybrid space, but the entire spinning disc market. Yeah, absolutely. So TMS always had some good performance numbers there, and there's a lot of competition in this space. It's moving hot. As we've said many times, Dave's were six years into kind of this wave of flash, and we think we'll see way more innovation and change happening in the next four years than we did in the last six. So I'm interested in people's opinions on this. We've got a number of analysts. John Tewego is coming on later. We've got Stephen Pratt coming on. He's the CTO of Centerpoint Energy, a lot of practitioners, a lot of customers, a lot of IBM execs, so keep it right there. Everybody's doing our way back with our next guest right after this brief break.


Next up, Adderford factory footage. Take away Adderford factory. We have some factory footage, but outside the window, we have a couple tracks this week. This is Disney being built across the street. It looks like they're making it taller so they can make the building taller. We also have some other footage, same thing. So they're making the crane. See, the crane is making a crane. Pretty soon all of the world will just be cranes.