Thank you, Kim, for inviting me to give a talk about immunotherapy. My role within the University of North Carolina is actually melanoma specialty. So you would ask yourselves why melanoma doctor is trying to give a talk in renal cell. And the answer is supposedly we are seeing the melanoma doctors are seen as doctors from the future for what is going on in the field of renal cell cancer. Which lacks approximately one to two years in development in relation to what is going on with renal cell carcinoma. Does anybody there to say what this looks like? Patients wise, not doctors. So I tried to find a picture in the internet about how a cancer cell looks like and how lymphocytes look like. So I want the patients to understand there is a size difference between what is a cancer cell which is usually a big thing and how these tiny things are trying to go against the cancer cells and kill it. So we have a size difference and sometimes number of cells of immune cells and function matters. So the talk point is that since it's Christmas I'm going to give you a couple of recommendations books for Christmas. I'm going to try as simple as I can with respect to describing what is a normal immune system functioning. Because a lot of lessons from the normal immune system functioning you will answer yourselves about what these drugs that are coming out in the renal cell carcinoma mean and how do they work. So an important aspect of what is immune surveillance and immune editing. So and then what are the mechanisms of cancer and immunosuppression. Just to explain the variety of different mechanisms that exist and why immunotherapies is not one side fits all. We also would like these audience to remind the high dose bolusile to it is no longer a sexy drug as this has been out for 20 years but nevertheless should not be overlooked as progress goes by. And then the future for now is immune checkpoint inhibitors and that's what we're going to talk in the end. And then the question is whether the future is for everyone. So these are the books for Christmas. The left side book I read when I was a resident 14 15 years ago. It is written very almost 15 years ago. So there's not going to be any excitement about the recent advances of immunotherapy. But it's going to give you a very nice history of immunology and immunotherapies in cancer. You will see all this drama that has happened over the last 100 years about questions like that a scientist had. Does the immune system work or does not have it all. So we had a lot of ups and downs throughout the 120 years as to whether the immune system plays a role. So there is a nice nice book here pretty big like 300 350 pages. Not an easy book to read but I would therefore recommend. And the one is the one I'm trying to finish when I'm going back and forth to work through an audiobook. This is a generic history of cancer book. There's no talk about a lot of immunotherapy but again you're going to see how doctors and researchers are by all means human beings and they're having their own biases and how progress is are being made. So the purpose is not to explain you how normal immune system works but show you that basically we don't talk about immune system in general. We talk about two different arms of the immune system.  So this is the adaptive immune system. The immune system needs to remember what the cancer cell is because it's a non self so it's not something non specific. And the key to all this the key is the interaction of these cells that are called habits and presenting cells. These are the cells that pick up stuff that is known for that is known for in from the from the environment. This can be viruses because this can be bacteria. But yes it can be cancer cells because cancer cells are known self cells. So these are sample from the micro environment and are being presented in these aunties and presenting cells. And it is this key interaction with this other cells that are called lymphocytes that you saw in the very first slide. That is the key to educating the immune system. Okay so that's a different way of seeing the adaptive immune system. Fancy picture where antigens are being picked up at these aunties and presenting cells. These are called dendritic cells from the Greek word dendros which means tree. So they have these spiny projections and it's again an uninstructed naive T cell that is going to come and encounter the antigen presenting cell. And then it's going to get activated and either it's going to kill the cells or some of them are going to be left behind for memory. So that's a very simplistic approach of what is adaptive immunity. And again the key interaction here is the interaction between the antigen presenting cell and the lymphocytes. So here's your first kind of complex slide but the way I'm going to present it is like it's basically the interaction between the antigen presenting cell that I showed you before. And a lymphocyte, a T cell is actually so complex that over the last 20 years there have been so many molecules that have been identified to play a role in this interaction. And it's no longer a simple interaction of a signal that means that these antigen presenting cells is going to present the antigen and oh, the immune cell is going to get activated. The decision, so it's no longer one what's called first signal. It is a number of other things that the interaction between these two cells have to be taken into account. And whatever is in red, it means that these are actually proteins that are going to say no, I'm not going to get activated. And then those things that are green, these are the cells that say yes, I'm going to be activated. So the net effect of whether an immune cell is going to actually get activated is the net result of the positive and the negative factors. And it's easy to understand that this looks to me like a complex car with multiple brakes and gas pedals. So that's how complex nature is. And all and right away, you're beginning to see things that you may have seen already on the Internet. You're seeing things like C-T-L-A4. So there's already a drug against C-T-L-A4. It has been used for renal cell cancer. It's called Hervo. It has not been approved yet. Also, you see these other negative immune checkpoint protein that's called PD-1 or PD-C-1. That is the target for Nevolumab or pebroluzumab, pebroluzumab that was FDA approved melanoma three months ago. And then whatever you can see in red, it means that there are already drugs in development. So it is no longer just the PD-1 that you see or the C-T-L-A4.  So this is a very hot area of interest. So there's going to be more to come over the next five to seven years. Okay, so this is the gas pedal scenario in normal states. So if you have two gas pedals in one break, then it's a go. And that's a nice looking car that's actually makes a turn and does not go upside down. And this usually happens when there is an early stages of an infection. An immune system has to become activated. Very simplistic the way presented, but this is a good way to understand how it goes. And then when the immune system takes care of business in the normal states, then all these several of these negative immune checkpoint proteins are being upregulated.  So I want people to understand here that cancer and the immune system, there is constantly an interaction. I remember I was a third year medical student in Greece when our pathologist said, our body makes approximately 30,000 cancer cells per day. And the only reason that we don't develop cancer is because we have a constantly working immune system. So there is always this tendency, the Darwinian tendency of our bodies to develop mutations, to become something different, to evolve over time. But there is constantly this system that's called immune system that is trying to seal things off. So therefore any conditions can turn a normal tissue into a cancerous tissue. And by definition, the cancerous tissue is slightly different from the normal tissue. And that is perceived as foreign as a non-selfmade immune system. And in so doing the immune system is trying to eradicate those cancer clones. And then there is this constant interaction between how a cancer becomes genetically unstable, develops new mutations, okay, becomes more different, and how it actually tries to suppress the immune system and how this battle between the immune system and cancer is going on and on. And that has probably been going on for years and years to come. This is not an overnight event. And eventually cancers develop because the immune system has failed. So when somebody has cancer, it's basically a failed immune system. So there's not anything to fix it. It's not like if you increase your exercise, or you increase your activity, or you improve your diet, or you get a supplement, it's going to get better. It is already broken, and therefore there have to be ways to restore in the way of drugs. I believe in alternative medicine, but the effects of it are very well-unknown in a patient with metastatic cancer. So again, will the future be one size fits all? I just talked to you about one way that the immune system is suppressed. And that is by upregulating these breaks. But there are a number of things that are going on. There are many different ways that the family can become dysfunctional. I quote one of the very nice phrases that Alexander Tolstoy has wrote in Anna Karenina. There's one way that the family can be functional. People would be happy and, you know, kids love their parents and vice versa and everybody's happy. But there are many ways that the family can become dysfunctional. That is how cancer is. There are many different ways that your immune system can become suppressed. So here we go. So if the cancer cell does not upregulate these HLA molecules, the ones that require for the first signal, the immune system is not going to see it. And therefore that's how cancer cells evade the immune system. That's one way to do it. The other way to do it is to produce all these molecules that basically suppress not only those cells that are supposed to pick up the Zandigen and instruct those lymphocytes, but suppress pretty much everything, suppress the anti-Zandigen cells, but suppress the immune cells as well. And guess what? Many of these things that are being secreted by the cancer, or when the lymphocytes are coming encoded with the cancer, it can be a toxic effect. So as this nice review article from Tessa Whiteside, who was my neighbor in the neighbor's office in Pittsburgh, she says immune cells in the tumor microenvironment are functionally impaired and I'm adding and are killed. So your lymphocytes are getting killed by the cancer cells. And you all are patients and you understand how to read a complete blood count test. But what I want to emphasize you here is I'm going to show you eight different patients, CBCs, simple as that. The common with these patients is that all of them have metastatic cancer. And the one thing that makes a big, big interest is that the fact that all of these lymphocytes are low. So there is a fundamental problem in most of patients that end-stage cancer, that their lymphocytes are low in the blood. So for people who don't know what is a high dose bolusal to it, it has been FDA approved therapy for 20 years. It's not for everybody. It is a very toxic therapy. Not everybody can do it. It has been given in hospitalizations. This is called a hospitalizations called the cycle. Two cycles include a course and we can evaluate things between every two courses. So this is what IL-2 does. So this is our very first patient that was treated at the University of North Carolina with renal cell cancer. So what you can see here is that before he got into the treatment, his lymphocytes were low. And then when he started to get IL-2, his lymphocytes disappeared. And that's what IL-2 does, makes the lymphocytes disappear from the blood and they're going to different parts of the body, including the cancer cells and they're supposed to eradicate the tumor. And what happens is when the cycle ends, then the patient shows up right before the next dose and his lymphocytes are almost double right before the second course. So what I want to emphasize, again, do not forget drugs like IL-2. So IL-2 is otherwise called T-cell growth factor. I call it the T-cell steroid. If patients, in a way, would mean suppressions, actually, they just don't make a lot of immune cells. IL-2 could be a very good drug to give. So the same thing now, but now I have this thing there, which means that the cancer cell can actually be immunosuppressed because it can also develop properties of antigen-presenting function. And then all of a sudden you see that the lymphocytes can take instructions, wrong instructions from the cancer cell. As you can see, there are more breaks that the cancer cell can induce as opposed to gas pedals. And this is now the scenarios when somebody has cancer. So you may have advanced cancer and your first signal is functioning and you have two breaks and one gas pedal and therefore you're looking like a Formula One car that is on high brakes. But if, for example, your immune system, the cancer does not have expressing those things that makes the cancer cell visible, then you're like a car that is driving in the middle of the night without knowing where things are. And you can have the third situation of immunosuppression where things are functional but the cells are dying because the cancer is suppressing them and this is a car on fire. So what the immune checkpoint inhibitors in the cell cancer, and that seems to happen in 50% of patients with renal cell carcinoma, is that you may actually be able with one of these drugs to eradicate one of the two gas pedals and that could be sufficient for the immune system to get activated. And sometimes if you use two of them at the same time, and this is the PD-1 plus the epilimumab, then this immune system is really revved up to the point of going up in the air. So this is a most updated list of clinical trials using these immune checkpoint inhibitors in various cancers. And I want to show you the renal cell cancer in relation to other cancers. So what I want to show you is that if you use these two drugs, the epilimumab and the involumab in various doses, in combination you can rev up the immune system to such an extent that you can see a response rate of as high as 44. Now if you use only the involumab in renal cell cancer then the responses are less. But nevertheless, much better for responses that you get in other cancers like lung cancer or variant cancer. So what I want to emphasize is that different cancers would respond to these drugs in different percentages and it seems that the renal cell cancer behaves in terms of response rates similar to melanoma. So again, see where the epilimumab and the involumab was given in patients with lung cancer, the response rate was only 16%. So whether the benefits and challenges of this new class of immunotherapy, so definitely the way we see that in melanoma when epilimumab was approved in 2010, we were able to give immunotherapies in a much larger number of patients. We were giving epilimumab in a 90-year-old. We were giving epilimumab in a 70-year-old with congested heart failure. We were giving epilimumab in somebody with coronary artery disease. IL2 cannot be given in those patients. So the application of immunotherapies will be much larger in a larger group of people the same way we saw that in melanoma. What else would be convenient? It's going to be an outpatient therapy. You don't have to be admitted for this horrible five-day course of high dose bolus IL2. In fact, if you come to the MICU, the Medicine Intensive Care Unit at UNC, you're not even going to have a bathroom. So it is definitely less toxic. So that's no questions asked. But again, we have to see the less toxicity in a different perspective. The benefit of IL2 is that you will do it for two months or four months or six months and then you're going to be done. Because of immunogenic point therapies, potentially the side effects can be long-lasting. In particular, if you use the combination of IPL1 and IL2. Will they be more effective? So in our mind, we have linked response rates that I just showed you with clinical benefit, which is progression free or overall survival. The trials are too early right now to say whether this high response rate actually lead to longer survival, but it's very safe to think this way. But unless we do follow these trials over a longer period of time, we will not be able to know the long-term benefit. And the challenge is we're talking about drugs that are, it's $20,000 in infusion here. So we should do better job. We as doctors to really refine which patients actually are candidate for. And I think I predicted that these combination of drugs can be effective in up to 50% of patients, but definitely not 100% of patients. And for how long we're going to give these drugs? So right now the drugs, at least the approval of the peperoluzma from melanoma is basically indefinite. So as long as you have cancer and you respond to that, then you're going to be getting peperoluzma forever. Is that the right thing to do? I mean, this provides a huge burden to the insurance companies and the healthcare system. And again, as I said, as a response rate correlated with longer benefit and what's the cost and how to combine these drugs with other drugs. And I intentionally did not do that because I would wait for you to make your questions in the final discussion. So my summary and conclusions is that future is for some, definitely more than the lucky aisle to candidates. So you shouldn't be privileged because most of you, you will be candidates for both of these drugs. The peperoluzma alone or in combination with epilimumab. But not one side fits all that. I think I showed you that there are many ways that cancer, either family can become dysfunctional and this is one of them. And do not forget that there are also good old drugs. So taros and kinase inhibitors. Can some of them have seen that they have response rates 20, 30, 40% and people have been on that for years and years to come. And there are also high dose bolusile do that you should not forget. But if the patient is in an advanced stage of disease, this cannot beat up a dead horse with any immunotherapy, in which case you have to use other types of treatments. So these treatments are not for everybody. So I thank the six, seven patients and their families who have trusted us to give them high dose bolusile to in the hospital. And I'm sure that they are eager to see something less toxic than IL2 and the GGU program that refers patients to us for this. Thank you.


Thanks for viewing another 12pm tutorial. This video is going to teach you how to use a service called DynAweb that was created by Dynamic Internet Technology, the same people who created the FreeGate circumvention tool. DynAweb is an anti-censorship circumvention portal that uses hundreds of mirror sites in order to allow users to access information that may be blocked whether using the internet. According to DIT's website, the DynAweb service is hugely popular in China because it seems to be able to circumvent the Great Firewall of China with relative ease. But you don't have to live in China to enjoy the service that DynAweb offers. DynAweb is easy to use, it doesn't require you to install any software on your computer, and you don't have to configure any settings before you're ready to access the whole internet. So let's get started by opening up a web browser. Now in the web browser's address bar, we're going to type in www.dit-inc.us. Okay, this is the Dynamic Internet Technology website. Here you can read about their organization, their products, and their clients. In the upper right-hand corner here, you can choose your language of choice. What we're concerned with is the products page. So let's click the products tab. Okay, here on the products page, you can see FreeGate, MassMailing, and DynAweb. Since we want to use DynAweb, let's click on the green DynAweb text. This is an in-depth description of DynAweb. Feel free to read through this information in order to better understand the technology that DIT uses in order to help you access filtered information. Once you're done reading, click on the link in the first paragraph. That link is us.dong.com, forward slash home underscore en dot php. What you are seeing here is essentially the DynAweb service. At the top of the page are a few links. Home will bring you back to this page if you navigate to any of the other pages. Download will give you information on downloading different pieces of software that DIT have developed. FAC will give you answers to some of the common questions about DIT and DynAweb. Support gives you information on contacting DIT with questions or comments, and the About Us page will give you an abbreviated version of the information you read on the DIT website. If you have navigated to any of these tabs, click the Home tab to return to the main page. Now we're going to use the DynAweb service to access the internet. It's really easy. Click in the address bar provided on the page, type in a URL, click Anonymous Surfing, and your web page will open up in a new tab. I'm going to type in www.google.com, and then click on the button marked Anonymous Surfing. All right, now I'm visiting Google. And you might be saying it looks the same as usual. However, if you look in your web browser's address bar up here, you'll notice that it does not say www.google.com. The address you see is the one that is routing you through the DynAweb service in order to access the website. I can enter search terms into Google, and DynAweb will continue to route my request around any internet censorship. Let's say I wanted to know more about video editing, and let's face it, I probably should. So I'm going to type video editing into the Google search bar and hit Enter. If you look at my browser's address bar, you'll notice that the DynAweb information is still there, and the Google search is tacked on to the end. This means that my search has been routed through the DynAweb service. If you want to go to a different website, simply click on the tab at the top of your browser, mark DynAweb, and enter a different address into the address bar. I'm going to enter www.wikipedia.org this time. This will open Wikipedia in a new tab. Keep in mind that if you type a web address directly into your browser's address bar, like so, you will not be using the DynAweb service anymore. You must access websites using the tab marked DynAweb. Once you're finished using DynAweb, simply close the tab, navigate away from the page, or close the browser. Now you know how to use DynAweb.


Greetings. Welcome to our first Friday forum. I am the chair of the Lisa Saphosy Committee, Mark Smith, and I will be moderating as gently as I possibly can today our two guests from Madison, two of our elected officials. Before I introduce them, though, I'd like to introduce and thank our sponsor, Praveya. We have a wrong applause for Praveya and the sponsor has a venue for today's first Friday forum. Today, we're going to have two of our elected officials speaking with us. And they're in the audience. I'm going to give them just a minute to wrap up with their lunch. But they are representative Katzma and Senator Laguio. They're here from Madison and we have a series of questions for them. And I'd also like to mention as they're making their way to the stage that this whole process, this first Friday forum process is brought to you by the VISTAs Advocacy Committee of the Chewbogat County Chamber of Commerce. For those folks in the audience who are members of the VISTAs Advocacy Committee, if you could raise your hand please. And this is an opportunity for you to take note of those members who are bringing this program to you. If you have suggestions, comments, concerns, complaints about the programs, ideas that you would like to see implemented for future programs, please let us know. We'd love to hear your comments. So with that, I would like to introduce today Senator Devin Laguio and Representative Terry Katzma. We have a series of questions for them and they are going to have a microphone and I'm going to probably after this first question just kind of speak as long as I can with the questions. The first question I'm going to ask, if you both please, can you summarize what's been going on, what's been happening in Madison during your first few months in office and what you've been working on? And maybe if you would please refresh us on your committee assignments as well. First of all, I'd like to correct you, we are not coming from Madison. We actually both live in Usberg, two blocks apart, so Usberg has great power in the state legislature right now. We are representing the entire district, so I serve on, I chair the elections and local government committee. I also serve on health and human services, agriculture, small business and tourism and the administrative rules committee. But what I've been working on in the last 16 sessions, there's been a lot of fields that I've been working on. I just actually had five bills signed into law on Monday and Tuesday this week, so I was excited about that. And then two more, which the governor has not signed yet, I'm trying to look forward to. But a couple of bills, before I get into the bills, I want to clear up a perception. I was on a radio show and the governor signed into law this session. And I said, well, I think it's somewhere around 300, which is a little high, it's actually closer to 200. We might end up close to 300 by the end. And he said, so over a decade, there's 3,000 new laws passed. Do we really want government passing that many laws? And that seems like a lot, but actually what we mostly do is changing current law to better help businesses, residents, citizens in our district. We're not adding new laws. We're making it easier for people to work within the current legal system. Just a couple of laws, which I just recently had the ability to work on, is one that was just signed into law. I worked with the county's association and our county planning director. In the budget, we have their shoreline zoning laws. And in the budget, there were some changes made to standardize it. And a lot of us felt that those changes went too far and took away local power. So I worked with the county's association, Aaron Brault, and the Manitowoc County Planning Director. And we gave a little more power back to the local levels of government to make sure that when a new house is being built on a lake, that it respects the property rights of their neighbors so they don't build up a huge house and block the view of everybody else, things like that. So it's just changing current law. It's not adding law. Some of the other bills that I've recently gotten through, I had a business up in Manitowoc, which is in my district. My district goes up to the city of Manitowoc and then over to Hilbert. And they do medical collections. It's a very collective, fast growing business. And they're having a hard time finding new employers to come work in their business. And they had a few people who had disabilities, some transportation issues who wanted to work from home. And under current law, you couldn't work from home. So what we did was just made a simple change to state law that allows them to have employees that work from their houses. They still have to comply with having their employees monitor the conversations, record all the same things that occur when they're working in the facility. But it gives that opportunity for someone with a disability to be working from home, to be a productive member of society while also ensuring consumer protection. So those are some of the things that we work on. A couple of bills I'm still trying to get through the system yet. One of the major bills that I've been working on. Well, just to let you know, I've passed 13 bills this session. I have 13 bills signed into law with two more that are going to be signed soon. All 15 of those have bipartisan support, which I'm sort of proud of. But a couple of bills that I'm working on right now might not have bipartisan support, but I think there's sort of bills. One is online registration. It allows people who are eligible to vote to register online. It's a pretty extensive bill, and it does a lot to make sure that our voter rolls are cleaned up. It signs us up into an interstate group that searches death records, obituaries, when they sign up with their deeds just to root out duplicate records, fraudulent records. And when people register online to vote, they need a valid ID. So that way it takes away the human error of some registrations and then typing them in. So it's a way of cleaning up the voter rolls while giving more access to people to register to vote online or eligible to vote. And it also allows who wants to go out and help people register to vote. Because if you have an iPad, a tablet, a smartphone, a secure connection to the state website, you can help people to get involved in the electoral process. We also made a couple of changes in there to make it easier for people who are in residential care facilities such as nursing homes to be able to vote and use their intake documents as proof of residency to make sure that the elderly have the opportunity to continue to vote if they've given up their driver's license and state ID card. And it also included veterans' IDs as an example of a voter ID. But the most important bill that I'm working on, and that bill actually has passed both houses at this point, but it's just in different formats so we can take it up again in the Senate to concur with the changes that the Assembly made to my bill. I'm not sure why they're making changes to my bill. The other bill that I'm still working hard on, for those of you who follow federal politics, they've been working on a RAINS Act which puts limits on what the rule-making ability of bureaucracy gives more legislative oversight. And we have a state version of that that I've been working with, a governor and a member of the Assembly to track me down in the business groups. And what it does is three things. We pass a law. We give the ability for different agencies to promulgate rules on how that law goes into existence. For example, the DNR promulgates a lot of rules over hunting and fishing and things like that. And oftentimes these agencies start to overstep their bounds a little bit and start doing things that go a little bit beyond that scope. So what this bill does is it adds a public hearing up front in the process. So it gives a chance for public input. And then the thrust of this is if there's a rule that an agency is implementing that has more than a $10 million impact on businesses or local levels of government, we as legislators actually have to pass a law to approve that. So that way an agency isn't going rogue and passing rules that puts a huge fiscal impact on either business or local levels of government. And the other important provision of this bill is that the current system is supposed to put out a fiscal analysis of what the rule is going to cost. And if we as legislators don't think that that fiscal analysis is accurate, we can request an independent analysis of that to make sure that the agency isn't being selected with what the cost of the rule could be. So we've been working really hard to get that done. Just a couple of examples of, you know, instances I've worked with, with businesses in my district. When I had one of my first hearing sessions back in spring of last year, there was a small business owner up in Manitowoc that came and she owns, it was a new business that's been moving into the state of Wisconsin and they have flotation devices which does massage and sensory therapy. It's a new business and the state, through one of the agencies, was trying to regulate her as a commercial pool. It's obviously not a pool. It's a little, I wouldn't visit her business, it's like a little small coffin and they fill it up with water and heaps of salt. It's not my thing, but apparently some people like it. It's helpful to some people. I guess they sit in there for hours and fascinating business, but the state was really coming down on her, trying to make all these changes to comply with commercial pools, which was going to put her out of business. So we, and granted the bill that I'm working on one purpose, it doesn't have a $10 million damage or $10 million cost, but these are just some of the things that sometimes state bureaucrats do to local businesses, which can be very costly and make it hard for them to operate. So we, the representative up there, Representative Hill and I worked really hard to put a lot of pressure on that agency to change the law and add a new rule that oversees how these businesses operate. Now there's eight new businesses across the state that are similar to this, so it's a good thing. Another example more locally here in Sheboygan is we still have a few commercial fishermen operating out in Sheboygan. Some very interesting gentlemen, if you ever meet guys who spend most of their life in Lake Michigan, they're very interesting. And they do a lot of their chub fishing and the DNR makes rules about the quotas and how many and they can catch and things like that. And the DNR had imposed a new rule to essentially work into effect and we had a committee hearing yesterday where the DNR didn't even show up to the committee hearing, which I was very frustrated because we've been going back and forth with them for quite a while. But we had four commercial fishermen from Sheboygan show up in Madison for the hearing and we suspended the rule that the DNR was trying to put in place. So we had some time to work with the commercial fishermen and the DNR to make sure that this industry that just doesn't affect these couple, but it also is producing fish for a short fish market and things like that which helps with the flavor of Sheboygan. So we're working with the DNR and these guys to make sure we can find a law that had a rule going forward that can help these guys stay in business and be viable for the future. So I was happy to make sure that we got that done for a local business. So since you guys are all involved in business, if there's anything like that that I can work on for you, that's a lot of what we're doing in Madison, making sure that government's making it easier for you guys to survive and be competitive and not have to deal with bureaucracy and you can do what you do best and provide your services to the Trinity. So I will turn it over to Terry. I'm going to stay sitting if that's okay, Kevin. Thank you all for being here. It's really an honor and a privilege. Betsy, congratulations on the gala that the chamber hosted last week. I thought that was wonderful. How about Stephanie Kledt for MC? She was very entertaining. What I want to talk about is some of the accomplishments of the legislation this past year. And I can assure you that our discussion today will be much more civil than what we're seeing like last night and what we're seeing at the national level. You know, there's clearly frustration and dissatisfaction with the politicians, of course, at the national level. We have increasing deficit spending. However, in the state, things went very well. We have a balanced budget that was passed, a $74 billion biennial budget that included no tax increases. Other accomplishments for the year was to change prevailing wage, right to work, GAB reform, John Doe reform. One of the interesting bills that I also came up was the budgeting process. And the way it works is the agencies work with the governor to propose a budget. And they may have a wish list up here, and then you have the legislature that tries to deal with this budget that, of course, doesn't have the knowledge and the inside approach that the bureaucrats do. There was the bill to not only pass a proposed budget, but a flat budget and a 5% reduction in the budget. And I think, again, that's a quality bill. A couple of the committees that I serve on, for those of you who don't know me, my prior career was in banking, 30-some years at Usberg State Bank. As far as my district, you're all in Devon's district, not the Senate district, but in the assembly district that I am privileged to serve, the 26th district, and the southern boundary is the Sheboygan-Ozaki County line. So that would include the Township of Holland, which is Cedar Grove, Thomas Sherman, Random Lake, Town of Lima, Town of Wilson, and about three-quarters of the city of Sheboygan and the city of Sheboygan Falls. I'm privileged to serve as vice chairman of the Financial Institutions Committee, served on the Consumer Protection Committee, the Ways and Means Committee, Housing and Real Estate, and the Workforce Development Committee. I was also privileged to serve on the Speaker's Task Force of Alzheimer's and Dementia. We had numerous four or five public hearings. We had some tours. It was a bipartisan effort. We came out with 10 bills that related to Alzheimer's and Dementia. It's a big deal, it's a big issue, as I'm sure all of you can point to a family member that has been affected by that. There's no cure. But the purpose of the bills was to bring awareness, to provide some funding for research, to provide some funding for respite. And so that was a good thing. Again, I want to remind everybody that 94% of the bills that we pass are bipartisan. And you wouldn't think that by reading the general sentinel. Of course, they want to focus on controversy and focus on where there's disagreement. But in general, there is a lot of agreement that's going on at the stake. Have we answered that first question very well? Yes, it was. One thing I should like to say beforehand is both of our guests have stated that any questions you have during the presentation, feel free. Before we go on, you talked about some bills that you were working on and a total of 15 bills, I think that you had hoped to pass. I've had four bills that so far have been signed by the governor. I have four more bills that are awaiting the Senate hearing or the Senate session, which will be March 15. So I'm hopeful to have eight bills passed that I'm very proud of in this first session that I had. Of a major bill, or the biggest concern, I think, is a bill dealing with foreclosure reform. And what that means is the redemption period and the length of time that it takes when a property is in foreclosure. And because of federal regulations, that time has extended. So the purpose of the bill was to shorten up that time so that properties could be on the market quicker so that it wouldn't drag down the property values of the community and of the neighborhoods that serve. So I worked very closely with some Democratic interests in Milwaukee that are very, very concerned about abandoned properties. It's a bit of a problem in Sheboygan, I'm assuming, but it certainly is not like it is in Milwaukee. So it was quite interesting working through that process. We worked with a number of trade groups. And it was interesting, the press from Milwaukee focused, of course, where the mayor and I disagreed on the abandonment portion, but they failed to report that they really did, like 90% of the bill, that did shorten it up. So again, that's a good example of the media. There's always two sides, obviously. Thank you. Next question is, how has your first term status impacted or has it impacted what you feel that you really can get done in Madison? Well, coming from private industry, my concern was in government, things are going to take a long time. In the industry, especially where I was serving, I'd stand through fingers and things get done. But it doesn't work that way in government. A couple of the bills that I worked on, the constituents that brought those bills said, I've been working on this for four years and we finally get it done. On the other hand, I was very impressed with the organization and the efficiency that our Republican Assembly caucus works on. That was pretty surprising to me. So that was one thing. Yeah, I think my biggest frustration over my first year, and I sort of touched on this, and my last answer in one of the bills I'm working on is dealing with government bureaucracy. It's not dealing with my fellow legislators, it's dealing with the different agencies. Sometimes there's been employees in some of these agencies that have been doing things the same way for 30, 35 years. And to try to get them to change and get you answers and work with you, you would think would sometimes be easier since we have both houses that are Republican and a governor who appoints the heads of these agencies who's also Republican, but that's not always the case. So it's been a little bit frustrating from time to time. But no, I think we do get to make a difference. I think that's sort of your question. Can we make a difference? I'll give you maybe one example. There was a change to, since we have a couple educators in the room, change to May 2 course options, that program a couple years ago by the governor in a budget that said that schools cannot charge parents to get these programs anymore. And just to let you know, my father failed in getting this changed. But I came in and no one told him I said that. I came in and through the budget process worked with the members on the finance committee and got that changed so the schools could once again charge the parents the money to get these college credits at a very reduced rate and make sure that this program is sustainable going into the future. So I was happy to get that done. I knew just some of the things I referenced on working for the credit we're not finished yet, working for the commercial fishermen since we don't have a solution yet, but just stopping the rule, helping out the business up in Manitowoc, those are some things that you can get done to help local businesses.  I guess, Mark, I do want to correct your statement and we're here from Madison. That couldn't be further from the truth. I spend one or two days in Madison and the rest of the days are in the district. We have regular monthly meetings with the school superintendents. That is very well attended, but we appreciate the dialogue and the discussion we have with that. We have regular monthly meetings with the Sheboygan County Board and the department heads. And again, that is well attended. We have bi-monthly meetings with the city of Sheboygan and their board members and their department heads. We meet with the chamber quarterly or every other month. So I don't want to spend any more time in Madison than what we have to. And so we really want to reach out and learn what's going on in the district and of course this is one way to learn that as well. Is this a suggestion? So point taken, Terry. Obviously a hot topic here as you know, can either of you or both of you provide an update on transportation, funding in general, and Highway 23 in particular, please. If I had a nickel for every time I was asked about Highway 23, I have a well-funded campaign for my next re-election run, but Highway 23, to the back story, you haven't been following it closely, which is probably not the case for anybody in this room, but it was set to go in 2015 to start work on the project. We had all the barrels along 23 the weekend before Memorial Day and then on that Friday afternoon the federal judge put a stop to it saying that he had some questions in the traffic projections that were done 10, 15 years ago and saying that those projections weren't actually correct and asked for updated information from the DOT to make sure that the project is justified. Personally, I don't think that we should necessarily have to justify road projects with traffic counts, because we're the legislators, but we should be held accountable to you whether it's accountable what we're doing in road projects, but anyways, the DOT then went and redid the traffic accounts and they found out that they were a little lower than projected, but they still justify a four-lane highway that looked at other options like passing lanes, things like that. They said with the traffic flow and the accidents and everything that a four-lane highway is justified so they gave that report back and they worked with the federal since there's federal money involved they had to work with the federal government in this project, they put so they gave that report back to the judge in December and the judge has yet to make his final decisions or hoping that it's too late to get anything done this year anymore although projects are being let out here pretty soon for building projects for 2016, it's still in the budget for 2017, so we're hoping that that the the judge can make a favorable decision and it can go forward in 2017 transportation funding in general since I'm talking about highway 23, I'll tell you what I think is the major problem with transportation which we need to ultimately find an answer to which I don't know what it is yet but in the budget we put in money to audit the DOT to see how they're spending their money. If you look at the highway 23 project when it was first put into the budget back in 1999, so I'll show you how long we've been talking about this, it's put into the state budget back in 1999 it was a $42 million project today it's a $145 million project it's 350% increase in 16 years that's 18% a year increase so a lot of people say that our problem is is a revenue problem, we don't have enough money coming in with gas taxes because cars are becoming more fuel efficient which is partially true but our gas tax revenue actually does go up every year, it's averaged about 0.8% over the last 15 years increase which obviously isn't keeping up with inflation but still is increasing but when you have the expense side increasing by 18% and the revenue side increasing by 0.8% you can sort of see the the challenge where we can't just raise taxes to fix this problem in the initial part of the budget the governor proposed borrowing $1.3 billion for transportation if we would have done that with a gas tax to cover that just with an increase in gas tax that would be 17 cents on a gallon can you imagine me, Terry, we're running on reelection campaigns we fixed the transportation funding problem by raising your gas taxes by 17 cents a gallon wow so that's unsustainable the increasing expense cost so we need to make sure that we're prioritizing transportation projects and trying to make sure they're more efficient part of the way we did that was was exempting local projects from prevailing wage which will is projected to save 10-11% on local projects so that is my spiel by the way, we ended up borrowing $850 million in the budget which is the lowest amount of borrowing in the last 20 years so we're trending in the right direction but we still have a looming problem of transportation down the road by talking about highway 23 is after you and I drive this a couple of times a week now we can understand what's going on and this was a federal judge and you say well what does this have to do with highway 23 well there were about 25% of the money that's involved is federal money so that's how the federal judge came into play here and with this lawsuit by the environmental group the judge has to find standing, the term is standing those of us in Wisconsin we can't complain about something in California because you may not have standing in California so the judge found that there is one person or maybe two persons that were members of this environmental group that live on highway 23 and therefore there was standing for this lawsuit to be brought for so it's just a great example of the problem with the separation of powers we have a three range system that we have the judicial, the legislative and the executive and we feel as legislators that again we're accountable to you the taxpayers and if we feel the projects is worthy of an expenditure that shouldn't be up to the judge but that's the system that we live in right now would you like us to take questions a federal judge is that person appointed I think correct me they're appointed and it's a life appointment they're not subject to election like the Supreme Court justices are or circuit judges are subject to election I think this is a just wondering just general comments on transportation yeah you're right that's the one thing we didn't solve and as Republicans it's very difficult for us to raise taxes or philosophically and if we would take a poll of you out here and you'd say well would you be in favor of a bill would you be in favor of six cents increase in your gas tax and we might find some of you in favor of that that's a very efficient way to raise revenue as opposed to setting up toll booths or setting up reporting what your mileage is that was based on mileage and not on gas but that's privacy so that has some problems with that and as Devin well stated we want to make sure that we can have the projects run efficiently before we just raise revenue that's the solution to that just curious what drives the 18% per year increase in the cost of building Highway 23 union contracts I heard one answer here that's a union contracts cost of material asphalt concrete I have a good answer for you thank you another question that's very much in the forefront here in Sheboygan County is the ozone non-attainment zone and the monitoring station at Highway 42 we've worked very closely as a business advocacy committee with the DNR's EPA and center in the past in efforts to prove that the data collected from the Colorado monitoring site is not accurate and it doesn't really measure what's going on in Sheboygan County but rather it measures what's going on in communities along the lake shore further south, Chicago, here in the Indiana and so on if we needed funding to sustain our monitoring station outside of Colorado would we have your support in pursuing this effort in trying to move into an attainment status in our county yes yeah absolutely and I haven't heard much about this issue other than I I'm aware that we moved the station but as far as anything beyond that I don't know if you know any more about the issue I don't know if it's on the forefront like you said since I haven't been asked about this in a year and a half but yeah I think it is important to get that new site set up because the one by Colorado is just measuring all the pollution coming up from Gary, Indiana, Chicago all the fun places don't sell in a related manner there are citizens in the town of Wilson that are quite concerned about the probable deterioration of their individual residential wells should the Kohler Golf Course go ahead and I just wondered we're talking hundreds of wells that would be you know think of Flint, Michigan only different causes so where do you both of you stand on that proposed golf course I think it's actually ten wells is what the proposal is not hundreds of wells I'm talking about the wells that would be affected the DNR is studying the impact of that right now they have scientists and we'll wait to see what their what their reports says and their recommendation is on those high capacity wells that's the same way where every other capo or anybody else who wants to drill a high capacity well has to go through that DNR process overall I support the Kohler Golf Course I think it would be great for the community we already get major international spotlight with Slade Straits it brings all kinds of people into the area so I think we're already known as one of the top ten golf destinations in the world so I think adding when the Kohler company builds a golf course they do and so I think it would be fantastic for the community again it's a local issue as far as zoning we don't have state legislators making those decisions but it's saying all that however Kohler has demonstrated that they are first class hospitality organization and investments and initiatives that they've done have been done thoughtfully and have been done first class what are the efforts at the state level with regards to the ever growing heroin issue within our communities yes there was it's called the Hump Agenda Heroin Obeats remember what the other acronym stands for maybe somebody else can help me out here by Representative John Maidren and that's been quite a number of bills that were done to try to release that situation and improve that situation and address that situation to give a little more background here to a daughter who overdosed on heroin and he's been working really hard over the last two sessions actually to keep making changes to law to help the situation I think we've been moving a little more to helping out local counties with drug courts trying to find alternatives to just incarceration for people who to help them get the treatment because if they don't get any treatment it also ties in somewhat with the mental health aspects too because a lot of people are suffering from mental health so we need to it's obviously a big challenge in Manitowoc County where I represent and so we've taken some steps I think there's a long way so we need to go yet but we're moving in the right direction Other discussions or efforts being put forward re-evaluating the mismatch is finding our schools to help enclosing the skilled labor shortage especially what we're seeing here in Chicago County I don't know if I necessarily agree with the premise of this question but in the budget that was passed last year there's $100 increase per student going for education next year the governor in the state of the state address back in January said that during our next budget cycle there's going to be an emphasis on working on school funding so we'll see what happens in the next session with that but overall I think there is an issue that needs to be done but we've been working with our local superintendents on and on throughout this entire process I guess the other thing that I'd like to add is that when we started the budget process we had about in the $70 billion budget there was about an extra $3 million or $3 billion that wasn't accounted for when we started the budget process 800,000 of that was just going to increases in Medicaid expenses state Medicaid expenses just to maintain current levels of funding so we've seen the economy pick up a little bit so hopefully that bodes well for the future but I think we're both committed to education and making sure that we can have quality teachers and quality schools in the community can we have a short hands here from companies are you looking for employees right now short hands and you're not able to find employees and so there's been an increased emphasis on tech schools and since in the technical education and I certainly support that I appreciate some of the partnerships that's being done by LTC by Lakeland College those are good things rather than having some assuring of credits being mandated by state government they're reaching agreements on their own that's a good thing yeah if you've seen the presentation by the Shaboin County Economic Development Corporation we actually have more jobs we're close to the tipping point where we have more job openings and people available to work in this community it's a challenge that the Economic Development Corporation is looking at facing partnering with the chamber and as Terry mentioned I think our local schools have done a good job with sort of emphasizing that there's great careers in Shaboin County manufacturing partnering with LTC and the groups like that it's going to be tough with sort of the aging population especially in the northern part of my district in Manitowoc County as the baby boomers keep retiring and my generation not producing enough future workers to fill that to fill that gap it's going to be a challenge it's going to be going to be a challenge to meet the ever increasing demands in all industries so we've been hearing across sectors touched on this last question a little bit so I'll expand it I'll take my prerogative to do that based on your professional career what has been the most surprising thing you've learned since taking office and what I would add to that is maybe as this is the last question any closing thoughts if you'd like to leave us with please it's been really interesting being a member of the legislature coming in as I consider myself a citizen of the legislature having spent a career prior to that and bringing a lot of life experiences to the legislature the legislature in the assembly the 99 folks that represent each and every corner of the state come from so many different different ages and different backgrounds and bring various levels of expertise and industry specialties that they come from and having that group work together and try to reach compromises that's been very interesting and very informative and that's the beauty of bringing government and having people come with those kinds of perspectives that's been really rewarding for you I think for me there wasn't a whole lot of surprises since I was sort of a political junkie at a time and had a little knowledge of what happened at the state level through relatives but a lot of it didn't take me by surprise even though I saw it was different when you're actually living it and being in those circumstances but I think I mean I've just found great enjoyment the stuff that goes out of Madison surprised me as much as how really interesting the job is when you're out in the district meeting with superintendents, touring businesses we have so many fascinating businesses that I do all around the district when I get to go from touring Q&A to Johnsonville to there's a great old manufacturer up in Manitowoc Scana that's probably the most fascinating factory that I've toured in a while Mericlect you get to meet all these different business leaders get to go to community groups like this business groups did an eagle skull presentation last week's Sunday so to me the most enjoyable part of this job it's not the praise because I have a praise every stinking weekend in the summer from Father's Day until two weeks after Labor Day so it's not the praise like it's a little left for a while but just going to different events meeting different people you're learning something new every day finding out what's going on in the community what's important what's on people's minds so that's I don't know if you call that a surprise but for me that's been the most exciting and enjoyable part of of this job over the last year and a half do you have any closing thoughts? I just wanted you to understand that certainly I and then Devin as well we want to hear from you we want to know what's on your mind we want to be be accessible and I think we do that so we hope that you sense that as well again there are industries that we need to know about and that we don't know about so how do we know this unless somebody tells us and informs us so please feel that you are comfortable talking with your state legislators and again thank you all for being here coming to speak with us I appreciate how very selfish you are with your time come to speak with us many many times I also appreciate how thoughtful you both are and your comments thank you very much I'd like to make a couple of announcements about upcoming chamber events that you may be interested in we'd love to have you join us for we have a focal point on Wednesday March 16th entitled Crucial Conversations it should be very very worthwhile our next first Friday forum will be April 1st April Fool's Day Chad Palaszek will be updating us on the city's developments and I'm sure there will be more joking there another event that's coming up that I think will be fascinating business after hours the Sherbrooke and Symphony Orchestra at the wheel center for the performing arts Tuesday March 8th, 5pm, 7pm so your Chamber of Commerce is continuing to work to put together a very interesting program for you and Betsy you may have more questions because I have one excuse me I just made a point that I should ask are there any more questions out there that you already asked and it was a selfish question I just you know as we all know we're trying to attract and retain people to our area we need to grow and one of the factors in that is having a really vibrant community and one of the factors in that is the arts which I think we're particularly strong in in Sherbrooke County there are a couple bills right now there's a Senate Bill 483 and there's an Assembly Bill 636 and I think they've been moving both I think they're out of committee they're out of joint finance I think you're looking it up I think a few of the committees you mentioned you're on joint finance it was approved so it's called the creative economy development initiative it's a modest amount of money but it is for matching grants for creative businesses small businesses most of them but also just to support that in general and communities so just curious where that is what was the bill number for you it's 483 it's available for scheduling in the Senate did we pass it and you passed it yeah okay so the Assembly passed it it's available for scheduling in the Senate you might be in the calendar for that I actually looked at the calendar but I was not looking for that bill yeah the quality staff is very very important so it's an employee appreciation day today it is I'm really appreciative of Senator Lemieux and his staff that work with my office a lot and we work very closely together but yeah my wife and I enjoyed the the groups that were down in the central part of Shevegan by the Color Arts Center a couple of times this sounds a little questioning yes Dave last session there was a big reduction in funding for the UW system has the legislature spent any time looking at how that reduction was implemented throughout the system we just basically said your problem you call it a big reduction percentage wise I don't know that it was a big reduction there was several sessions ago where the legislature suggested or required that the UW system spend down some of its reserves so rather than us micromanaging the process no it was left up to colleges and universities to incorporate that there's been reductions for about the last six budgets actually to the UW system and yet their reserves keep growing we put tuition freezes on and their reserves keep growing but the main concern for me is the two year colleges because there are some cuts to them in the last budget some of that was restored through the legislative process but it's forced them to maybe make some good changes at the two year colleges now instead of having a chance to or whatever you call the person that runs a college campus ID instead of having a dean at each of these two year colleges they've gone with regional deans things like transit into that so I think it's sometimes good to challenge agencies to find some cost savings things. Yes Tom. It's easy for yourself there and say the value you get from listening to us as administrators I want to speak to know how much we value that as well and thank you for your attendance at those meetings because it isn't easy coming to those meetings knowing that you're going to be facing difficult questions but I want to make sure the business leaders in here know that we value your timing and your expertise and the efforts that you put into that because I think you've grown, we've grown historically it's been great meetings somewhat contentious at times but I think we've all benefited from them and I wish this would happen throughout the entire state because I think it would help everybody understand public education more and just wanted to acknowledge you and say thank you. Thank you. We didn't even put them up to say no. No it's now it is important for us to get feedback half of our budget was to education spending about a third of it is to K-12 education spending so we need to know what's going on what schools are looking for what their priorities are so it's very important and if we don't have that open line of communications even when we don't necessarily always agree on everything it's certainly good to get that perspective. I would challenge your comment that it's contentious I would disagree with that I think it's we grow a lot from it and thank you for those comments Tom. I saw a headline about some kind of changes to the workman's compensation system in Wisconsin is that going to be brought up to the 21st century because it's so old and antiquated it's really not working for my company? Are you talking about there's been proposals for a fee schedule there's arguments with the medical folks on that are you talking about workers' comp or unemployment? No, not unemployment workers' compensation for injury on the job and I can put it with the carpentries sector just because I built peers and I have so little to do with carpentries that it doesn't make any sense we're not elevated we don't use power tools it's like I'm way in the wrong thing and it's just it doesn't make any sense but 110 years ago You would like more categories of classifications? It's a reflection that I'm a good employer with a safe working conditions and we only had two claims in 30 years and only one gets issues but I don't get any credit for that and I have to pay 15% $15 or every $100 and pay to my guys I have to go into the systems of the bad guys I've done already bills that specifically address that situation if you do let's work on that because it's randomly put this is based on the nature of your work in certain categories and there's only about 80 categories Do I extend as an experience based? Not at all Not at all It's like a good project for me to work on Let's get together on that I guess that's all Thank you all Bye