Hello everyone, once again I welcome you all to MSP lecture series on Transmittal Chemistry. In the last few lectures we have been discussing on the classification of ligands by donor atoms. In my previous lecture I was talking about nitrogen donor ligands and I did mention before concluding about another important class of ligands common to nitrogen donor atoms are skiff bases and a variety of skiff bases have been made and they explored their coordination chemistry and applications. Let me give the preparation and some important components of skiff bases. As you know the general method of preparation involves the reaction between ketone and primary amine. It is a typical condensation reaction. We take a specific example here. Let us take two equivalents of salicyloldehyde and treat this one with ethylene diamine. It gives two equivalents of water to form this condensate bis-salicyloldehyde ethylene diamine ligand. It leads to the formation of bis-salicyloldehyde ethylene diamine ligand. So if you remove this hydrogen it becomes a di anionic tetradentate ligand. This is bis amine. We know the general method of preparation. We can make a variety of bis amine complexes or skiff bases. One can also generate those things starting from for example oxides like this when we treat this one with RNCO. It can give a compound like this and this can readily eliminate carbon dioxide to form a compound like this. This on further treatment with another RNCO can give a compound like this. So these are very important class of ligands called ureto and carbameto complexes. So that means we have numerous examples of nitrogen donor ligands that we saw in last couple of lectures. And there is important class of macrocyclic I did mention having porphyrin as a base unit. Apart from that one we also have another interesting cage type compounds they are called sepul crates. They are essentially a cage ligands with various sized cavities. So let me show one example here. So we have here a typical sepul claret is given here and you can see all of them have Hc on the middle nitrogen atoms. So this is another important class of and also we have pyrozole borates also have, this pyrozole borates also we come across. So of course we can keep on discussing about nitrogen donor ligands in length. So at some point of time we have to stop it and proceed to look for further donor atoms such as oxygen and phosphorus because of time constraints I do not think I should be able to deal with almost all other nitrogen atoms. Nevertheless I can show you representative examples. And another class of ligands are nitriles that already I showed you while giving the preparation of important coordination compounds like acetonitrile and benzonitrile complexes. For example from synthetic point of view these are all very important nitrile compounds and another important compound of group 6 metal carbonyls is this one. This is a very useful compound. So one can prepare this compound for example you take metal carbonyl where M can be chromium, molybdenum or tungsten reflects for 24 hours in acetonitrile. So it gives a compound of this type. So this is a very useful ligand. Now you can ask me why only 3 acetonitriles have been substituted, why not 4 or 5? Yes you should remember metal is in zero valence state and once this compound is formulates in 80 electron species. Since metal is in zero valence state and more electron density is coming on to the metal always although many complexes do satisfy 80 electron rule and also another effect comes is repulsion inter-electronic repulsion that can always try to destabilize. In that context CO being by acceptors they can release little bit of electron density present on metal through back bonding. As a result these back bonding capable ligands stabilizes metals in their lower end state and here if you consider acetonitrile, acetonitrile is only a sigma donor and it is not a pi acceptor. As a result what happens when metal retains its zero axis state and now what would happen is electron density does not change but on the other hand number of back bonding ligands are decreasing. So that means when we have only pure sigma donor ligands then minimum of 3 carbon monoxide are needed to minimize inter-electron repulsion as a result no matter how long you reflects metal hexacarbonyls with astronitrile you cannot get more than 3 substituted and whether you take astronitrile or whether you take ammonia or whether you take any other alkyl amines you can make a mixed carbonyl and amine complexes or nitrile complexes but you have to have minimum of 3 carbonyl that is an advantage also. So you can make this one for example now if you take this one and reflects with toluene or something it can eliminate all astronitrile to form eta 6 are in MCO3 compound. In that context this is a very useful compound for example you take this one here and add in dichloromethane after formation of this compound you can remove all the solvent under vacuum to get dry stuff for this one at 0 degree temperature add dichloromethane and iodine one can generate a compound of this type. Now it will be oxidative addition metal will be in plus 2 state. So now let us say if we add any bisphosphine this bisphosphine is essentially substitute for this astronitrile to form a compound like this. So now you can see 1, 2, 3, 4, 5, 6, 7 are there. So this is a 7 coordinated compound and of course here depending upon what kind of phosphines we are using this can have a capped octahedral geometry or pentagonal by pyramidal. So now another important class of compounds among macrocyclic ligands are porphyrin this is the basic unit and it is very easy to prepare this one. One should remember here we have 2 N without with only lone pairs whereas other two have NH bonds so opposite side. One should remember this compound can be made by simply condensing aldehydes various aldehydes with 4 equivalents of pyrrole molecules. For example if we take 4 straight with 4 aldehydes or CHO it can give through the elimination of 4 equivalents of water molecules and of course it is very easy to write this structure. I shall show you how to write this structure there is no need to remember the structure of this one. You just write porphyrin units without adding double bonds and one here one here you for this do not add any hydrogen and then connect them with a methylene bridge. So now since this one is NH is there in this one what you should do is you should start putting double bond here when you put double bond here conjugation is there so one can go here and then one can go here and then only lone pair is there here. Now here next here it comes and then of course double bond is there now double bond should come here and then this only lone pair is there ok there should be something you have here ok and then this is ok. So this is how one can write porphyrin unit and of course here if you take simple acetaldehyde it will be H whereas here it can be anything depending upon what you are choosing here. So this is how the basic porphyrin can be prepared by simply condensing an aldehyde with pyrrole and of course we also come across another important cage compound used to trap cations alkali metal and alkaline earth metal cations that is cryptand when I talk about croneithers I shall give the preparation of that cryptand as well. With this let me conclude nitrogen donor ligands as I said nitrogen donor ligands are very wide in coordination chemistry and starting from as simple as ammonia or dinitrogen and two we have macrocyclic ligands having as many as 10 to 12 nitrogen atoms in the ring or cages very nicely they encapsulate. So this is the typical bis solicilaldehyde ethylene diamine complex preparation here of course here you can also take any alkyl one you can also get it instead of OH you can also have PPH2 then you have skip base with P donors or even S donors and a typical example of a metal complex I have shown here urethanium is in place two state these two are anionic and then of course one can also make very interesting compounds like this here you can see two cobalt are bridged by two bis, two skip bases in this fashion and also they are called compartmental ligands you can see here we have NH, NH is there and oxygen donors are there and then this can also become anionic once you deprotonate these two nitrogen atoms and also you can have homo metallic or heterometallic complexes can also be made here you can see here and then once the electrons can also delocalize and then you have two four negative charges also can be seen here if this also undergo tautomerism. So very interesting ligand system of course they come up with lot of applications so with this let me stop and start discussion about oxygen donor ligands when we talk about oxygen donor ligand the first ligand that comes to our mind is water and then oxygen itself molecular oxygen itself of course molecular oxygen one can reduce it to make O2 minus then is that is called super oxo and then you can also have peroxo and then of course hydroxyl ligands are known like O2 minus I mentioned O2 2 minus and O2 2 minus is also there and all alcohols aryl alcohols alkyl alcohols are all one way oxygen donors and then you should remember we have two more electron pairs are there once a covalent bond is established after elimination of hatch it can also triply bridge it can also bridge three metro centers one through covalent as either two other two through coordinate bonds and of course ethers and phosphine oxides sulfates phosphates nitrates and several other ligands. So when we look into the donor abilities and coordination modes we come across we can see in case of hydroxyl it can bridge in this fashion two metro centers also there can be terminal one also simple MOH bond and also two or three hydroxyl groups can bridge two metro centers and then this OH moiety can also bridge three metro centers or one can also have a cubane structure like this where alternate corners are occupied by metro centers and hydroxyl groups and also one can have something like this also these are important coordination modes are binding modes of hydroxyl ligands and then let us look into the molecular diagram of water here of course water when you consider we are taking the ligand group orbit is here two electrons are coming from two hydrogen atoms and then we are getting six electrons here and okay and of course you can see here this and this one. So this is mainly OH bond and this is the second OH bond and then this is the lone pair on oxygen and this is the lone pair on oxygen another one. So this lone pair it is non-bonding in nature is responsible for making water as a two electron donor and we normally do not come across water bridging two metro centers acting as a bident technique and as a four electron donor because this is little deeply buried because of this one what happens utilization of second lone pair for coordination is not possible when attempts are made what happens it loses one of the hatch and it forms a hydroxyl group and then hydroxyl group can bridge two metro centers as long as it remains as water molecule normally it does not donate two pairs of electrons to perform as a bridging ligand this for the same reason that the difference in the energy between these two is quite enormous and this is little deeply buried as a result taking out this one for donation to a metal is not that easy. So these are the binding modes of oxygen one can see oxo bridges are quite common and two oxo bridging is also quite common and this is symmetric oxo bridging this is unsymmetric oxo bridging so here what you have is O is there and then this is a coordinate bond and then one can also have a linear bond like this and also mu 3 bridging is also known or in this fashion or in this fashion pyramidal fashion or it can also stabilize four metals arranged in a tetrahedral fashion or something like this or something like this is also known or in some cases we also have examples of oxygen bridging as many as five metal centers having these five metal centers in trigonal bipyramidal arrangement some more example even it is not just five it can also you know bridge six metal atoms in an octahedral fashion you can see here six metals arranged in an octahedral fashion directed towards six vertices having central oxygen atom here and this is the common one and of course here another one where you have two oxygen and also you can have something like this or one can have something like this oxo or it can be like this so these are some of most commonly seen coordination modes of various oxygen and hydroxyl group and with different oxo states. So when oxygen is made to react with a metal center generally electron density is transferred from metal to oxygen with formal oxidation state of the metal and reduction of O2. For example if we look into metals where we can see only one electron donor properties in that case we will end up with super oxo complexes where we come across metals capable of donating two electrons or they have a stable ox state of plus two in that case we can also come across oxo complexes. A typical reaction I shall show you take this one and put oxygen so we come across this one here acetyl estronate complex plus if we add O2 so oxygen state is changed from 2 to 3 so you can now you know what is the nature of oxygen here this is about one electron donor let us look into two electron donor transfer. Again I consider a complex that you are very familiar with Vasca's compound with iridium is in plus one state this transchlorocarbonyl bis triphenyl phosphine complex on treating this one it forms a iridium three complex so we have a few more examples of oxygen donor ligands. I do not want to elaborate more about oxygen donor complexes for example you consider phosphate, sulfate, carboxylate, acetate all are ACAC most of the ligands we talk about all oxygen donor compounds and of course all alko oxides or iloxides are also oxygen donor ligands even simple ethers ketones aldehydes also some to an extent they are all oxygen donor ligands. Let me tell you about couple of more examples of oxygen donor ligands in my next class and I shall move on to discuss another important class of ligands very very important class of ligands that is phosphines which play a major role in organometallic chemistry and also utility of organometallic compounds and coordination compounds in homogeneous catalysis for a variety of organic transformation. Let me stop this lecture and continue in my next lecture about other ligand system.


Let's see what's up around this spot. There's any striped bass. I'll flounder whatever we can find, man. Sunny day today, man. Hope we get lucky. The tide is low. He just hit low. So... This spot I fished before, under this bridge. And I've been getting lucky, you know, so... Let's give this spot a try, man, you know. Let's see what we can get over here. If we get lucky again. Ah, let's go, baby. What's this? Ah, small striper. Get over here. Ah, get over here. Ah, not a keeper, but... On the jig. White jig. Ah. Little one, man. Small little stri... Ah, man.  I'm gonna let you free. Damn. You're not a keeper. Ah, man. Let me just take a picture. Oh, damn. I got him. So I'm talking about, baby. Ah, small little striper. On the white jig, you know what I mean? I guess they're going for white today. Not a keeper, but... I guess I'm gonna take a picture for my Instagram. Red to fishing. I'll be back, guys. With striper fishing today. Ah, let's go, baby. I don't go into the rock, man. Come on. Ah, it's not that big. Ah, man. It's a little one. Ah, let me go over here. Ah, he's a tiny one, man. Ha, ha, ha. It's a little one. Ah, little stri... Oh, man. Hold on, dude. Damn, he almost got loose. Almost. Damn, hold on, little dude, man. I'm gonna let you free.   They're loving the white jig. With the little white lure. Looking like a minnow. Let's go for the release, man. Thought he was that. There he goes. There he goes. Let me see if I could grab him again. Ha, ha, ha. He got scared. All right, man. Let's go for more, man. This is a good spot over here. Under this bridge. Ah, let's go. I'm hooked up. Ah, it's not a big one, but... It's a small striper. Ah, let's go, baby. So I'm talking about... Ah, not a big one, but... Ah. Better not fall, man. Ah. Got him. Ah, let's go, baby. That's what I'm talking about. Hold on, little dude, man. I'm gonna let you free. Hold on, dude. I don't want to hook myself. Oh, damn. Damn, bro. I'm gonna let you free. All right, you need to quit, man. Thank you. Jesus. Another little striped bass. Ah, man. This little striped bass, man. Let's let him lose, man. Too small, man. Ah, let him live. So he could get bigger. I better not lose this one. Get over here. All right, he's pulling drag. I don't know if it's a striper or a rare robin. What is it? Oh, it's a striper, man. It's a good one. Get over here. Ah, ah, it's a good one, baby. Feels decent. Get over here, man. Get over here. Get over here. That's what I'm talking about, baby. Let's go. Decent striper, man. Not a keeper, but, hey. Ah, good striper, baby. Let's go. Ah, damn, bro. Hold on, man. This is a good one, baby. On the white swim bait. Let's go, baby. You know how we do, man. We saw water fishing today. I think I might need the pliers for this, man. But look at this decent striper, man. Go straight past, baby. Over here. Ah, man. Let me pause the video over here so I can get my pliers and remove the swim bait. It's all the way deep. But look at this on everybody. Damn. Stay tuned, guys. I'll be back. Ah, hooked up again, baby. Let's go. Oh, this one. This one is pulling drag. He's a striper, man. This one feels decent. It's not a keeper, but... Ah, let me go onto this bridge, man. Ah, so it could be easier. Get over here. Ah, don't get loose, baby. Come on, man. Ah, this one feels good. It's not a keeper, but... Ah, get over here, man. You better not get loose, man. Get over here. Let's go, baby. That's what I'm talking about. Not a keeper, but, hey... This one feels decent, baby. Man, stop flapping. Damn. Little chubby one. Not a 28 inches, but, hey... Good stripers. Oh, man.  What's pulling drag? Ah, I'll be back for the release, guys. Stay tuned. Damn, he just started raining. Ah. Got hit by a striper. Ah, man. It's raining. Ah, get over here. Not a keeper, but... Damn, bro. I guess I'm gonna go down here. Get over here. Damn, man. I don't wanna slip. Ah. Where is it? Ah, get over here. My shunt pulled drag. Get over here, baby. You been caught. Quit fighting, man. That's what I'm saying, baby. That's what I'm talking about, baby. Ah, yeah, baby. Let me get out of this rain, man. He just started pouring. But look at this good striper, man. That's what I'm talking about, man. White jig. Swim bait. Man, look at this good striper, baby. They got some beautiful eyes. I'll be back for the release, guys. Let me take a picture. And I'll be back. Stay tuned. See you, baby. That's what I'm talking about, man.


Infinite root problems are typically pretty easy to solve, and this was no exception at all. So now, we're going to show off how one function can be passed into another function. This is a functor, and is the defining feature of higher-order functions, one of the most important parts of functional programming. The entire loop that we had written before is gone. Now, I needed to change these slightly just because I only have one definition of where right now, and it requires a function that accepts a node as a parameter, not the instantiated value type. I'll probably add one for the value type as well, just for convenience, but the one that operates on the node is the most powerful, just because it can also check other things about the node in entirety. Most people who use this are probably going to want to operate on the value type though. But, this isn't really about containers, this is about higher-order functions. If you didn't watch the first one, I wanted to do a real quick crash course. I have a list of 1, 2, 3, 4, 5, and I want to create another list of just the even values, using a functional approach. So here, we're taking the result list and assigning it to all the values in the original list, where, and then we're passing it, in this case, a named variable whose value is actually a function. And this function just simply does a check of the value of the node against the set of evens. So this should, assuming it works correctly, return another list of just even values within the original list. So, looking at the original list, it should be 2 and 4. And now I've already built this, and you can see returns 2 and 4. Now, do you have to go with the named value? No. Because of Addis type safety, you do have to make one little consideration, and that's just calling the access attribute on the function. But this will also work. That's it. So as you can see, Addis clearly supports higher-order functions, one of the most important parts of functional programming.


restrial photography photography is a major force in explaning man-to-man Edward Stritchett creative birth institute of photography


I'm gonna a quick thing before I start so yesterday I posted something that TMZ posted so James Harden the basketball player James Harden was like he missed basketball camp.  I mean fucking. I don't know anything my rap so don't so but all I know is this it was on TMZ So this is gonna lead it into the Furu thing.        James Harden's worth like a million times more and you'll never see a big baller James harm brag because he knows he's the man So it leads me to what I'm saying So the topic today is how do you spot a furu?    That's a lot of money But not someone James Harden level Kanye West level You know P. Diddy level things like that. You never see those guys flash like that. They used to like when Jay-Z was young He had no money. He was flashing now. He's a billionaire.  Okay, if you see these motherfuckers sitting on a plane So this is where we got this so yesterday. There was a big article came out of Washington Post Okay, I don't want to mention it. Maybe I should but you know James Bond raging wolf They they've been indicted by the SEC or something like that.   They're on planes.  And so what happened is this man yesterday?  That's a good thing. That's a good thing for the public But the bad thing is this now the public's gonna think everybody's a scam.  All these trading communities all these services are scams.  We don't alert.   So if you go to Twitter Trading is easy. I start all that I started through I start all that stuff and it's funny But you know some people actually like think it's real like great. It's not easy motherfucker. You're scammer. Oh, okay Dude, if you don't understand sarcasm, I'm sorry, man. I cannot teach you that stuff, right? and so when when when raging bull got caught and You know, I'm not a lawyer. I'm not here to say they're guilty or not.  They rock people.  It doesn't mean everybody is a Ponzi schemer, right? Just because you know, you got your heart broken by some girl.    Oh, that was broke now.     Let me take a look at this. Oh Yeah, how you doing Nice doggy.     You're the man. You're the man.  I was young back then.    I'm flying on a plane Have a Lamborghini have all these big P&L.  How does that help you guys?      I can show my car.   Okay, and so how do you spot a food if food does not trade?  It's his service. It's a mentorship making other people money Are you going to make money when you get mentored by these guys?   It's only gonna bring more people if you want to learn to trade So how do you spot a food a food never post his own trades Where the fuck's your trades, bro?  I see a lot of these guys. I don't want them to name names.  That's my strategy.   They may make money, but you won't They will show their lifestyle.      That's another sign. You see these guys You will never see them do a meet-up Alex and I Tosh it might see guys. We've thrown Jesus. How many meet-ups already? We walk around we are not fearful if anybody got something in high they were gonna hide Okay, no one's gonna jump me. I didn't do anything wrong these trolls.  They am that that thing is it's called masturbation club, right? And if you are I loved having a troll when I don't get trolled for an extended period of time I actually talked to Alice ago.  Are we not the hot chick anymore? Does nobody like us?  I know we still the hot chick.  We made so many of these Furu busting videos Okay, trading is very very simple. We have gone it down to a science Okay, we're the first person people just to use the word process guys now Everyone's talking about process though.  No, we've been talking about hard stops We are the transcendent all that stuff.     I'm not gonna do Bitcoin. I'm very happy.                  I am the mentors I am your mentors mentor, but it doesn't matter anything about me guys. I just so when we started M. I see We did it not because I needed the money You know, oh, you can't trade for yourself.     I did it because the educational Universe is in trouble. I see so many scammers It's only a matter of time that these scammers get caught guys We knew that these guys will get caught, but it's not I am not a litigator.    You know what you do you? You become a good person and eventually karma takes care of itself and anybody that joins these get rich gamers I'm gonna say man.  They stopped doing monthly guys Who's this? You part of the problem are we getting trolls? I love it.  I don't know you talk about us or what?  You know what happened I think 50% state Alex.  I never knew you guys were legit I never knew how good you are.   I love this topic man. I love you know anybody got scammed anybody can scan by Furu Raise your hand And I'll bring you on and we'll talk about experience. Okay, so who here got scammed by a Furu I'm gonna bring one on this might be fun Seriously guys, I keep asking this all the time. What's stopping you from joining? You know what you know what I keep asking this I feel bad because eventually what's gonna happen is this you see our program is so cheap like $1800 a year whatever it is And then you look at another program four thousand a year. You're like, hmm Must be better because this guy leads he's more legit.   Seriously $500 account is used to train yourself to learn So who who you think may say investors? I don't want to talk about them. Everybody has their opinions or whatever, but uh Um, unless you have a you want to get on Okay, who would raise your hand guys?   How about it's like I got Good, I don't I don't scam is a big word Unless it really defraud you how about I got suckered Who got suckered? Okay, I'm gonna bring this I'm gonna bring my friend on here. I don't know who this guy is go live with poppy I haven't pronounced your name my friend So we're gonna use this that's not used to worse scam anymore. I got suckered This scam is a very legal term So I I'm trying to connect with uh Gora poppy Hello Oh my are you on It says it's trying to connect. Hold on. Let me try that again It says it says it's waiting. Let me try that again one more time Waiting for gara poppy Hey What's up, man? New jersey new jersey Are you Italian? What oh my name. Yeah, what's your name my friend? It's uh, Daniel Arias wait. Let me park real quick We got someone's guy. Yeah, I love this though, man. You listen to this when you're driving, man What's going on dude, what's going on? Yeah, I've gotten um I've been through a couple like So let's let's start real quick so people know so So um, are you pulled over? I don't I don't want to be uh, the problem with the accent there I'm good. I'm good. I'm good. Okay. So tell your name your age and where you're from All right, so my name is Daniel Arias. I'm 26 and from Morris town, New Jersey So tell us your experience with that. How you got suckered All right, all right, so I started college.   Do you know, do you know will karaman? Oh, yeah, yeah, the eyebrow guy Yeah, yeah, yeah, I did. I heard he went crazy. But yeah, man. I um So let me let me ask you this let me ask you this what a track Of all the other guys that that could sucker you why do you choose those two to sucker you? So, I think it has a lot to do with age Just the fact that they're like around my same age group So relatable It's more relatable Exactly exactly And they were cheap, right? Uh, Austin's wasn't that crazy. Uh, wills was a little bit like up there. How much did you pay by the way? Uh for Austin, I think I paid like 700 and then for Will's thing I paid like two grand Whoa Yeah, man, but not do this.  You're very like So we'll do this man. I want to get a little person on but I appreciate you telling your pain story Text Tosh, I'm gonna text Tosh and give you a great offer or you know, maybe he'll help you out man Cool, man. Cool about thank you, man. Thanks for having me on. Thanks my friend. Thank you All right, who's the other who's the other person? That was a big echo. So how did um I want to bring another person on tell you tell your war story man. So what happened was this?     They're very relatable. They're flying an airplane.  Why are the students talking? That's why we created MIC Instagram page with testimonials Dude, there's tons of testimonials. I haven't tagged the people on instagram. You want to know go ask them We don't hide behind fake testimonials by fake people These are real people that you can actually hit up and ask questions Okay, so that's the big key. So if you take a look at testimonials guys Do they tell you who these people are? Because if you read a testimonial, how do you know it's real or fake? But we tagged the people that that have the testimonial You can go to that individual and ask them.  I mean, so these are the signs you have to be better And so these these are the learning things that become making you better day trader When you're putting together the pieces of the puzzle of the clue, okay?  They must be fake You know, it's just kind of like because you know what man to be honest We the only ones that probably are legit out there. There are very few people that are legit I would say I know the people that are my friends are legit. So whoever I I talk to you and say, hey, they're legit Okay, but the other people, you know So, okay, okay, I'm gonna bring this person on here I'm gonna live with a Raul Called the wrong. I like that name called the wrong sounds very like Diplomatic Whoever who else has a story that being suckered you raise your hand man I like I like these stories. These are battlefield stories Raul Hey, what's up? I get your name, right? Yeah, you got it right All right, man. Tell everybody who you are. How old you are? Where are you from all the good stuff my friend? Yeah, my name is Raul and I'm 21 and I'm from past Washington. I've been with you guys for I joined Uh, November 9th, so a little bit less than a month Or so, how do you like it? Tell us your experience and all that good. So I'll let you present now Yeah, so um, I Funny enough, I first time I heard about you guys was like on on this youtube ad that you guys put out when Alex went to the smb capital. Um And he was talking about it, but I'm like it's like an hour long and It's like all this millionaire tell like shows these people how to you know make money and they're and I'm like, ah, that's not real and then Like starting like two months ago um I kept watching your guys's videos and I'm like this guy this actually kind of makes sense like You know, this is a service that and I've heard a lot of good things about you guys So and I'm okay. Well, then I'm a joint And yeah, um, so far I've been liking it and I think it's worth it And I'm awesome, man. So Did you uh, did you join another service in 40 you got suffered or anything like that? Uh, no, not really. Well, I'm pretty new to the day trading world. Um Basically started at the beginning of this year. So I was just in this free discord room and then I was you know joining this other room. I can't remember the name But um, I haven't but you guys were pretty much the first ones and I'm glad you guys were the first You you are very lucky my friend. So a lot of times what happens is I have a lot of people that go You know what man, they join us.  This is great I've learned a lot of stuff Then they get thinking like holy shit if these guys are good These other guys are flying in private jets It must be 10 times as good because alice and battle have a private jet Raging bull has a private jet And then they and they go, whoa, alice and battle is only charging $200 a month in my suit. These other programs $4,000 Damn, they must be hella good.    This is a great steak knife.   So like the most important thing in my opinion is just to be patient Test things out go go and go and slow. You don't want to go in all the Deep all the way in you know starting out because You're going in not knowing anything or not having the experience and then you see guys going in Okay, first trade going in with a thousand shares and I'm like, dude, no That's crazy, you know You know the fact that you just joined like a month ago my friend and started to talk all this stuff like processes And stuff means that you've already learned more than most people Because you know what you know what the other rooms do they tell you to chase their plane They're like do not do not copy my pics.   I'm up a hundred thousand.   I need to have the best keyboard I need I need to be the quickest guy. I've got to get into the inner circle because they're inner circle You know, they need they need to get the pics early. So that's what a lot of people do too They have so the guys on streamers But what they do is this they stream it to youtube or instagram wherever the hell it is And it's like a 15 second delay a 20 second delay I was watching one of I was watching the farmer on youtube yesterday and then at the end after he was done trading He's like, okay. Well, I want you guys can ask me questions. I'll I'll answer your question for like 10 minutes And you have all of these people Asking the same question with all what you want to hear why you want to hear and he he answers like one I'm like, all of these people are lost and I'm like, I feel bad for them because They're just people from all over the world. They don't know what they're doing, you know, and You know, it's kind of it's kind of it's kind of sad to see all of that.  They will get beat up You can jump On site, I'm on site. That's true. Yeah. Yeah, so I wish I was like girls would jump me But I'm like, I keep walking around on purpose. Don't they know that I'm rich? Come on. Come on. Jump me Come on ladies jump me All right, Rob, thank you for joining man. Thank you, man. We'll see you in the room my friend.   You'll I just wanted to bring it up because this happened really recently, which is just yesterday and so Well, Alex, are we good? I mean, I I could go on for literally for days on freeroo is a mess So I just can't wait for the pandemic to be over. We're gonna throw more meetups and you'll see how legit we are It's not even about being legit guys.    So text osmosis to tosh Okay, we're gonna put the phone number there again guys um There we go two one three four five eight five nine nine seven I've been again Okay, text osmosis.  Oh tomorrow I keep forgetting we're gonna give away the 500 dollars five people tomorrow tosh's webinar tosh's webinar is at 2 p.m. Market time. It's gonna be on youtube live Check his twitter If you don't find tosh's twitter, I don't I can't really help you dude. There's a google and everything right t bradley, right? And they join tomorrow. We're gonna randomly pick five people to give 100 bucks to


Morning everyone on this 28th day of November. This is Wednesday and we're looking at the Dow at $33,291 up 52. Just some residual strength there as the histogram has been improving a little bit over the past few days but it still hasn't got enough oomph to get to the $33,480, $33,520 level. That's what it needs. It's at $32,296 right now, just up 53 points in the S&P. There's also been struggling some this morning. There's to be this particular point is up at $38,39. It has squeaked to a leg A and that's important here, gray leg A. Not much to see. The day is young. I'm just wondering if we aren't going to be seeing later on as the day progresses if there isn't any sell-off but buyers just start to creep in a little bit because it's a very low volume day that we close towards the high of the session we'll see. We haven't had that yet, any sign yet that there's that kind of strength. Meantime the QQQ has made a lower low trading at $264.82 up to $1.24. Gosh, I want to see strength in the QQQ and the strength of the S&P society. Any rally has got sustainability. IWM, any market rally that is. IWM very weak, up 11 cents at $1.1734. Now this is going to be very important because gold did pull back some. It's down 11 at 1811 after a really strong session yesterday, but it didn't get an inverted chapter with Roman Candle, which suggests to me that if at any point in the next two days our gold is able to hold for 90 minutes above 1831 and it's called 1832. Above that for about 60 to 90 minutes there's a chance we could retest yesterday's high. Otherwise I think gold is just in a situation right now where it could pull back a little bit. You're not seeing strength in the dollar to do that. Down 20 ticks at 103.99 is just nothing to see there at the moment. And we're looking at crude oil. And crude oil over the last few days had a really nice rally pulling back today at $1.50 at 78.04 in the slower range stuck at the 200-period moving average. And the last thing we'll look at here is the TLT up 24 cents as yields have been running quite sharply. I'll be back there for the Tiger technicians out a few moments to check out my opening full dating newsletter and have a great day, great programming. See you at the end. I'll be back for the Tiger technicians out here at 10.


I don't want you come back a little bit keep coming getting line with him I don't want you two in possession on that line Okay, so if he comes back where you're going Brilliant He squeezes on so we want that little offset So keep an eye on where each other are we want you slightly offset What does that do to the opposition? Draws them out exactly that we want to get between the lines of the opposition If you stay on the same line, it's easy to mark if you start moving them. They have a problem the opposition What I would say Whilst I want them off the line If it gets tight for you and as the game goes on we have to give the opposition credit


All right, I have 301, so I'm going to go ahead and get started. As you can see, you are here for hopefully the right place, the geneticist workforce session entitled Challenges and Opportunities. I'll explain a little bit more for those of you who want to hear a little more explanation about that before we start. I'm also going to go over logistics, but here's the basic agenda. We're going to go, we'll be strict and we'll end it at one hour, no matter how much we've covered or not. I'm going to start with just a quick intro and go over a few logistics for this meeting. Eric Green, the director of NHGRI, will provide the official welcome and some background remarks, and then the main portion of this session will be a moderated discussion with Debra Gehr, who should be up there on your screen, who's the chief of the division of Genetics and Metabolism at Children's National Hospital in DC. That'll take about 30, 35 minutes or so and then at the end, I'll provide either a five or a 10 second wrap up depending on how much time we have left. So let me stop sharing this now. All right, so again, I'm Ben Salman. I'm the clinical director of NHGRI. Thank you so much for joining. The only, I guess, overall remark I wanted to provide other than some tedious logistics is just to mention to set the stage a little bit about the scope of these sessions. So these sessions started from some discussions that a number of us had, including some leaders of groups like ACMG, ABMGG, NSGC, APHMG, ASHG, I'm sure I'm leaving out some others, but lots of folks who have been dedicated to this challenge for many years. In terms of the scope, and Eric's going to define this a little further, but we're really interested in folks who are, I guess, ABMGG or similarly certified as physician genesis, or you might call them clinical laboratory genesis, those two groups. We don't mean to exclude other groups who are involved in this field, such as a cardiologist who works in genetics areas or genetic counselors. We wanna learn about a lot from those groups, but we don't wanna boil the ocean. In a nutshell, my overarching question, or our overarching question is, how do we bring more people into the field? And how do we ensure that the field is vibrant and diverse going forward? So we'll leave it at that for now. I just wanna go over just a handful of quick logistics. First, this meeting will be recorded and will be available on the NHGRI YouTube and website. The first session from a couple of weeks ago is already available there if you wanna go back and listen to it. If you rejoined, thank you for coming to the second session. We're gonna ask some polling questions about that. And hopefully we go into some new areas, but also I'm sure are gonna repeat some really important themes. If you can, as mentioned, you don't have to. If you wanna list your name in addition to your affiliation, that'd be great. If you do, raise your hand and have a comment. Please mention, again, your name and where you're from just so we can learn about each other a little more. We'd love, I know this isn't always possible, but if possible, if you could keep your cameras on, that'd be great. But we understand sometimes dogs, kids, et cetera, genomes are running across the screen so it might not be possible. Please do try to keep on mute. If you can, we have a great group of folks that are helping that will try to put you on mute. If again, your dog or genome is barking in the background, but try to keep on mute unless you're making a point. I will ask if we could try to focus on the discussion that we're gonna have here on the Zoom screen versus in the chat. You're welcome to use the chat. We have actually folks from Extramural NHRI that are gonna help monitor the chat and are gonna help respond to, for example, questions about funding opportunities. But we want to have maybe not two totally separate parallel discussions here, one in chat, one on the screen. Try to direct your attention to the screen if you could. We've outlined a set of questions that we'll show you after Dr. Green presents the introduction or the welcome. If we stick with those questions, great. If we go quote unquote off script, that's great too. We just want to take this in whatever direction you feel is most valuable to you and to the field. I do want to mention that we'll have one more, our third in this set of sessions on August 29th that's gonna be co-moderated. I'll be with Shamita Dasgupta from Boston University in a couple of weeks. So again, you're welcome to come to that, but we're hoping people will have attended only at least one. And then last but not least, I do hope these sessions run smoothly. I think we're all used to lots of Zoom and virtual type glitches. So my preemptive apologies, if we have some technical difficulties, we'll do our best to avoid those or deal with them if they come. So with that, I am delighted to turn to Dr. Eric Green, the director of NHGRI for his welcome and opening remarks. Thanks Eric. Thanks Ben. So welcome all of you. Some of you I know, some of you I don't know as well. We think this is a really important set of discussions that I actually asked Ben and others at the Institute to convene so that the Institute could learn more about the current circumstance with the clinical genetics and genomics workforce as Ben defined. And that includes laboratory clinical geneticists as well as classic medical geneticists. I will say now having been the director of NHGRI for almost 14 years, I'm always profoundly grateful and flattered that when we invite people and ask them to donate some of their time to us as an Institute, people come. And I think it's a testament to the field. I'd like to think it's also a testament to the Institute that people are willing to give their time and help us brainstorm and hoping that if we get good ideas we will improve the field by the work that we do. So why are we here today? Well, I don't need to tell this audience that the field of genetics and genomics is changing quickly. There's unprecedented opportunities for genomic medicine implementation. We've seen rapid areas of accelerated growth when it comes to technologies for sequencing genomes, analytical tools for analyzing such data, better and better technologies including longer DNA sequencing technologies and on the horizon are new opportunities for genome editing and hopefully gene therapy. And all of these have great potential for clinical implementation. And I can't tell you how profoundly honored NHGRI is to be able to help facilitate these areas reaching their full potential. But at the same time, while there seems to be this incredible opportunity for clinical laboratory geneticists and medical geneticists, there's just a lot going on. I think some of it relates to industry consolidation, artificial intelligent approaches and various things going on that might influence how people are making decisions about their career. And so to be honest with you, we need to recognize that we have a lot of challenges. For example, we all know that there aren't enough physicians going into medical genetics training programs and that many hospitals and clinics have a hard time recruiting experts in these areas. And this has many consequences, not the least of which is that it creates issues related to access and equity, something the Institute passionately is concerned about. So we've had a lot of discussions at NHGRI related to the workforce, various aspects of the genetics and genomics workforce, including scientists and other career opportunities and genomics. But that's not what we're gonna focus on here. These discussions, as you heard from Ben, we're gonna have three of them this summer. They just seek to get a better handle on the barriers that seem to exist why more people aren't going into medical genetics and laboratory genetics as a career option. And to see whether there's something that NHGRI could do, unlikely we would do it alone because we know there's a number of organizations working hard on this. Some of them are joining us today and our staff is having discussions with leaders of the full set of letters that Ben went through, A-B-M-G-G, A-C-M-G, A-P-H-M-G, A-S-H-G, E-I-E-I-O and so forth. And those conversations are terrific. And we absolutely don't want to, we'll aim not to step on anybody's toes here, but we just wanna know, can we be helpful? We wanna make sure that NHGRI can partner with anybody else in this universe that will help us understand these workforce issues and work with us to see if we can improve them. And we also know there's another aspect of this as we know it's really critical to recruit and train a more diverse workforce to serve the country and the world. And so in addition to just the size of workforce, we wanna be thinking a lot about its diversity. Now we delved into many of these issues in the 2020 NHGRI Strategic Vision, which is our latest strategic vision. And like many parts of that strategic vision, we are involved in ongoing efforts to hear what the community has to say that our barriers or desired strategies or concrete actions that we can take.  So tell us what we can do. And so that's the charge. And with, I don't wanna take it any more time, I'm gonna turn this over to Ben and Deb, who will co-moderate the discussion with you today. Thanks to Deb and Ben for doing that and for helping organize this.  I look forward to the discussion. Great, Ben. Thanks so much, Eric. That was great. And again, thanks to everybody for joining. I can see our numbers still ticking up. I'm always shocked and surprised when anybody shows up. But obviously this is very important to the whole community. Deb, do you wanna start? I don't know if you're fancy and technologically savvy enough, unlike me, perhaps to do the poll part. If not, we have lots of other folks that can help. But can you guys, can everybody see the poll? So it's only two questions where we're easy people. First, did you attend our prior geneticist's workforce session on July 17th? And do you plan to attend the next one? We're trying to figure out if this is a one-time deal. So we'll do more breadth or if a lot of people were here the first one or doing the third one, we might do more depth today. So we're trying to figure out how to focus the discussion. I'll give it, I'm gonna count to five because I can't. One, two, three, four, five. Okay, so I always, I love seeing my results. Do you guys love seeing the results too, like me probably?   Ben and I love to have you together with us. And it's about 50-50 if people will be joining next time. So great. So I think we're gonna kind of start at the basics, Ben. So for the few of you who were here last time, the fourth of you, don't worry. You might have thought about some things or might wanna bring up some things that were brought up last time too. So I'll let you go ahead and put out the questions, Ben. Good, so I'm gonna share, thanks so much. Very interesting to see who had been here or not. We weren't sure how it was gonna turn out. I'm just gonna briefly flash the agenda screen, not the agenda screen, I'm sorry, the question screen now up here. These are the questions that you should have received in the invite emails. And thank you for bearing with me as I sent you lots of invite emails to make sure nobody missed them. These are the four main topics that Wendy Chung, Deb, who's obviously with us today and then Shamita Dasgupta, that we came up that we thought might be interesting to address. And so Deb's gonna go through them with you. In turn, I'll be acting more as a behind the scenes but I'm kind of figuring out if there's stuff in the chat to bring to the forefront. Again, I wanna emphasize if we stick with these and devote equal time to them, that's great. If we only go through one of them because that's where you wanna spend your time, that's great too. This was just more of a set of menu options versus a required script.  And Deb, do you wanna take us into the questions, if that's all? Yeah, so I feel like sometimes, I know we're supposed to keep it on the screen but there'll be some things that if you can't talk where you are, if you wanna put in the chat, we're gonna capture the information in the chat as well. Let's start and spend about five minutes on the first question. I know that there's more than five minutes worth of barriers to kind of, what are the barriers to helping our field grow? But I'm gonna start with about five minutes of that discussion and we could talk a hundred hours on that, I know. But we're gonna try to focus because I'd love us to get to some strategies and some brainstorming also today. So what do we think are some of our leading barriers? You get to take yourself off mute, you can raise your hand, you can put it in the chat. I can even tell Ben to give us one or two from last time. I see Peter, you took yourself off mute, so I bet you have something to say. So barriers are several. One is salaries for clinicians. The second is the definition of what the specialty is. We have to find ourselves into a corner, which is basically a specialty of rare disorders and that's how we've taught it for years. I think we've made genetically subspecialty in medicine. I think that medicine is a subspecialty in genetics and the sooner we can get to that point, the better off we're going to be and it means changing the way education works in our medical schools and others. And the last is inclusion of other specialties as opposed to making it a, trying to make it a subspecialty, that cardiology and others would be within genetics or related to genetics rather than really touching and include everybody. Can you explain that last one to me a little bit more? So the idea that kind of within cardiology or neurology, they would have more genetic training and be able to do the work or do you mean that there'd be more like neurogeneticists who would be trained in neuro and then become a geneticist? Well, I think that the training should start in medical schools and begin with it. And we for example, the University of Washington have eliminated genetics as a standalone course as we get small groups with the expectation that the clinicians who are helping with small groups will have enough genetic background to integrate the discussion. They don't. The only people who do as far as I can tell are people who are either actively working in genetics or who are geneticists themselves. And so really going back to models where we think about genetics in all contexts as we're teaching in medical schools and that that then gets incorporated into the further training. And I think, I really think that the idea that medicine is subspecial to genetics is an idea worth considering. And I know it's hard to implement, but I think that if we make it a more major part of training, then we don't have to deal with cardiologists having to take genetic specialties and do that sort of stuff, but really make it integrated in Ireland. Yeah, thanks, Peter. I'm gonna go to David and then Catherine. Go ahead, David. This is probably a long list. I think one of the things that comes to mind though is that there's just not that much exposure of medical learners to geneticists. You just don't see, you get a lot of, you see a lot of cardiology consultants and neurology consultants and et cetera, as you go along, and you don't have somebody modeling the profession to you. So you don't really think of it even as an option or see what they do to get excited about it during the course of training. Yeah, and I would say, Adam, that's being, some of the chat is exposure, right? Like you don't, you don't know you can be something you've never seen. Yeah, that's great. Go ahead, Catherine, thanks. Yeah, I think one of the things that I think could be really helpful is somehow advocating for more GME funding for genetics residencies. So most people on this call know that we have a categorical genetics residency program and then combined programs that also include pediatrics or internal medicine training. And the pool of applicants, I'm program director for both of those at University of Michigan. The pool of applicants is actually really strong for the combined programs. And I think that potentially there are more, more applicants that would consider it as a field if there were more training positions available. I think right now maybe they're like 27, I'm guessing. Actually, Mimi would probably know this positions available. So if we were able to advocate for more GME funding at various institutions, I think that that could be something that would really help out.  I'll just comment that there are right now 27 combined piece genetics programs. There aren't enough, it's my bias, and internal medicine genetics. And part of that has been the challenge with the integration with the internal medicine departments in funding. So I agree. I think there are more funded positions. There's that many programs. We're all hearing those that the applicant was strong. I do think that that's one way. I do think that for some prior comments that were made about exposure in med school and a light may increase even our cataclysm as well, but it's not there right now. Yeah, yeah. Go ahead, Mustafa. So I completely agree with the discussion points. I think that it's no longer limited to just internal medicine or pediatrics. I mean, a lot of other specialties are very strongly involved in genetics either. It's genetic testing, sometimes with genetic counselors or without. And then also developing some, these novel treatments in patients. I mean, you can think of like ophthalmology here in very advanced stage doing gene therapy in a lot of inherited diseases. So I think the way to do it will be to increase the spectrum of these combined programs, not just limit them to certain like traditional specialties and others. So then it will be attractive to medical students knowing that they're gonna be in that specialty, but also in genetics. The other point we noticed during the interview, some there are very strong applicants for the residency programs. And some of them are very research oriented. And I think we should find ways of having dedicated year or years for the training during genetics so they can become like physician scientists. And those people can really contribute to developing novel treatments in these conditions that we deal with. Yeah. So I have a lot of, I guess, follow up questions for the last couple of speakers, but let me limit it to a couple just to make sure I understand. So Mustafa and Catherine, it sounds like what you were advocating for are more an emphasis on more creating or expanding more combined spots and programs versus putting more emphasis on the traditional categorical one. Is that where the quote unquote money is or where the opportunity is? Absolutely, in my opinion. Yeah. Yeah, yeah, I agree. And that's been the conversation at APHMG the last several years that's come up too. Let's go ahead, Maria. Can I? I have two thoughts. One is because I came from internal medicine to genetics, salary is a big thing because genetics is a fellowship. It's a second residency. We already have to have some previous training before. I did three years of internal medicine and then did genetics and my potential income was caught in half. I did four years more of fellowship to make half the money that I could have been making if I stayed in internal medicine. So that is a hard sell for a lot of people that have a lot of student loans that have a lot of things and many of our friends who have come and done an specialty before like OBGYN, neuro, whatever, they are practicing that primary specialty with a focus in genetics. They are not practicing genetics because that is just not realistic. And my experience also as an IMG is these combined programs are out of reach for anybody who has not graduated from the United States. I was lucky to find an opportunity at the NIH because the NIH was one of the few fellowship programs when I applied this was 12 years ago. So maybe things are different now that accepted visas and that could sponsor me to come to do a fellowship like that when I was just coming out of internal medicine. So you keep increasing these combined spots but those are highly selected only given in a few universities not all of them sponsor visas and then you're limiting your pool.  Great, thanks, Maria. Other comments, so I feel like a lot of what we've talked about is now you make a comment. Yeah, of course you decide. I just wanted to comment that Dr. Takin commented that we need more research spots and I actually think that that's a deterrent for some medical students. Medical students a lot want to be practicing medicine and they think of genetics as a very heavily research based lab based field and I'm not sure that's not a deterrent. I was gonna make the same comment or a similar comment that I think a lot of folks think that if you're going to genetics you have to have like a PhD background or you have to have a bench research background or you have to want to be a physician scientist or have that in your future. And I think it's really important for us to make students aware that there are other paths. And of course, Genesis is an academic specialty for the foreseeable future but there are ways to be a geneticist that don't involve doing clinical trials or doing a lot of research that may be a better fit for certain people and I think that might be a deterrent. And I would piggyback that with there are many university settings where you can be a clinical educator and so that would solve our issue of having geneticists who are involved with residents and with students and having an example for people to model to then want to go into genetics. Thanks, Edith and Chair, I agree with both of you, yeah.  Well, the reality points that we have to deal with is that we train about 60 medical geneticists, MDs, DOs, et cetera, in a year and we're training 550 genetic counselors in a year. But the total number of genetic counselors that's out there now is closing in on 10,000. The number of medical geneticists hasn't changed since we developed the board, it's about between 1,300 people. So there's been no rise, there's been no uptake of genetics as a profession among medical students and a tremendous rise among people in genetic counseling. So, we've seen genetic counselors come into play in the large companies, at least for a while until they got a little bit stressed in terms of their finances. They're very active in all the academic programs around the country. They are, in many cases, at least as knowledgeable as our trainees coming in because they've been there for longer. There are real resources in terms of practicing medicine but we have to change a number of things that has to do with that. So the bill that's been lagging in Congress about making geneticists eligible for compensation through Medicare really needs to be pushed despite opposition like the other from the ACMG, it seems irrational. But I think that we're still at the point of, I think, I agree, we get much better candidates in the combined programs, they do well, they have insight into what's going on. Can we create combined programs throughout or make something combined with all the other training programs as we're going along and make genetics a significant part of training? We've had remarkable success with an unusual group of people like vascular surgeons and cardiac surgeons in terms of realizing the benefit of genetics and what they do. And I think we need to be really thinking more directly about who's going to be part of it and assuming that everybody will be, not assuming that we can't make ourselves an insular specialty. We have to be part of the DEI and inclusion part of the I as part of that. And it doesn't mean welcoming them to our table, it means going to their table. I'm gonna go to Matthew next and then we're gonna move on to a little bit more delving, a tiny bit more into the role of the future geneticist. We've kind of touched on that but I wanna go there after Matthew's comment. Thanks, Matt Taylor from University of Colorado internal medicine genetics. I agree with your comments there, Peter and was sort of gonna raise and lower my hand because I'm a little hesitant to sort of say this out loud, I'll say it anyway. I think I don't know if it's a barrier or a challenge or how we wanna face it, but at least in the medicine world, it really seems to be that we're losing the battle around what a geneticist is because what I'm hearing from my colleagues is it's just someone who orders genetic testing by the way that's really easy to do.  I don't know how we address that necessarily because obviously testing is expanding to your comments about counselors expanding and likely at some point being able to bill for services and probably order genetic tests and in many cases, they have to be tied to a provider. But I don't know how we collectively address that issue that the thing that we do that no one else could do which was like, remember what was in those textbooks is now gone because essentially what we do and what is perceived we do is we just drag our feet and take a long time to see somebody and then order a test. And so I don't know how we kind of address that. And again, this is not a comment against the NIH or anything, but we are a little bit of a victim of the successes with what's happened to all this sequencing technology that has been generated and driven out there. And so if we're only training 60, 65 of us a year, guess what? We're not ordering the lion's share genetic testing. We never will be ordering that lion's share. And somehow we've got to figure out how to pull some of that back potentially because we really at the moment are just the people who take longer than everybody else to order the damn test. Matt, I think I'm gonna steal that line. I think it was something like we drag our feet and then order some tests for future talks. It's a different app. You can put it on a T-shirt, something shorter, something like that. I don't know, doddering around and then getting around to working with, sorry. Look for the boot that ASHG, I guess, sorry. I'm gonna go to Melissa because she had her hand up and it came up in the middle of that. So I think that might have spiked something in you. So go ahead. Thank you, thank you. I'm Melissa Dempsey and I'm a genetic counselor. However, I work at Illumina, so I haven't done genetic counseling in some time but I used to work in clinic and actually I work in the marketing department at Illumina. So through what the last couple of people were saying, I feel like maybe the geneticist needs a new branding exercise to kind of rebrand what a geneticist is. And I do think some has gotten lost in this battle between the genetic counselor and the geneticist that I feel like's been going on since I was trained 20 years ago. And instead of focusing on what you both do, which I think there is overlap, focus on what is unique. And I think, I mean, as geneticists, you go to school for a long time to be physicians and you can manage and prescribe and treat patients and now we're at such an exciting time where there's treatments. So it's like, wow, if I go back to medical school, like being geneticists is super fun right now because there's some treatments coming up and genetic counselors can't do that at all. And so I think I would love to see more collaboration between the two and figuring out how to work. I was part of a working group recently and there was a quote that somebody said, figuring out how to work at the top of our scope and not just side by side next to each other in clinic, each person doing the thing they do best at their point by themselves in the room. And I can speak just quickly of my history. I started out as a pediatric genetic counselor and a lot of genetic counselors say there's 550 a year. I would wonder how many work in pediatrics. They've moved into areas like OB, cancer, oncology and industry because they get a little more autonomy and like one-on-one time and independence. So I think if there's a role for them in pediatrics that does give them that autonomy and then give you the chance to be treating the patients and interpreting the tests and the things that I think the genetic counselors aren't is, don't have that medical background would be great. Thanks, Melissa.  Hi everyone, I'm sorry I came in late. I was actually seeing patients with genetic counselors. I work in a large reproductive and cancer group and I work with eight genetic counselors. My life would be a lot easier if they were paid independently. The problem with the bill is that the genetic counselors right out of school wanna be paid 85% of what a physician gets paid for without working in a team. And as many of you know, most of this is team-based care now and multidisciplinary care. The bill, if you read the wording has genetic counselors practicing as physicians. And AMA is not supportive and we're members of the AMA as part of ACMG. I agree with, I'm sorry, I think it was Melissa Dempsey with what she said. We should both be practicing at the top of our scope and I agree with what a lot of people said and I think this has been repeated at the ACMG, APHMG at a lot of different things about working. The combined programs clearly have the best applicants and it would be wonderful if we could have more. I'm doing my own part and starting the application. I just have to wait until I have a pediatric colleague to help. I just wanted to make sure that everyone understands ACMG is not against genetic counselors getting paid, but they have to, the bill, the way it's worded now is not gonna get supportive AMA and most medical bills without the support of AMA do not pass. So there's a lot of issues because licensure in multiple states is different, et cetera. I'm happy to discuss it with anyone. I am trying to work with many of my genetic counselor colleagues to get something passed so we can all work together. There are only 56, 5,629 certified genetic counselors now. We may get up to 10,000 soon, but as someone who trains the genetic counselors right out of school from Sarah Lawrence, one of the top programs in the country, the genetic counselors right out of school should not be practicing independently. Maybe after a few years, the genetic counselors who see cancer patients can be practicing independently, but they're not really practicing independently because an oncologist sent the patient to them. And same thing mostly with prenatal. So I think that a lot of the issues came from the worry of genetic counselors ordering exome in the Peds world. Dr. Byers just said, can you send the text of the bill to all of us? I'm gonna have to, I'm on my phone, but if you, I think it's 14, 15, I'll look for it and I'll, if you just Google it, you can see it. By the way, it was put up for adoption or promote, I forgot what the word is in the Congress by someone who didn't know what a genetic counselor is. So it was the ACMG folks who advised this person about the value of a genetic counselor. So I'm, I'm, I've spoken to people in NSGC. It definitely is, would be valuable for all of us. Oh, thank you, Matt. Thank you, Matt. I want to put it up. Thank you, Matt. Yeah. So let's talk for a minute more. Oh, Joan, I see your hand up, and then I'm gonna talk a little bit more about it. What should be the- Has her hand up as well? Or maybe it's a legacy hand. Sorry. My comment goes back a little bit earlier, but I'll be quick about it. Yeah, I think it was Melissa. I'm brought to introduce myself. I'm a pediatric geneticist at Baylor. I think Melissa had said, you know, or somebody had said, we need kind of a rebranding of geneticists that we also treat and we can do gene therapies. I think one of the challenges that a lot of the departments are not set up for that structure, with that infrastructure and that support yet. So that would require a lot of changes at the institutional level as well. I don't practice metabolism. And I know in metabolism, there's usually more of a robust kind of support structure. But if I were to start having to treat lysosomal patients or whatever it might be in my clinic, we would need a lot more infrastructural support. And I think that would be something that needs to change across the board. Great point, Tanya. Thanks. Go ahead, Joan. Sorry, I can't get my video to work. I don't know why. That's okay. I was, there's a lot of stuff in the chat about, you know, what do the residency programs? And I was going to say, I trained in PEEDS and then I went into genetics. So I think a big problem with going right into genetics is if you end up at a small institution like I am in Syracuse, you need a medical home. And it's, you know, I'm in PEEDS. The other geneticist who's with me is trained in internal medicine, but we're in the department of PEEDS. And sometimes our, I mean, we have such a huge backlog that we've just now stopped seeing adults, period. You know, and it could have been a similar problem if I was in an OB department, when I first came out and there were certain patients I couldn't see because OB said, well, why should I pay you to see them? So, you know, it's tough because if you come right out of genetics and you don't go into a department of genetics, you have to find a home in some other department. Well, I think from the conversation today, our home being internal medicine might help the salary structure. Part of it is that our homes are in pediatrics and the expectation of salaries are different in things than they are internal medicine. Susan, I see your hand still up. I don't know if you meant it to be up or not, though. Okay, well, she knows how to, I mean, interrupt me. Okay, role of the geneticists. We haven't gone there much and then we're going to move to strategy. Anything else about what you envision there? Like, how am I supposed to be spending my time in 10 years? And as part of that, I've heard, I guess, I just mentioned that in monitoring the chat, lots of discussions and several of you mentioned more about management, kind of echoing things that biochemical justice do. Is that the main future, one of the main future roles? And I was wondering if people could expand on some of those points about, is that feasible? What would it take? And so on and so forth. Yeah, Catherine. Yeah, so I'm really lucky. And so I also, another role that I have is I'm the division director of pediatrics genetics at University of Michigan. And I have, I'm fortunate to have several incredible faculty members who are super enthusiastic about bringing treatment into medical genetic or pediatric or medical genetics as a specialty. And so implementing not just treatment for biochemical disorders, but for things like the psoratide for echondroplasia. And I can't remember the name of the treatment, but the new one for RET syndrome and bringing all those treatments in and having genetics as the home for those patients. Another thing that we're trying to do is start a gene therapy service line that would be, you know, at our institution. So we're trying to actually work with the business school to develop a business plan for this with the hope that we can bring this in and have geneticists as the sort of point people for delivering gene therapy services here. And so I think that, you know, we've always been the diagnosticians, right? And I think that that is a role that we will always serve. But as we get more into the cardiologists ordering the genetic testing, the neurologists ordering their genetic testing, et cetera, I think that in order for genetics to survive, we need to move into treatment and own that as a specialty. How are you doing it with the business model? So I've heard from some places, that's the hard part is, you know- Yeah, I'll let you know in about a year in the months where we've actually got a proposal for a team of executive MBA students to bid on a project to help us develop that model. So I'll let you know how it turns out. Yeah, Cynthia, your thoughts? Yeah, I totally agree with the idea that we need to emphasize the role of geneticists and treatment of patients. And I think that's something where the training programs need to, you know, expand. And, you know, part of that will be some of the requirements that come from ACGME to do that, you know, it's nowhere really in the milestones that I'm aware of to really say that, you know, students, trainees have had experience in clinical trials or gene therapy. And I think that, you know, we shouldn't give all those away to other providers, you know, possibly, you know, we're not gonna be doing gene therapy for eye diseases, but although we can train those ophthalmologists to be geneticists also. But yeah, I think, you know, we need to find a way to emphasize that part of our scope of practice. Yeah, go ahead, David. Sorry, unmuting. So I'm a little bit of two minds about the whole treatment thing, because often the, what you're treating is some falls well within somebody else's specialty, you know, do you expect vision to get better, epilepsy to get better, renal function to get better. And I think although I can imagine it's being part of a team, it's taking it over entirely. I guess I'd have to think a little bit more about how that might work. I guess one thing that I haven't seen coming up much, and I realize the laboratories have taken this over to a large extent, but is the use of genomics data as a lifelong resource for healthcare, including reanalyzing data. You know, the radiologists interpret MRIs, which are orders of magnitude less complex than the genome. I mean, I think that there should be a role for us to engage with that data set and connect it to the patient's healthcare in a way that we haven't pursued as a field. And we've seeded it to a large extent to testing laboratories that are very sort of, in many cases, narrow in their approach to how they use it. Yeah, Matt? To your comment, David, I have the same struggle with where this sort of fits in terms of what we can do. And I agree that it's gonna be difficult for me to walk into pulmonary clinic and say, hey, newsflash, CF is genetic. Step aside, I'm gonna manage all this. I completely agree with that. On the other hand, I think we have to acknowledge that we're not doing a very good job training our trainees to do gene therapies and enzyme-based therapies and some of these novel therapies, RNA-based, in our own sort of ultra rare specialty field. And I think that we should lay claim to that, even though we probably won't necessarily lay claim to CF for sure, probably a lot of the eye diseases, understandably, based on the mode of injection. But I think we could do a better job. And unfortunately, that's gonna be training some of us on this call, many of whom I suppose have had some exposure to gene therapy, others, myself, nearly, but not quite dosed anybody yet. So we'd have to train our sort of discipline and then help move that in a direction. That'd be pretty exciting to medical students to be able to probably do some of this stuff. But I think traditionally, we as geneticists outside of metabolic disease, I've really been sort of the stand back at the back of the room and say, here's a diagnosis from 50 feet. That's pretty impressive. And we have to shift a little bit to where we actually get more involved in those trials as we're involved in a trial right now, but it's a cardiomyopathy trial. And it's pretty clear that the sponsor is really looking for cardiologists. We've done some of the seminal research in this space, but they're looking for cardiologists to run that trial and we need to figure out a way of flipping the script for these rare diseases that ultimately do fit with what we do. So Matt, I want to bring up, I guess something that I'll, I can't take any credit for Wendy Chung who is the previous co-moderator just in some discussions behind the scenes, mentioned this. And I'm just curious if the group agrees with this or not, but I think there's a lot of neat things here is there's obviously lots of genetics to go around, meaning there are many different people affected by genetic conditions, whether they're managed by a pulmonologist or a cardiologist. Her thought, which I personally agree with, but I'm curious again about what the group thinks is that the niche for geneticists could be these multi-system disorders that a renal doctor isn't going to take on because they love the kidney but they don't want the other pieces or a pulmonologist is going to take the lung. Does that, is there enough to go around with that? Are there, are the treatments promising enough for that? Or will that not work for other reasons that folks can think of? I will just say since you, I was just the last one speaking, that'll work in some circumstances. In other circumstances, things may get seeded away. And so, who's taking care of Pompeii disease these days? It's mostly neurologic, so a lot of neurologists are involved. Fabric disease, which is multi-system is kind of across the board. There are some places where it's genetic, some places it's more nephrology. I think we're gonna have to pick and choose to some degree for the more common disorders that have sort of got their own clinics, got their own space, even if they're multi-system, we may be already, that may be already cast out of the bag, so to speak, but there are thousands of rare disorders, many of them that, I haven't heard of all of them, of course, so many of them that are cresting the horizon with possible therapies, we're probably best suited to take those ultra rare things, especially if they're polysystem diseases as well. We might need help from colleagues in managing some of this for sure, but we should, I think, step up and be more on that therapeutic front line for the, at least the rare and ultra rare stuff, I think, but maybe others disagree.  Now I'm commenting as a comment or not as anything else, that the reason we all do this job is because we want every patient to have access to the right tests, the right treatment, and not to be lost in the shuffle, right? That's the point. So if the CF clinic is doing a better job than I am, take it, that's fine. I have a 13 month wait list. Let me go take care of someone who needs me. So on one hand, yeah, I don't wanna, you know, give away what brings us money in our bottom line. I'm a chief, I have to get the bottom line, but I also am not gonna fight with CF. I'm gonna choose my battles. I'm gonna go for the ultra rare. Great, let me be ultra rare. Can I bring a different perspective here? There are like, I'm sorry, I forgot to introduce myself at the beginning too. I am a clinical and molecular geneticist and I work at GDX now. One of the things that we see when different outside collaborators approach us looking for patients for their trials, like the people driving the trials that develop the drugs are rarely geneticists. We are not involved in industry where the initial steps of the clinical development is happening. And when the medical directors in pharmaceutical companies have other specialties, their relationships are with those specialties. Eva cardiology is helping develop a new therapy for cardiomyopathy. They, their network is gonna be with cardiologists who is gonna talk to direct to drive those clinical trials in the different institutions. So it's probably gonna be cardiologists. If we wanna be involved in treatments, we also need to get in industry. We need to be in those roles and we need training to do that. We need training on regulatory compliance and FDA regulations and all those things that could be part of our group to be as medical directors in industry and then bring it back. Let me go back. Susan and Julie have both noted that we need to take back genetics at the level of the medical school level. And I think that that's really true. I think fiddling at the, once you get to the fingertip, which is something of what we're talking about, that is that we're looking at the very end of the process about where we're gonna get changes without bringing, coming back and making genetics a requisite part and an integral part. And in fact, I think the part of medical education, we're gonna be stuck and we're gonna be stuck trying to change the things that have already been put in place. And we need to introduce the language of genetics and the thinking process of genetics. I mean, I think you know, when you talk to your colleagues about things that you think differently than they do about disease mechanisms and about how to understand diseases. It is a different process being a geneticist than it is being an internist or being any of theologists. And it's a very, very integrative language. It's applicable to every ology out there. And it really should become a very strong basis of how medical learning is done. And I think we need to really get it back and recapture. I'm not sure how to do it. I think we've seen some people at Rochester has done a good job at getting it to very much part of the curriculum. Hopkins or Dave Valley really tried to make it happen there. There's always been a lot of pushback. But I think that if we can get that operational thing going a lot of the rest of it will flow and will work more easily. But without that, I think we're sort of dealing at the end of the process. And that's very difficult to change. I think to have cardiology, to have cardiac surgeons talk about as this happened here, that we should be testing everybody who comes in the door is a remarkable transformation of that specialty from somebody that we think of as plumbers as opposed to thinking about how genetics fits into their specialty. And we should be seeing that in every single specialty. And we provide the language for doing it, I think. Thank you, Tracy. We're gonna go next to you. And then I don't know if, Maryanne, if you're in a place where you can unmute yourself after Tracy speaks but I was wondering if you might mind, wouldn't mind expanding on this medical home idea which I think is interesting in addition to some of the direct treatments like gene therapy. But please Tracy, please go ahead. So I'm a medical educator at Florida International University. I do not have a clinical practice. FIU does not have a genetics residency. And so our students are really left with nothing unless I'm really pushing super duper hard. And I push really hard. But what about all of those other medical schools? We have 150 plus medical schools in this country and we don't have near that many residencies. And so what are we doing to get attention to genetics in those places where there is no clinical genesis and there is no genetics residency? We've got to be paying attention to them as well. So for the last, I know we only have a few minutes left. I don't know if Maryanne's able to talk a little bit about the medical home comment that she put in which I thought was very interesting. The thing that I want to have us spend at least a little bit of time and I'm going to conflate a couple of questions into one are, and I've seen a lot of this in chat so folks can just mention this verbally to make sure we don't miss key points. So what do we do now? And I'm going to ask this in two ways. This is what I'm conflating. One is what do we do to concretely get more of genetics into medical education or to steal Peter's phrase, take back. I think Peter is what you said, take back genetics education. Are there concrete things that we should be thinking about doing and ways to address that? That's number one. And then much more proroquially and boringly, what should the next steps after this third session on August 29th be? How should we continue this conversation? How do we get the group to keep working on this issue instead of just leaving the Zoom issues with a lot of these Zoom meetings with a lot of ideas but not necessarily next steps. And so I would love for folks to just talk about what our next step should be both to improve things and just to keep the conversation going in the last couple of minutes.  And I saw a comment saying, we're getting this pressure. We can't even get into the first two years of med school.   You tell the best stories. They get that biochem is meaningful because of you. We're gonna keep an hour for you. And I was like, cool, keep an hour for me. I'll be there. This idea of can we help our trainees teach better? Can we be the best stories? Can we be the ones that show the application every day? We have the best stories on the planet, right? But I think sometimes unless we get in there and then do an outstanding job, we're not gonna keep the spot in med schools. I just tell stories. I would follow up that question to everybody again. And to you, when I look at the maps, I think it's that Jenkins et al article and Ginex and Medicine from the 2019 survey. It shows as you'd expect the academic quarters, their geneticists there and hiring geneticists, right? But we don't see a lot in certain other parts of the country, let alone other countries. So I guess the other question, I think going back to Tracy's comment, how do we get exposure? How do we get exposure to the places that might not be connected to Children's National or to some of the other places where folks are? So I'll comment that there is a move within National Organization for Rare Disorders to have clubs at med schools. So they're now starting to ask us to come and talk. So they're getting the CF centers and the sickle cell centers, but every once in a while, if they know there's a geneticist out there, you might be asked to call even if you're on a coast. So call in Zoom has changed how we can get into these, like specialty clubs too. I think Tracy's comments about things are really very relevant. And that is if you teach the language of genetics to medical students and you engage as part of that, the faculty, even if you don't have genetics as a specialty in the school, you teach the language.  And Tracy may have the ideal situation in which to test the model, that is get it in early and get it in hard. We only have a very few minutes left. So we're gonna go kind of in lightning order. And if you guys could keep your comments maybe to a minute and a half and then I'll sum up in three seconds at the end, but I'll go Julie, Matthew and then Catherine, if that's okay. Julie, please go ahead. So my comment was to state that we have a club for interest for med students, for every single possible potential pathway they can take after med school. And at WashU we have one for medical genetics. And I have a student now who's in the interest group and the thing is though that too many of the med students don't even know what we do and it's not presented to them. So they don't have an attraction for joining this particular club whereas the internal medicine club has a lot of student interest or even general Peds or OB. So I think we have to be there and be in their faces and teach them and be a friend to them and tell them all of our stories. And I think that is a really important thing. Thank you. Catherine and I will say I like the vest or the fleece Catherine. Good a good a good shout out. And I'm probably the only one wearing a sweater here. Ray also I'm sure is very hot. I'm in San Francisco and it's kind of cold and foggy today. So wearing my nice APHMG switcher. But so to kind of follow up on some of these comments I'll just say quickly that to refree some or to restate some of the things that came up in the beginning as well is we're really caught in this vicious cycle of we need clinical geneticists to be in front of the students for them to see about that this is a field that it is a specialty in and of itself. And we need clinical geneticists to be taking a lead role as well as many of us PhDs in medical genetics education. But I can say at our institution the clinical geneticists are totally overwhelmed in clinic. There's a major shortage of geneticists. They don't have time to teach. So it's all put on me to do and I'm happy to do as much as I can but I need to have clinical geneticists involved. You need an MD to talk to MDs. Unfortunately, that's the way it goes. To talk to the deans, they really are gonna hear more from other MDs. And so we just need more clinical geneticists to be out there with time to teach and to be engaged with students. So it's kind of this vicious cycle as I'm saying. Right. Maybe we can start a more of a road show movement or re-engage some of what I heard in the chat. Matthew, you're gonna have the last word and then I'll sum up in about 10 seconds. Go for it. Yeah, so embracing the we're caught in the cycle part. I'll just say that I think that a lot of things that were just mentioned, get in front of med students, more teaching, more clubs and stuff. I argue we've probably been doing that and trying to do it for a long time as best as we can with the resources we have. And if anything, we're in no better possibly worse situation we're before in spite of our field getting much more interesting and excited. So I would just caution us to say that we're a small group with limited bandwidth. I don't know if we've done it long enough to test the question of can we influence change from the grassroots level of the medical school? Cause it's a one potential, you know, explain it or not answer that hypothesis is possibly not. Cause for the last 20, 30 years, although we are sure had some successes, globally as a group, we're flat lined in terms of new geneticists and we're having these conversations of workforce. So I just think that we should be sober about sort of that approach. Cause I would say I'm not sure it's worked before multiple times. Yep. Yeah, thanks. I like that a good way to conclude is to phrase it as a well-designed research trial or the need for that. So very briefly that I wanna thank everybody for your time. I know you're incredibly busy. I really appreciate you taking the time out to attend this session and maybe we'll see you next session. I got four themes from this. I just wanna repeat out loud, but please go back and look at our notes and look at the recorded session or share it with others. So money, money, money, that comes up in all ways, shapes and forms. The need for exposure or I really liked what Melissa said about some perhaps some consider some scientifically based rebranding. A lot of interest very concretely in combined programs and the potential that's there to bring more people and people from other specialties. And then finally a lot of discussion on the move I wanted to say from diagnosis but to include diagnosis as well as a lot of the therapeutic and management areas but that would include institutional requirements. With that, I know it's a poorly organized summary but I wanna thank you all again and please feel free to reach out to me. Thank you so much Deb. Thank you Eric. Thanks to our whole team that made this happen and we'll see you on the road or on Zoom at least. Thanks so much.