Hey, how are you doing? Yes, here is Rami from ICON. We are in global source international fair We introduce in our new product in this show something like tablet PC and some for education tablet and Most of our product now you as you guys know is Very good in in the market in the retail store and some in education business and here is Axel is My partner in business in Latin America and we help each other we do it together a new project for education called tabby Axel can also give you more reference about tabby project. So hi. Hello. How are you? So who are you? I'm Axel from Argentina. We produce We did so sorry my English is not so good, but you know, I'm learning Chas a few years ago Here we I want to present you. This is my good friend tabby He's not he's not a Animal he's not a human being you see he's tabby With him you can learn a lot of different things focus on kindergarten Only kindergarten. Yes until two to six years old. We already have this in the market Yes, of course, we are in more than 100 school in Argentina, Chile Colombia and Mexico and tabby has friends. That's the it says Los Amigos. Yes, Los Amigos the tabby So what kind of friends does he have? Yes, you know the most important thing is they have become annexed a One wall is you know is any machine a machination world This tabby is not alone. She also have some friend and Let me present Lenny. He's Lenny and for for woman Ladies girl, sorry, she is Bonnie and the most Funny guy is looting So how do the kids choose which one they want to be? Looks we have cartoons also we have a you know some videos honk and use The technology on the kid a garden, but the kids also can play with them Every character have a style and you know, maybe Ludi is the most funny guy on the videos on the cartoons So maybe you can send me a video of the software you have some special software It's not just a entry tablet. The UI is not like this, right? It's a kid's friendly, right? Exactly This is have a Specific user interface for kids is a very easy. I'm very simple to use because we target from two years to six years old kids and When we start this project we come with a first here and then step-by-step we increase their friends We have now four friends inside tabby project. Can they talk together? Yes, of course. How does it work? It's very easy. Hello. I'm tabby. You know I'm looting. It's like this nobody also we have behind this product is a story and the cartoon The kids can watch the cartoon can watch the singer song and the inside have a lot of apps to How to say to analyzing the kids what product what devices what is apps is they really like to play more? So it's apparently easy to understand what is their hobby for their kids in early time Then they can direction them in the right way if they like music art or something They can understand more about their kids from this kind of apps we built inside. Does it work? Yes, of course Of course, you know, we are ready testing the the apps on the kill the garden And you know you can find on the YouTube some videos Oh Well, yes, of time we're already done over the the school Is it done before? Yeah Tablet project for kindergarten No, no, no, we are the first one the first on the wall, you know Intel took us like example on the wall for this project The chips in here. No, it's all winner. All right. Now. It's all winner. Yes, we follow Yes, of course We follow right now This company because they they have a big commitment with education and and the other thing is Very important is these apps we built with more than 20 Specialists on the on the field of the education psychology director of the school engineer app engineer Also, you know for build the cartoons many many Important guy from Disney's work with us Yes, we base in Argentina but right now Yes, so all the project came from Argentina, but right now with my friend Rami and Ney Kun We are doing this project around the world. That's why because Argentina speaking Spanish, right? Yes many countries could put that Oh, we already we start this project in Latin America with the Spanish language And now we are discussing with more distribution in in in Europe for German and Italian Some other like a French language as well as Arabic language because you know now the Kids have to work with the technology now everything coming in touch in touch screen So we need to engage all the kids with this technology early Then they can grow up in this environment Then it increasing their intelligence and also increasing their Experience about this such product So the the the way we start this about three four years ago, right three years We start about Almost four years and all this inside all is is designed patent And technology baiting and also the apps inside it's made for this and by these guys So we don't use the public apps. We don't download from google is a specific app Is made after a lot of discussing and the study for a real environment kids In the kindergarten and we get the feedback from them what apps they really like and what apps they don't like And from 200 app we select the best app which the kids really feel friendly and happy to play with So we don't like to just take a one piece of tablet and put one case or something like this because Many in the market you can see something like that, but really it's low value Here when we're doing something we think about how to evaluate it Not only how to make it beautiful outside in the cool of this product is a lot of story When you guys buy this product you will understand that it is you buy really something will value and will get your Your kids interesting always often Happen this with us. You have a good display We use we have we have here the technology we use inside. We have all winner is a quad core cpu You know because icon is a strategic partner with all winner for four years And we do all this one of the first Yeah, we are one of the first people for for all winners to build such product and also a lot of product We have a medical. We have a gaming. We have education. So We we are not working like Cheap tablet going to the market with million of pieces. No, we don't do this business We have a 3000 here Yes here here just through the whole but this is an opposite here have some specific place for charging And here have the camera open and here have the speaker. Oh, look, this is the most important thing. Look The children You know, yeah Ken all down Southern time and never happened nothing. We make after two years worked on the school never Have some damage easy for the kids to carry exactly. That's why Very light. That is one of the important things. We try this one to do in nine inch But become very heavy heavy for children Yes, exactly. That's why we choose 70 the most important as as he said to To protect the kids the most important is is a healthy issue No need to put we built a very nice battery inside We put a very nice screen is ibs screen inside to 10 24 by 600 We have a very nice performance as well and we come with the kids Back back for people to boot inside so they can just put the tablet in yes Yes, it's not only for the school. No, no, it's a school. You know, I will tell you It's exactly the size for Nice They put it in there. Yes To learn at home. Yes, of course. Look I also this project is is much bigger than this Have difference have difference And accessories, you know, he's rocky he you can listen music This kind of speaker is bluetooth and we do you know why because the because the The teacher need to put some application with more louding And the most important for children when they they are learning is also Communicate with the divide who teach them. That's why all the character the character And also at the school you can connect Ah, yes You know when I hear bring the the carton box, but you can change the eyes Also, you can put your name here, you know Uh, but the most important thing is this project have two different Unit business one of this one of the unit of the business is a school This school means, you know, all for a school is not for sales We we focus on how can teach Perfectly to the children is very very deep Our project on that we don't want to sell to the to the school We want to give to the society something Through the technology that that's why uh, we can be and must be this Not only working it's already in Success already we are talking with uh, uh, some country I can tell you right now because all the country will uh buy that I can't tell because it's secret with them, but We have some confidential agreement with some country for this project And we sign us some contract during the show and before the show But we have a very nice meeting with together to to to Introduce in this product to different market like as I said, like Middle East market like a Europe market And some in in ashi as well So we we can sell uh is in argentina one Very good province invest on tabby and already Buy and is working right now for more than one year And another in argentina Buenos Aires You you can find in Vicente Lopez is one. I don't know how to say in english is is uh, município And they they they are together doing this shop on This work on the kindergarten for more than two years and every application was Hardly is a study You know and pass all the tests. We have more than four pilots around the world One one is in the north of chili and we tested how the The the the Poor people can take this one You know because some Countries want to promote education with the people that can take technology And this is the they started with them That's is our focus in education So the price can be good Very good. It's plug-and-play It is plug-and-play That is very important thing because in some in africa, for example, they don't have internet And also from yes work all offline and online Have a platform for the country can control how can how many Devices are open, you know and it's useless or no use So you have these these characters they're like animated in the maybe you can send me a video, right? Yes, I will send you some some video for cartoon educational software. They animated inside the software Yes, even entertaining and At the same time is it is not like a platform if the country want to contribute more content Yes, add more. Yes, exactly. Maybe they say this is amazing, but we need to put 100, uh, you know, like, uh Education specialists to do more. Exactly. This is an open. It's our open Inside have an open tooling is not only our apps if the school or the country Wants to add his own app also can put by himself. No need to call us That is very important You really like and you can work in in different environments You can work in in in android environment as a regular tablet But you'll need some password because this is have a better and full control to go to android android environment because You know when we give this to the kids We don't need they go by themselves to download anything actually We have a password for to moving from tabby environment to android environment. So If if the baron want to download any extra app They can go to android environment and they can go to the play store and can make the download Which is a like to do and then close again to back to tabby environment And they can find the apps already put in the tabby user interface This which is to make a make sure that your kids will never waste his time in something you really don't know Here is you have a full of control about what is your kids will do How many hours you will play and what is he like to do in this project in this in this software? If he like to do art, you have statistics. You have this very clear and light very good result Yes, and they tell you how many hours he plays this and how many hours he draws and how many Everything a very clear information if you solve this or that Yes, and questions that you can see you can see everything and also we we have a different password and username if you have two kids or three kids You can set up a different username and password for different kids by this way you can enjoy Your daughter or your son together in one pc And you can share together with them From here to here or opposite according to your your your kids like I think it's a big charge to bring some Educational games so it's fun, but they learn that is the point. You're right. You know, how can you start this business? Start for the retailer, you know a kid's tablet now. It's very common about four years ago was not and I say How can you know all the the mobile phone one mobile phone? Maybe 1000 us dollar or 500 us dollar The tablet is less than 100. You know it's much cheaper If you give something to the kids Like this a tablet is and broke Also is cheaper, but if it's not broke is much better If in the same time when the the children's is playing can learn Is the best that's why we focus on the education And what's next next? Okay, we want to go to all the country and have one tabby in the At the schools every every every every single school have a tabby How many schools in argentina, you know, we have more than 100 schools in Not only in argentina And the country that I told you before chili In argentina, maybe one two three four five thousand So you need to bring to every school not only 100 schools. Yeah, of course It's our target to go more and more, but we have really a very clear Market roadmap and we don't flood the product everywhere. As I said, we just have a strategic market Market business plan together and in argentina already succeed and in going to biru and then to chili Chili sir really Mexico, Colombia, and when we found already that this is a very successful project And very welcome by by school education Then we get this example and show to another another country government at different Different places in europe as I said and they all love this project And the volume really is going to be so big for this type of product You think the small kids can also use laptops or tablet is more suitable Yeah, that we have studied that Until six seven, you know, all the the kids right now is Native digital native And you know when my kids was Two years old you go to the lcd tv lcd tv and he went to change the channel.  I'll say like this, you know what I mean All the the children right now is digital native That's why They can Type in It's no good for typing. That's why the most suitable Technology on the kindergarten are a tablets. We are interested. No after seven After seven years seven years It's we we have a lot of different tablet regular one I don't say this is a tablet. We don't call it tablet. Yes, right. It's different Because this is not only one piece of tablet. This is inside have a lot of work have a lot of Valuation inside so we don't say is one piece of tablet. We built inside a lot of software And to help your kids so the kids if you give him one piece of tablet, he will he will Through it around one week later to week he will keep away But with this way with this software with this environment He will learn and love to carry his product as his friend, you know, so it's not a tablet It's tabby It's no more it's and a divide it's a divide for education entertainment And the name is tabby. It's not a tablet. You're right. Sorry And after this let me let me explain one thing is very important Because it's not good to merge a school And retailer or big seller at the supermarket. They are different. They are different The business at the school is with a special application for them We also have the most important how can the the teacher Teach to the student all this one pressure the other pressure is the retailer This retailer is The same device But with different features and the other friends. That's why we have We have a rocky. This is a bluetooth, you know, have headphones. It's over there. It's over there I bring I bring in there the the headphones, you know, the backpack, but this is for retailer. That's why who See this video They can eat in the retail business. They can take this part and sell on the retailer reseller Everywhere, but it's working good. Yes itself a huge quantity for the retailer, but for education have tabby plus The application application for for school, you know and the platform How about the kids that use this? Do you maybe you can measure that they become like a super Even more digital native they become like the hackers Maybe maybe you know with tabby or without tabby will be You take a headband Yes, as I said, we we we try to build a tabby environment around the kids We like to he really loved the concept of this project So we built a lot of By this way most of the kids Most of the people and kids and the family apparently they all love this type of project. They don't get too loud though.  Yes, this uh ear headphone First for all is a small is the size of for children Second with the software inside that we built Have a limit always is a Accurate for the children, you know never never if put the more louder is no damage here All right, cool. So, uh, this is just the beginning, right? Yes. Yes. Yes. Thanks for ramy He'd be like, yes, of course. We playing at least more than 10 extra product is under development He's a very very good designer. He he get a price in german for designer. Uh, you know, we trust A lot of ramy Yes, and the most important is what we have here. We already Have the patent is un-batant for all this You designed the yeah, we designed together All the characters Story teller. Yes, and it's a box. Actually, we don't have the box is a fantastic very nice box Including some sticker, you know, we have some sticker for kids To to stick their name in the back here and the summer to read the number It changes the eyes. We can change the eyes for the smiley or with cry eyes with some some to to to give like Kids to involve in this one like his friend every day. What is his feeling? He will talk to this tabby Can tabby tell a story when they go to sleep? Yes, exactly. You are right Yes, it's a tabby tell a story before sleep and this can adjust by bearing which stories you wanted to tell This night is a lot of stories Yes, we have many stories inside You just can sit up the time and you can let tabby tell the kids the story And also tabby can let the kids Stand up in morning for school because it have alarm You can make it you can adjust the alarm with seven o'clock morning Tabby will start to work in seven o'clock and try to call the kids to get up for school Can the kids learn other language can they learn chinese it can with tabby you can We are doing look, uh, we are um This is prepared for any language until now. Yes No, but this for learn have a specific education software This is very very specific. This is for education and we have a partner for that right now. We have The one partner to do Sorry to learn how can learn english right now, you know And the software is set up in right now in english, spanish, french German and we are doing in arabic language right now China No, yet. Not yet. No yet. Okay. Okay. So looking forward to more It would be so great if you can change the world and make the kids smarter Let them learn in a positive way Yes, we we tried to give a society something different for the kids to to help them to To study educate them very well and also with a happy mood is not only pushing them They they will go by themselves to to study But the most tip since uh, we have a dream You know with this tooling if each each school have this tooling The teacher also the the school can see if some Every every children are good or not or have some disease or some problem You know on the world 12 of the people born with some disease like dyslexia autism Daft can a little bit that hyper Ecclesia uh, you know But with this tooling with some specific application that we we are doing Shots started doing we a We can The teacher the teacher can see if One of the children have one of these problems and what happened you know When somebody couldn't find that your small children that two or three or four years old Have some disease and you became real life of that very late You know this guy on the future will we have a lot of problem with this tooling With had it early Find an early if you find it early, you know you save his life and you also Save the life of the parent, you know how far how hard how hard if for the father Don't know that your children have a problem and you realize very late. You feel very guilty Okay, if for example, you're in the school where you have 15 15 children and using the same app, you know for detect If how about qc for example and you see the 14 that's good and one have a problem. It's very easy to see and you know, of course the the The teacher they are not a doctor, but they can talk with the father and the mother and say, please Could you check in this? problem your children with the doctor That's only think with only think like this You change the world. I told you why because happen with my children Yes, that's why this is our dream, you know, and We are under development. Maybe we need one year more or two years on that But in the middle all the school will we have tabby and we will give like gift To all the school already by tabby Software update But sir will be most of will be free which is save the kids life exactly we get for free We don't charge money. We pay money to we will pay money for that to to to Figure out early if the kids have any health problem for ear or for some other kind of Weakness in his health So when you find early you can save him early and this he will he will really thank us so much And there's a variant really many of them They thank us to to help the kids to figure out if they have any problem early to easy to solve I think it should be a big priority for the governments to Exactly, yes, but not only invest in the product, but also invest in helping you making a better software Also, if one government buy The government will keep this tooling But for me it's it's not for business. It's not for the government if for the kids It's only for the kids You know, that's why we do this business more deep than the only business, you know business is easy Business you can do everywhere, but if you want to help the world You need to do something more and we do something more. That's is a we are doing here. Nice. I hope uh The other old Bessie is watching the video. Yes. I love it. Please messy help us. We are shinchinian We need right now, you know, it's no it's not cheap to to do this the show We need his photos here. No, I don't need messy if I know messy is one of the best guy of the world Look, I can give my free for the the new children that he had He has I think three right now. We send to him. I love him because his personality is Great, everybody loves him, right? No, he's great. Argentina is a big Like yes, but you know, it's not like god. He's a normal people. That's is the most important You know, he helped a lot of where but he doesn't he he he doesn't say nothing You don't know that it's a big helper around the world. Nice He's don't see nothing. Just do it. I love him all and do it. Yeah We also help to do something like that So our business is is not about only money is our profit Our business for this type of product is about helping the society the kids to really save their life early This is a major objective make their future better. Yes. Yeah. Yes. This is the objective for behind this project Actually, this is the story behind so I wish we can succeed and if anybody wanted to to help in this project To make any like this in his country welcome We are open to discuss about any distribution agreement With this tabby project So I will connect your video at the end with the ui so people can see what you're talking about We have we have the carton. We have the ui we can send you then you can add in in your end of the Also some pilot that we already done in argentina and chili You you can see on the video how can use the children and how happy they are Thanks


Great. Thank you. And thank you so much to the organizers for asking me to be here today. Is this better? I could hold it. How's that? Alright, I will hold it. Okay. Thank you for inviting me to be here today. I am from the Preventive Medicine Department in Northwestern, but here I'm today representing the Emerge PGX Working Group, and I would like to acknowledge that many people in that working group are in this room, and many other people who aren't here have been tremendously helpful, particularly Dan Rodin and Josh Denny. We're both former co-workgroup leads with me, and Cindy Prouse, who isn't here today, is my current workgroup lead. So I want to quickly describe Emerge PGX. It's been mentioned a couple times today, but I just want to give sort of the minimum amount of information so we can all understand what we're talking about, detail the outcomes that we've worked on to date, and then highlight areas where we've encountered some challenges, and then talk about future directions for Emerge PGX outcomes, and other outcomes project with an eye on promoting implementation. So the Emerge Network, this is a map showing all the current and former participants in the Emerge Network. Emerge PGX was funded as a supplement during Emerge 2. We're currently in Emerge 3. And the supplement came about.  First of all the PGRN came out with the PGRN Seek platform. This is the paper describing the platform here at the bottom. It's a targeted capture sequencing panel for pharmacogenetic research, so it has 84 pharmacogenes where you can generate next generation sequence. And PGRN Seek came together to develop that panel, and it became available. And at the same time, there was supplement money available for extra sequencing. And we said, what can we do in Emerge to promote both discovery and implementation using this nice resource? So we came up with Emerge PGX, which had three aims. So the first aim was to recruit people who we thought were at high likelihood of being prescribed one of our pharmacogenes of interest. And how we determined they were at high likelihood varied very much between different Emerge sites. And then each of these people that were recruited were sequenced on PGRN Seek. Then as I said, we had an implementation aim. This was our second aim. And at that time, very few people were running next generation sequence platforms in a clean environment. So we had to generate validation genotyping for the genotypes that we wanted to put in the electronic health record. So we generated clinical variant validation. Then we put these results into the electronic health record with associated clinical decision support. So each site developed clinical decision support for a certain number of gene drug pairs. And then we had associated patient and clinical education. Now the CDS handled some of that education, but as we've discussed previously the CDS isn't usually entirely sufficient. So we also had individual immediate efforts for patient, excuse me, and clinician education. And then our third specific aim, we populated a variant and phenotype data repository to promote discovery efforts using PGRN Seek. So pretty early on in the process, we decided we needed to publish a design paper. And we did this for two reasons. First of all, the implementation of PGRN Seek by necessity had to vary a great deal between the different Emerge sites. So a lot of what this paper is, is tables describing the different ways in which we had to implement Emerge PGX at the different sites. And this is just sort of one example of ways we've tried to summarize some of these implementation differences. Different site it's implemented different drug gene pairs. We had some sites that were pediatric. We had some sites that were primarily adult. Again, if you read the paper, lots of tables that summarize this. The other thing we wanted to do in the paper was sort of layout a roadmap for the outcomes we were intending to measure. It's the first thing that we said that the outcomes we were going to achieve is we were going to recruit 9,000 people. And we did. We recruited 9,015 people. And this is a breakdown of the number of people recruited by Emerge site. I also wanted to highlight here the number of people who were recruited by different racial and ethnic groups. We did have a fairly large number of African Americans over a thousand, but similar to many previous studies, study population was predominantly Caucasian. Okay. So what were some of the outcomes? I did the somewhat painful exercise of going back and re-reading the paper to see what we said we would do. And I thought I would tell you what we said we were going to do. And we actually have done a lot of it, which was nice to see as I did that. So we said we would sequence 9,000 plus people on these 84 pharmacogenes and document variation. Marilyn mentioned this paper yesterday. This was on the first half of the Emerge PGX samples. There's another paper in progress that will document on the second half. HLA is sequenced on this paper. On this platform, CYP2D6 is as well. Obviously those pose particular challenges, but there are work groups investigating those, and I think there'll be papers coming out about variation in those areas as well. We said we'd create a searchable variant repository. And we did that. This is Sphinx. I would urge you to go, I'll go to the website and check it out. It has a public facing and a private facing side. It summarizes a lot of the sociodemographic variation. You can look at different gene frequencies. You can look at the number of people who have a certain ICD-9 code. We don't have individual level data in this because that, considering we're using electronic health records, could potentially violate patient privacy. But there's a lot of population level data here. So what else did we say we'd do? This is a sentence from the paper. We said we'd talk about recruitment and sequencing. We've done that. We said we would summarize genotype validation. Again, we did both PGRN-Seq and an orthogonal platform. That's in press. We talked about provider education. That's in press. Patient education. That's working its way through. We talked about the complexities of EHR integration for the CDS. And, Mark, I apologize. This wasn't entirely a PGX paper, but elements of it did include things from the PGX experience. So I've borrowed it here. We also talked about how we'd summarize actionable rare variations. Six of the ACMG genes were on this platform. And one paper's already been published focusing specifically on the arrhythmia genes. And there's another one in development, I guess, looking at the six ACMG genes. So that's what we've done so far. And we actually accomplished many of the goals we set out in that paper. But the bigger question is what's missing? So I think the first very obvious thing that's missing is cost. And actually, when I got invited to speak here today, I got an email saying, will you talk about cost effectiveness analyses in eMERGE PGX? And I emailed back and said, I would love to, but I can't, because there haven't been any. There have been no systematic network-wide efforts at cost effectiveness in PGX. There may have been a few minor efforts at the individual sites, but nothing that I have seen that's really, you know, come to publication or move very far ahead. Frankly, the other thing that's missing is any assessments really post-implementation. Other than the genotype validation paper, most of what we published was sort of about what we did to get PGX up and running. We haven't published very much about what we've done since it's been going. And I'd say the plan at baseline was that we would the outcomes would largely be individual level and would be assessed through the EHR. And we do have several projects in progress.  People are working on these, but, you know, as we mentioned in when we're doing pharmacogenomics, the number of people that have relevant genotypes is often pretty small. And then when you take a general presentation like PGX, not everyone is prescribed the genes of interest, so you start getting to really small sample sizes very quickly. So we just haven't had a lot of power to do a lot of these analyses. And in a lot of cases we're waiting, hoping more samples will accrue. But the other thing we haven't done is we haven't really summarized the challenges involved in getting eMERGE PGX up and running. And honestly, they were considerable. So what I wanted to talk about for the rest of my time today was eMERGE PGX was made in a highly heterogeneous way. And in many ways, I think that's inhibited our ability to talk about outcomes to date. But how do we account for this, but also really capitalize on it in future research? And I thought it would be helpful to present a specific example of ongoing work. So there is a PhD student at Northwestern, Tim Hurd. He's a PhD student in biomedical informatics. And he's really interested in CDS implementation and what goes on behind the scenes in clinical decision support. What are clinicians doing? What's happening after they click that? And he really wanted to do a project around that. So he proposed a network-wide project where he asked how did you do it? How did you implement CDS? And how well did it work? So he did informal interviews with different people. And he found the right people at each site who really knew a lot about CDS and the sort of back end of the CDS. He started with informal interviews. He moved on to a formal questionnaire. And this was a highly detailed formal questionnaire. He needed a lot of technical expertise in the EHR and in the CDS to understand this. And then he tried to do an analysis where he aggregated and identified trends. And he presented this at AMIA. And I put these numbers up here because Tim did a ton of work and he generated these numbers. But when you want to present them, he said, it's just really, really hard to come to any conclusions based on these because each of the sites were so different. Some of the sites, what ignore meant at one site might essentially be the same as override at another site. At some sites, the CDS wasn't the first time they were seeing the information. So maybe they'd already received it as a test result. So what does it mean if they ignored it, if they'd already had a conversation with the... So trying to implement this cross site was becoming incredibly, incredibly difficult. So Tim, he's rewritten the paper and he's about to circulate it. And I just quoted some things that he said that I think are really true. There's significant variation in how these are designed. So they create a real barrier to trying to analyze the target physician response. But instead, on a positive note, what we've done is created a series of natural experiments with a variety of alert design and DGI choices. So a single site study could compare physician response across different DGI's, and here I'm called drug gene interactions, I apologize for the acronym, across similar technical infrastructure. So maybe we can compare how people are responding to synvestatin versus a clopidogrel alert, but in the same HR system where it was designed essentially the same way. Or maybe multi-site studies could focus on closely targeted analysis of specific DGI's where design choices make meaningful comparisons. So maybe we could look at clopidogrel implemented at one site versus clopidogrel implemented at another. And this is where I started talking about implementation science yesterday. I feel like if I had read a little bit more of the implementation science literature before Tim started working on this project, I could have probably alerted him to a lot of these pitfalls before he did some of this work. So I just wanted to talk briefly about implementation science, and I am in no way an implementation science expert, but I think this slide's been really helpful to me in thinking about it. And a couple of things I just wanted to point out. The traditional unit of analysis and randomization in implementation science is not the individual, it's the clinic, the team, the facility, the school. So in eMERGE PGX, I think the unit of analysis that we should think about for some things probably is the site, not the individual. And again, another thing that I think is helpful is looking at these outcomes. They talk about adoption, adherence, fidelity, level of implementation. These are things we heard coming up over and over again when we were talking about challenges for implementing eMERGE PGX and we weren't necessarily capturing them in a consistent and cohesive way. And I think we had a good reason for that. So when I dug a little further, this is a paper from implementation science published in 2015, again, listing some of these important implementation science outcomes. But their conclusions were that the instrumentation is underdeveloped. There are many different instruments available, but there's limited, you know, most of them are not validated and there's very little consistency. Each group is sort of creating their own. And this is a real problem, right? If we want to do this, we want to do it well. We need well-validated instruments to assess these outcomes. Another thing I want to bring up that I've seen up coming a lot, come up a lot in the implementation literature is the notion of hybrid designs. You know, so we have effectiveness research and that's, again, where we're looking much more at the individual level. And we have implementation research, which is where we're looking more at the site level. And multiple people have proposed that we should really be thinking about these hybrid designs. And the difference between the three is just really the balance between the emphasis on the individual and the emphasis on, say, the site. And I think as we're moving forward with different implementation studies and studies that we want to really use to help other people implement pharmacogenomics, I think we need to be thinking more about these hybrid designs. So I just wanted to leave you with a couple lessons that I think we learned from doing the Emerge BGX study. And the first, and this is, again, something I now have stumbled upon a fair amount in the implementation literature, is it's really important to document where you started. Particularly in a multi-site study. And this came up for us when we went to publish the provider education study. And, you know, we were talking about different educational techniques that we used at the different sites to educate providers. And a reviewer very appropriately said, well, where did you start from? You know, had you ever introduced the concept of pharmacogenomics to anyone at your institution before? Or were you implementing several other similar programs and people were very conversant in this idea? You're exactly right, of course.  So this is a very small table and I'm not assuming that you're able to read it. But this is something Cindy Prouse put together in response to that criticism for the provider education table. It went back in as a revision and it's now accepted. But, you know, we, in Emerge BGX, we really need to document where we started from. And the reality is, across the Emerge BGX sites, we started from really different places. Again, I doubt you can read this, but, you know, Cincinnati had, to some extent, an existing BGX program for eight years. Same with Mayo Clinic, whereas CHOP said that their model really only been implemented for one year. And again, some of these sites really had no previous study. So it's, of course, not surprising that they needed to use very different provider education models to get everyone up to speed. So just some other lessons learned and this is entirely my ideas. I didn't have time to run this by the Emerge BGX working group. But, you know, I think one of the important lessons learned is you need to plan to capture outcomes in advance. And we didn't really have that luxury in Emerge BGX. We had this really nice situation where we had this extra sequencing money. But at the same time, we had to start recruiting people like now. So we didn't always have a lot of time to think about exactly how we wanted to set it up to analyze and advance. And obviously, that helps. But more than just thinking about outcomes in advance in general, I think you need to decide, are we focused on clinical effectiveness? Are we focused on implementation? Are we focused on both? I think there's a really strong argument to focus on both and to plan to collect outcomes in both areas. If you're going to do that, though, and this is not a need that is unique to PGX. It's a need that spans implementation science. We're going to need some better, you know, validated ways of measuring implementation outcomes. And finally, I think at kind of a challenge we have as PGX researchers is, we need to get better about learning how to share implementation challenges. And I think part of the reason I like implementation science is it gives us a nice framework for doing this. But lots of us are grounded in clinical trials, in cohort studies, where fidelity is king. And, you know, you have to adhere to that protocol. And if you don't adhere to that protocol, you are punished in many cases. You don't get to continue in the trial. You don't get to enroll as many people. But when you're doing an implementation study, you have to make adaptations to make this work at your local environment. And I think we need to be better about being very open about that and talking about that and using that as a learning experience rather than something you're sort of ashamed about because you couldn't get X, Y, and Z to work at your institution. And again, I just wanted to acknowledge the members of the working group, Cindy, Jan, and Josh, and anyone else here who's been helping with PGX along the way. Yes. Go ahead. So I can't overstate the importance that this project had for the installation of a whole series of things at the Mayo Clinic that you haven't captured there and that I think you need to include. Number one, John Black at our place did the sequencing in a CLE environment in his department of laboratory medicine. This project acted as approximate stimulus for I think the largest academic reference lab in the country to really go whole hog into next-gen sequencing. It was a test bit for that. And I think that needs to be something that you take credit for. Number two, it stimulated our educational efforts for both the providers, patients, et cetera, which are now quite mature, but this was the approximate stimulus to kick that off. And number three, it was clear to us that the 1,013, John Black keeps reminding me it wasn't just 1,000 at Mayo it was 1,013, that the 1,013 samples clearly were inadequate, which is why we're moving on and taking many more of the ours were Biobank samples from the Biobank. So I really think I remember that there was some concern that at each site this really wasn't an adequate number. And we were underpowered, Terry, but the fact of the matter is it was a very strong stimulus and somehow or another I'd hope that when you move forward with saying what the project did, it's certainly at our place. It was an extremely important step toward much broader implementation. So congratulations. And I hope that can be reflected in what you end up saying. Great. Thank you for that clarifying addition and that was an excellent presentation. I think while Steve's coming up to get his slides loaded, we can have time for one more question. Yes, go ahead, Sandy. So really, really neat work. A question that I'm wondering about is about when you were implementing, about how long did it take? I know it's a general average, but the sites to set up a clinical decision support role. Assuming these are event based intervening if it appears that something different should be done when a drug is ordered. So I'm going to take the cop out answer and say it varied a lot. And Mark chime in, you know, because this was really the EHRI working group was really involved in that. I mean, some groups I feel like less than six months, but others more than two years. Yeah, so the hair paper that Laura referenced does have some of that information in it. And it's also worth pointing out that in this current version of Emerge, along with Caesar, we're in the process of trying to really cost out what it actually cost to stand up the CDS rule across different organizations. So we're very interested in some of the, of quantitating that type of information because I think for our IT staff, they're very interested in knowing how much of this, how much of my life is going to get sucked into this cool science project that you guys are doing. Thank you, Laura. Our next speaker is Steve Leader from Children's Mercy in Kansas City, and he's going to speak to us about the Goldilocks Project.


So, our kind of almost final session of the day is going to be a really rather interesting panel. Now, how many of you here have watched Raw Code and in particular, clustered before? You've got some people who are familiar with clustered. So it's a really great, like, YouTube show where people break Kubernetes clusters and people try to figure out how those clusters were broken and fix them. So we've been doing over the last couple of weeks, we've had some teams fixing some broken Kubernetes clusters using EBPF tooling. And so our panel today is going to be hosted by David Flanagan, also known as Raw Code, who is the host of clustered. And we have a panel with representatives of our three teams who fixed those clusters. We're going to learn about how they use these EBPF tools to solve problems that are representative of real-world problems. So we have David, we have Duffy Cooley, we have Margot Monteirola, and we have Loris Dejane. I'm going to get your name right, Dejane, something like that. Sorry, Loris. OK. There's going to be a couple of minutes here to just, I think, get the screen sorted out and mics. And oh, we've got lots of microphones. That's good. So I guess once the microphones arrive, maybe we can start with Loris and have the speakers just introduce themselves. How about that? Yeah. My name is Loris Dejane. I'm the CTO and founder of CISDIG, CISDIG is a company that does security invisibility for modern cloud-based containerized applications. I'm also one of the early contributors to Warshark, the network analyzer, and one of the also creators of Falco, the open source tool. So a career in open source and kernel hacking. I'm Duffy Cooley. I'm a field CTO at ISOvalent, and I've also been working in SIG cluster lifecycle on QBDM and kind of helping people fix and break clusters for quite some time. So this is a really fun thing for me to be a part of. I'm Margot Monteirola. I'm part of the KingFolk team at Microsoft, leading the team that does Inspector Gadget, which is an eBPS tool for Kubernetes for figuring out when the cluster isn't working as expected, which is really fitting for when you're trying to fix a broken cluster. Hello. Hello. Hello. My name is David Flanagan. I go by Rocko. I'm excited to have this panel. So we have slides. Okay, we're good. So let me fill you in a little bit for the people that are not familiar with what Clustered is. I often call it the worst idea I ever had. Having people break Kubernetes clusters and then live streaming fixing them is extremely stressful, but also a very valuable learning experience. And we have two different versions of Clustered. One is Solo Edition, where it's just one community member and another community member. And we also experiment with Teams Editions. And I'm always looking for new victims. So feel free to reach out to me. I also want to thank Equinix Metal. They provide the hardware for the three clusters that we are going to watch get fixed today. So we've got Teams. We've already done the introduction. So we'll skip by this. And I want to just say before we show the videos that this is not easy. So I want to thank everyone involved, the breakers and the fixers. Like being given a cluster and you have no idea what is wrong with it is intimidating and stressful, but they all absolutely smashed it. So well done. And all of the tools that we're going to see today to debug and fix these clusters are open source. So this is stuff that you can play with and experiment on your own time as well. All right. So we've got our first video. And this is our Isovalent cluster. Oh, we don't have audio. Can we get audio? Daph is just going to do the voiceover while the video is playing, if the audio doesn't work. Yeah, it's so fun. It's so fun. It looks like you're there frozen on the screen. That's definitely my troubleshooting face. These clusters were broken by Thomas Graff and a few other folks from Isovalent. And so I was definitely expecting some very interesting breaks. Yeah, for sure. I don't know how nice your colleagues were with you. Mine were very nasty. Oh, really? Well, one of the problems on our cluster that we'll talk about here in a second was obviously a DNS problem because it always comes down to DNS. It's always DNS. And then another one, we thought that we had fixed it, but it was a decoy problem. Like you get past that problem and you're like, no, no, it still isn't working. So we're starting off by just taking a look at what's happening inside the cluster. We're just trying to see what's happening. And we can see that initially we see that there is a pod that isn't up and running. And we're trying to figure out why that pod isn't running. And we find a very important init container that is basically keeping it from running by trying to make a connection to Google.com as a pre-check for the container. So until that init container happens, it won't start up. That is your mic? Hello? Yeah? Yeah, that's what he's doing. I can keep narrating, I guess. Yeah, the narration was actually pretty interesting. I don't think I recall what was working with our cluster to narrate it. I guess we can discreet what's happening? Yeah, I guess I'll keep going with the narration, yeah. So we were, you know, the goal of our efforts is to make it so that container that we're referencing here is able to come up and that we're able to see, like, a success image on the website is being hosted by this container. And so first we try to figure out, like, what was happening with Google.com. And we eventually came to the conclusion that what was happening was that someone had actually put Google.com into the Etsy Hosts file pointing at, like, some other, you know, URL. And so it was never going to actually resolve because it was against some, I think it was against local hosts or something. And so that was actually probably one of the more creative DNS problems that I've seen in a while because basically it was just intercepting it since Core DNS was using the Hosts file to determine what the result of Google.com was. And at that point we started moving on to the second set of problems. And the second set of problems, actually, I think we're still talking about the DNS one here. So we're trying to figure out, like, what the problem was. And we had a policy that would allow for us to communicate to Google.com, but for some reason it wasn't resolving. And so we were trying to figure out why it wasn't resolving. And the reason was because of the Hosts file, which was very clever. Thank you. Thank you, Breaking Team, for that one. Finger crossed. The scope should be allowed. Your idea is that the init container is going to use the Hosts DNS. OK, let me restart this then. Team eyes of villain, best of luck. Take it away. All right. So let's look around this thing and see what we got. Morning. Got some previous things. Something's not running. Small splash. OK, so init container is not ready. And init container has a very important name of probe do not delete. So that special version of cluster to just for team eyes of villain must be able to reach Google before it can start the cluster application. Given that we are a network things, you know, plug in, maybe there is a networking problem here we need to look at. That looks good. This is nice. Yeah, everything's running. Yeah, the total stuff. And we have a UI. We have a UI running. So we have Hubble running so we can use Hubble. But if we rewind a bit, so we had this init container and it was not in red state. And I believe it was doing paying Google.com. So I'm wondering. It should use the host resolver. So even if the core DNS was not functioning, like it was not able to. So I see here we've got the rule that allows anything to reach QDNS. It also has a rule to allow to start at Google.com. So that should that FQDN lookup should be allowed. Your idea is that the init container is going to use the hosts DNS services. Correct? And there you go. That would not be. So how's our pod looking now? Well, it's running now. So is this why we're supposed to try and upgrade it? Just changing the tag to be two in hopes that that one reasonable thing to do. We have an error. Fail to connect to database. We definitely saw some policy drops between Postgres and things. So let's take a look at that policy. OK, Gary. It is policy denied. What? Cluster talking to a clue. What's that got to do with clue? So is Gail and Rollins' service selector here? Shouldn't redirect to those endpoints. It should be redirecting to a different endpoint. That doesn't seem right. Do we have a service at this particular thing is targeting? What services is it trying to connect to? And let's look at the service for is it that's the database Postgres? Could you? OK, I think OK. Where do we go? Let's look at this. This looks yeah. Big fan. Big fuzzy hearts all over the place. I actually don't think you would find that one so quickly. What we're seeing here, yeah. So what we're seeing is that when we do the Hubble Observe, we're noticing that the clustered application, when trying to communicate with the database, is for some reason going to the Fluent Depot. And we're like, that's weird. Now, there is a function in Cilium that allows you to do local redirect policies. So if you were going to do something like you had a node local DNS cache, you know how you can use IP tables to intercept the DNS traffic and send it to the node local piece? This is a mechanism that can also be used for that, but it's implemented in the EBPF where a policy might look like this. And that policy is basically saying that when traffic within this namespace happens when something tries to reach the service Postgres in the default namespace on port 5, 4, 3, 2, and it's TCP traffic. We're going to redirect that traffic to a different back end using a local endpoint selector that matches labels at Fluent D. So basically in the EBPF, we can be like, don't send it to the Postgres database and send it to this other thing that is local inside of the namespace. Should we try the web page? See if the web page will refresh. Just one more. Oh, I'm broken. At least it's going to have Postgres. Does the pod have a matching label? Yeah, that's what I'm looking for. Let's take a look at the policy real quick. CNP. Reading this, I'm looking for app Postgres and app clusters. So if I did kubectl. Or you could just do get pod show labels and see what. Use an active. Call the label. See what they actually did call it. It was Postgres QL. Look at how fancy. He's guessed it before it even happened. Well done. Can we do the browser check again? The goal of Clustered is to see the dance. And they did great there. So these episodes are nearly an hour long. So been able to condense it into six minutes. I hope you were able to follow along with the breaks. But it was a whole lot of fun, but well done to my availing. So if anyone has any questions about this, feel free. We're going to try and get you a mic. And I've got a couple prepared here first. But if you do want to ask a question, just put your hand up. So Duffy, Isovalent has gone all in on EBPF from replacing kubproxy, removing dependency on IP tables, and more recently, tetragone. Do you want to explain the buy-in for EBPF and what you're excited about by using EBPF on a daily basis? Yeah. I mean, what's interesting is that priority of product actually describes the value in EBPF across a variety of different verticals, if you will. So with tetragone, when we started talking about tetragone, one of the amazing things that we're talking about is the ability to gather context about what's happening at the application layer and present it to you in a way that you can use it to understand what's actually happening, like which given process is making what connect call, what system calls are they making, and those sorts of things. And then if you look at the way that we're using Cilium, we're using Cilium to leverage EBPF to solve a lot of the networking use cases. Like how do we handle load balancing? When we replace cube proxy, we're talking about using Cilium to be effectively like that internal load balancer that every Kubernetes cluster has. So it's a variety of different really important use cases for EBPF. Awesome. What I really loved about our session was the developer experience, which we haven't got in that six minutes, but the videos will be available. But there was the Hubble UI. There was a Hubble CLI. There were Grafana dashboards that were shipped. And even the use of the Cilium editor for network policies. So you seem to favor the CLI in our session. And I was wondering if you could tell us a little bit more about it and how people can also use the Hubble CLI. A little bit more about what, sorry. Oh, can you tell us about the Hubble CLI, why you enjoy using it, and what people can do with it? Yeah, I mean, for me, the part of it that is kind of amazing is that Hubble CLI gives you a view into what's actually happening at the network layer as far as connectivity and that sort of stuff. And so it's basically just a way of using a text-based visualization tool that lets you see event-based network connections between things. And in this age of microservices, where there's a network between everything, we need that kind of visibility to even know where to begin to troubleshoot. Because usually it's not, I mean, how often has it been an actual application problem versus that there's actually something on the network? Maybe you've misdefined a network policy. Maybe you typed the wrong URL. You actually wanted to see some kind of an ex domain that it is actually DNS. But this visibility, I think, is pretty killer. It's one of the big differences. Awesome, thank you. Does anyone want to ask a question about Hubble, Selium, or Taddafi? All right, let's roll the next clip. Pretty good, take it away, start typing, and best of luck. So yeah, here we have the cluster. So let's see the nodes that we have before going on. OK, so yeah, let's check the pods that are running there. So yeah, here's the pods of the control plane of the QP system in this place are all running and good. So yeah, that's good for us. And yeah, we have this pod that is in crash loopback of state. So probably this is the one that we have to fix now. We can get the logs. So get the pod, the name of the pod. OK, so let's describe this pod and see what we have there. I think, yeah, we have a set-consecurity profile there. OK. Yeah, if we have a permission denied problem, maybe this is related to second. Yeah, we have the annotation here. And it's a custom one, so that's a specific history. Yeah. OK, so yeah, I think we can use inspector gadget to understand what is going on with this set-con. Probably what is happening here is that the pod is trying to use as it's called. That is not allowed by day. So in order to use inspector gadget, we have to install this in our cluster. So yeah, this is gadgets. Set-con. So this is telling us that there is a pod running on this node in the default name space. And this is in fact the pod that was crashing before. This is the name of the process that was trying to perform as it's called. This should be a little bit confused by the output here. This system call is not part of the clustered spec. But it's not the reason the pod is crashing. Yeah, yeah, at least. This is two breaks colliding together to cause a very unfortunate side effect. But what else would give you permission denied if it wasn't assist call? Well, capabilities. All right, so we can trace capabilities. This should be good. OK, here we are. Oh, so we have security contest capability. All, yeah, this is not good. We are running the pod without any capability. Of course, this is going to fail. What we need to understand right now is what are the capabilities that are required by this pod? So yeah, I think we can use the capabilities gadget to get a list of the capabilities that this pod is trying to use. So we have capacity and gadget-dressed capabilities. We are only interested in this one. Oh, here we are. OK, OK, got it. And yeah, this is the name of the container, the UID, the PID inside the container. This is the command that is trying to do that. And this should be the capability that this is trying to use. Netvine service. Does it look good to you? Looks good to me. Ta-da. This is working. It works. I mean, saying it is working is a pretty bold statement. But you can confirm that, right? We wanted to curl from 30,000. Local host, 30,000. We were trying to verify that the application is working. So with this score. It doesn't seem to work. Connection refused. So there's something else that needs to be fixed. So this is 30,000 here. And this should be 8080. So what's the pod? Maybe we can list the sockets that are opening the pod to check what is the real pod name that the pod is using. I like how you don't even look at the manifest to see if it's got a container port. And you're like, no, please, just go and list all the ports so that it's used to be. I don't trust the manifest. Let me try something. I think we can just trace the whole name space. And that should be fine. I'll use the gadgets here. Just delete the pod. OK. Seems demonic. It's working. So yeah. The pod 666, right? So what we can do right now is to edit the service and change the pod. I think that this is why. Yeah, that's good. Nice try. OK, something doesn't work. Another thing doesn't work. Your last break. I think somebody said before that second wasn't the problem yet. Yeah, I think that's it. And let's use that on the whole name space. I think this is OK. I think what's interesting about this is that Postgres traffic means your request has been received and the application is trying to respond. OK, so yeah. It doesn't seem to be a problem with the networking because the traffic is arriving there. The full connection is established. I hadn't seen that TCP connect before. That's awesome. OK, I'm sending a request now. It's shut down. Can you try to send another request, please, Iago?  So this is easier to read. And this is more terminal. Yeah, it is shut down. It was funny that you said that the JSON is easier to read. OK, so maybe we need to edit the second profile. And because the shutdown is never called, the response is never sent to the client. Let's do it in a poetic order. I appreciate that. And then the queue will apply the new second profile. Yeah, yeah. Ta-da. This is working. All right, so that was quite a tricky one. We dropped all the capabilities. We added a custom second profile that was missing once this call. And I gave them a poll with no idea what port it was running on. All right, so debugging Kubernetes is a huge challenge for all teams. But what I thought was amazing there is you really didn't look at the yaml to see if there was a container port. You just lest eat all of the ports that the container was using. And I thought that was very, very cool. So can you tell us maybe two of your favorite gadgets that you use and why you like them? Sure, yeah. So I think one of the cool things about Inspector Gadget is that it has a wide array of things. And it has very simple gadgets, like tracing the exec syscalls. And so you can see if something is executing a command and it's not finding the command or whatever, you can see what's happening or tracing the open files. These are very simple but very useful. But it also has complex gadgets, like the network policy advisor that can capture output and generate network policies based on the output captured. And so yeah, I guess I like the flexibility of the different gadgets available. Awesome. So we use the custom set comp profile there. And we're actually in more people adopt set comp and apply them to the container images. But I think there's still a lot of frustration around generating those profiles. So could you maybe give us some tips and advice for doing that? Right, yeah. So we also have a set comp profile advisor that is just for that. So you can run the advisor like in capture mode first to see all the syscalls that your pod is making and then just tell it to generate the profile. And it will generate a profile with just the syscalls that your pod is using. And you will have a matching profile and you don't need to handcraft it because it just generates a profile for you. Awesome. Thank you very much. We'll just do questions at the end. I'm going to move on to the next one, which is the sysdig video. And I just want to say, I worked with breakers from all of these companies. And of course the sysdig breakers really wanted to make you sweat. Like they really wanted to cause you some trouble. So exactly. I can tell you that your colleagues have left you some Falco workloads in the cluster. So we have 5-star QQI. Yep. If you want to access the Falco site QQI, I'm happy to open it in a terminal browser on the site just so the audience can follow along. I mean, right now it doesn't look like it's broken. So yeah. Oh. OK. I have to connect to the database. Passful authentication. There's also an image here in the page. Can we open it with the browser? Where is the chat? Yeah. Looks like we're upset. Should we go take a look what the site QQI is telling us? If we get any hint from maybe any Falco output, first of all, maybe it's captured or something. We have an exec into a pod, a DV program was spawned, and Bash history was deleted. A naughty person has been in one of these pods, I think. Scared your current jobs? Keep scrolling. Three times. Deleter in a mystery, attach or exec in pod. Definitely somebody has gone into one of these pod. Which one is it? Yeah. And there is an alter user in the database. It's Postgres, right? There's also the password in the alter command. Not today. So somebody went into the Postgres pod and manually changed the password. Is that what they did? It's very cool that Falco gives you visibility into these arbitrary random commands within a pod. That's pretty sweet. Here, the Postgres pod is running in your next list. Oh, wrong image. The Falco UI also said something. Container image Postgres 1, 3, alpine. So we have a meeting somewhere. Those are nasty. I haven't maybe got rid of that.  I did it. I did it. I can delete it right now. Just look it. Yeah, I'm just taking my pics are pretty opaque. You don't know what they do. You just know the permissions they have. We do have v1. So currently, our application is working. Oh, look at that. So now you have to upgrade it to v2. Just watch this thing with event.type equal exactly. And we can see the executions in the cluster. Yeah. Yeah, exactly. There's some kind of hidden process probably somewhere here. There's a process code, definitely not. Yeah, that was the question. Where do you see it? Or now that we need it. What is that? What is that? What is that? It seems to be running date and sleep.  We have the PID from sysdig, right? Try just to do a sysdig filter with a definitely prog.name contains. Definitely. Definitely. Maybe let's try from sysdig.  But let's try from sysdig. And before the filter do dash p, prog.name. Can you scroll up in the meantime? Because there is that clone. The clone should contain the parent too, yeah. pt systemd. It's systemd. And the arguments is barcatch, definitely not. So this is run by systemd. Just kill dash nine systemd. That's a good way to do it. I killed the PID one. OK, exactly. Guys, have you seen the Falco UI service there? Do you see that? I would like to check the service Falco UI. System CDO cat Falco UI service. Good call. There you are. Barcatch, definitely not. Yeah, yeah, yeah, yeah. Cool. Dun, dun, dun. Not today. Oh, it's nice. Loops forever. Checks to see if the pod is old and resets the password on postgres. Good catch, Vicente. You have to dance. So what was really funny about that is they had the bad code instead of a Falco UI service that obviously wasn't Falco UI. But they actually went to the extra effort of that bash script, which was running every five seconds initially. And they said, it's too noisy. They'll find it too quickly. And they actually made it check to see how old the pod was so that it only ran when they deleted the pod. Yeah, exactly. So we were trying to capture it, but it wasn't happening often enough to actually be able to see it. Yeah, it was very nasty. They put a lot of effort into that. So that was a lot of fun. And we see mutating webhooks a lot on cluster. They are very opaque. They're difficult to track down. So it was actually really cool to see Falco with Sidekick and the UI actually give you visibility into what was happening and that, which was kind of cool. So something that I often see is that security is still kind of considered like a day two problem. But now that we have tools like Falco coming in and becoming adopted and there's ability to share rules, do you see a shift changing there where people are starting to maybe work on security earlier? Yeah, for sure what we're seeing with Falco. So Falco is to attempt to accomplish two goals. One is the use of modern techniques like EBPF to capture data that is as granular and as real time as possible from the operating system and from other sources as well nowadays. And the other one is creating sort of a simple policy language that people can use really in a community way. A strong belief that we have in the Falco community is that you can have a chance to win the war with the bad guys only if all of the good guys can get together on a single platform and a way to, for example, create security policies that are built on top of a simple language that is working on top of EBPF is one way for the good guys to work together and for sure we're seeing people are incentivized essentially to produce policies and rules that then become a value for the whole community. Do you feel that we are on the path to there being secured by default rules or policy that can be deployed to our Kubernetes clusters? From one point of view, I would say we're going toward the direction. From the other point of view, it's also constantly a challenge because security is always, it's always environment dependent. So building something that works out of the box for everybody is the dream. And definitely with every iteration of security tools we're getting better and better. But I don't think we're there yet with something that just works out of the box for everybody and is secured by default. OK, I'm going to throw a set to all of you now and maybe we can have a bit of a conversation. But I think what's really cool here is that we've seen EBPF applied to networking, security, debugging, it's almost a superpower that anybody can learn and harness and use. So do you have any tips for people here that want to adopt EBPF? And let's try and tackle that as consumers of EBPF tools, but also as being EBPF developers. So any tips and advice for people? I don't know. I can go first. In my opinion, EBPF is a super cool technology, incredibly powerful. And I recommend to anybody to learn more about it. It's such a powerful Swiss Army knife. But at the same time, you don't need to be like a compiler expert, a kernel expert to take advantage of this. What we saw in this panel, what we saw today is that there's a bunch of tools, Cilium, Falco, that expose this kind of functionality in a way that doesn't require you to be a rocket scientist, but still allows you to take advantage of this. So start maybe from the tools, learn the tools, and then use them as a way to go deeper and actually learn how it works. I completely agree with that direction. I think that even earlier today, we saw a talk about leveraging Pixi and some of the capabilities of just leveraging BPF trace to understand what's actually happening on your systems. I'm an old systems administrator, and I've worked in networking for years and years at this point. And I would say that for me, the easy entry point into BPF and starting to learn and explore what was possible was playing with those tools, like being able to use BPF tools that kind of already existed in the community to look at the set of problems that I'm used to looking at in a different way, getting more context presented maybe at a higher abstraction, being able to understand what system calls were happening at the same time as the networking problem that I am having was happening, like being able to kind of widen my perspective with these tools. That's definitely, I think, a good place to start. Yeah, I agree. I'm not sure I have much to add. But earlier today, there was a plug for at least talk from last year. So for those that were not there, that's like a good introductory talk. And I think the BPF trace is also a great tool to getting acquainted with, what are the different trace points that are available? What kind of things can I do? And you don't need to learn all of the BPF to just start experimenting and do a few cool things that maybe are not particularly useful. But it's like the first taste. It's like a hello world that you can then move on to do something more interesting. All right, thank you. Does anyone have any questions for our panel? No? All right, well, I hope you all enjoyed that taste of Clustered. Thank you so much to the panel and the breakers and the fixers. Thank you very much. Thank you.


The results of this study indicate that children with autism have a higher prevalence of obesity than children without autism. Further research is needed to identify the underlying causes of this phenomenon and develop effective interventions to reduce the risk of obesity in this population. This article was authored by Muster Viva, Anderson Sarah E., Cutting Carol, and others.