Hello, thank you for joining me. Today I'm standing on a bridge over Shire's Ditch. This is a little river which comes off the Fraser River, which in turn comes off the River Colm. We're about three-quarters of a mile away from Uxbridge Town Centre and just along over there is an old railway line. What we're going to do today, we're going to, well firstly we're going to walk along this boardwalk. We're going to go into Uxbridge and we're going to go and look at all the lost stations that once served this town because currently Uxbridge only has one station and that is the Metropolitan lines Uxbridge branch from Harrow on the Hill. But there have been various other stations which have come and gone so we're going to walk around Uxbridge and we're going to go and find the sites of those stations. So we just get through to here. Now you can see here the footpath goes under a bridge under the old railway line to Uxbridge High Street. So what I'm going to do though, I'm going to go round here. There's a little gate here and we'll go up some steps and that will take us on to the trackbed. So we go along here. It seems to be a bit of a nature reserve. That was the official public footpath where we were on a moment ago. Up these steps onto what is quite a low embankment and then we'll be on the actual trackbed itself. So when we get up to here you can see you can't really easily go any further. I could if I wanted to scramble through the bushes. I did do that a few years ago. I'm not doing that today. I'm going to follow the railway this way towards where Uxbridge High Street station was and I just tripped into a hole. So about a mile that way is the Chiltern Main Line. So there had been a triangular junction between Denham and West Rice. The Chiltern Main Line opened in 1906. This was added in 1907 and Uxbridge High Street station opened and closed to passengers a few times. It eventually closed completely to freight in 1964. What I'll do I'll put a thing on screen now telling you all the openings and closings of Uxbridge High Street. So it's got a fairly complex history. So what I'm going to do now I'm going to keep following this footpath until we get to the site of where the railway station once stood and then once we've seen that we'll go and hunt down some other sites of former railway lines and maybe the odd current railway line around Uxbridge. I'm just getting a little bit closer to Uxbridge. Now just down there you can't really see it because of all the trees and bushes is the river phrase which as I said comes off of a conch. Look at that. It's interesting there's some old rail here. In fact I think I know what this is. This where it's been tipped on its side. To me that is the base of a set of points. So that's where the rail would have moved. That's quite interesting to think that that survived here. I think that they've been last used in about 1964. Still here now. That's an impressive little survivor. I wasn't expecting that. The embankment has widened out a bit here. So I'm not sure exactly how to look but I imagine from it had been a single track. It might have been double track if anyone does want to comment and confirm if it was double or single. But from here it looks like there probably was double track and we obviously know there were some points for the various shunting and everything that would have gone on. So yeah quite quite an unexpected discovery there. I'm just going to keep going now. We're still a little way from Uxbridge but I'm going to walk along as much as I can while it's a footpath. So I'll show you where the footpath ends and we have to find another way to find our way to Uxbridge High Street. Well the footpath I've been walking along seems to have drifted off the track bed. You can just see there's the low embankment. It does make me wonder though it drifted off so gently over there. That's where Samderson's was. They made material. There'd have been other factories now it's all a business part. Whether there was possibly some sidings into what would have been a very industrial area. I'm not entirely sure on that one.  Please do. So we come to here you can see we're now going back up to the level of the track bed. There's um so it's what is it Hartfordshire Middlesex Wildlife Trust and it's Uxbridge Aldergate Nature Reserve. So they're taking care of the section of track bed. So this is we're back on the bank now and as you can see what happens here it becomes a housing estate. So I'm going to walk on through this housing estate until we come to the site of where Uxbridge High Street station would have been. So we've kind of gone from one extreme of an old railway to another. So we've reached the site of Uxbridge High Street station. That's the river Freys down there. It would have been about just over there where this building is. So this is part of Buck's new uni. This has been built on the site. We're just coming up towards Uxbridge High Street itself. So when we get to here this road which is now a dead end if you go that way because into the housing estate that is the Uxbridge High Street. And as you can see looking this way they've put a modern road going around the you know the bypass round the oldest part of the town. So this building here this is where the station would have been. It would have probably been about there. And what happened was there was a bridge. It was on a viaduct by then. There was a station building underneath the bridge and the bridge ended probably about midway there in the road. Now the reason they built a bridge was because it was intended not to be a through station. We shall fairly soon we'll go and see the site of Uxbridge Vine Street station and the plan was to link the two together but it never happened. Had that happened you never know it might have survived because it would provide quite a useful link to bypass London. So if you're coming down from High Wickham and you wanted to get to Heathrow Airport but unfortunately that didn't happen. So we get to here. I think the ticket office would have been around here somewhere. The bridge would have gone out ended there and you'd have bought your ticket you'd have come along here somewhere and you'd have gone up a set of steps up to where the one platform is. So yeah not a lot to see really now just an office block but this is the site of Uxbridge High Street. One other thing it really is nothing to do with the railway but I'm going to show you because it's quite interesting. Is that building there it's built to look like an ocean liner which I've always found quite fascinating and that pub on the other side of the road that's one of the oldest buildings in Uxbridge. What I'm going to do now I'm going to head into Uxbridge Town Centre and we're going to go and find our second lost railway station of Uxbridge. I've just walked through Uxbridge Town Centre I'm now walking up Belmont Road because this is where we find our second lost station of Uxbridge it was called Uxbridge Belmont Road that's a bit of an unusual one because it was determinous of the branch from Harrow on the Hill the Metropolitan Line branch Harrow on the Hill and of course that branch still is here today but the station has been relocated I'll get onto that in a moment we look across here Sainsbury's Car Park this is where Uxbridge Belmont Road would have once stood. Now you can just see there there is an s-stop train in Uxbridge sidings the Metropolitan Line now dives down behind those sidings into the current Uxbridge station so the station that would have been here it opened in 1904 it was steam hauled originally for the first few months and then in 1905 it became electric they have of course on a few times returned steam to the Uxbridge branch with steam on the Met so I have done a steam train on the Uxbridge branch it closed in 1938 when they built the current Uxbridge station so it's the shortest live station it had been a similar style to Rhyslip station which we went to when we went to Rhyslip Lido Railway I'll put a link to that video on the screen now so if you have a look at that video give you an idea what Uxbridge Belmont Road would look like I'm now going to head round over there to um although this is Lost Stations of Uxbridge for the sake of it we might as well go and walk through the current one and only station in Uxbridge I'm now just walking through Uxbridge bus station and we're going to go through the current Uxbridge station which is just over there so not going on any trains we're literally just going to walk across the concourse and out onto the high street so here we have Uxbridge station this is what opened in 1938 it replaced Belmont Road where we've just been so this would never have been served by steam it only ever had steam on a couple of occasions in preservation so I'll just let you see that so you get barriers an S-stop train which you can't see it's already there we go there's the S-stop train one thing I really like about this station well firstly it's brutalist it would almost be like a 1930s church it's brutalist style and it's got these lovely stained glass windows here so I really I really like this station now if you get on the Piccadilly Line and go all the way to Cockfosters they've got a very similar station so you can actually get on a station like this and travel to its twin sister so yeah I really I think this is a really nice bit of London Transport architecture what we're going to do now we're going to go out onto the high street we've got one more station in the town centre to look at and and then we've got one more slightly further away to look at so come over here the high street so yeah really nice you can see this curved shape that was so when trolleybuses they used to terminate on on a circle here so anyway I'm going to now walk off down towards our next one which was Uxbridge Vine Street Vine Street the street that gave Uxbridge very first railway station its name the road you see along here this is still the main high street we're going to go down Vine Street which is this road here it was always exciting to go inside it was very much like being in are you being served it was so old-fashioned and it was just great and it's you know a really nice art deco building unfortunately closed it looks like it's all been rebuilt the end bit down there has been demolished and they're building a more modern building because I believe only this section here is listed and there's a model of it at Beckinscott model village so if you have a look at this video coming on screen now you'll be able to see that so you can see how they're building an extension here if we look at this picture here so there's going to be this is a building apart there's no coming see an old picture of Randalls and you can see some older buildings there so they would have been demolished and an extension in a similar style to the original art deco would have been built that's now been demolished because because it was a later addition it wasn't listed and we're just going to go down here now to where Uxbridge Vine Street station was where this building was more on the corner down there there was a pub um the name has slipped my mind but i'll put it on screen here was where the local press office would have been and just there coming to it now where there's a rather modern office block that is where Uxbridge Vine Street station would have been it was the first railway station to open up which opened in 1856 close to passengers in 1962 closed to goods in 1964 so it would have been well the ticket office would have been somewhere here on the road that's the main bypass block because of course that wouldn't have been there because all the traffic would have gone along the high street so the vine had originally had um a roof like you get it i'm trying to think of a station that's still got one a great western overall roof a bit like kings where down on the plainton and dartmouth railway i've had a roof like that that was later taken down there'd have been a good yard probably about where the road is now and i do actually remember what i never ever remember seeing trains here as a child it was a car park and i vaguely remember seeing the platforms were still there the track bed has pretty much been obliterated by housing and roads in that direction but what i'm going to do i'm going to walk down there because i want to show you the site of cowley station that's the other station in Uxbridge so i'm going to work my way off down there somewhere and um let's go and find a site of cowley station i'm about halfway now between Uxbridge and Cowley stations i'm in the cuttings so the track would have been about where i am i like how the cutting has found the modern use because if you look there's garages on each side and up there are houses so the houses are at the natural ground level and the garages upload them i'll be able to show you by seeing these bridges we've got we'll go up here fortunately the bridges aren't high enough to accommodate any trains if they're ever reopened but i don't think it ever will one thing i want to show you is these bricks they might look fairly normal but they're actually bigger they're taller these are a modular brick they were a metric brick that was bought out but they were never very successful so you don't see modular bricks that often but here we have an estate which is all modular bricks so if we come to here and if you look that way you can see the bridges going along there the railway would have carried on i'm going to carry on down there until we get to Cowley station i've just come out of that housing estate you can clearly see the cutting which would have once carried the railway it's been filled in from here and there's a few trees planted where the railway line would have been the road which runs along there that would have always been there when the railway was here but it's what happens here that's i find quite interesting you've got another road crossing you can see there's a hump which if you didn't know there'd once been a railway here you might think why is there this sort of hump which the bus is just about to go over so this bus is now crossing where a railway bridge would have been so that's why there is this hump the railway line would have carried on beyond that corner for head so i'm going to carry on down there and soon we should be at the site of Cowley railway station this is a rather unusual bit of old railway it seems to have become a pond in front of brunel university so looking that way that's looking towards us so there would have been a cutting but it's been completely filled in i don't suppose this pond goes down to the level of the track but i suspect they filled it in and then they've put this pond in afterwards but we're heading for just over there where those trees are i have a feeling there might still be something of the cutting which i'm hoping to go down and get to you know track level again this little duckling there swing off into the pond and i'm not sure about that but let's let's have a look so i just thought this was quite an unusual bit of old railway the fact it's new from brunel university so i'm going to probably carry on along the road but i believe in there um that's where the cutting of the old railway is if you look over there you've got the brutalist concrete jungle of the brunel university well after showing you the pond my plan had been to walk along the road along there but just as i was going i'd call something out the corner of my eye now remember this is brunel university so there's you know it's obvious who it's named after it's named after the great is and barred kingdom brunel and um to sort of highlight that there's a section of one of brunel's bridges here this comes from one of the bridges over the river why it chips those they've bought this section here they've plinthed it for people to see so there's a bit of brunel's work at brunel's university now the other exciting thing to do with this railway um well it ran along the cutting is still there on the other side of the fence now unfortunately we can't get in i have been in here before so my plan had been to take you in and show you but um the gate there's a gate here just goes down to cutting is locked i'm going to show you over the gate have a look down there you're not imagining it you can see brunel's broad gauge track i think as part of an art project someone has decided to lay some broad gauge track on the old railway so it's nice to see that he's actually still track on this line even if it doesn't carry a train as far as i'm aware this railway never was broad gauge i believe it only ever was standard gauge but as it runs right past brunel's university it's real shame it it doesn't still exist because you know the railway would serve the university cannelly station was and i'll keep saying we're nearly at cannelly station we are now it's just down there um so you know students could use it they could jump on the train go on stop into uxbridge or they could go that way to west straight and when they get trained to london or the west country so yeah it's real shame the way it's not here anyway i'm going to now go out there walk along the road we're going to go and find cannelly station and finally we are now coming to the site of cannelly station so the railway track bed is just down the other side of the road in that cutting it's the most uninterrupted section of track bed it's the same bit just up there where we were having a look at the section of raw gauge track bed laid we get to here now you can see there's another hump in the road as the bus is quite clearly showing that so where the bus is now that is going over the old railway bridge across the road so you can quite clearly see this very unnatural hump we have here the station would have been just down there we will go down there in the moment i just want to show you something here so if we stand on the old bridge we on the ground here at these bricks these look very much of railway origin and i'm not entirely sure this is there's some kind of metal bar running all the way across i don't think it's an old section of track but it looks to me very much like it's of railway origin so there's now houses on the site of cannelly station we're looking that way that's looking towards uxbridge along the track bed what i'm going to do now i'm going to go down this cycle path so we can be roughly where the platforms would have been so there had just been two platforms there was no goods facilities here it was just you know it was the only intermediate station on the branch the next station would have been west raster which of course is still open the bay platform is still there and it was also the bay for the stains west branch um that's something we have to do another day at some point in the future i would like to do the stains west branch because that's quite an interesting branch and parts of it are still open for freight so that's quite a fascinating branch but that's for another day and but the the bay platform is still there so you you you know you can still see that when you get to west raton so here we are this area here another housing state similar to what we found at uxbridge high street this is the site of cannelly station i should think where i'm standing now this is probably where the two tracks would have been the platforms would have probably been about each side of the road so from the site of cowley station i hope you enjoyed joining me and looking for the lost stations of uxbridge thank you very much for watching please do feel free to like subscribe comment thank you very much goodbye


Item Number – SCP-557 Object Class – Euclid Special Containment Procedures – As it is not possible to relocate SCP-557, research site 29 has been built surrounding it. Geographic and aerial surveys of the area have been altered to make it appear to be empty desert, with no valuable archaeological or mineral features. Unauthorized personnel have several tasks. To prevent unauthorized observation of, and access to, SCP-557. Despite its inhospitable location, several occult groups, including the… appear to be aware of SCP-557, and have shown an interest in it. Unauthorized personnel are to be taken into custody, interrogated, and dealt with appropriately. Anyone attempting to tunnel below level 5, or disturb the stone block in the floor of room 501, is to be terminated immediately. To continue to attempt translation of the records found in SCP-557. To monitor the area for SCP-557-1, SCP-557-1 should be assumed to be Keter Class, and is to be captured if possible, otherwise terminated. To monitor room 501, and serve as a strike team, should anything emerge from beneath it? Description SCP-557 is an um-an-nar-era tomb, estimated to have been built circa 2400 BCE. On a gravel plain in the empty quarter of northwestern Oman, investigation of the surrounding area indicates it may be part of the lost city of Ubar. SCP-557 was discovered in 1988, during an inquiry into the disappearance of a geological survey team in the area. Unlike similar structures, SCP-557 includes five underground levels, constructed primarily of sandstone, apparently used as an ancient prison and containment site. Although living quarters and weapons for approximately f*****g staff and guards exist on level 1, the facility appears to have been slowly abandoned over the years, and empty since circa 300 CE. Only two skeletons were found on level 1. A substantial library of records was found on level 1, in a number of ancient languages. Only the records in Egyptian, and a final note left in Greek, have been translated. Levels 2 and 3 are stated in the records to be a prison for heretics and sorcerers, that appear not to have been used for up to 1,000 years before the site was abandoned. Level 4 is described as, a place for the abnormal. Skeletons resembling SCP-5 and SCP-5 have been discovered locked away in stone cells, confirming the intent of the structure. Level 5 consists of a 51.2 meter long hallway, filled with complex traps and deadfalls, leading to a single large, 21.3 meters by 19.7 meters by 5.4 meters, room, designated as 501. Although all of the traps appear to have been sprung or cleared, researchers should exercise caution. The door to room 501, anachronistically composed of f*****g, was found torn down from the inside. Based on the distribution of dust in this area, this event happened only approximately 20 years ago. In the center of the floor of room 501, is a partially buried 3.2 meter by 3.35 meter granite block, estimated to weigh 80,000 kilograms. The block is covered with untranslated runes. A similar, thinner block stands in the room and shows evidence that a living being, designated SCP-557-1, was chained to it, using chains from the same material as the door. No evidence of the continued presence of SCP-557-1 has been found. Translated records only refer to SCP-557-1 as the prisoner, with the exception of one reference in Egyptian 2, the bastard son of APEP. Addendum, translation of a note, found in the records room. I will write in Greek, so that any learned man who finds this place will understand. I am the last of the keepers, and I will be dead soon. The sands are taking this place, and perhaps it is for the best. The prisoner must not escape, and the gateway to the dark must never be opened. I do not think the gate can be moved, but who knows of the prisoner. Not even the gods could kill it, and it was only with their help that he was secured. Without the rituals, I do not know. Secure the door the best you can, and never move the stone. Lesson complete. If you missed the previous orientation, go watch SCP-556, painted aircraft, right now. Or for the complete course, watch this playlist.


What's up everyone? It's your girl Kenty here from Layton Sports Cards and I'm ripping another personal year for Justin S. We've got a 2022 Bowman University football hobby box. Best of luck Justin. Thanks again for hopping back in. Just a heads up. No paper ships out of this for you. It's just your chrome card. Your hits will be shipped. We've got first Refractor Otto of Chimerque Decay. Refractor first Malik Cunningham. We've got Orange First Connor Baselack out of 25. Nice Orange. I don't see too many oranges. Otto Wayraved 199. DJ Oogadeli. Got first Refractor Devin Lloyd. Hey, second half here. Let's see some color. Let's see some more color. Got first Refractor Marvin Mims. I picked up Justin Ross. First Otto to 99. Graham Mertz. Can we get an extra Otto on here? Nice. There you go Justin. Three autos. We'll take a bonus Otto, especially a quarterback. Number one. Heck yeah. We've got Purple First Malik Willis. Nice. Purple's are not numbered, but nice insert there. First Refractor Jalen Tolbert. Invicta Chris Olave. Chimer first Mackenzie Milton. And paper. Alrighty Justin, that will do it for your Bowman U-Box. Thanks again for hopping in. We do appreciate your support as always and we'll get these right out to you.


Well, good afternoon, everyone. Thank you for coming. I'm Eric Green, Director of the National Human Genome Research Institute. I'd like to welcome all of you to the sixth lecture in the Genomics and Health Disparities lecture series by way of reminder or background. This series is cosponsored by four NIH institutes, the National Institute of Diabetes and Digestive and Kidney Diseases, the National Heart, Lung and Blood Institute, the National Institute on Minority Health and Health Disparities, the National Human Genome Research Institute, and then in addition to those four components of NIH, it is also sponsored by the Office of Minority Health at the Food and Drug Administration. These five organizations get together and choose the speakers who we ask to come in and present their research on the ability of genomics to improve health equity, or at least to help us understand the issues around the use of genomics for such purposes. The speakers in the series are deliberately picked to approach the problem from different areas of genomics research, including basic research, population genomics, translational and clinical research, and so forth. And the lecture topics have a focus across many disciplines by design, and today's speaker is especially notable for his ability to use genomics to advance public health and precision medicine. So that's the series. This is lecture number six. More will follow, especially in the fall and beyond. And so to introduce today's speaker, I'm glad to invite to the stage one of our co-sponsors, the director of the National Institute of Minority Health and Health Disparities, and a good friend, Dr. Elisayo Praz-Stablig. Elisayo. Thank you. Thank you, Eric, and thanks all for coming on a critical day with a lot happening across campus and in the city. So it's a real pleasure to introduce Mark Collin. I'm trying to remember the year, but I think we met in 1989 in Aspen at the annual meeting of the Henry J. Kaiser Faculty Scholars in General Internal Medicine group. I was the first-year awardee, and he had just completed his time. And we got to hang out and talk and become friends, and over the years these kinds of relationships end up coming back, as I'm discovering being here in Washington with a lot of people. Mark is extremely accomplished. He spent most of his career at Yale, but in 2008, right, 2009, he was lured to the left coast in part accompanying Michelle Barry, his wife, who is an accomplished scientist in global health. And he became chief of the Division of General Internal Medicine as well as brought his research program there. Mark's legacy is that he and others reinvented the discipline of occupational health as far as a clinical discipline is concerned during 20 years of research and really was a definitive reference point in that area. He subsequently then reinvented himself or moved into looking at big data, trying to understand all the different components that lead to health outcomes. As someone who was very focused on the environment, he understood the importance of the physical and cultural environment, not just toxins, the individual behavior and demographics, and the biology. And I think this has led to his current role as director of the Stanford Center for Population Health Sciences, which he's been for the last two years at Stanford, which I think is a very exciting enterprise to pursue precisely what NIMHD has proposed is our research model of looking at the different components that lead to different health outcomes. And I'm sure you can weave the health care system into it in your role as the co-PI of the Stanford CTSA. So Mark is also an elected member of the National Academy of Medicine. He's currently the IOM, and he was a student, has an MD from Yale, where he spent most of his career before moving to Stanford. So it's a real pleasure to have him come and tell us about this exciting work. Mark? Thank you. Well, thank you for the generous introduction. Thank you, Eric. Thank you, Eloseo. As I said, Eloseo and I go way back. And thank you all for coming, frankly, with the director's council meeting across campus issues as senior associate dean at Stanford that are near and dear to my heart. And with whatever it is that's going on down at the Capitol today, I'm shocked that any of you are here, and very grateful. Thank you. Thank you. This is one that you clearly won't be able to read about online tonight. I want to start in the following place. So I was one of the, because in my more administrative capacity, one of the early recipients of the PAR that emerged from NIMHD, suggesting the development of disparity centers whose central conceit would be the application of the tools of genomics in addressing health disparities. And like many of you who have been engaged in this, I greeted this with both remarkable interest but also a very healthy amount of skepticism regarding whether or not this was an attempt to make something that was problematic politically correct or whether there was really underneath it all some potentially enormous scientific opportunity, which those of us who'd worked in various ways in health disparities, whether it was in the workforce or in other of the important life stages. So this was a big open question. And what I'm going to do today is walk you through a little of that angst that we went through in thinking about whether or not this was a good idea, starting you with reasons why it was a terrible idea, moving you to think a little bit about why it might not be such a bad idea. And then I'm going to finish by showing you just a brief window into the projects which we have been able to launch as part of our new center, which graciously funded by NIMHD, and in which I think there at least are some opportunities that hopefully we will begin to explore. As a spoiler alert, I don't want anyone hanging on the edge of your seat waiting for the answer to this question. We are not quite there yet. In fact, I don't really know yet whether I can view myself in the role I'm now playing as an intrepid explorer into a really great new world or someone acting out of remarkable hubris and trying to solve a problem that is effectively insoluble. But in any event, here goes. So let's start with the reasons we should not go there, because I said the first 10 discussions that I had with my own team and with colleagues were in this space. And the most important of them I call first things first. And I don't think anything I'm about to show you is new. I'm treading over territory you've seen before. I'm going to show you work in my own hands just so you see how I personally got to where I worried about this. But it's all laid out on this single map. You've seen many versions of this map. This is actually a rather old one. But at the time we did the study that I'm going to show you, we didn't have full access to the decade later data, although I'm going to show you a little of that a bit. And this just shows the probability for white men in this particular slide of making it to the age of 70, not exactly old age. But we use survival to 70 because we wanted to be able to look individually at all of the counties, at least all of those with reasonable mortality in terms of size in the entire country. And I think you can see you don't need to be a rocket scientist. There's no big surprises on here. You can see that there are some counties out and about heavily concentrated in the South, but by no means uniquely in the South in which the probability of a white man making it to a social security check, assuming they decide to hang out for the real thing, is barely a little over 50%. And on the other hand there are places like the area that I'm happy to be living in as we speak today in which that chance is well over 80%. This is an incredible geographic disparity, not surprising. What we decided to do was see to what extent social factors that we could easily measure at every county level could explain those.  And here are a few more of those, and oops, and then a few more that could be easily gleaned from other available reference points, including looking at climate, looking at at least one indicator of available healthcare, an indicator of food supply and air quality, given my long standing interest in physical environment. And then a few demographic risk factors. And it will not surprise any of you in the slightest that a handful of factors for each of the four populations, we were unable to, in this analysis, look at populations other than whites and blacks because of the numbers in the various counties. So we looked at white men and black men and white women and black women. And you can see certain factors just show themselves as being enormously significant in explaining those health disparities. Again, I don't think there are any surprises on this slide. But what was a little surprising to us was this slide. So this is just looking at the residuals, which is to say, if you take those 18 or 20 variables and really only six or seven that add much weight to the regression, how much do they explain? And if you look at the four curves, you see they explain basically everything. So 80 plus percent of the variation is explained by those variables, all social variables. Again, this is ecological. We're looking at average health effects. We're not looking at individual effects. There's not a single big outlier. There's more variation in men than women, and I'll show you why it is set. And there's more variation in African Americans than there is in whites. But frankly, there's no surprises here. It doesn't even leave a hell of a lot of room to look for another explanation, let alone a genetic explanation. This is just how they distribute. And I think that again, the shocking information contained in counties in which African American men don't do very well. It's just horrific to look at a place where barely 40% of the population is going to ever see a social security check. This was again in year 2000. It has improved for African Americans, as you know, in the subsequent decade. I'll show you a little of that data in a bit. You can see that white men and black women are pretty much more or less the same distribution, and then the lucky white women over on the right. One question we wanted to ask ourselves is just doing a thought experiment. Just imagining that we could do the big project that unfortunately in the social climate we cannot do, which is level the playing field and give the inhabitants of all of these counties values not their own.  So again, we just redid the regressions.  And lo and behold, there ends up virtually no county in the country in which there's a big difference between the whites and these sort of make-believe blacks. And the same was true for women, although there was a little bit of a disparity that remained after you adjusted for it. One of the things we could not do incidentally using the same strategies to explain the difference between male survival and female survival. I'm going to give you some insight into that in another slide in a few minutes. Now, as we were doing this, we were also looking at possible, even though the study itself doesn't beg for alternative explanations. But we were curious about various things. And one of the ways we looked at the possibility that some of the variation, incidentally, I should mention that geography fell out completely from this analysis. So living in the south, which you might imagine is a remarkably bad thing for your overall health. And indeed, most counties in the south have dreadful health statistics by comparison. But it turns out when you adjust for things like education and occupation and wealth and the like, most of that disappears from sight. But in this particular slide, we took the data from the health and retirement study, which now has genomic information available. And we took the state of birth of all of the people in the HRS, which includes thankfully every one of the 50 states. And we looked for those states, using again the available data, at the distribution of social factors in the states in the decade that the HRS subject was born. And we looked at their genetic risk scores using three of the currently available polygenic risk scores. And I think you can see what's pretty obvious, which is there's no variation at the ecologic level in these risk scores. Basically from a genetic point of view, and again, unfortunately it's state level, not county. But from a genetic point of view, these things distribute pretty evenly. On a social point of view, however, there's four standard deviations in wealth, education, and the like, and it's true of any variable you look at. So just from, if you're looking for an opportunity to explain health disparities, you probably shouldn't spend too much of your time on the left side of that slide. Just again, this is remember, why we shouldn't go there. Now, we even went further with the health and retirement study, because we were particularly interested in seeing to what extent those early childhood predictors, either from a social point of view on the right, or from a genetic point of view on the left, actually, again ecologically predicted outcome. And on the left, the fact of the matter is they didn't, not very much. Again, not individually. This is not individual genomics, but the state they were born in. Whereas the state social factors 70 years later had predicted a substantial amount of the chronic disease burden that this population had experienced. In a model in which we took into account every other observable individual factor, smoking, non-smoking, and the like. It's quite stunning that this much survives of our early childhood. It's itself a huge line of interesting research, and does suggest that there may be an opportunity to try and study early in life what's going on that embeds many of these things into our overall health opportunity. Now, I would love to say that for those of us in the healthcare world, especially those of us like myself who are clinicians, that has nothing to do with us. It's all about social factors. One did notice a very small but real impact of the single measure we did in that study of health quality. But I think the slide outlines four bullets. I'm not going to go in detail. I assume that there's no one sitting in the room that is unaware of these issues, which contribute obviously to health disparities and which, in theory, could be addressed. So once again, why would we go looking at the genome when we've got this heavy lifting to do staring us in the face?  But we have substantially less available information to study the genetic influence on health, certainly in minority populations. And there are two reasons for it. One illustrated by this slide, which is that we haven't done it. We just haven't assembled those populations. And many of us, as I've been discussing throughout the day, are waiting with bated breath for all of us program to all of us research program to mature so that we can begin to look at populations with both genomic and social information as well as clinical phenotype information covering the real spectrum of the US population. But in this slide, you can see that we've made apparent progress over the past seven years in the amount of GWAS studies that have been done in non-white populations. But you can see almost all that progress is in Asia. And we still have done virtually nothing to look at minority populations other than the Asian population that are major parts of the US population. Now, the other problem, again, for those of you who are in the genomics world, this will not come as any news. But there's also enormous differences in the ability to study some populations. And not only have we not studied African-Americans, but to study them is going to take a long time. Because there is, as you well know, an enormous amount of variation. This is from some work that's being done by Esteban Bouchard and his lab in which they have been trying to assemble some African-American populations and other minority populations for very important work they're doing in respiratory disease.  And you can see that the sheer number of variants in the African-American population literally dwarfs what's seen in here, the Puerto Rican population, but which is at least largely white. In fact, it's not even entirely white and includes some overlap here. And then Native Americans, who have a much smaller amount of variation, another area that I will come back to before we're done. And then, of course, there is the part of this discussion that's actually most difficult for many of us to meaningfully talk about. Which is that the real concern for many of us around the genomic revolution and its applications in finding new drug targets and fantastic new therapeutic agents, which I think we can certainly say is rapidly emerging in the cancer field and is likely to emerge in a wide range of other therapeutic areas. That unless we substantially change the social organization of our healthcare system, these advances are likely to widen, not narrow gaps in that the part of the population that has access to the testing, has access to the knowledge, has access to be able to afford the therapeutic interventions. If indeed, Coumadin won't work, but you need a thrombotin inhibitor. It's unfortunately an area in which the parts of our population most in need of investment is the part of the population least likely to be able to exploit that. I just want to add one additional point before moving on to the glimmers of hope, that there may be some potential value in the direction that we are headed. And that is that even if, even if we could level the playing field on access and cost, even if I didn't continually hear things, we have various focus groups going now in some of the disparities work that we're doing, which I'll come to in a bit. And one of the things that we hear most often is we assemble focus groups to talk about what do they understand about the genome? What do they understand about gene testing? What do they understand about how knowing about your gene might influence your health? We are repeatedly assaulted with the following basically now predictable comment that comes out at least once in every focus group, which is, yes, my doctor said that I should go get this test only then to discover that even the test was not paid for by insurance, let alone any evidence that they could benefit from the result of that test. And we're talking about people that are, we're talking about 40-year-olds with breast cancer in whom their insurance would not pay for them to be tested despite a family full of women, that kind of thing. We really are, I mean, the last thing I'm going to say of this, but we really are in a deplorable state in terms of our ability to bring the genomic revolution to the bedside to deal with disparities. So I want to now turn the corner a little bit. I feel like I've gotten a little bit preachy here to talk about where potentially some of the opportunities may lie. And again, I'm not trying to in any way cover this in a comprehensive way. It's really more conceptually to sort of get people to think a little bit about where some of the work may go. When, for example, some of the worst of these problems are addressed, or at least where we have some confidence that they might be. So the first, and I think it's not a huge leap, and many others who you've heard from and who are publishing very actively, we're early to recognize that it's not the genome itself that is likely to be the explanatory factor that's going to help us really address deep disparities. And the reason for that's pretty clear. It's because the genome's not the cause of those disparities and probably contributes only modestly if at all frankly in some populations to what we see. It's very, very likely that environmental factors are contributing quite substantially. And so the question now lurks, given that we have the technology to explore it, is to what extent might understanding the relationship between those environmental factors and the genetic alleles of interest? To what extent might that relationship itself actually offer us the beginning of some clues as to a pathway for application? So again, here this is not to push the genome off the page, but only to recognize that it's not the genome per se that could be the target of our research and certainly not our applied research. But in fact, it's potential interactions with the environment.  There have been some interesting ones, don't get me wrong. They're scientifically very interesting. But we don't really yet have a very, very broad pallet of places in which showing that social disadvantage as an environmental exposure or any of its components easily interacts with an allele or even something larger in the genomic world that would help us exploit it from an interventionist point of view. So I actually want to show you one that you probably don't think about in terms of a gene environment interaction. But for a variety of reasons, I think it's the right way to think about what I'm about to show you. So this is plots from... It's exactly the same thing I just showed you before from the S70 study. This is now with the newer data. And this is the black data, which I didn't show you before. Again, I don't think it takes much imagination to see that men and women are rather different here in terms of where they are on the plot. Women have an enormous advantage. And then over on the right-hand panel, you can see what the whole population, all the counties look like, all glommed together. And I think that the social gradient is pretty obvious. I didn't draw a line there because I wanted to draw the line here. So this is again the black data. And it may not be completely obvious looking at the curves how remarkably different the slopes of those two curves are. But you can see it a little more transparently when you look at the county by county ratio of male survival over female. It's a number always less than one, except in a few remaining post-conflict countries around the world. It's true in every single society. Women enjoy an advantage. But you can see that that advantage is not fixed. And in fact, here I've just done the quantification for you. You can see that the slope for men is about twice as great. The gradient for men is about twice as great as the gradient for women, suggesting that something in the biology of females is resilient relative to the biology in the same social climate. And the x-axis here could be substituted for any bad predictor. I mean, income could be there or proportion with high school education or whatever you want. I mean, it really doesn't matter which big social predictor you use. The curves look the same. If you doubt, if this doesn't look that compelling to you for a variety of reasons, because there is some truncation on the left side, because, frankly, there aren't too many counties in which the proportion of Africans-Americans are living outside of poverty. But when you look at whites, you can see that better as things get closer to zero. And you can see how remarkably divergent those curves are. So whatever is conferred by that second X chromosome is an unbelievably valuable factor. As I said, there's not a population in the world, post-transition population, where women don't live longer. But it is hardly a fixed biology. And what's stunning about this, at least to my eye, and I hope you would agree, is how remarkably different the response of men and women is to their social environment. In fact, I'm not going to go much further here with this particular line, because it's not the central focus of my talk. But frankly, when people say, talk about the biggest health disparities in the United States, the biggest health disparity is men. They enjoy remarkably poorer health and longevity than women over the long haul. And it's an area I know we don't typically talk about that as a disparities population. But you can see that it is the men who are the recipients or the victims, I should say, of much of the social variation that we have observed. And again, it doesn't matter what you use for an x-axis. So there are other reasons. Another reason for at least thinking in this space is that not only do we see rather huge differences in overall mortality, which I think from a data point of view is a very secure place to work, rather than sort of trying to dissect it by individual causes. But there are some diseases in which there really is a substantial difference in both the prevalence of the disease, and perhaps shockingly and more importantly, the mortality, especially for a disease like asthma, which is intrinsically treatable, and for which we in the biomedical community, even if we can't ourselves, prevent asthma, because we don't control the environmental factors yet or don't understand the environmental factors that contribute, we do control the treatment of patients who develop asthmatic symptoms. So the question here is whether or not this is an example or any of these other diseases that are hugely varying between or among our various populations, and therefore single themselves out as extremely relevant for disparities-focused research. And I was glad to see that some of the institutes that focused on particular diseases, cardiovascular disease diabetes, are active participants in this series, because I think this is one of the areas in which there may be some real potential opportunity here. So the second thing is whether or not diseases that we do end up not entirely living out in that social universe of disparities, but in fact come into our midst, they become our patients, we take care of them, we have opportunities directly to substantially modify the natural history. And in fact, it's particularly important for those diseases that occur relatively early in life, in which we can make real differences in health value over the life course, not just cosmetic differences at the very end of life. And this is one again, this is from Bashar's lab up the road from us at UCSF. And one of the observations they've made, as I said, they've been assembling some non-white populations and doing some fabulously interesting work, looking at GWASs within those populations and also looking at particularly looking at markers that may have direct physiologic or clinical relevance. And one of the observations is a substantial, at the ecological level, substantial difference within the populations in their responsiveness to standard bronchodilator challenge and albuterol challenge. And as you can see, the Mexican Americans have, on average, the kind of response that is actually fairly typical in the white population, whereas the Puerto Ricans and the African Americans that we recruited actually have substantially lower average levels of responsiveness, leading at least to the idea of here's a gene environment interaction, not that it'll help us make one particular treatment decision, you know, use this drug before this drug, but which might fundamentally change the way we treat if this entirely pans out and this is relatively new work. If this pans out in further trials, might introduce entirely novel ways to treat very important diseases that disproportionately affect minority and underserved populations. And finally, an area that has really blossomed in my own institution in which, you know, I recognize this now becoming widespread is to extend substantially our notion of what genomics is really looking at and what the real focus of genomics should be into all of the more downstream products of what the Human Genome Project has uncovered and the things that we are now learning. And it may be, and I'm just gonna show you a very, very simple example in a second, just to illustrate the point, it may be that again, even if in the gene environment interaction, we can't immediately see a reality that allows us to intervene as we fill in the missing pieces and try and understand mechanistically what's happening between the cellular level and the ambient environment or the social environment, we may find that there are very exciting opportunities for at least understanding and possibly intervening. So here's an example, this is from Steve Kohl's lab. Steve, if you don't know him, is an oncologist at UCLA but has been doing some extremely interesting work looking at gene environment interaction. His particular interest has been in the bottom of three steps leading to the genome. The reason for showing the slide is you don't ever see the genome at the bottom. I mean, that's just not the normal way, you know, normally it's the genome first and in fact, a lot of the inferences from gene-wide associations and others have been the primacy of the genome in the biologic pathway and quite pointedly, Steve's group has developed a series of nice illustrations like this in which they point out that it's actually not the genome that starts this process necessarily but what the genome does. Obviously, huge portion of the behavior of the genome, some understood, some not yet fully understood, is biologically determined and over which we don't, you know, that regulatory process, the target of an enormous amount of research not aimed primarily at disparities but basic mechanistic understanding. But what Steve's lab has been trying to do is sort of understand how it is that the social environment might be getting under the skin and in this fabulous drawing and this sort of paradigm, the genome now sits as the target of the environment in an odd way, again, not the genome itself, we don't imagine the genome is changing, thank God, at least not for this purpose but the factors around it, maybe there's methylation going on, maybe there are other pathways by which transcription is being rapidly accelerated, turned off and so forth. And so one can think about this pathway and say this is interesting, let's try and better understand how these pathways work under a variety of what he calls social processes, I would translate that into environmental circumstances, the world in which we actually live. But the really more interesting question is to try and understand these two issues, which is not what's happening time after time after time after time as sort of a kind of a system that's auto-regulating as many of us who went through learning basic biology, learned about the way these systems auto-regulate, but how it might turn out to be that environmental factors or social factors might lead to a more persistent embedded change in the signaling process. And this is just one slide, this is again from an animal study that he did because he's looking for examples in the laboratory, I'm sorry, this is not animal study, these are from human leukocytes rather in vitreous study in which he is looking at cells drawn from different phenotypes. And in this one just showing that persistently individuals that they classify again, this is the psychologists in their group classify as lonely or isolated. And the relative difference between the inflammatory pathways and their obviously more protective pathways and these turn out to be constituent. I mean this is persistent in these populations and presumably ends up having something to do with why these, how this is getting under the skin and why it is, if you think back at my first slide, one of the far and away biggest predictors of survival to age 70 is the fraction of the population that has partners, the adult population that has partners. So it's probably a pretty important example. So he shows this nice example of an animal, this is now from animal work, of an animal raised under two conditions. So in the experiment they initially raised animals on what they consider to be very favorable social conditions in a peer group and then basically throw them out of the family at the age of six months. And what the slide illustrates is I just want you to look at the black dots which illustrate an interesting phenotype that emerged and turns out to correlate with a genotype in some new work that they're doing which turns out to be a particularly volatile one. So most animals in fact after some decline in the more productive part of their gene expression will revert back to a probably reasonably stable, healthy mean. Certain animals about 5% of the total population they studied actually warped off into orbit after they were thrown out of the family and ended up doing very badly and most of them died early in the experiment. But this is an example of a single phenotype and again corresponding to a genotype that they identified that appeared quite resilient. So an enormously exaggerated response to being kicked out but then what appears to be a sort of a palliative or resilient overall response so that by the time that they were two they rejoined the biologic pattern of their peers. So maybe we've got examples of that too and maybe understanding what biology of resilience is as understanding from my point of view the biology of being a woman will turn out to be that protects women from some of the worst scourges of social adversity. Maybe this will turn out to be advantageous as we begin to try and explore other forms of disparities dealing with populations that appear to be quite environmentally sensitive. So in that vein we decided Huber is not withstanding to go ahead and apply for the opportunity of putting together a center and this is our sort of logo and we're just gonna show you some of the projects that we have now embarked in. Again, I warned you at the outset that I wasn't gonna have you leaving here saying wow, look at what they can do because we haven't done it yet but we've made a really lovely start. So the first of our three projects called Bracelet is a project looking at the relationship between genomic determinants in the American Indian population and we identified a set of partners among the Lakotas in South Dakota on a couple of reservations. This is our team and their team at the first of what have now been five meetings. This is there, you can't see it very well but this beautiful marker that marks the entry to the reservation. And frankly what we're trying to do is something that will address one of the big gaps which is the willingness or potential willingness of our underserved populations to embrace what we learn in the genetic revolution. Will people even seriously consider the information? And for the Native Americans and I think many of you probably know some of the struggles that have gone on with engaging Native Americans in this kind of research, the biggest problem has been in control and ownership of information. And one of the things, there had been a failed attempt by folks in our genetics department some years ago to work with the Lakota around a very high prevalence of autoimmune diseases and it was clear from a national point of view and the local tribe as well that this research couldn't go on because the data was being handled too much by us. And so what we're gonna do, very simply you can look at the aims but the goal here is to help them build a biobank, help them learn how to do genetic testing themselves, learn how to interpret the information, to educate the tribes on what's important and what's not important in the hope over the period of what we imagine we're just now starting to build the physical biobank, I mean like the freezers, teaching them how to process material but more importantly beginning an educational process across the reservations to engage people in the potential value that knowing more about their own biology may be critical to their long-term health. Now this is a very, very, very steep uphill struggle. These are reservations in which between you and me the biggest problem is an enormously high adolescent substance abuse problem and suicide rate. That's what they're dealing with on a day-to-day basis and we do only with a certain amount of trepidation go on to the reservation and talk to them about underlying biology but we do think that at a minimum we're gonna learn something about what it is we are gonna have to do as a scientific community to help develop this level of expertise and knowledge in the populations who are potentially most at need for the information. Now a second project epitomized by this, oh I didn't get the pretty slide, oh we have a lovely slide of the kids, sorry. This is a project of Tom Robinson that actually has been going on for a couple of years. It's a very, very intense long-term intervention strategy to deal with the obesity epidemic in Mexican-American adolescents. And the focus is, yeah, pre-adolescence. So the focus is on identifying vastly overweight or clinically obese children between seven and 11. They've been put through and you're gonna see what we're adding to the study. They already are about two years into an intervention that involves very intense home intervention. So there's a family component, there is a school component and there's an after-school component and I had a nice picture of them playing out on the sports field so you can see kind of how this is going. But the results have been very mixed which is to say that some fraction of the families thankfully it appears over 50% are doing amazingly well and kids are having a really good result from this and it appears over a couple of years that this may be sustainable. Of course you never know whether it's sustainable until you go there. But we decided, and this was sort of the conceit that we added as part of our sphere center, we decided to use the omics idea and Mike Snyder who's the chair of genetics at Stanford has popularized the notion of iPop which is integrated personalized omics profiling in which he not only does these studies but does them repeatedly on population sometimes as frequently as every two weeks in a study he just finished looking at pregnancy which is gonna be amazing when we start seeing the results. But in this case what we're doing is taking advantage of the material that Tom's group thoughtfully had managed to biobank. So we have a nice trove of the periodic specimens that have been obtained during the several years of the trial. We did have to re-consent everybody because it wasn't clear at the beginning of this that we were ever gonna do this kind of work. We've been very gratified that somewhere in the 80 plus percent range have been willing to consent for the omics testing which has been great. I should point out incidentally that this trial has had a 95% adherence rate over two and a half years. So it's a testament to the principal investigator and his community engagement team that we've done so well. What we'll learn from this I'm not sure but the hope is is that by looking at the entire pathway between on the one hand the underlying genetic alleles but on the other hand what the expression of those alleles has been we'll be looking at the methylation pattern we'll obviously be looking at the expression patterns over this period of time as well as all of the intermediate products of that. So at least at a minimum we are sort of it's preemptive of what will be going on in the all of a study it incorporates many of the same many of the same concepts in this population. Now with the superimposed clinical trial which will hopefully give us some insight somehow into what it is that appears to be working in those who respond and what's working or what's not working in those who have failed to. So this is what the aims of this piece of the trial are. The good news is virtually all the materials in hand everyone's been reconsented who's willing to do it and we are well underway so that the next time you see anything coming out of our center at least some of the descriptive statistics will be available and it is just as chance would have it kind of a nice opportunity to look at an interesting cross-section of the Mexican-American population of that age. And finally a study that's aimed again at the people. And this is a study that V.J. Paracoil one of my junior colleagues who's a geriatrician and a palliative care physician based on her quite substantial experience primarily with cancer patients has anecdotally observed a both relatively poor performance on the part of physicians who identify enormous opportunities either on the therapeutic or on the diagnostic side for genetic testing in cancer patients but also an extraordinary reluctance on the part of many of the ethnic groups that we deal with in Santa Clara County which has one of the most diverse populations virtually any county in the United States 40% of them were not born in the United States and 100 languages being spoken. I'm trying to get some insight into what it is that's happening in the communication between the healthcare providers and the patient and the patient's family that is impeding the general willingness to use genetic information. So this is a population generally they're all Medicare patients that's the focus of her study is looking at the elderly cancer patients so they're all insured and that's actually part of the purpose is to look at people who are being given various kinds of advice about diagnostic tests about the availability of unique treatment strategies given the surface markers or the somatic genome of their tumors in which we have good prior reason to believe that information is being very ineffectively incorporated ultimately into care trying to identify where the lesions lie in the hope that we can develop some strategies for ameliorating them over time. So with that, I will close as I said hardly a solution to the problem that confronts us all but we think we've at least identified some areas in which as greater access to populations accrue as our experience with being able to effectively interact with those populations improves we can meaningfully start to exploit the extraordinary opportunities created by the omics revolution. So I'll stop there, thank you. And I think we've got time for at least a couple of questions I unfortunately have a short leash and have to get out to Della soon but I'm more than happy to entertain a question. There's looks like one here and I see another one over there. Courage people though to please come to microphone since we're videotaping and videocasting or the videotaping it, I think. So there's a microphone over in that. I was welcome. Maybe you started to talk a little bit about it but like for the three studies you talked about at the end of the Dakota, what exactly is the conversation around any genomic data and the plans for what's gonna happen with that data? Right, so the conversation is all about genomics data. I mean, we're trying to slip in a little health information while we're at it but the focus is, and again some of this goes back to the history in which very early on a senior member of the tribe had actually himself developed I forget some complex form of RA and noticed that lots, there was lots of arthritis on the reservation affecting young people and it actually through a series of calls contacted the geneticists at Stanford and they'd actually started, they'd come out and drawn blood on some dozens of members of the tribe and it started to do some work when in 2014 the national outcry from Native Americans began and basically the leadership of the tribe said you can't do this. So we actually had some specimens sitting around in freezers in Palo Alto and it stopped and so the good news, if you can call it good news is that the awareness of the excessive amount of rheumatic disease was very clear to members of the reservation. So there was some interest in trying to understand why so many of their kids were getting disease before the age of 15 or 20 and so there was interest in that and so the whole focus has really been on we don't know what the cause is, we don't know whether there's an environmental cause or whether there's an underlying biologic cause but because you're a relatively isolated subgroup who've been intermarrying over generations there's some chance that this actually lies in alleles so that's actually been the direction of the education. And at least up till now, again, what we haven't done yet is go out to draw more blood. What we have done is recruit people for focus groups to come to large meetings which have been extremely well attended. We have identified technically skilled people to help physically build a biobank. They're making some investment, I mean a lot of the investment's coming from us but they're actually investing in some of the hardware to do it. So we'll see, it's a terrific question, Eric and I'm just not sure where it's gonna go but we do think that at a minimum it's changing the dialogue that we're saying you're gonna learn how to do these tests, you're gonna learn how to read them, nothing's coming to Palo Alto, you're gonna have the information, we'll sit there and talk to you about what we think it means, you're the ones that'll tell each other, you will learn HIPAA, you will learn what it means to do all that and that's what we're teaching them. So we'll see. Hi, good afternoon. Just a question about the last slide that you had. You talked about assessing confidence of clinicians, communicating genetic test results and risk information to the breast cancer patients. So the question is, is it really a question of assessing the confidence of the clinicians or maybe the knowledge base of the clinicians around genetic testing? So are there genetic counselors involved as well? It's a great question and unfortunately, VJ is not here and I would, if she were, defer it to her. This was her choice of word and we actually had substantial discussion. Do you think they're not competent or do you think they lack the confidence to talk to these patients? And she said that at least from an anecdotal point of view as someone who was frequently called in as a palliative care consultant to see the same patients and so she interacted both with the clinician, the primary clinician and the patient. She said very often it was that this was a conversation these physicians were having every day. If you treat breast cancer, you're talking about genomics every day and yet they were seemingly not doing it. And so again, she felt that the problem was that they felt too nervous because they'd gotten pushed back. But I agree, it's a great question. Between you and me, I'm guessing both are true. Question, given the disparity as it relates to African-American males, I was just curious why you didn't have an initial project or initiative trying to take a look at what's happening in those populations. Well, if we were in Birmingham or in Nashville or even in Oakland, we surely would have done it. This was not for lack of interest. Well, you have East Palo Alto. We have East Palo Alto, which once upon a time, so you're probably dating yourself here, once upon a time was 80 or 90% African-American, it's about 10% African-American. Wow. So to give you a little reassurance, virtually all of the African-Americans in the peninsula have moved north and in fact the same is happening now in San Francisco and the African-Americans are moving north and most of them are settling in and around Vallejo on the North Bay. So we have started now a big county level project with Solano County, which is the county they now live in and we also have opened up a little office in Oakland where we're going head to head with our partners at UCSF to get access to the area. But the problem, frankly, was just lack of access. Only 3% of an otherwise amazingly diverse Santa Clara County is African-American. Thank you. Hello, my question is specific for your program, your institute. I wanted to know if there have been any considerations for research for recently arrived immigrants or has they acculturated into the US system? So the answer is we talk about little else and in fact in the two pilot projects that we're now able to fund about three quarters of the applications were in this space for a wide variety of reasons. It's not that it's hard to get access to some of individuals. What's very problematic is getting organized access, which is to say they don't have electronic medical records. What little care, what fragmentary care they get has unfortunately been shifted from federally qualified health centers to the safety net health system that the county itself runs so that it is probably next in queue for something to study. The other problem is that we're dealing now with, it's not an it, it's a they. So we're dealing with very, very different immigrant streams. I said there are 100 languages spoken. So we have, you know, we have Khmer, we have a large Vietnam, huge Vietnamese population in San Jose, but again, getting access to them and getting them closer to us is gonna require substantial improvement and enhancement of our community engagement core, which we're actively working on. And we view that frankly as the first step, which is really making some inroads in those communities before we feel comfortable in trying to attract them for research. Thank you, I understand that there might be many social factors or political barriers in order to have access to those populations, but I'm happy to know that there are initiatives at least. No, and thankfully we're in California. Thank you. These are the kind of studies that you couldn't do in many parts of the country, but we can do them. I think most Californians feel as safe as you can feel in today's America. I really appreciate how you structured your talk from don't even go there to the potential of scientific knowledge that could be gained. So my question is a little bit more along the don't even go there side, but I wonder if you would sort of reflect on what is the likelihood that this omics revolution will should change our strategies to reduce health disparities in the short term, five, 10, even 15 years? Well, of course it's a great question. And one I would happily try to sidestep if I were forced to do. I think the possibility for benefit in the next five to 10 years will most sharply focus on advances like the kind of work that Esteban Bouchard's lab is doing at UCSF, which is looking at very common, very important, very earliest in life, like as unfortunately increasingly type two diabetes is becoming, disorders in which there is a reasonably high likelihood that understanding the pathway could at a minimum change the way we treat such people much as there's been a substantial revolution in the way we treat hypertension so that it's one of the few things in which the basic algorithms for how we treat whites and blacks has changed. And although it wasn't initially based on a genetic observation, it was based on population level, you know, old fashioned heritability in which it was pretty clear that the physiologic pathways were gonna be very different and therefore your first best guess as to where to start would be different in the two populations. That's the kind of thing that I think offers relatively short term promise. I think in terms of will we develop tools that will substantially change the way we deal with disparities, I'm a little less optimistic, but I think it is incumbent on us to learn enough to make those probability confidence intervals narrower, which is, you know, I don't know, but right now the confidence intervals are bigger than the point estimate. I mean, I'm sorry, that's not a great answer, but it's probably the best I can do. Anyway, I have time for one more and then they're gonna swallow me up. Hello, Dr. Cohen. First off, thank you for a really informative talk. I'm just a summer intern here, so I apologize in advance. Good place to come for the second. I apologize in advance, if my question is not as impressive as some of the others, but I noticed there was a huge disparity which you point out between men and women in the probability of reaching the age of 70. And I was wondering if, in your opinion, this disparity is more based on biological differences, for instance, menstruation, which releases toxins out of the bloodstream, versus genetic differences by which females have the extra X chromosome and so can kind of read off the other chromosome if there's a problem of one. So it's the subject of a whole nother talk and so forth, as to how that sex difference emerges. So my own belief is that it has mostly to do with the way women live and that women are socially quite different in terms of their ability to support each other so that women don't always need a partner, as most men do, to be socially connected. And I think that, of course, derives from some underlying biology. So there's biology, and so we talk about that as a social biologic difference. So it's probably not estrogen, and it's probably not the singular advantage of menstruation or childbearing or any of the other more obvious biologic functions, but probably something that over evolution has come to protect the female of the species for very good, we think very good teleologic reasons in terms of the preservation of the species. But we don't know. The striking observation is the one that it's not a fixed difference. It's not like women live five years longer on average than men. It depends a hell of a lot on the social conditions. Thank you. Anyway, thank you all. Thank you.


Yeah, this is Zach Loy. I'm on tour with Egg Koalachik. We're doing the 20th anniversary of the throwing copper record. And we're here at the city winery here in New York City. And I'm checking out this new Black Star Fly3 amplifier. So it's battery powered and you have a gain button on here. You have a level for your gain. You have a level for your volume. You also have a delay feature which you can adjust pretty drastically as well which is really, really cool. You also have an EQ level over here which is an ISF setting which is a really, really cool feature as well. You can shape your EQ that way. Tiny little speaker and super light as you can see I'm holding it up. But man, you can get some really, really killer tones out of here. You can also plug in your headphones or your iPod or your iPhone and play music through it and jam along with it. But a pretty cool little feature, man. I'm really excited to check it out. So yeah, here's a little bit more.


story with the way the team has struggled lately, how much pressure did you feel coming into this one to to go out there and try to set the tone? I didn't feel any pressure.  You had talked about last time that you didn't feel as though you could get in a really good rhythm. Did you feel like you were able to find a good rhythm tonight this afternoon I should say? Yeah yeah my timing was better today. I lost it that one inning but I made an adjustment and got back to where I needed to be and I'm just competed. What happened on the two home run pitches? Where did what did you want them? Just OO being aggressive trying to throw a strike and they got a got a barrel on it. How frustrating has it has the start of this season been to this team overall? We're not panicked. I mean we got a lot a lot of games left and we're we believe in ourselves and how talented we can be. Greg Joyce please unmute. Jordan how frustrating is a start like that when it's you only give up two hits two walks and it's still you know results in four runs? Yeah I mean it's not great but I don't know. I gave us a chance to win so that's all I can do. How important was it to to get deep in the ball game after the bullpen has been been pretty taxed recently? I mean we got an off day coming up and guys back there ready to throw whenever they're caught on but I'm always trying to go deep and take some pressure off other guys yeah. Sarah Valenzuela please unmute. Hey there so just getting through those games something pitches did you feel like you had a little bit more left in you? Like how were you feeling coming off of those 80? Yeah I mean I definitely felt good kind of through four uncompetitive pitches to pursue but I wanted the ball but Boone pulled me so I respect his decision.


busy schedule to join us today in this momentous occasion of the standing up of the 319th Expeditionary Reconnaissance Squadron at Kanoya Air Base. The ceremony is performed in the presence of the members of the unit allowing each person to observe the placing of authority with their new commander. All command authority and responsibility will be transferred to Latina Colonel Kelly the moment he salutes Colonel Oh and says ladies and gentlemen the commander 319th Expeditionary Reconnaissance Squadron Latina Colonel Alexander Kelly we had a C-17 land came in and it had 18 pallets on it got our crew together we got the 60 k-loader what we used to download the aircraft and a forklift pulled up to the back of the aircraft loadmaster came in spotted us in and at that point we started to download we downloaded six pallets at a time with the k-loader and then at the forklift right behind it to pull the single pallets off took us about an hour to download all 18 pallets and we had a five man these are the final pieces that will allow us to then build and assemble the aircraft so then we can start our operations and our flights most of our tools we got age equipment stuff to help store raised aircraft our tie-down so we can safely perform all the operations and checks next step is to we're going to inventory it make sure we have everything we need and then we're going to go ahead and we're going to start the build of our aircraft and then after that we're going to then begin our test flights so I'm a crew chief we don't have we have no back shops I'm the engine troop the hydro troop between me and my guys we're the ones that assemble the aircraft has this hole and then we perform most of tests until we get to the avionics portion then we pass that on to our specialist equipment that's going to help start our initial build so once I came in we went right into it we were able to get the aircraft body out install the wings the tails and as you can see behind me the prop is finally installed so we still have a additional components to install but we're pretty much ahead of schedule but we would like to see for today my guys did amazing today so like I said we're definitely ahead of schedule they have been wanting to get right into work so after that last C-17 arrived we went right into it but once we start getting more aircraft filled up we can start doing our operational checks be able to establish a link between our GCS which is a ground control station our GTs ground data terminals and allow the ops crew to actually be able to start flying so very critical step today I would just like to express my gratitude not only to my maintenance team but the boss function they've been a huge essential part in making sure this mission becomes successful so thank you an increasingly severe security environment in the Indo-Pacific region the US Japan Alliance has repeatedly committed to bolstering our defensive capabilities this MQ9 deployment is just one more way in which we are working together as an alliance to enhance our bilateral abilities to maintain our mutual peace and prosperity this deployment has been planned in coordination with Japan and in support of the US Indo-Pacific Command's intelligence surveillance and reconnaissance operations as you know the 319th exhibition reconnaissance squadron was formally stood up on 1 October 2022 and is comprised of professional service members from various bases such as Masawa, Karina and Yakota air bases here in Japan others have arrived from bases in Guam, Hawaii, Alaska and Nevada to participate in this mission the aircrew and aircraft are from the 432nd wing headquartered at Creech Air Force Base in Nevada these personnel will be repost responsible for the launch and recovery and maintenance of the MQ9's preparations are well underway to ready the aircraft and airmen for this important mission I'm encouraged by the progress we're making and appreciate the tremendous support we're receiving from our SDF partners and the local community we expect the first operational flight to take place this month the BIAC exemplifies the evolution of shared Japan US defense initiatives resulting from shared mutual security interests in the region as regional globe and global threats have increased so has the cooperation imperative for us therefore having a first real time information sharing capability between the JSDF and US is very very important the BIAC will provide timely reports from data collected by US and Japan ISR facilitating joint analysis analysis subject matter experts will increase regional threat situational awareness in order to support informed decision making by defense leaders of both countries China's unilateral attempts to change the status quo by force and North Korea's repeated ballistic missile launches the establishment of this organization further strengthened the persistent monitoring posture against unusual actions of vessels in the area surrounding Japan and contribute to enhance the deterrence against provocative actions and core seep attempts to unilaterally change the status quo in the region


We're here today to induct the 34th class of the Arkansas Agriculture Hall of Fame. They were selected in 2000 for 2021, but due to COVID epidemic, pandemic, we had to postpone it. In fact, we've postponed it actually three times doing this. And I hate that we weren't able to do it last year, but we had to put it off to this year because there are so many outstanding stories out there talking about Arkansas's biggest industry and where you get the people in here that are doing the job. To me, this award is just a confirmation of Arkansas agriculture as a whole. We have an industry that is the most vital and important industry in our state. We have lots and lots of people who work every day to make it that, and I'm just one of those. So I accept the award today on behalf of all those people who are so important to the citizens of this state. Well, first, I am honored and humbled to be included in this group. I was talking about Dick Baxter a moment ago. His dad was inducted in the class of 98, Bill Baxter. And what it means to me is a reward to a whole bunch of people because I didn't get here by myself. This is a team effort, big team. I had folks, federal government, state government, conservation associations, the farmers that I work with, my family. My late wife was a tremendous proponent of keeping me on the right direction. My two sons, one of whom couldn't be here today. He had major surgery yesterday in Virginia, but I'm just elated to be selected. This is a very, very great honor for me for this award. It really shows that how much that we know and put into agriculture and how important it is in our state, and not only in our state, but in our whole nation and most of the world. We feed most of the world as well. And so this honor that we give out is really great and it's something that we will cherish forever and we'll take it home with us and remember about how that we did and how we did it and the things that really matter and how important agriculture is. While it's to be selected for induction into the Arkansas Agricultural Hall of Fame is just humbling to me. I know how diverse our state is in agriculture. I know the importance of it in this state and the tremendous amount of people that are good people that are working hard every day to provide the necessary products to sustain life for humans in this country and many others in education. And I think it's just overwhelming the amount of importance that we need to put on agriculture. And being an ag teacher, I think we need an ag program in every town in the U.S. just for the appreciation and knowing where our food comes from and having people lined up to take care of the future. Of course it's a singular honor because I know a lot of the people that are already in the Hall of Fame and admired many of them certainly know this class and admire this class. So for me personally it's a singular honor but I kind of accept it on the basis of all the must be hundreds maybe thousands of people that made me shape me made the program that's being recognized today so I guess the bottom line is it's really not about me it's about family. It is a great honor for our family to receive this induction on behalf of Russ Reynolds, my grandfather. His commitment and vision for the timber industry and land stewardship and the passion never stopped even after retired he continued to give tours and try to educate. He really was about educating and trying to establish that vision that he had early in the 30s and 40s for what did the timber industry in the state of Arkansas could be. It's pleasing to see that he's still recognized 50 years later.


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So my forces were arrayed to essentially come in and assist the Coastal Police. This was day three of an ongoing operation. Essentially we were just an asset to allow them to rest and refit after two days of operations. So my guys came in and assisted with essentially deescalating the situation. And really it was our validation event so they can see that we have the capabilities to assist them if needed. We specifically planned to go into the replicate our capabilities in an ongoing operation. And our most important point of this is to have a third responder that respects our ongoing operations and integrates with us. And it was a great opportunity to not only execute this what you're seeing but actually conduct a lot of planning behind the scenes. So that going forward should we ever need them we know exactly how we can integrate with them. Absolutely it was a success they gave us space here at the government building which was the target of the riot so that we could work internally to keep everybody safe and then restore safety all over in town. And we were in contact throughout the entire operation which is what we hope for going forward should this ever be a real life event.