It's my pleasure to introduce Dr. Saraswathi Vaidam. Saraswathi is the lead investigator for the Birthplace Lab at the University of British Columbia. She has been a clinician and a health professional educator for over 30 years. Professor Vaidam has successfully coordinated multi-stakeholder community-led research projects in provincial and national settings. Her research projects include the National Canadian Institutes of Health-Funded Canadian Birthplace Study that examines attitudes to place of birth among maternity care providers and Changing Childbirth in British Columbia, a provincial participatory study of women's preferences for maternity care. The Giving Voice to Mother Study explored experiences of respect, discrimination, and inequalities in access to quality care among communities of color and among those who plan home and birth-center births. Professor Vaidam is currently the principal investigator of the Canadian Institutes of Health Research-Funded National Research Project to evaluate respectful maternity care, research examining the stories of pregnancy and childbearing today, the Respect Study. In 2017, she was selected as one of the inaugural Michael Smith Health Research Institute Health Professional Investigators. Saras, I'm going to give the presentation over to you. Thank you. Good morning, everybody. It's morning where I am. I'm grateful to be sitting here on the beautiful, traditional, and unceded territories of the Coast Salish nations, the Indigenous nations, particularly the Musqueam, Squamish, and Swela nations. And I am a guest on their land, and grateful to be able to be with you today at this time when we are in an unprecedented global acknowledgement of the power of the uncertainty of nature. I'm going to spend a little bit of time with you today talking to you about what we do as midwives when we are faced with crisis and unexpected events and how we pivot and how we are well poised to bring some sucre and some common sense and some fellowship to this moment. Many of you are aware that in the global context, families and clinicians are questioning what happens when we have moved birth into facilities where there's a lot of exposure to each other.  We've been hearing about it in the UK, in India, in South America, in the Northern Indigenous communities of British Columbia, and in Africa where people are not sure about they want care, they want skilled attendance, birth attendance, they've been exposed to the increases in wellness and well-being for themselves and their families when they have skilled attendance, but when the skilled attendants are all co-located, both skilled birth attendants and midwives and the populace are understandably concerned about exposure. Because of diverting care to people who are sick with COVID and really symptomatic and where people who have been normally looking after childbearing families are repurposed to look after those who are very sick, then there becomes a scarcity of care providers in other settings where the midwives have been providing the care in facilities, sometimes even getting to the places where they work is difficult. There's also in the context of there's an involving evidence basis for the care of the childbearing families should they come into the hospital, should they not, should they be wearing personal protective gear, do they need to do that in community-based settings? Is it only for hospitals? What is happening about the incubation period? How much do we have to be concerned? In fact, there's no local or global consensus on how to contain this as it's constantly shifting. And it's difficult to social distance in shared or un-stable housing when people are living in houses with many, many other people, particularly in low resource or in families that don't have the other options. There's challenges with social distancing every time you walk into an institution or the number of people you interact with. And what we're hearing all around the world, and this is what I'm really going to focus my remarks on today, is that there are increases in violations of human rights throughout the childbearing cycle right through the newborn period that people are experiencing. And that's in the context of specialists also recommending separation of wealth from sick people. So how do we respond to that? And what can we do to understand the context? I just want to point out that, you know, meant much of the discourse and the ability to rapidly put out guidance has come aside from the WHO. A lot of it has come from countries that have a lot of resources. They have communication systems. They have ways to use multiple systems to put out guidance and complex evidence and analysis. But much of the world is facing pregnancy and childbirth in these kinds of situations where they do not have the ability to isolate even when they're in labor, they don't have private rooms, and Nord of the midwives have access to things like personal protective equipment or the ability to stay distant. In some settings, you labor postpartum and give birth in in boards that really you're sharing even a bed. And these are these are images that have come from around the world that are quite current. So that's just to put it in the context. Now, when we know that the WHO as early as 2016 has shifted its focus from clean water and skilled births attendance, it has included the experience of care as a fundamental and essential component to quality safety, to reducing fetal neonatal and maternal mortality, that you need to have functioning referral systems, effective communication, that the respect and preservation of dignity are core to quality. And it's not just an also additional thing, but it's actually has everything to do with whether people feel like they can access care and feel safe and that cultural safety and emotional safety has to do with how labor progresses and how what outcomes and whether or not people will trust recommendations that are offered to them. So that includes competent motivated personnel and the availability of physical resources, of course, but also the application of the best available evidence that we have around quality of care. So what we know is that if we look at previous pandemics and I'm going to talk a little bit about today about the situation that we're all in right now, but I want to remind all of us that this is just one in a number of crisis that we've developed that we've faced before and often the crises, whether they're floods or earthquakes or like the Ebola epidemic in West Africa and 2014 to 2016, those crises have have affected most sharply the people who live in the in circumstances where they have the least resources and the least ability to to access high quality care with all the bells and whistles there in in low resource or middle resource settings where people are unable to access antenatal care visit visit birth skill, birth attendants or equipment. During the Ebola epidemic, the use of reproductive and maternal health care services plummeted so much that maternal and neonatal deaths and stillbirths indirectly caused by the epidemic outnumbered the direct Ebola deaths and that's an important thing to remember at this moment women were unable to access family planning completed fewer antenatal care visits were more likely to give birth without skill birth attendants and some people stopped going to facilities because of fear of increased infections others because of financial barriers or transportation barriers others were denied care if they were suspected of having Ebola as many facilities were not equipped to provide care to people who were infected and didn't want to increase the contagion that's the same situation that we're in right now. In very recently some researchers the the Stein word and Katelmo used the save live saves tool to to model what it would look like over the next year in places like Indonesia, India, Nigeria and Pakistan if if we do not think about how we can reorganize and reallocate care these four countries are the most populism low and middle income countries in the world they account for almost a third of the world's population and as you can see from this slide they impact of the additional deaths from COVID-19 service use the decrease in their service use is is huge it's you know so so disturbing that this is just about access really it's about what we can do when all of the care has been centralized what happens when people don't access that care. On the ground we hear we're hearing in indigenous nations and people who are rural and remote that if they are in a remote and rural setting where they are they are COVID fee free and they don't have the pandemic if they have to be relocated to give birth they have both the the risk of contracting COVID themselves and bring it back bringing it back to their communities later also they cannot no longer bring the support systems and culturally safe ceremonies that that make their labors and births more smooth because of the because the system-wide concerns about too many people present in large cities where they were not prepared for social distancing and really aren't able to especially in in black and brown communities and in immigrant refugee communities and communities where they they are co-located at home and at work with lots of people we know that the impact has been very great and that is yet to come to to Mumbai and to see what's what's going to happen we know even in London where there's very different different birth threats are responding differently we have different types of prevalence rates impact in New York City they are now beginning in public hospitals to screen everybody who every material every pregnant person comes into the hospital and they're finding something like a 38% COVID positive rate not all of them are symptomatic but it's throughout the population in low and middle income countries we've heard from Uganda Malawi Colombia Pakistan many of these places and they're rapidly shifting their systems to try to cope with what might be coming down the pike so and we know that in high resource countries there's very very different responses depending on whether you're in the Netherlands or the UK or Canada or Spain or Italy and that in all of those situations marginalized communities are the ones who are most at risk for for receiving late or no prenatal care having more experience more likely to experience mistreatment loss of autonomy and decision making loss of lack of continuity of care that is consistent with what we've seen throughout time it's not something new but it's more sharp now and so we're more this challenge sort of increases the impact on our most marginalized communities and really requires rethinking re-engineering the system that drives disparities so that when when we focus on the needs of the most vulnerable that we can in fact get it right for everybody interestingly we can also learn from those communities and how they have have provided for themselves mechanisms and community-based solutions that have filled the gap that healthcare systems have not the national core quality forum produced a roadmap for promoting l-health equity and eliminating disparities and they talked about some of these interventions which I'm going to talk to you about so we've done research as Susan mentioned on what what care looks like both in in high resource countries like the North America where I have studied in collaboration with communities of color what their experience of care looks like and we've also done it in low and middle income countries quite a lot Megan Boran and her colleagues published just this past year and we published two studies that talked about one in six families who who experience sorry my slides are not advice advancing so one in six pregnant women people have experienced mistreatment in the United States overall now if you looked just at the communities of color and just if people who had lower resources had challenges in their life maybe they were homeless that that rate went to two and six and that is consistent with the one in three rate of mistreatment that has been found in low and middle income countries so it's really it's the same it doesn't matter if you're a high resource middle resource or low resource people who have less less ability they're marginalized they're not in the mainstream and they're not well resourced themselves in their families they're more at risk for this kind of mistreatment so what's linked to mistreatment we know if you're an immigrant if you're at low socioeconomic status if you have some sort of pregnancy risk or social risk maybe you come from a non-dominant identity of of any kind it might be that you have an LGTQ identity and it might be that you have a disability it might be that you are homeless or or live in a situation where the people around you are just not the same that's definitely a red list and we've been shown shown this that also the types of birth that you have and how much interventions you have that that they being shouted at being scolded being your your request for help being ignored physical and verbal abuse increases every time there are more unexpected events that happen and we know that in many of these situations the midwives and the physicians who are involved are themselves disenfranchised they don't have the equipment they don't have the resources to be able to provide the care they want to and everybody's anxiety is up so what can we do in in in this context you know what can how can we respond to to think outside the box and maybe this is a moment certainly at a moment right now where we want to respond to the increased demand for community-based care we want to have evidence-based strategies placed in in place to triage to hospitalization when we have people who are sick or who are not sick with COVID but who have some condition or situation either the mother or baby could benefit from the additional equipment or personnel that a hospital has to offer so this is about appropriate triage interestingly midwives also already are well set up to do that in most situations they know how to set up and run free-standing maternity units they know how to attend people in low-resourced settings they know how to do community-based birth and when they don't when they're midwives who are in countries where that hasn't been normative and where their role has been mostly facilitated but birth they know how to attend normal birth without a lot of elizabeth because most of undisturbed and birth that's physiologic happens without that now there may be some cost-shifting and upskilling that needs to happen i'm going to tell you about places that have learned how to do that and done it in a very rapid way we also know how to repackage our supplies and keep infection control within community settings and there are standards for equity access and respect and quality that are in our core to the values and the ways that midwives have worked from the beginning of time so we're poised to partner not just with the specials but also with the community health workers who've been doing this i'm going to just flip through these next few slides fairly quickly to show you that there is a lot of evidence behind the midwifery approach to respectful maternity care and what i'm calling talking about respectful maternity care now i'm talking about 12 domains which includes access to equipment access to PPE access to clean water access to the basic quality things that we think of when we attend people through pregnancy and childbirth and postpartum that include that that is a measure of respect also when people can access that that type of care but it's also how people are treated we know that there are many many there's a lot of guidance that's come out this this guidance which i'm showing you here that comes from all over the world has been put out very rapidly in the last month and it all supports the fact that inclusion of persons in decision making ensuring the presence of a companion through labor and birth not separating parents from their babies even in crisis situations those are all supported by best quality evidence by people who have looked very carefully at how to attend to the needs and the health and the disparities and outcomes that we're seeing for marginalized families we know that if we address those things the the the outcomes improve and then people also access care and are able to do so in a in a safe way safe medically safe culturally safe emotionally safe ongoing for their long-term health so prioritizing prioritizing community-based birth in places where they're supported by the health care system right now can be rapidly done for places there and haven't been traditionally supported by the health care system we need to think about how we can transform thinking about delivery of care in ways that they've always done when they've had war or earthquakes or floods or pandemics we know that prioritizing breastfeeding best practices helps long-term health and immediate health and well-being for babies and mothers we know that we're limiting the use of of unnecessary interventions using them certainly but using them when they're medically indicated thinking about the fact that every intervention whether it's an early induction or an epidural every single time means more requirement for more scarcely available right now health care providers and more people involved more nurses and midwives who have to start IVs who have to counsel who have to monitor how that those interventions are being being delivered so that there are more people involved if on the other hand you bring in a companion and the companion can do that close continuous support then the health care provider is free to look after the people who really need them more more often and also be a little bit more distance not have to do provide that that care and that's been supported by the WHO and many situations of having a single supportive companion can benefit everybody including reducing exposure for providers as well as as well as the population so seamless access to receptive a hospital environment is when needed is key to that we know that expert consensus guidance also talks about trusting community responders so i'm not talking necessarily about there are of course amazing transport people and people who are actually taking taking people from the community to facilities and many of those in india there are community health workers who are being paid $50 a month and their job is to help do the home visits and take people to facility when they need to and identify when people need to be accessing care even postpartum they do postpartum care and they haven't stopped doing that work they're they're not being paid they're not they're not employees of the government but they have they're basically volunteers and they're still doing it in what we find in places like whether it's looking after low resource people in the united states or low resource people and immigrants and refugees and in refugee camps or all through europe in the uk in the nevelins or in africa or the philippines we find that these community members have rapidly pivoted they have started to bring food hampers they've used the elders and the way they need they have always been used to do ceremonies do blessings but they're they've figured out how to kept those elders on zoom and how to use telehealth in ways that have been very rapid and responsive in what that that haven't been able to be done in the large health health systems because they're they are they have to be nimble and they have to react and they have to figure it out they have not however left to the side the importance of ceremony respect fellowship food basic services that's where they're putting their energy and that's what we can learn from when we are in partnership with communities so we are safer together i want to draw you i know this is hard to hard to see this the slide but i want to draw your attention to the to the the bucket that's under ngos and media it says share evidence-based information with women and families integrate integrate learning from women's experiences of pregnancy childbirth and postpartum to continuously inform decision makers collect and share examples of best out of the box practices that can be implemented in other settings i just put to you that as mid-wise we can do that as well it's not just about ngos we know we work in partnership with with families all the time and one of the things that we have done is set up a transdisciplinary a transdisciplinary task force to look at quality maternal newborn care to look at what the precedents are for rapid review of human rights and also strengthening health systems there's models that exist for how do you strengthen health systems in times of crisis and so what we've done is put together a large group of people in fact they have self they volunteered themselves to to join us and we do have uh people from all over the sector all over the world and also people who are across obstetrics midwifery human rights infectious diseases pandemic and disaster planning community health global health organizations like the WHO several of us are working on implementing these strategies in our own jurisdictions and we believe there's a benefit to sharing our insights insights once we have figured out what these templates are how do you mobilize a hotel how do you take community-based providers and help them extend the health care system by doing postpartum visits or pre-medal visits or or triage how do you take doulas and have them go doulas or cultural match who are trusted members of the communities or maybe they are traditional birth workers or maybe they are traditional midwives and have them do this screening and uh COVID testing even or taking food or take or helping them mobilize transportation so they can access care when they need need to we know that this is happening all over the world and many of the people who come to this task force have brought their examples they've already set up protocols and standard operating they've figured out how to reallocate call schedules how to take uh people who midwives were working in hospital settings and give them the skills and the confidence to provide the same care in in communities for healthy well people and then how to limit the transfers to those who really need it they've also figured out how to work with policymakers and um health systems to make sure that the human rights are preserved we know that happened in New York where initially people were not being allowed to have a companion and that was taken to policy and that's happened in the UK it's happened in India and in in Kenya so our goal is to make a an accessible resource it will be accessible by many to many different uh many different levels and you will see um this is a slide that shows you a model that someone uh some group of researchers in 2017 put together where if you click on any one of those circles it will bring up uh all of the evidence or the strategies that you that are relevant to that sector of the so you may be a midwife you may be a community health worker you may be a policymaker where can you get the template or the protocol or the call schedule or the PPE that you're looking for and this would this kind of tool would rapidly put that in the hands and we're working our goal is to work with a technology partner so that it's available through mobiles it's a mobile phones it's available to through um in places where we don't have zoom or connectivity but maybe there is a way for people to get it through telehealth or through systems that are now being put into place uh multi-level so maybe you're very remote you don't have that and you need it in a uh a hard copy form so we can produce that we'd have the technology we have if we can put our global minds and our expertise together and work in a transdisciplinary way I believe it can be done now to transform health systems and access for those who are most marginalized which will then improve access for all ongoing not just through during a pandemic pandemic and maybe it'll live on a website yes you asked me to give you a time when it's 25 to it's 25 to okay yes I'm I'm moving moving I'm I'm getting there so thank you for that okay so um we have organized our work into committees we have an operations and logistic committee a clinical workforce recruitment community health linkages we are have a a subcommittee that's working on legal advocacy and human rights training and support of course evaluating what we're doing and also how to make this strategic policy and acceptability uh really being realistic that that that in order to rapidly change we need to buy in at every level including community members and so there's a communications uh mandate there these people are not trying to reinvent the wheel they are looking at what's already out there what's working in indigenous communities what's working in black communities or in rural india or in columbia what has been working in in kenya or for in any of these sectors for reserve respecting and preserving human rights for giving access to clean water to food to transportation to seamless access to hospitalization when people need it what can be then shifted back out to the community with community health workers what can we do now to respond in a crisis time that then can inform the future uh so we have already i'm going to just flip through quickly and show you some of the things that we've gathered we have best practice guidelines for interprofessional collaboration both between community midwives and specialist providers and that is throughout the course of reproductive health but also uh how um how that can be done during the moment of transfer what everybody's roles are what their responsibilities are this sort of a template there we have training resources around how to do person-centered decision making and how to rapidly teach that online we have policy guidance from the icm from from the WHO from the birthright folks we have a tracking system so this is from elfin circle which is an organization that has set up a rapid response tracking system to report violation and you could be a midwife you could be a doula or a birthing person but then you can then uh log in from anywhere in the world and say you know describe what you witnessed did you witness something directly what did the mid-treatment include it's already set up according to the WHO guidelines for what mistreatment the buckets that it looks for you can describe it in as much detail as you want you can do it anonymously and you can talk about where it person can start to provide some accountability and understand the prevalence what we're talking about is really reaching that critical consciousness in your own practice to appreciate the context that you and then take this moment to illuminate those power struggles and move beyond the day-to-day procedural but in fact think about how social justice and understanding the the need you know we all understand the needs of our clients but what can we do at this moment to transform access respect care and quality for those people in our communities who are least likely to be able to access it so I've in my own practice have I have a website so I started to gather and put up the WHO guidance we have in vc a lot of wonderful guidance around coordination of care so I've just put that in a way that that is accessible to my community who wants to get it of course it needs to be more globally accessible there are five approaches that the white rhythm alliance has brought forward and they have talked about these very simple things that you yourself can do and that is promoting the right to respectful maternity care and mobilizing the communities to around respectful care and recognizing that respect includes access to care access to PPE access to companions access to care when they're depressed when they're alone when they're postpartum all the way through they've done this in Nigeria they've done it in Nepal and and in Kenya they've integrated this so if we can do it there we can certainly do it in more hybrid or so settings where we have much more many more tools also supporting healthcare providers we should not set up these false doctor dichotomies between client patients and providers everybody needs to be protected and needs to understand their emotional safety as well and you know healthcare providers have families and have to think about what they can do so values qualification and attitude transformation has to do with us respecting everybody in the system and then incorporating the respectful maternity care into policies we have we're going to give you with through this task force we're going to give you the the the letter the template follow letter that you can take to your local government state health department or your your through your own systems and adapt them as you want we've done it in the past it's been done in Nepal it's been done all over the world so if you want to learn more about that and keep in touch you can go to the birthplace.lob.org if you want to just be informed about what the global task force is bringing forth at this moment and what you can do at your level you can go to birthplace.lob.org global-task-force we can put that for you and we look forward to your input and to our fellowship this is one moment where in fact we're all we're all in the same boat and we need to mobilize the expertise that we already have thank you thank you so much Saraswathi we have about seven minutes for questions there was an initial quick question the photos in your early slides wherever those from they look like they might be Africa yes one was from the first one is from an African country I believe it was Kenya it might have been Malawi and it was some years ago when I when I was given that by a photographer and the other one is from the Philippines thank you Saras tell us a little bit more there was a grid about a project that you're working on that would also become available on cell phones where you hit the button and it gives information yeah so that we are that's what we're building now with the global task force is a matrix that allows you just locate yourself maybe you're a community health worker maybe you're community a midwife maybe you're a hospital-based midwife maybe you are a health policymaker or a lawyer and you can locate yourself you can say I'm in a rural or a large urban setting I am interested in rights or I'm interested in access to PP or the evidence and then you can find the area in this grid where you want to go and find the documents that will help you move the needle forward in your own context in your own role now what we will probably ultimately produce will not that that grid was produced by researchers to pull together the research around community health interventions that grid is a complex grid and not really accessible to the average person so we are going to we are our goal is to partner with technology with a technical technology experts to turn something like that into a web-based tool or a mobile-based tool that could be clickable or searchable very easily to bring you right to your cell phone or to your contacts the documents that you need or the template for the letter or the step-by-step protocol how to change your call schedule or how to repackage your birth supplies you can find it how you want to and that's what we're trying to produce in a rapid way over the next few months thank you there's a question from Jenny Hall what is being done in your education practice to help improve respectful care thank you yes so we have content if so in i'm a midwifery educator and in the university where i am we have content all the way through the curriculum that addresses what equity looks like and that equity is not the same as equality and that in fact we have some resources we have online courses and content that has been developed by indigenous partners that help all of us not just our students but our faculty members also to understand about communication i put up a slide a few slides ago around a person-centered decision making i can bring it back up for you it's the wheel that has person-centered decision making that is part of a course an online course that is delivered to physicians midwives nurses anybody who wants to do this and it can be done non-synchronous in these small groups where they they're interprofessional groups and they learn how to communicate with each other as well as how to communicate around the family and keep the families goals and values and priorities at the center as opposed to our own agenda and how to attend to those power imbalances and of course document it and revise the plan it's necessary but it's a step-by-step process that we teach our our students it's a respect is a large word and it may be about communication it may be about how you ask permission before touching it may be about attending to their cultural context and doing anti-racism training all that needs to be done i would say we're on a journey we're certainly not perfect at it ourselves one more quick question and then we'll need to start closing off the session several people are asking all these activities by government and non-governmental organizations there's still a lack of supplies and personal protective equipment saris what would you say your one target for action there would be yes so we will have as part of our resources how you can work with your government and system systems to to change that but since that it is not a rapid thing we also will provide guidance around personal pp that can be made in simple ways some of that is on my website already on if you go to the last slide the web birthplace lab dot org and you go to the cove it so you'll see there's some guidance around making personal protective it and with very very simple materials that are available globally we don't have testing about what you know what is perfect pp but we know that there are some guidance around negative ion materials that can be used at the plastics and things that that are available all over the world in the world that where people can and in india they're making those ppes themselves communities are making it and community health workers are making it for themselves so i think we don't know everything about that but we know that just simple masks and eye covers are what's necessary and i think that it's possible to do it to do in collaboration with our communities who can core not health workers but can make those things and are doing it saras thank you so much this has been a very informative presentation i am going


My name is Paul Dourish, I'm a professor of Informatics at the University of California at Irvine and most of my work lies at the boundary of the technological and the social so I do a lot of work with sociology and anthropology of digital media. I think Laurent's metaphor of liminality is really powerful. I think we're probably going to be hearing a lot about that for the rest of the day. I think it's important though to try and this is sort of as I was arguing to try to place that back in a sort of social and historical context. So the notion of liminality comes from Van Gennef's work on the ritual process and the way that people are sort of moved from one important sort of cultural status to another through different kinds of rituals that they don't have marked. That one set of adulthood and things like that. And that's linked into a spatial motion that extends beyond spatial and I think that's a really powerful and useful idea for trying to think about the role of publicness in a sort of cyberspace world. I don't see a major sea change associated with cyberspace and with information technology because those things have been subject to continual change throughout history. We can see changes associated with the development of different kinds of technologies of urban spaces, urban technologies, spatial technologies and now with information technologies but I don't think it's a major transition point. I think it's much more gradual evolution that we continually sort of respond to what we need to. One of the questions that's important that we haven't talked about so far is the granularity with which different kinds of spaces could be represented and that we start and then shape how it is we think about those spaces. Think about the power or everything that's happened around zip codes and how much the zone improvement program, which was designed simply to make it easier to deliver mail, has reorganized everything about how it is that urban space is understood. Everything's in terms of zip codes, that's where marketing information happens it's there for how demographic profiling happens it's there for how state services are deployed within urban spaces by both commercial and state actors and so I think granularity is going to be really important. Clearly one of the things that we're experiencing right now is the growth of mobile and location based technologies so I think all the interesting questions for the next five years are going to be around how it is that we can re-understand the relationship between public and private space through the information technologies that we have. One of the things we're interested in is how people re-encounter space through GPS. Not just because I was actually using the GPS on my phone to find my way to the hall this morning but how you get to navigate spaces in radically new ways. A couple of years ago I spent a couple of months over the summer at Intel's facility in Portland, Oregon and drove there without having ever consulted a map before I went. This is the longest, the first time I'd taken a trip of a thousand miles without actually checking a map before I moved and it then sort of results in this weird thing where I would like no move through space and suddenly go, oh my god this is lovely I'm driving through a national forest and I never expected this to happen you didn't know what was around the corner and so the availability of technology to allow us to move through space in ways that change our sort of anticipation of those spaces and change again granularity with which we understand those spaces has offers up all sorts of different kinds of design possibilities and so that's a lot of our work has been focused on how the technologies then act as lenses through which you encounter spaces as being available for you for different kinds of actions whether I can get on to the network, whether my phone is going to operate where I can get data services and where I can't, where power is and where always when we create new infrastructures and deploy them in space we reorganize that space by raising the new kinds of possibilities to use the space in different kinds of ways and GPS is just another of those.


What is an apple? I don't know what an apple is. That's an assist. Assist? Wow, okay. What is a fishbowl? That's a visor, but it's a bowl. Okay, and then what is the biscuit? The biscuit. Is that the puck? The puck. The puck. The puck. What's a beauty? A good player. A good player. A good move? Like a good move, a good player? Like someone that's like good? Yeah. What is the sin bin? The sin bin is the penalty box. The penalty box. The penalty box. The penalty box. That's the best turn. What are chiclets? Teeth. Teeth. What is a clapper? Slap shot. Slap shot. Slap shot. What's a twig? Stick. Stick, hockey stick. Wow, okay.


Wow, he's patient. I told you the Wolfang fist we did earlier in the game got him. How's it going everybody? Dotto doi here with another round of Dragon Ball fighters, ranked matches. This time we're going with a Zamasu fused point character lead.  That being said, I'm not exactly too sure if Zamasu gets any, you know, extra cool combos with these two in the back. I know he gets a lot of cool stuff with Vigito, which is, oh god, hold on. We are in the corner against the Gotenks, so I do ask for your time. Oh, that Gohan assist wasn't there. We were, we were. Ah, Yamcha assist, that was nice. I have to respect that as a Yamcha player. I was going to try to down heavy him. We're probably dead here. Oh, the pop up. I was about to say I don't think that's going to connect, but it does. It does. All right. Well, Zamasu will get his chance in the next one. As of right now, we got to focus on getting this win back. Oh, this is good, though. He has Yamcha out front, which is fine, you know, that's, that's good for us. Oh, he really was going to try that. There we go.  Okay, and that's going to take out Yamcha. Very, very nice. And we're kind of back in it right now. I mean, down a Yamcha assist, all he has left is DP. Switch out, switch out. Usually in those situations, they try to press the attack and it's right there. Wow, no tech. This guy is just kind of letting me get away with murder tonight. Uh-oh. Oh, that's not a good sign. If they get hit by the first Yamcha thing, usually that means Yamcha is pretty free in the matchup. Just to do whatever he wants. Let's go ahead and double check that. Yeah, it looks like Yamcha is going to be pretty free tonight. One more time. Aha, okay. Now we got him conditioned. Let's, uh, yeah. Conditioning, boys. We keep it, we keep it nice here. Oh, wow, the light was so fast. The light was so fast. We're not actually hitting any big combos. I've more just been doing random Wolfgang fist, which, you know, is a tactic I like to employ from time to time. This is not going to kill. Oh, especially not when you miss. Oh, our goal is to kind of get Gohan back in here. However we got to do that, that's going to be it. There we go. Not, not, not ideal to say the least. Ooh, we got those beams down packed.  Wow, we actually caught him. Oh my goodness. Cheap stuff coming all around. When it gets down to Goku and Yamcha, you know, I have it down packed. We actually got the conversion off that. That is a little too cheap. Oh, no. I definitely could have got a punish off there. Level three. Yep. Okay, it's, uh, it would be hard to choke this away, but to be completely honest, I've choked, I've choked in the past. So this is not safe, not safe at all. Wow, no dragon rush. That was insane. He just stopped and looked at me, dude. Oh no, we didn't get the beam off. Okay, he had to use a bar so he doesn't have three, but still, not the best situation to be in. Not going to lie. My confidence is, I don't know if anybody gets this, but when it's this low, wow, he's patient. I told you the Wolfang fist we did earlier in the game got him. He was expecting me to go behind. He switched up his guard stance, so I just powered right through. Zamasu, what are you doing on this screen, bro? Let's be honest, you did not do anything that last time.  Okay, guard the lows. Wow. My Zamasu was trash right now, but my defense though, can we talk about that? He has to be getting frustrated at this point. I'll meet you there. Has this been one of the worst matches at DBZ of all time? Oh, he left the ground just when I called in Yamcha for the cheap stuff. Just when I was doing my cheap antique and there's the first dragon rush, the first shot has been fired. Oh no. Okay. Oh no. Wow, misfire. Dude, that was supposed to be a guard cancel, but I guess I accidentally back dashed. Oh, Zamasu, you were doing so well. We just needed to hit him one more time and it would have been glorious. Oh no. That's fine. That's fine. That's fine. That's fine. That's fine. That's fine. Okay. Pretty much just means I don't have to waste sparking to switch him out. I can just do this. Classic, classic stuff. Oh, wow. He just reflects afterwards. Oh, he's going in. Don't have to respect the mix up. Pretty sure Cross-up Protection might have saved me there. Over at Yamcha. He's got the defense for that, but does he have the defense for the beams?  I am feeling, I am feeling it today. Dude, I'm loving this. Yeah, that was a little obvious. Okay. That one, that one, I delayed it for too long and it just seemed like, you know, it was in the air. You could really feel it in the air. Can't chain anything to this. Oh, wow. I could have, oh, we're just going to, Goku, turn around, my boy. What is you doing? What is you doing, my man? Wow. Okay, we're living. Okay, we're just going to, wow, that was safe. Arcsis. Arcsis, you are getting me good today, my man. Y'all have pranked me before, but this is a new level of prank. Okay. Well, maybe I just sucked to be completely honest, Arcsis. I'm going to have to ask you to disregard everything I just said. That was awful. That, that was like 20 seconds of the worst Datadoia I've ever seen. Catch up, my boy. Oh, thank Fist. Let's give him a treat. All right. I don't think he's going to spark. I do think he's going to try something that we can, yeah. He was going to try something risky. He was going to either do DP or level three. It was one of those two, and I just, you know, that was me playing a game that he wouldn't be able to input it for him again, more of a me thing. So let's get this defense. Oh my goodness. Oh, no, I didn't block fast enough. Oh, damn, that was nice. Nice, nice, nice, nice. Knocked to the ground. Oh, this sucks, dude. This match has not gone according to plan. All right, we got to keep Yamcha. We got to try to get that health back. That's going to be crucial. Oh, the good news is Yamcha does not have a good beam. See, he tried it there without a good beam. Yamcha has no good ways to get in here unless by forcing. No, my guard cancel. I messed it up. He asked to force something. Of course, now we're in a Yamcha-V-Yamcha scenario, so we'll take the hard knockdown. I'll take the hard knockdown with extra please go away, sparking. I cannot. All right, let's risk it. Yes, sir. Yes, sir. You got to, you got to get them.  If you're going to try to hit something, hit it, frame one. All right, we take a cheesy second win and we're just marching our way down through a lot of cheese today. Let's hope Zomsu can do something, dude. Really? That was sick, though. Oh, come on, Zamasu. Okay, nice. Wow, that hit me. That didn't work. That didn't work at all, but we still are in there. No, no, no, I'm not doing that. I'm not doing that. I'm not wasting time waiting around to see if that hits or not. That was just me doing the wrong super. Okay, I'll spend the extra bar just to make sure I don't absolutely lose. Oh, look at the range. Oh, this is why we play Super Saiyan Goku boys. I tried to throw out a light, thought it would catch. No luck, though. Okay. Wow, caught me on my jump frames. Okay, try to get out of there, but Yamcha said no way. Nice auto-combo. Boom. Lightning of absolution. Get him. All right, that's down. We probably should be looking to switch Zamasu out here, but it's so late in the game that I'd rather just Nicola and Diamond here. But we are getting close to the corner and if we do that, nice. That's the mix of Yadu-Lakafor with these lightning. Oh, it goes over crouching opponents. Why can't I ever remember that? No, Zamasu. Hell, live, live.   Oh my God. All right. Oh, wow, that sucked. Oh, wow, level three. Okay, he's really going for it. I don't know if I want to waste sparking. Well, waste is a strong word, but I don't know if I want to use it. Switch. All right, Yamcha player to Yamcha player. We both knew it had to end this way. Neo-Wolfing. Fist. Get him out of here. That's going to wrap it up today. Oh man, if you have a favorite moment, let me know down below in the comments. Great games to my opponent. Thank you so much for playing them. Yamcha did put in the work today. Not Zamasu, but he came through that final match. Did we do a bonus? No, I got to go. Well, like I said though, if you have a favorite moment, let me know down below in the comments while you're down there. If you like these videos and you want to support the channel, make sure to hit the like button and subscribe. Helps you make sure you never miss another video. Speaking of videos, got a few on your screen right now. Watch those if you haven't, or if you're interested in them, and I'm Datsudoya. I'll see you in the next video.


So, 10 guidelines for healthy lifestyle, and I'll start with one, maintaining a healthy weight. So, as you get older, that's a little harder, but it's important, again, so if you start early with a nice exercise regime, it can help you with that and some nutrition. If you can stay away from saturated fat, there's some things in there that trigger the cells that help feed cancer cells. Maintaining a nice regime of healthy exercise and increasing it when you can.  Some of us will look at some hormone replacement therapy, and again, that's another cautionary avenue to look at is what those levels are, because as you change your hormones in your body, it can change how your body reacts to or develops cancer cells. Fleet, as I mentioned over and over again, know yourself, know your medical condition, know your health condition, know your family history. Those are things that you have to know and make aware to your physician. So getting your regular checkups, doing your PHA, when we say birth month, recall, and we say get your dental checkup and your medical health, it's not because we have a check in the blocks, you know, to make and say what was done, but it's to keep you healthy, not just for yourself, but for combat as well, so make sure you get to those appointments. Stay away from tobacco, so you know the risks of tobacco, it's on the label, so stay away. We can help at the Naval Hospital. You can also get help at the hospital or a Fleet Family Support Center or in other classes with the gym and so forth on stress management, very important, because as your stress increases, it does all kinds of chemical things in your body, and it can lower some of your defenses. So keeping up your stress mechanisms in the proper stress and combating it is very important. Rest, learn how to relax, that'll help also. Early detection, folks, early, early detection, make sure that you get in there and you'll survive it. The stronger and the healthier you are, the more of your chances of being healthy through the procedure and healthy after through the process. Don't wait for things to happen to you. Make them happen for you.


From our studios in the heart of Silicon Valley, Palo Alto, California, this is a CUBE Conversation. Hi, and welcome to this special CUBE Conversation. I'm Stu Miniman coming from our Boston area studio and joining me for this special discussion of hybrid cloud monetization innovation white space. I have James Kobielus, who is our lead analysts out of the DC area and also have David Foyer, who is the author of Wikibon's hybrid cloud topologies coming to us from San Francisco. Gentlemen, thanks so much for joining us. You're welcome. All right, so we've been talking about hybrid cloud quite a bit and the reason we're doing that is if you look here in 2019, public cloud, we think we understand it. It's well-defined, we've talked about it. We can talk about the winners and losers. We can talk about innovation and growth. There's a lot of money there. A couple of years ago, we spent a lot of time looking at private cloud. We put out research, what we call true private cloud. And the reason we called it that is because how do we differentiate it from virtualization, things like the operating model, how we buy it, how we consume it, how we management, all is different than the traditional data center. But when you talk about hybrid cloud, it's interesting. When you think back to the early days, it was, well, I take public, I take private, I put them together and I have hybrid cloud. But is there much more than just selling those pieces? And earlier this year, David Foyer put out the hybrid cloud taxonomy, really put together some of the planes that we should be examining as well as the spectrum of the offerings. So, and today we're gonna talk about some of the opportunities to really up level and where there's opportunity for customers to get a lot of value. And therefore the ecosystem will also be able to get some revenue and monetize that. But David, to kick things off, if you could just give us kind of the primary thesis of that hybrid cloud taxonomy for those that haven't seen it before. Okay, so we've created the taxonomy, which if you imagine it going from left to right, is multi-cloud and then loosely coupled hybrid cloud, tightly coupled hybrid cloud, true distributed hybrid cloud and autonomous standalone clouds. So those are the five labels that we've given to them. And if you think about those five labels, there are four characteristics which increase from left to right. State, for example, the autonomous standalone cloud is all about state. It's about the state of a IoT or a moving car or whatever it is. Integration, the level of integration, automation and hybrid applications. So those are the four levels which change and then covering of those, we have the concept of planes. So we're looking at different types of planes, network planes, data planes, control planes and there are other planes as well. And looking at the functionality that's in those planes which has to increase the further to the right to go. All right, thank you, David. And there's a lot of nuance and complexity and a lot of areas to kind of dig in. But before we go into any of the specifics there, can hybrid cloud be more than just a composite of the various pieces? Where is their innovation? Where is their white space? Where is this going to be more than just say the world of the past where we talked about multi-vendor? Well, I think the way to answer that is to think about what is the most important characteristic of data centers and the characters to computing. And that is what is different now is data. Data is spread everywhere. You have data at the edge. You have data in your own data centers. You have data in the clouds. You have data in SaaS clouds. Data is distributed. If you want to maximize the value of that data, then you need services, not to just pull everything up to one cloud. That's one model. But the key disadvantage of that is it takes time. It takes time and a lot of money to move all of that data up. So a better model is to move your code and services to that data. And to do that, you need a hybrid cloud mechanisms to achieve that. You've got to be able to send that information across the network in some way and you've got to be able to coordinate where and how you send the code and the services. Yeah, well, David, we've been talking for a couple of years now. Data is really at the center of all of this discussion. You talk about cloud. We've talked about big data for years. Want to pull in Jim. So Jim, data is your world. You're talking developers and data scientists and of course the giant wave of AI has data at that center. So you've been looking at and been writing a lot about the role that data and AI play in this hybrid cloud discussion. So up level us a bit to some of the apps in the data as to how this fits into this overall discussion. Well, yes, yes. Well, AI, of course, rides on data and really AI rides on an entire pipeline and workflow of data from sources through to data lakes where the models are built and trained to and then the serving of the built out models into downstream applications which also have their own local data and so forth. So we look at hybrid clouds, they in multiclouds they quite often bring a lot more complexity by their very nature into the whole AI development and operations pipeline. But there's value to be gained from using distributed data for all manner of AI applications. The applications become more powerful because they can leverage more data. You can build more types of models to do more kinds of inferencing and so forth. So when you look now at the multiclouds we have distributed data, distributed models, distributed workloads that are doing everything from natural language processing to face working mission and beyond. That's the power of AI. Now in a hybrid cloud environment you need, like David said, these planes to enable a degree of integration. One of the planes is the data plane and the data plane at its very heart involves moving the data where it needs to be for training the model for doing validation of trained models to make sure they continue to be fit for purpose and so forth. And much more of the training is happening at the edges now because that's where the actual AI is living because that's where the data lives and dies. So you need to make that happen. That data plane needs to be highly versatile. Increasingly needs to be able to work in more of a meshed multicloud environment. And that's sort of the bleeding edge of Istio and all those other things that we're seeing coming into the mainstream of AI and data management in the multicloud. Yeah, great, Jamie. I'm glad you brought edge into the discussion because often it's the battle of public versus private cloud. And that's not really the discussion. It's about my applications. It's about my data. It's where things naturally gonna live. When we've done lots of interviews where you talk about just the natural laws of the cloud. There is latency and the speed of light are still very important things. David, I've spent many years talking with you about these pieces and the role is to what lives in my data center, what lives in the public cloud, what ends up the edge, where code goes, where data goes is a complex thing. But David, I think we're gonna spend most of our time talking about this data plane. Help us peel the onion a little bit on this. One of the services that should be extracted from the individual platforms that we've looked at is data protection. Is that part of the data plane? Is it the main piece of the data plane? How does that and other services fit into this discussion of hybrid cloud? Yes, data protection is obviously a key component. And I think a good way of thinking about it is that there will be, in most cases will be multiple data planes. You will want a data plane, for example, that helps you with high speed record moving or high speed small pieces of data moving around, which is maybe of transient use. The type of characteristics, the network to support it, the protocols and the distributed management of that is gonna be very, very different from, for example, data that you need to get ready for an AI example, where you're training something. So where bandwidth is much more important. So there will be, in my opinion, multiple data planes. There's a big opportunity here for vendors because you need to be able to run your storage services across all the different hybrid versions that you have. You need to be able to run that at the edge. You need to be able to run that in your local private cloud. And you also need to be able to run that in whatever other clouds, public clouds as well. So a key characteristic then is all of this is gonna be code. All of this is about moving those services. And if you think about the types of services that you want in that environment, if you want to write a hybrid application where you are having data in one place and computing in one place and data in somewhere else, you need to know the latency, for example, how far away in time is that data? Should I move the data here or should I move the code to the data? You need operational systems. You need orchestration that will manage that for you. So you need different courses for different courses. You will need different data solutions for different types of application. Different ones for AI, different ones for transactional processing, for example, complex one, like maybe that you have a transactional system and you want to, at the same time, to do a large amount of fraud detection. That's a different type of application and different databases associated with that. If you're at the edge, you're gonna be using far more time series databases, state databases, whereas you'd be using traditional SQL databases for your systems of record. Does that help in explaining? It does quite a bit, David. And yeah, I would say people, please check out wikibon.com. You can see some of David's research. It brings back to mind just the discussion we had on software defined in the infrastructure space, pulling these services away from just hardware and being independent of that as a discussion. David, you've been having for decades and I've been reading some of your stuff from even before I joined the team. So it's great to see kind of what's the same and what's different as we build these out. Jim, the piece I heard from David is, it's a lot of, there's the database and there's all of these services that we have, but at the core of it, when I go back to that data, one of the things we've been grappling as companies is how can I actually monetize that data and get value out of it? It was one of the things that we talked about, big data was supposed to be that bit flip from, oh my God, how do I deal with all that data to, oh boy, I've got all this data and I can do something with it. And it had rather mixed results. So for AI, there's lots of companies out there to help unlock the value of data. It's going to be the rocket ship to drive thing forward. AI is going to drive all this. So it's a complex environment and there's lots of things that companies would have to spend. So are they going to have to spend more money or can they actually make money when it comes to our data? Give us a little bit of an insight as to what you're seeing there. Well, yeah, well, monetizing the data, Stu, where AI and machine learning come into the picture, is that essentially these are statistical models that are derived from the data and provide monetizable value if deployed into working applications. So that's what the whole data science pipelines all about is taking the source data, looking for the predictive variables, building models to incorporate those predictive variables to do, you know, face recognition or natural language processing, et cetera, into models that are trained and deployed into working applications to do inferencing. That's all the monetization train as it were for AI. And so what we're seeing, what Wikibon is seeing is that there has been in the last several years a growing niche in the industry of workflow tools, DevOps tools for the data science pipeline that handle all of those processes-enabled teams of data scientists and data engineers and subject matter experts and so on to work together to really industrialize the process of extracting that value and building those models from the data and deploying into all manner of applications, including deploying these models AI over Kubernetes and, you know, within containers and in serverless environments. This is happening. I mean, we're seeing all over the world in every industry enterprises setting up very much industrialized processes for incorporating data science into the very heart of application development. Jim, that's awesome. So I'll go back, as I've heard Peter Burris talk about this, the thing that differentiates a company, you know, before and after they've gone through that digital transformation is to how they can actually leverage that data. Are you a data-driven company? Is that something that you can take advantage of inside what you're doing? So we've only scratched the surface. Jim and David really appreciate you talking about that. What my call to action for people out there is if you go to wikibon.com, you're going to see the regular ends of research coming out for the team on this. We actually have regular conversations with the community and welcome your input. If you go to crowd, excuse me, crowdchat.net flash action item, you'll find the latest and you'll see if you look on the right side, so some of the previous ones. And of course, our team is, you know, at lots of events, all the big cloud and infrastructure and software shows, check out thecube.net for all of those for Jim, David, I'm Stu. Thanks so much for watching. Please reach out to us with any question. And as always, thank you for watching theCUBE.


Good morning kids. How was your day? Yesterday we all have learnt about some landforms right? Do you all remember? As today we will come to know about few more landforms. Okay? But these landforms are all related to land and water. Yes. No? No problem. Today we will learn about it. I will tell you what is a coast, what is a valley, what is a line. What is a valley? Nothing where the land means the sea. The land where it means the sea is called a coast. The land where it means the sea is called a coast. That is why these are all called as coastal plains. And this is what is a coast. The sea is called a coast. Now we will learn about the Bay. What is a Bay? When you have learnt about Triadans, yes. The land map, the water body is called a Bay. Got it? That is why it is being as Bay of Bengal. Clear? It is a land map which is aerated. It is called an island. That should be islands. Because southern part of India is called a peninsula. India is called a peninsula. That is why India is called a peninsula.