nclusion and openness I think that needs to be much stronger. And as I've been thinking about this those of us on the city equity task force and then in the other subcommittees and working with the seed so closely we really had to do a lot of internal soul searching and defining on our own what diversity, equity, inclusion and belonging means to us. And council will see in the presentation they're going to present exactly what the broad view of that is. So those of us are a little bit more invested in time with the seed collaborative have a different level of commitment to it at this point but I think that statement needs to be much stronger and really look at diversity, equity, inclusion and belonging as a cultural change into our norm. And then the last thing I'd like to add is we talk about changing it from customer experience that we're looking at external customers or members of the community. I think particularly the city manager Smith's point and some of the things we've been experiencing the last five years approaching employee health and wellness as part of organizational excellence making sure we're taking care of each other and taking care of our employees to be tied into the training of professional development but really that has transitioned particularly in the last five years to also the health and wellness of the organization. So I think it should be included here. So we're making sure that we're measuring external customer service as well as internal customers. Thank you. Yeah, so I just wanted to add on to our equity and inclusion work that Collar made this comment earlier today that it should be tracked and transparent. So it needs to be measurable and then we need to have a way of communicating within the organization and through our residents what is happening and what our achievements are in that area. And then I'd like to see Xerox implemented inclusion I think it was both gender and racial inclusion in the 60s or 70s and they started holding their management accountable for recruitment, retention of employees and it worked. And I'd like to see us do that here that I mean, I know that there's a culture in every department and have the same expectation across all departments would be unfair and not work but that there would be expectations of improvements and that each department head or hiring manager would be held responsible for that along with HR. And then the last piece is that the diversity equity includes that officer we need to have a people employment officer and we need to have an office diversity equity and inclusion that is not under HR. There are two separate functions and it's, I think it was an error of the past that had it in the org chart way it is now and that we're really going to move into the future and take this seriously, we need to adjust to that and correct that mistake. Ellen. If I'm here and I don't speak about this will help I think I get mugged in the parking lot. Actually, I think the bullet is good maybe to carry it along the theme of sustainability is that we swap out ensure to sustain the physical health by doing these things. But I think what we need to add in there is we need to look creatively at leveraging other funding sources. So I don't know if that's state and federal grants or regional opportunities with county and other partners or creative financing mechanisms. But looking at all of the things that we wanna do and they're all very noble good things that we wanna do but they all come with price tag. And there's one that in order to sustain the physical health we need to be able to find those other ways of basically paying for. So that's it. All right. Yeah, please. Just a couple of thoughts. I obviously I should probably speak up because Scott called me out about the asset maintenance and the replacement. There is another components that I think is important because we do have a change or course you have a change in the community and we need to be prepared to make adjustments in our facilities. And the fire stations are actually a very good example of things that were built prior to or gender normalization where we've got now a greater number of women in the workforce and the fire stations or a fire station comes from gender may or may not provide that service. And I think we're seeing that in some of our over facilities that we haven't historically always accommodated for the changing demographic of our workforce. And so when we think about that asset maintenance and replacement we probably need to make another work of justice in there to accommodate the change workforce that we have. And then the last bullet up there. I like the concept of optimization and organization structure and strength and teamwork but I'd like to make a suggestion on the backend instead of deliver results it's accomplish full core services and council goals. I think part of the organization is focused on core services and not council goals because that's the job that they've hired into. And they sometimes feel left out of the organizational conversation because they are filled with pot holes where they are fixing that water line or cleaning the restrooms. And so wanting to make sure that we identify core service in there will help bring those individuals into the livelihood that is with the council goals. Okay. So a couple of just thinking back on Brax Right sizing our resources to acknowledge and accommodate core services in addition to council goals. Looking at that citywide perspective it might be in there somewhere but I think it needs to be said there's been inequities across the organization because we have to focus on council goals. A lot of the last few years but getting back to core services and staffing appropriately to support those. And then I think I might say that earlier just modernizing and embracing modernization of our service delivery to meet the community. And that means mean different things to different segments of our community. They all need to be addressed but I think modernization of how we deliver services is something that we should put in energy into. Amy. On the second bullet for asset management I'm wondering if infrastructure is a good word there because I think in addition to actual physical assets you have to think about technology assets and modernizing our workforce and our processes. So we are more strategic. Again, we talked about this a lot today but I think in terms of creating a culture that should be as inclusion, belonging and openness. And then I think generally speaking in order to achieve organizational excellence it's important that we are able to position the city of Santa Rosa as a premier employer. And I think we have a unique opportunity to try and make a comeback for public service as a career path. I know that a lot of us have talked about the educational system and partnering with schools but I think if we invest in our people we can't go wrong and that's investing in our people related to training and development, professional planning and health and wellness and mentorship and life on learning opportunities. And then in terms of the investment related to education in the community I think that there's some programs that start at the school age level but also Santa State has a master's in public administration program and I think the partnerships and having our staff go out speak to public service as an admirable career at the college level is really important because it's gonna develop our applicant goal for the future because that's one. Okay. Any other comments? Yes. So this goes to the line that has to do with customer experience. Not anymore. I was getting out, it's gonna be a long life but this is short. I think we need to have something in there about first week service provision. We are first and foremost a service provider. I remember one of my city managers in the past said be careful when you refer to our residents as customers. Customers are used to getting what they want, when they want it and how they want it. We're not a store on the daily drive. We provide service and we have restrictions on how we offer those entitlements that we are mainly responsible for as a government agency. So referring to our residents, customers is a little dangerous in a light sort of way. Because they're not, they have a choice. They don't have a choice. We are in monogamy when it comes to entitlements. So they're not customers. They are indeed, they come to us to provide service and we should be offering it to them at a first rates level. So it just works the thing. But I cost, anytime we use a word customer when it comes to the city, does make me a little simple. Okay, you and the mayor are getting pushy. We struck that. We struck that, it's out. No twitching today. Good. Any other final comments on this one? Excellent. All right. So what I would like to do is we have the next slide that we're going to get some help in the back. We're just going to do a quick update. So this is what we want to do. I want to do the word revisions that we have come up with thus far and see if we're getting close. And so on the first one, we need to take it out of the display mode and move it. Or can you do it back then? Okay. Great. All right. So the first one, we changed pursue to deliver. These are for my notes. And you'll get another at that. This is just to recap it. Oh. Yeah, we're just, that page is not here because yeah, surprise. But I wanted a place to recap that whatever the discussion materialized. All right. And for the thing you're calling along. So the next one, we changed to read reduce homelessness and its impacts. Okay. And so the next one, we're just going to like put the insure in red or something because we haven't landed on the word there but we did say something ensure a healthy and safe community for all. So a healthy and safe community for all. Here we go. All right. Then our next one, we are done with resilience. We are moving on to vibrancy. Next, we are going to build and maintain sustainable infrastructure. By the way, it's really hard to type when everybody's watching. So, I'm doing a great job. Me, I would be like, okay. And then I think we're okay with the last one. There were some questions about how do you measure excellence? But I think for now, I didn't hear any major objections from council on achieving organizational excellence. So, it's okay to do it. Just measure it and tell me it's done. Good. All right. So how are we feeling then about the set of council goals as currently drafted? Council members. I'm not sure if the next slide's going to be our, if there's anything missing because what I've been through with each of these is we declare racism a public health crisis. What goal or strategy is addressing that? Then some of us went to leak out for cities. A lot of cities have declared it. Period. What are we doing about it? And I'm not sure what are we doing about it is reflecting our goals or strategy. Okay. And so I guess one of what maybe is, we can, how you can have a further conversation on is a part of your inherent core values, right? And how you operate all the way through which is where we had started on values or does it need to be still articulated as a goal? And that's up to you guys entirely. Exactly. Yeah. This is a conversation that you and I had. This is a conversation that the city manager and I have had that the council members might have had. But the biggest, but the most challenging aspect of this to me is that three things in particular, the diversity, equity, inclusion, work, environmental sustainability and community engagement are three things that are pervasive through everything that we do. So even just the act of making them a goal, silos them off by themselves, when really I expect us to have a DEI and a climate and a community engagement plans in housing and homelessness and in safety and in vibrancy. I don't know if this is where we go back and make sure that that is very clear in our vision, vision and values and then have it filter through all of the goals or if council feels like they need to have a specific goal that touches on all of those. That's the challenge that I run into repeatedly with these. Yes. So I don't feel that I necessarily need a goal for each of them as the mayor suggested, but what I would like is a return from the city manager for how you're gonna operationalize the accountability of the values and objectives through the goals, whether it's having somebody within the organization who nothing gets to her desk if it doesn't have those things within it or some other mechanism I would like to see. I don't think that it's realistic to spell out every thing that we wanna see on this list here. I think this is pretty high level. There's things that I'd love to see on it that I'm willing to let go if we can have a return to us with something really measurable and it can be the conversation that's ongoing. We just asked Ashley to be on the bike rack to make a note around how to operationalize the values and so that that can be something that's on the bike rack to get it recorded. Yes. So how... If a goal is something that you choose and most of these are not all we'll be doing the aspirational. So are they counsel ongoing goals? Should we even be using the word goal? Are they, is there a better word we should be using that suggests this is, these are umbrellas that we will be, that we are constantly trying to achieve or trying to, that we are being aware of. And then I'm not even sure how to articulate because I think of a goal, it's like a race and you're going to win or you're going to keep running. And so if you win the goals and I don't see a speed. If I may be your point, what it reminds me of a little bit is that since we've had more or less the same goals for years now, I don't think you've changed the goals. And with the first year I got in council, we added childcare and the second year we added first year, but we haven't really immediately changed them all that much. It's like at this point, there are initiatives and that, which to me is a more appropriate word. I think maybe we need to, in addition to some of the other changes that we look at that identify goals are these don't, these are. Aspirational. Aspirational. Are they aspirations? Yeah. Anyway, I just, I've been thinking to be clear about what we've accomplished. Right?  Right. Well, and so what we have done is we have tried to give them some action, right? Some action orientation, but they've aspirational in doing that as opposed to the topics, which is also not a goal necessarily. It might be a priority, but it's not necessarily a goal, right? So I think your, your prior goals had public safety, climate change, like they weren't written as goals for say they were focus areas or, I mean, there are a lot of things you could call them, but I think your point's a good one.  That's one way you could approach that. Or you can rename them or kind of repurpose and then your goals can be tied more to your success measures. The metrics that you ultimately, you don't have currently, but as you get there. Well, I think you're right. If we were to tackle something when issues brought up by our manufacturing home, that could be a goal. The change, we've identified potential changes in the ordinance and make those changes. That's a goal. That's something we could be done in one year or however long it takes. But yeah, these are the aspirational goals that I think we need to be clear about. I would put them in the bucket on the strategy and like John said, Tom, sorry. We wanna actually define the goal. The strategy is deliver housing for all. And what is the goal that all of us, to me that's not the goal. That's a strategy? Okay. Well, so maybe this is gonna have to be a continued conversation about what kind of best structure, what the framework is. And we can put that into the report in terms of how to define there being some options for these. So the goal, we can go, maybe we could flip back to the definition of a goal, a strategic goal, right? Bring us back there. And the idea is that they are multi-year in nature. As you're pointing out, they might be lots of years in nature, but they span time that you're working towards them. So here we go. Provide direction and focus of the organization, which I think this conversation today has, I shouldn't speak up about this stuff, but it gives direction. We wanna focus on increasing housing and building housing on addressing the homeless issue that gives focus. Building and maintaining sustainable infrastructure that gives focus. And so that's part of what we're trying to do goal in their multi-year nature. And then from there, you have the how. And that was the conversation we had about all the strategies. What are we gonna do? How are we gonna get there? Which then leads you to your work plan, leads you to your budgeting, all of those more tactical pieces that will come back to council. And that includes how you measure success. What are the metrics that will tell you if you're moving in the direction of the goal? So if you're talking about housing, if you're defining what it is you're trying to accomplish in terms of the work you're doing on a regular basis, regular repetitive work, and is it moving the needle? Let's go in the right direction. Am I supposed to come up? Go ahead. Yes, so I did say that backwards. So I'll come up with that. I'm not trying to sell you guys on a model, I'm just trying to figure it out. So I see overarching goals as a destination and the strategies that move us along that way to that goal. So I do see that overarching long-term goals are a good way to map out what we wanna focus on. That's how I see goals. Because what gets focused on gets money behind the programs behind it. So if it's housing, we certainly know we're not going to fix that in one year. But the long-term goal is probably gonna be there long after even we're here that housing's gonna be focused on. It's the strategies or the smart goals underneath it that I think that get tweaked every year. So while we need to affirm, I think, as a council and as staff members to say these are our long-term goals or destinations of what we wanna get to, the strategies change year by year based on what's happening in the world around this. It's based on who's at the table and what our lens is when we're looking at the strategies. So from my perspective, maybe it's because I've done a million goal settings with smart goals, I'm comfortable with this and we all know that we stick to what we love. So I see it as an opportunity that we aren't saying this is for sure what we're going to do just this year. And to your point, you've had some of these same goals for a long time because of the continuous issues that come up in a city. And so I don't have this comfort in calling them goals. And I do like the opportunity to change the smart goals and then as far as the metrics go is where I would see the opportunity to focus on those three things that they mentioned around diversity, equity and inclusion and the environmental as well as what was the lab. Pardon me, Mayor Rogers. Those would be to me something we would want to see perhaps from staff in a measurable metric of these are how we're seeing these results from these three things under this goal. Other, yes. I just wanted to ask a question. One of the goals that was stated related to homeless, just want to confirm that there's no concern about the negative connotation of homeless and its impacts. And so I don't know if Council Member Schwedholm has an opinion since he's working very closely in this field, whether the advocacy groups out there will see Council is taking not necessarily proactive approach by identifying those words in their goals. Especially in the community that is engaged in there's no way we're going to please everyone. Because someone's going to have an opinion about I don't care what we do. I think this captures it for its purposes at least that we've reestablished. I don't know what other words someone might want to suggest but I think that's good enough where it is because it is a complex issue. You're not going to find five words that capture everything that's going on in the community related to this issue. Yeah, and if I can, one of the bullet points was about how we address the campus. And that specifically talks about the health and safety impacts on the community. But I think it needs to be included for lack of a better way to put it. I just, hang on, but I think it acknowledges some of the limitations we have with the Boise decision and the injunction. So we do have some legal limitations for what we can do if we need to work around us. Okay. Do we answer your concerns? Are you feeling like we still- Yes, I just wanted to make, sorry. Where's that one you asked? Sure, go ahead, go ahead. Sorry, I answered my concerns. I just wanted to make sure that- Right. No, no, no, don't apologize. Because I understand- You know, it's not, I don't want to follow my story. This particular issue, if I still kind of wonder about the definition, future councils, these can change everything. And certain councils may have very short-term goals that might get, so some of these could actually be placed over the years, some goals that are very short-term. Do they become short-term goals? You know, I guess that's what I'm looking for. How do we justify this body of work to future councils? So the next council, next year, when they're looking at these goals, what might they have, what could they be confused about what they need for these goals? Right. Given the long, the potential long-term nature of August long-term nature of the majority. I hear your concerns in terms of how do you hold on to them when you're going to have turnover on council. Right. Council member Fleming, did you have your- Yeah, as somebody who was new, not that long ago, when you're a new council member, there's just general confusion. And I don't know that you would go down to this level to become confused, necessarily. But your point is well taken. I think though it's different about this goal session, setting sessions for our last ones, is that, you know, and again, I wouldn't say these are initiatives rather than goals, because they're so broad. But is that we had tier one goals, which were these things that we knew we were never, not never, unlikely to achieve anytime soon. And then our tier two goals were things that actually could be achieved and were going to be achieved at that time allowed. They were much more specific, like adjusting the CPI for mobile, or minimum what you could think of that, but we've got that. Didn't have that. Okay. Suggestions or ideas or bring back the report. You guys can look with fresh eyes. What are your, what's your pleasure? Okay, you got it. I like the idea of prioritizing them as they come back from staff. If it is some sort of aspirational goal that is going to take multi-year, multi-hours, that type of thing, I think that's good to know when we're looking at prioritization. Can we do something that's kind of going to happen in the next 12 months and how do you prioritize it? It's similar to what you do when you're trying to maybe legislation. You can prioritize the bill based on how much staff time you have, how much money to appropriate, find it, because you're looking at, is it going to go through or not, or it becomes a little bit lower priority? Not necessarily because it's not important, but just because we don't have enough resources of time in the next 12 months. So I'm wondering if there's a way once we have the full report to be able to come back and say, let's do the tier one, tier two again. I don't know if I'm comfortable doing that today without staff input because I think that that would be an important piece for us to know before we can say, this is a tier one, just based on feedback that I think we need. And that's an important point that this is step one, right? And so you will have the follow-up to be able to look at this, both in terms of budget, you're prioritizing when you make budget decisions, but also in terms of a work plan and understanding what the choices are and what can be accomplished this year and what has to wait, and also creating those metrics. So Rikisha, any comments you want to add? No, I was just going to remind the council that we still have the American recovery fund that had to be prioritized, I'm going to say second because core services are first, then we have the American recovery and they're pretty detailed. That's a lot of money to spend. You need to make certain that the dollar amounts that we've actually allocated to it, that we're going to spend it all, because there could be a potential case that we come in under and do we need to go back and submit another report because that spending report is already in. So we have to look at that on top of this as well. Well, this becomes a strategic plan and the elements of this, which is sort of what we're describing is your roadmap. So maybe if you think of it that way, this is the direction that you are trying to move the city and move forward. And I completely hear the concerns about, well, what happens if you have a change and all of a sudden it's like, well, now we can pick something else. It's like over here. Well, then you has a body, talk about that and how you want to address it. But the way that these are written, they're certainly intended to have some longevity. And so it's how do you make sure that you're comfortable with that and that they are important for a foreseeable period of time. Evaluating annually what you're going to prioritize within that, but this is a broader framework. And I get it that it's departure from prior practice. And so maybe it takes some time to kind of practice or to acclimate or to tweak to the way that you want it. So. Just worth going to China to say, I think you kind of described, you'll be getting to it here in a future slide, which is the establishment of council goals and then the strategies that go with that. That's the establishment policy for what staff is going to then be bringing you with specific tasks and implementation or specific projects. And so looking at it in that format, which is these are overarching goals. This is the big picture of what we are as a city going to predominantly be spending a majority of our effort to focus on with the strategies being, this is that roadmap. This is how we're going to get there. But then staff's going to say, okay, within that policy framework, here are the projects that we think we want to undertake. Here's how they're going to be smart. There's strategic measurable attainable and realistic and timely. And so it's up. We're going to be taking this large policy document and coming back to council with specific and strategic projects or tasks. And I think a lot of the things that we've talked about previously, we had projects and tasks that may have been labeled as goals, but they were really specific projects and tasks. And trying to create that framework of goal strategy and project or task is I think is a good one because it will definitely help staff as we go back and start to strategize on our own how we're going to work toward this end product. Okay. So council, are we okay for? Okay, I'm seeing. Yeah, okay. And again, hopefully when it comes together and the report that comes back to you, you'll think, okay, I'm comfortable with this and where we're going. And you'll work within the framework, hopefully as you're prioritizing more details. All right, let's take five. No? Well, I mean, we can go to that. I don't know that we have any more. Unless there's anything, do you want to go to the next slide? I was going to take a seat. So if this was our, we've kind of just done this, I think, but I'll let you reflect. Yeah, I think we just did that too. All right. Do I just keep plowing career? Okay, all right, we're going to hop. All right, so the reminder, the next slide is just a reminder that we've already just been talking about with using smart goals in the next steps and we can't do, you want to need to prioritize. And then we're going to talk about our wrap-up topics. And so working together to get to success and then specifically council, what kind of updates and communication are helpful to you? So let's start off with a team sport idea, all in this together, right? To be successful, everybody in this room and even those who are not need to have clarity, have to work together, understand roles and navigate that together. So council says policy, we know this, staff implements. And that's the, those are the lanes that are most productive, but you can find yourself to stay there. One informs the other, the other informs the one, goes both directions. So what I would like to ask, first of all of council is what do you need from city manager and staff to feel informed and prepared relative to these goals that we have been talking about? So this is a question for council. What would be helpful, what do you need? Okay, Mayor? Yeah, I guess I'll start. Clear flow of information. I mean, that's the biggest one. Most of the time when we get questions from the public, it's about what are you doing here? When is this project coming forward? All of those sorts of things. And so just having the ability to provide a level of constituent services where we're helping to facilitate that flow of information from the individual staff member who's the most informed about the project to the person who's most impacted by the project is really helpful. And you'll see, I mean, I know we all start to get the same ones from people, but there are district-specific ones. I'll get emails that other people won't get. And so having the ability to work with the city manager to get those answers and that, and like I said, I think if my job largely is a conduit of information for the public, that to me is what I need the most from the city manager and the staff is clear information and timelines. Excellent, thank you. Vice Mayor? Secco's comments. I believe that being informed of where we're at on different projects throughout the city of San Rosa and you're actually right being able to convey that information to the people that are the most in a timely manner is definitely only interesting. To those that affect us as residents of the city as well, where are we with our future projects? It's definitely powerful. Okay, so again, those regular updates are, it's good. We'll talk about the means for that in a moment. Other comments, yeah. One of the things really has been important to me has been realistic cautious when it comes to policies that we may be beginning to make policies that we're developing, maybe not quite baked that we're thinking about it and then have those reports from staff that give us all the information we need to know positive and negative about the path that we are potentially going down. And that has been really important. And also as we always throw things into the bucket as the year goes on, some of those things that we throw into the bucket can be so taxing on staff that they have to say, well, you need to pick, you need to choose. Unless we hire up, we can hire people. That's possibility. That's the decision that could be made at that time once we hear the caution. But it's important to know how our policies affect prior policies and the development of those policies or tasks for staff, especially when they are. So when their capacity is stretched. So those cautions are. Yeah, I think that's a good idea. Great. So I know on the agenda is we put the fiscal impact, but what I think might be helpful is if, if the council is to take a different direction and not go with staff recommendation to put maybe four, four council that that would have a different impact on the fiscal budget, either car or future, just so that we're clear. Sometimes I think it's there pretty clear. But I think that if the council is aware that if we make a different decision, how it's going to impact this physically or if we're directing staff to go a different way, what that impact is including staff crime. I think a lot of times we ask for things from staff, and we're not actually accounting for the fiscal impact of asking staff to draft or do something different based on their hours. So incorporating the staff impacts not just the fiscal impact. I think that could be helpful, especially when we're dealing with limited staff in many capacities right now to have an understanding. And I know that's really for the city manager to, to be able to have that oversight oversight, but I think it's also important for us to know that we're asking for something about how much time that could take. So that would be helpful. I think it's also important for us to know that we're asking for something about how much time that could take so that we have a realistic idea of how long it might be for it to come back, even for public to know. That's my finding. Oh. Sorry. I was just coming around. That's all. So for me, city council need from city manager and staff, no surprises. One thing I would really appreciate is things that things happen in the organization that we never hear about, especially some of the parts of the long time employees. And you hear about it.  And if we truly are part of the team, it doesn't feel like that way all the time.  You know, there's been some other exceptions, but there's been some other long-term employees that I work very closely with every other government. So being included as part of that team. And also chair. Staff successes. I'm more often. You've been doing the next job. About getting more and more communications with staff or with council. I really appreciate that because again, that goes to feeling belonging that we are. We are. The longing. Yes. So in the. Definitely, I think that our teachers and our city manager, I've gotten more communications, more clear communications and more communications before. I found finding out on a newspaper than ever before. And so I just like to take a moment and say that I am getting a lot of information that I need. And the other thing that I really appreciate is that. When I have the most brilliant idea in the world, I really appreciate that. I really appreciate that. I really appreciate that. I really appreciate that. So. My teachers find a company that is not really all that stellar. So. You know, as far as what I need that. I'll type up if I'm not getting what I need. And. And then we'll talk about it in there. I'm feeling pretty good. Excellent. So that opened to honesty. Reception. Great. Okay. Good. Anything else you would want to add to that. That's a great list of. Things that are helpful. All right. So I'm going to ask Mary. First of all. Thoughts on what would be helpful. So one is trust. So, you know, Hire me to leave the organization. And. I hope that when I'm breaking you information, one that it's clear. That you understand it and that. You believe I'm giving you all the information, but you make the best of it, right? Listening to the needs of the staff. In addition, finding one avenue to drive policy. I feel like we have a lot of weight that we're driving policy right now. I won't call any names, but I feel like we have a lot of ways that we're driving policy. And sometimes I'm blind blindsided by that information. I'm here to move your agenda forward. It's going to move forward. You know, I may have to prioritize it a little bit. I'll move it down, but it's going to get done. And for the most part, just communicate. You know, communicate when you're happy. Communicate when they're not happy. Let me know what improvements that we need to make. Because we have such a small window of time in local government. Right. So I want to be able to make adjustments when I need to. Anything else, anybody else on staff? When I add in terms of, will it be helpful to your success? All right, I'll jump in. Action speak louder than words. So support of these initiatives. All the way through is always a great benefit. When we, when staff. Works really hard to get these things all the way through the process through the engagement. And it's always a great benefit. Through sometimes appeals and gets to council. We really do look for council support. It's great when we have unanimous support. And I know that's hard. And I know there's a lot of work that gets done to make it unanimous, but I cannot underestimate how powerful that is. I have that kind of alignment. And it gets. Credit to the process of tier initiatives. So that that sort of final result is all about that. I'll just add one more. I think it gets combined with what. Artisha and Claire both mentioned. It's just the appreciation of staff. And the successes. Even if the success doesn't quite achieve the line, but gets us closer. You know, I think your team works extremely hard to try to deliver. A lot of great issues and projects.  Council. So that would just be my, my call. Okay. All right. So let's just touch on this a little bit, but I want to underscore the next slide, which is about updates and communication. We can all agree that that's very important. It's not always easy. It's sometimes imprecise. But there's a commitment to doing that well. And so in thinking about. All of our discussion today and thinking about the means with which you currently receive information. You know, what, how are you receiving it now? And what's working well and what would you like to see change? One of the, just I will deposit this. One of the things that has been a recurring theme all day is. Metrics, metrics, right? And so, you know, that's an example of something that might be beneficial. I don't mean to, you know, see the thing, but just to get you going. Comments. Yes, mayor. One of the things that I really appreciated over the last couple of years, it mostly started with a fire. We've incorporated it on a number of different things is a data dashboard. That not only gives us a way to push things towards. Push the public towards information and data that they can then check up on, but also it makes it so that council members that particular interest in the topic. Don't have to both bother staff and then wait for a response from staff on things that are of high public interest. So for example, the, the dashboard that shows the rebuild numbers, something that I look at every once in a while, just to see sort of where we're at. And otherwise it'd be emailing Claire emailing the city manager to email Claire. And that's, that's really, really helpful. And I know we're moving in that direction. So I just wanted to appreciate that. Perfect. We're a little bit about dashboards really. Okay. What else? It's working well. What would be helpful? The staff reports are working really well from a brand new perspective of coming in. They're very thorough. They, you know, of course I'm going to have questions on the agenda. But I think that's very helpful to have not only the staff report, the presentation and all the data that you give us ahead of time in the agenda. Really, I think it was an opportunity to prepare and, you know, ask those questions. I think as a council member, being able to ask the question and then get them the information back in a timely manner is, is really important to me so that there is no surprises for, for either of us. I think that, you know, as a council member, if you have a discussion, you, you more than likely will have that beforehand as well. But I think that that's working at least well. And then anything else that staff send out on a regular basis to make sure you include me now in that. Distribution list would be great. That seems like a reasonable request. Other comments. Information how you want to receive it, how you are. Yeah. Thank you. Thank you. A couple of years ago when we first were moving into district elections, we did have a conversation about how we wanted to handle events and things in specific districts, not that we've had many of those last couple of years for obvious reasons, but I do feel like staff is doing a really good job of letting the whole council know about things, but also working directly with the district representative to be involved or to be there for the ribbon cutting, for example, for the part that was in Eddie's district yesterday. I think that staff has fully made the transition to thinking about things both in terms of the city at large, but also the district representation focus. And I appreciate that as well. Thank you. I'm going to make a comment on the vein of sharing information. One thing that was particularly helpful when I was on the water advisory council was Jennifer would report pair. There were quite he felt to maybe not this detail and lovely of those, but prepare a few bullet point takeaways from our subcommittee meetings. Oftentimes, you know, when I'm in a sub community, I'm so very focused on the work at hand or leaving the meeting The actual and calm really good at reporting this out but getting assistance reported with report out so that because there's so many things that happen and if I don't sit on that committee, I don't frankly know what's happening. And also, some, maybe a monthly or five monthly report out from our board the commissions on some of the items that they're working out and that's coming from us because, well, I try to watch all of those. All of your subcommittee meeting every once all one switch to the track so just sort of that informational flow so that when things are about to come to the council, you know, begin to prepare ourselves. So for me what really works out well it's just the communication. It's like, I'm the city manager. There's no agenda what do we need to talk about. Right, so it's not a party established. What do you need and I say the same thing to her what do you need for me have to help me be successful. And I just like that format. I also do appreciate access to staff, because I am engaged in a lot of different arenas that touch other parts of the organization. I don't talk to one or two employees. Right. That's not there. We're all again, being part of the team. I have a different role in the team, the new director of one of the partners that I'm a support device person. So I just like that communication and building that trust. I think that was your word is building the trust that we're on the same team of trying to accomplish the same goals, which is, you put up with me once. Cool. So, I'm not sure if councils may be provided with some of different from the water board or from the different departments, maybe update on just like we're working on these two things over the last couple of months. Just because right now I seem to be a little bit popular being asked to go out and speak about what we're doing. So I'm trying to learn as much as all of you know for many years in the next two weeks. So if that would be very helpful at least from my perspective, if we're being asked to go out and speak about what's happening in City Council, I'll never be able to eloquently do what Mayor Rogers said. You know, any question that comes in and I think just arming it so that we could speak as eloquently as possible when we're at representing a community that would be really great. We as a council have become accustomed to some really great staff reports and presentations and all the information necessary to allow us to do our job and community community. And I want to do a special shout out to our 15 and Stephanie, the gatekeepers of detail and general information that allow us to do our job without their knowledge of zoom without their knowledge of getting getting every week. They have an obligation due to our commitment to the community about our transparency and giving the community as much time as possible to get up to speed on the various issues that we're about to speak about is a real challenge. And I think that doing an outstanding job. And even if I can't find something. It's the answer is always let me just send that to you now. And I do that are fairly. I get a little overwhelmed by computers. And they, they always do it just such grace and dignity, thank them for because I don't know what to do without. And, you know, I've got to say, the staffs that I have experienced for the years, they are all so incredibly dedicated and none more so than the staff we have right now. Just really, if the community knew the kind of dedication that our staff exhibit on a daily basis to this organization in the city. I think that there would be probably fewer criticisms. And more appreciation, because they are just a stellar organization when they sell people and now guided by stellar. Thank you. All right. Well, it's hard to end after that. Anybody else have anything to add. Okay, so let's flip over and just summarize kind of our next steps home stretch guys almost done. And so, as I mentioned several times during the day, all of this work that you have created that we've been capturing throughout the day will be brought back to you in the form of a summary report. So you'll have that all documented fresh eyes you can look at it and if there are areas that require refinement or we are tweaking, then that will be the time to do that. So we'll be working on that to get it back to you for an upcoming council agenda. You'll hopefully adopt those goals and strategies. And if there's some refinement ultimately you'll get there. And then from there, staff will be working on plans to deliver on this and creating the budget and developing some metrics and so that's kind of the flow that will be forthcoming. And this will take time as they're building. Consider the building blocks working together. So those are our next steps I wanted to just kind of close them with. First of all, I have an evaluation form so please don't escape until I have handed those out so we can get to your feedback. But I would like to stick, you know, I think it's nice to have a couple minutes of just any takeaways you have from today. You know what stood out to you. Any thoughts or closing comments you might want to make don't feel obligated I'm not going to be around the table everybody, but if you want to share any kind of final takeaways, I would invite you to do that. Just because it's still sitting with me and I'll put a black cloud hoping the whole comment about racism with public official I didn't hear any reference to it. I'm a staff member, we declared it at the public health crisis are going to do anything about it. So I don't know what the takeaway would be from staff as to where the ones that said it all seven of us I'm pretty sure it's seven. Oh, I don't know what our next steps are because, as I said earlier, I didn't see it anywhere in here so is it a non issue. And you know, any of me reference to back in 2020 when we had those listening sessions those conversations, and that was rich conversation. And you know I'm not married anymore so it's been somewhat radio silence for that that's right. It's rich is a difficult conversation. And I'm just not sure we choose to not have the conversation or someplace else. I don't know. So unfortunately that's what my takeaway is. Okay, that got missed. Okay, so I just get incorporated into there. Okay. Other reactions or comments I don't want I don't want to leave that just hanging I mean is there a way to. What are your thoughts about how we might make sure that that stays front of mind clearly that's an important topic. Yes, we do have staff working on next steps for that. I know you haven't seen it so that's the communication gap there, but we have our community engagement team following up on next steps measurable performance about what that means. I know that came up at the meeting when we declared that what's next and so we haven't showed that, but we will, and I hear that it's important. But in terms of the framework including how you're articulating what you're going to focus on, I hear exactly what you're saying. We need to find a way to make sure that that gets recorded. Yes, ma'am. I think this is a question for the council member for perhaps adding a strategy and I don't know the full point to fall under achieve organizational excellence or ensure a safe community for all, I think probably organizational excellence. What about adding a bullet point that says, finish and implement the scene collaboratively. I'm not sure if that is the focus of the scenes five years for that. That was very helpful, but thank you for that. So, I think our next policy with staff is doing, because I know we did have a conversation. It just really resonates. One of the cities when this one woman talked about Yeah, a lot of us have done it, and it's creating science and I don't want to be one of those cities for the leader in the North Bay, let's act in this arena. But again, a good fact, I know our community is so many, so many people. Oh yeah, too much. They have enough resources to actually do a council that seven of us are asking. Yeah, it seems to me, does that become one of the bullets under the insurer, I don't know how we revise it to ensure safe and healthy community for all. It's, it's healthy part of it, that is the racism as a public health crisis. So, correct, that's where we are looking at it from a staff perspective already so you can lose the sight of that and it's part of our community empowerment plan process. Okay, so we can include that as a strategy then and articulate it and yeah, I appreciate you bringing it up again and making sure that we have this conversation and it has a home. And just to clarify, because I'm not knowledgeable the seed collaborative is is related to this is something what what is that is different, different. Okay. Right. So we might have some clarification on the next steps as far as some of the things that were mentioned today. Not the one that Thomas mentioned, but the mobile phones, the manufacturing homes question. The, the annexation question that the mayor mentioned, where to those, where will those other comments and suggestions that were probably a little more specifically goal is potentially embraced by the council, because there was a the manufacturing home issue is brought up by a couple of people in the community, I brought it up, the council has not had an opportunity to discuss it, and what do they want to move forward with that. Is that something that we're going to time and energy into the world have staff with time and energy into how that those issues get dealt with now that they've been surfaced in this. Thank you. I'm not sure I'm the right person to respond, but I'll, I'll give it a shot. As I understand it, those would be part of what staff evaluates when we're looking at what are our next, what are the plans that we are going to propose implement these are the goals and strategies. I can't tell you right now whether the whole part issue gets incorporated into that or not, but those would be brought back to the council to evaluate our work plan, what our next steps are. That's important to the council, like the city manager, their comments, but that's why I understand what you want to say. Well, I appreciate that. And before we hear from the manager what we're usually left with more of what traditional environment are these sheets with red dots. So without doing the dot exercise.   So that's why we do the aspirational goals and then staff can come back and tell us, here's what we think we can do to achieve these goals this year. And I'm not believe me, I'm not complaining about losing the dog exercise because it was so often gained anyway so there were some effective. Oh, so that's kind of what I'm so in what we have. So I got the question, but what are we going to replace that with how do we, how do we know what direction we will now move it. So I think some of that conversation come back when I had the discussion about policy direction, and is it going to be driven by council committee committee, or you know how are you going to drive the policy direction. So I can direct staff to operationalize some of these items I think maybe we could bring back a report and study it if it's of interest to you. I just need to know. So, but even if we break back a report, and we talk about the short term or medium sex of it, you know, then it has to be at the end prioritized. But I don't there's nothing wrong with study, you know, we want to talk about manufacturing homes. I think it's something that we can talk about as a team, and tell me what, what are you looking for. We can study it, we can have a study session on it bring back a report. And from there, you can guide us, give us the policy direction. Maybe we put dots on the bike rack. I get the mayor's points about the top of the dots but I would say that one thing that is really helpful about that is that it's an interactive exercise. We're so passive in this role we sit here and respond to what we see. Whereas that allows us to really engage and do this kind of work where we say, you know, if this is really important to me and may not be really important to you, what's really important to you and it allows us to sort of prioritize as a policy body. And to make agreements amongst ourselves and the movements for it and that is the piece of it that I really miss is being able to engage in that way.  I get it and the council really wants to do a dot exercise they can do a dot exercise. But for me, but for me, it doesn't help us, because it misses everything that's important from core services to delivery timelines. It is a task list or a check box that we put on it and it that works very well for specific items like the mobile home rent control ordinance that makes that very easy for us to go back to the team and say that's what we're going to do this. But that checking that off the box that nothing in terms of telling us how were we actually doing about achieving strategies to keep people falling into homelessness. It's an item on it with no data attached to it on impact that it's happening to the manager and I think Megan was going to jump in at one point as well. I was just going to pull up with the mobile home organization that we are actively working on it. It's the capacity issue. We've had a request for proposals that twice no respondents so now we're developing our next steps for how we create capacity to address it. So it certainly is not our work plan, but we are attacking tackle. And I'll just say I think what you heard and what we were just talking about those are work plan specific items that we actually didn't discuss today. So, you know, without wanting to get in trouble with my boss. I think that's part of the coming back to counsel is, here's the work plan based on the goals and the strategies that you've asked. Here's what staff is intended to do. If we were to do something like the mobile home case that we would look to counsel to say, hey, we thought that needs to be a part of this. So, so for me that's the way I view the, especially the couple of the public comment they were here today, you know, but it was southeast green where the mobile home or the bikeway cruise improvements, you know, wanting those as specific work plan items. And that's that's coming. We'll bring that back to council. And, you know, staff sometimes the shiny object syndrome as well. They're such a professional staff and they want to deliver so when you bring them on item. They just want to run. And I have had to say, we got to stop we got to stop we got to slow down. We got to think, you know, because I'm going to tell you, every time I meet with another staff member, it is just like over the I have high expectations. So, even when I'm communicating with staff to say, hey, are we doing this, are we doing this. I'm trying to learn to pull back as well because I'm like, oh, I got to reset. So you have to remember, when you bring something to staff's attention, they're running to get it done because that's just who they are. I couldn't ask for a more professional dynamic staff. So that's why we're trying to set, you know, some boundaries set the goals try to figure out where we're going to go next. And even with the metrics we have to look at what what we're going to bring back to you and from a metrics perspective right because we have to look at what are we actually collecting.  So I don't want to bring you information that is actually not usable are accurate. So, and that's why, you know, I am going to have a conversation with each council member to talk about, okay, how are we going to drive policy directed because we do need to be innovative that we do need to be able to pivot at some point. But at first let's just get the work plans together. Let's get back to being what the city of Santa Rosa needs from us and then and then we can do it. So, but I am going to tell you we have the shiny objects syndrome to, you know, you tell us to do something and it's like, yes, and then they're like, Oh, I'll have time. So, you know, just, you know, keep that in mind they want to do their best best for you. Okay. So first of all, for those who are looking forward to that exercise. I'm so sorry. I have got to buy bags by the way. But I think if you think of this as a big step one, and I recognize this is a departure in terms of a framework and how you're approaching this. So, again, trust the process, you built this framework now that will get built in with the actionable items items that you're familiar with and you're going to talk about, as they come before you, you'll have plenty of opportunity to prioritize and to wait those items through that process. And so, I would just invite you to kind of try something new on precise and, and if it doesn't work, then, you know, nothing lost you can always add next next year extra dots extra dots for all. Is that is that fair. But even for you maybe. I don't get the mayor next year. Yeah, there we go. See when we have new mayor new dots. Okay. So with all that, any other kind of closing comments or takeaways that would be like to share. Yes, completely off topic but I didn't want to thank my colleagues for changing the dynamics on the dice, especially as a benefactor of their vote and support. I don't see Councilman Rogers here, but she's joining us on Zoom. Just want to say thank you. Hey, and I'll just make my final comments and it's a big thank you to everybody for being here. I think part of the reason that we've been able to shorten our goal setting this year is we have a team that's already growing in the same direction. And to me that says that we have a team that is invested in the community that hears the same things that Council members are hearing is trying to be as responsive as possible to the needs of the community and everybody here who loves Santa Rosa. And so there's not a whole lot of dissension in terms of where we're going when it comes to our most critical issues whether it's housing homelessness or public safety or transportation, because everybody who's in the room and everybody throughout our organization has been living it for a number of years. So I want to just thank you all for the hard work it has been a lot. And I do appreciate that we have the chance to stop and talk about the accomplishments from last year, before we then ask for more. I think that's important for us to do, but your teams are all extremely efficient. You work very hard, so dedicated to the community. And Council members appreciate that and see that work every single day. So thank you for taking your time to be here as well and thank you for Council members for doing this process. Even though we talk weekend and we doubt about what our priorities are from the day as it's nice to also hear from folks who don't have the microphone. This is a group that we haven't spoken too much about today. And that's our volunteers that do our boards of commissions. Don't get any kind of pay or oftentimes acknowledgement. I don't know how we would do what we do without without our board. Our volunteers that do so much to help us do our job. And they're not part of this. And they probably have some pretty good ideas might want to listen to the future. They do they do great work. They're appreciate. All right. Any other final thoughts. Okay. You should all have received an evaluation form. And I know I'm going to hear about dots. That's okay. So if you just take a couple minutes to provide us your thoughts and feedback, we would be grateful. What work would you change? We know the answer. And then we will be able to adjourn this workshop. Thank you so much for letting us be a part of your day today. Appreciate it a great deal.


to do for Bradford here and really forced into trouble a slip from the keeper but it gets away with that one Now they attack on at the other end instantly Bradford on the front foot Chance opens up for Roe, Roe's in and it's underneath Thonsley and Bradford are back ahead It's a debut goal for Danny Roe here for movement Bradford might be in for a third And they are and it's a second for Evans Slips the ball underneath Thonsley Bradford look like they are extending their own beaten run in league two to seven Looking to make a fast start Oh, what a lovely turn.


Hello and welcome to the session. In this session we will discuss a question which says that find the values of f of minus 1 by 2 and f of 2x plus 1 the whole, then f of x is equal to 2 into x plus 3 whole square and second part is if p of t is the population of a city after t years from the year 2000, interpret this statement p of 0 is equal to 456,300 and p of 10 minus p of 9 is equal to 4500. Now let us start with the solution of the given question. In the first part we are given a function f of x is equal to 2 into x plus 3 whole square and firstly we have to find f of minus 1 by 2. So there let us put x is equal to minus 1 by 2 in f of x and here we will have f of minus 1 by 2 is equal to 2 into minus 1 by 2 plus 3 whole square. Now here we will have 2 into, now taking LCD it will be minus 1 plus 6 whole upon 2 whole square and this is equal to 2 into, now minus 1 plus 6 is 5 upon 2 whole square which is equal to 2 into, now 5 square is 25 upon 2 square is 4, now 2 into 2 is 4 so this is equal to 25 upon 2 therefore f of minus 1 by 2 is equal to 25 upon 2 and now we have to find f of 2x plus 1 the whole. For this we will replace x by 2x plus 1 in f of x and here we have f of 2x plus 1 the whole is equal to 2 into plus 1 the whole plus 3 whole square further this is equal to 2 into 2x plus 1 plus 3 whole square which is equal to 2 into 2x plus now 1 plus 3 is 4 whole square. Now using this identity that is a plus v whole square is equal to a square plus 2ab plus b square this will be equal to 2 into, now let us denote 2x by a and 4 by b so this is a plus b whole square that is 2x plus 4 whole square which will be 2x whole square plus 2ab that is 2x into b that is 4 plus b square that is 4 square the whole further this is equal to 2 into 4x square plus now 2 into 2 into 4 is 16 into x that is 16x plus 4 square is 16 the whole further this is equal to now 2 into 4x square is 8x square plus 2 into 16x is 32x plus 2 into 16 is 32 so f of 2x plus 1 the whole is equal to 8x square plus 32x plus 32. Now let us start with the second part now here we are given p of t is the population of a city after t years from the year 2000 that means we have started calculating population after the year 2000 also we are given p of 0 is equal to 456300 it means value of t is equal to 0 now t is equal to 0 means after 0 years the population of city is 456300 initial population that is population of the city in the year 2000 is 1300 year given minus p of 9 is equal to 4500 that p of 10 means population from the year 2000 that is the year 2010 p of 9 means population after 9 years from the year 2000 that is the year 2009 and here negative sign notes difference of 100 of the given question session hope you all have enjoyed the session.


شكرا لك دكتورود للتساعدة شكرا all for coming It's great to see familiar faces, friends among you here And to come to MD Anderson on a beautiful spring Weekend of Easter, this shows your motivation And your advocacy for this field So this is my disclosure slide So this is a timeline of the several of the therapies we have now For Riyan Sakkar Sinoma We have 11 therapies approved by the FDA And are available in the clinic Starting with high dose interleuk in 2 In 1992 And over the past decade or so We've had 10 therapies come from December 2005 With the first target agent Sourafnib And then a month later Sunitnib Which you heard about from Dr. Yonash And then Tamsir Alamisi Which you heard about him Also the mTOR inhibitor in 2007 And while several of these agents Can be used in the first line Or second line or beyond Really what I show here in this Is the 5 drugs that are used in the second line And beyond Meaning third line, fourth line, etc Everolimus, the mTOR inhibitor The brand is called Affinitor And Aksitinib Which was approved in 2012 And that's called Enlighta And that's another VEGF TKI A drug that starts the blood vessels It starts the tumor by blocking the blood vessels And then 3 therapies came In the past 18 months or so And that's the immune checkpoint inhibitor Nevolumab or Aptivo in November 2015 And then in 2016 In April, Cabosantinib, Cabometix And then this doublet Is a pair here of Linvatinib Another tyrosine kinase inhibitor A drug that targets the blood vessels Plus other things And then again we see here Everolimus being paired in combination So since 2015 The RCC landscape for second line And beyond has rapidly changed And here we have these therapies And I'll be going through Each one of these trials That led to the approval of these therapies Nevolumab I'll start with Nevolumab first And the study that brought it Is checkmate 025 Then I'll show data from the Meteor trial that brought in Cabosantinib And then a study called 205 that brought in Linvatinib plus Everolimus So it's important to note That all those 3 trials Were conducted in patients With the most common type Of kidney cancer The clear cell Our conventional type Riansoccasinoma And it's also important to note That the majority of patients Treated on these trials Had good or intermediate Trisk disease And I would like to thank Dr. Yonash for the grocery He provided So I don't have to go through this Again the definitions Of what good, intermediate And poor risk means And coupling mild curves Progressive free survival And overall survival etc So first starting with Nevolumab This is the design Of the checkmate 025 Study So patients with clear cell Again the most common type Of Riansoccasinoma Were recruited to the study After they had already Up to 3 prior therapies Before they go on to this Trial And those patients Had to have 1 or 2 VEGFR TKI Meaning drugs That are approved In the first line Something such as Sinitinib or Prisopinib That you heard from Dr. Yonash They could have received Also interleukin 2 So they could have received Up to 3 prior therapies Including interleukin 2 They could have received 1 or 2 of these Front line therapies The oral agents That are the approved Sinitinib or Prisopinib And then once they They are screened And they are found To be eligible They qualify For enrollment on the trial They get randomized Meaning half the patients It's like passing a coin Half the patients Get A standard of care For second line At that time Of the time Of the enrollment On the trial And the other half Of the patients The other group Will receive this Immune checkpoint inhibitor Nevolumab At the dose shown there The primary endpoint Meaning the first Goal And the goal of that trial And the primary endpoint Is overall survival So the interest Is to show Whether patients Who are fairly Grouped Or randomized To receive This drug Or that drug With one of the Two therapies The two arms Of the trial Show a survival Advantage Over the other one So here obviously Here the interest was To see if Nevolumab Treated patients With the Immune checkpoint inhibitor That is Will have a better Survival Than Patients who Received a standard Of care agent The mTorin inhibitor Everolimus And here You heard about In my curves Where it means So this is for The overall survival So that's the primary endpoint So that means That from the Day they receive The first dose Whether the oral agent Represented in yellow here Or the IV Immune checkpoint inhibitor Nevolumab Or abdivo Here in red So the clock Starts ticking From the first dose That you see And patients are followed And You know Those who are survived Are censored Meaning They do not have The event They didn't die From the cancer And so And when The substations You know Plot these curves And that's What's called The Kaplan-Meier curves And if you can Run a Like here The arrow Or if you have A laser You can Pointer You can use If you can Run that Between the lines Then it looks like There is really The curves And there is One The top line Patients Represented by The top curve Have a better survival And indeed Patients who were Treated with Nevolumab Had a better survival Than patients Who were Treated with Everolimus And the median And you know Median means You know I think In layman term The closest You can say It's average Basically The median Was 26 Months So how you translate That into Hazard ratio The hazard ratio Was 0.73 Which means That there was a reduction Of 27% Mortality 27% Reduction of mortality In patients Who received Nevolumab And that was Statistically significant So this did not Happen Due to You know Just random It is because Of the therapy It didn't just A Happaz A random Occurrence Now As is The case With many of these Immune therapies That we have In the clinic Including vaccines For example A vaccine That's FDA For prostate cancer patients Including To look into And including These immune checkpoint Inhibitors While Survival Has been shown To be superior To these Immune therapies In this case here The Nevolumab We simply Don't really Understand Exactly why We think We understand why But the Survival Is better But When you look At scans And you look At time From Those one First those of therapy Or In the infusion Until There is progression Or death There is really No Such a significant Difference Between the two arms So somehow The immune therapy Is helping These patients Live longer Even if The Kaplan Markers For progression-free Survival Is not significantly Different Between the two arms And then There was a question Can we predict Which patients Are benefited Are surviving better Have a better chance Than Of being treated With this agent Because Every treatment Is a gift To our patients May have Some side effects So you won't Try to Give a treatment To the patients That are most Likely To benefit From therapy So this is One of those things That has Been looked at This actually Is a good Biomarker For lung cancer Who are Patients with Lung cancer Who are treated With a similar Immune Checkpoint Inhibitor Called 50% So meaning That those cells Have 50% Or more PDL1 Expression And the tumor cells Then that predicts For benefit With this agent However In Riasocasinoma At least In this trial This did not Been out Meaning We could not Really predict Whether patients Whose tumors Had an expression Here It's 1% Above Or less It didn't matter It's Regardless Of this PDL1 Expression On the On the tumor cells Responded To And benefited From Nebulumab Looking now On the Response rate About a Quarter of the Patients Responded To Nebulumab Less than 5% Responded To everolumines And here Are Here is The time It took from The Response For Both Agents Summary Of the Safety What we Refer to As Adverse Events Or side effects Of the therapy Nebulumab Treated Patients Had fewer Any grade Adverse Events Compared To Everolumines Which Everolumines Is By the way Adverse Events And Grade 3 4 Is You know Refer to The Severity Of The Adverse Events Compared To 37 So About Twice More Patients Had Severe Adverse Events That Led Patients From Protocol You have 8 Here 8% Versus 13% So More Patients Had to Come Off Protocol Of this Checkman 025 Who Are Treated With Everolumines So now With This Second Agent And Some Of In a Destruct That We're talking about Cabosantinib Or Cabometics How it works So As a result And again Here The focus Is Clear cell The most common Type Of As a result Of VHL Inactivation What happens As a result Of Mutation And The Avoid things That We call The Ligands For these Receptors So this Direct Cabosantinib Blocks These Three Pathways These Three Significant Pathways And We Know That VAGF Helps Tumors Draw Blood And Gasex Help The Tumor Progress Through Growth Invasion Metastasis And Helps Also Resistance Through VAGFR Inhibition So This is What This Direct Does And This Is The study That Led To Its Approval So This Is And Then They Were Randomized To Receive Either This Agent Which Was At That Time Investigational Versus Evernimus Again You See Evernimus Being The Comparator Or The The The Arm That Is Basically Standard Of Care There Was No Cross Over Because Not Only when it comes to progression free survival, the patient treated with Khab 2010 had a better progression free survival than patient treated with Abarolimus, it was 7.4 months versus 3.9 months, when you look at response rate, 17% versus 3%. When you look at now the overall survival, same thing, patient treated with Khab 2010 had a better survival than patient treated with Abarolimus, and here is the median for survival for both, 21 months versus 16 months. وكان ذلك مختلفة التي كانت تقلق بها وقادرها إلى المدينة من هذا المجال. عندما تظن now about exposure and those reductions هذا ليس مجدداً لتأكد من المشاهدين لكن المشاهدين حصلوا على تحديد تحديد وقط 9% came off because of adverse events and 10% for the evrolimus ولكن there was a higher rate of dose reduction in patient treated with Cabosentinib 60% versus 25%. And the average dose that patients received of Cabosentinib was 44 milligram from the starting dose of 60 milligram. And most patients on every MS received as close to the standard dose as can be. Now, this is the third trial that led to the approval of this combination. And here is this is the important thing to bring to your attention here is this is a phase 2 trial. It's not a phase 3, so it's not as large as the phase 3 trial. And it doesn't have a hypothesis testing. So basically the level of evidence that's inferred from this is not considered as robust as phase 3. However, the results were really impressive. So again, this is a second line study. Patients received one prior therapy, not more than one prior VEGF RTKR such as in internet or PASOPRI. And they were randomized to receive one of those three therapies. This combination or this agent by itself in VATINIB or every MS. Again, you see every MS being the comparator. And then patients were followed by scans. And they were stratified before they were randomized by the level of hemoglobin and the calcium. And here, when you look at the progression-free survival, again, coupling markers, you see the patients who were treated with a combination had a better progression-free survival. The median was around 14 months compared to half that for patients who received, you know, the VATINIB single agent. That's the curve here represents the VATINIB single agent. And you see here, patients received every MS had a lower, a shorter median progression-free survival of 5.5 months. And when you look at the same data, coupling markers curves for progression-free survival, but now not the physicians themselves doing the assessment of the scans, but an independent neutral objective blind radiologist to really see if this will be confirmed. You see basically the same separation. Around 12 months, median progression-free survival for the combination versus 9 months with the single agent in VATINIB versus 5.6 months. So this is another way of looking at this. And when the FDA saw the data, they were impressed even though this was a smaller study, phase 2, not phase 3, yet they decided to approve this therapy. And when you look at the survival, again, survival here was numerically better for the combination than for these other agents. So again, this is a summary of the efficacy, higher longer progression-free survival, higher response rate by the assessment of the physicians who treated those patients. This was 43%. And this is the median survival. When you look at, again, how long and if you had duration, dose reduction, this is a combination that's not easy to take. 71% of the patients had to reduce the dose. 62 had to reduce the dose for this agent by itself. The combination almost three quarters of the patient. And around a quarter of the patients had to come off study because of toxicity, because of the side effects. So this is a therapy that's toxic, although it is effective. And again, it is challenging to take two different drugs in combination at the same time. So here is, so you saw that three trials showed an experimental agent or an investigation of therapy being better, producing better results than Evrolimus, the standard of care, the comparator. And here are the studies side by side. And I put Acetanib because that's the trial, the drug that was approved in 2012. And none of these three trials compared their agent with Acetanib. So Acetanib is still there as an option to meet for our patients with Clear Sarion Sacrassinoma. So now, this is for you and this is for us physicians at academic centers, as well as in the community. And this is important also for government officials or insurance people to look at what are the considerations that we take into account that we factor when we select a second line therapy. I mean, when we have multiple choices, we have not just one we could use, but actually several different therapies we can choose in the second line or third line. How do we choose? What are the things we look at? This is what I believe are the most important and I start with the top which is I believe the most important for me. And that's basically efficacy. As a patient as well as a physician, I want to make sure that the first thing I want to give to a patient of mine is this drug going to prolong their life? Is this first going to cure them? I mean, ultimately that's the ultimate goal. But if we cannot, if we don't have a curative therapy for every patient, can this drug prolong which is of those drugs prolong survival? The second is the study that brought this drug didn't have the highest level of evidence. Was that a phase three trial? A large number of phase treated? Thirdly, tolerability. Can patients tolerate this? And then cost is important. And then there is the convenience and oral agent versus intravenous. And then there are some important things that we should not forget and that's basically did the patients who are now looking at taking a second line or third line drug, what side effects have they had from their prior therapy? Are they having high blood pressure? Are they taking three, four blood pressure medications? Do they have diabetes? Is it affecting their kidney function? Do they have some immune problems such as, you know, do they have mysthenia gravis? Do they have past history of Guillain-Barre? Because those are things that can basically force you to go one line to one therapy over another or to prefer to use one therapy over another because of those things. So in an environment, in a time where value-based care is talked about, this is what I believe how these several therapies that I mentioned stack up. Everleam is by itself except for select few patients. I think you show data for clear cell at least. We're not talking about cremaphob. We're not talking about papillary. We're not talking about these other rare tumors. We're talking about the clear cell, the most common type of clear cell. So there is enough now studies. I showed you three that showed another therapy is better than Everleam. So it's hard for clear cell alone now too. There is little justification justification to use it by itself nowadays. So I would not go to it in the second or third line or fourth line by itself unless it's been combined with something else. Accident, I think, is still remains an option and I put it there. But I really believe that if you want survival the accident trial that brought accident did not show survival advantage over its comparator Saurafenib. But Linvatinib and Everleam as I showed you did. So I would go to that and I would go to either Nevolumab or Cabuzantinib. And there will be patients that I prefer to give Nevolumab to rather than Cabuzantinib and there will be patients that I would prefer to give Cabuzantinib rather Nevolumab and these things that I mentioned yetollorability what side effects and symptoms do they have from the prior therapies? Do they have immune disorders that make me worry about giving them Nevolumab and maybe prefer Cabuzantinib or do they have very bad blood pressure problem that makes me go with Nevolumab? So what are in the next three four minutes I'd like to speak about some of the emerging therapies. I showed you what's FDA approved what's on the market now for use for our patients but now what's on the horizon because obviously we don't want to sit and be satisfied with what we have but we are looking at pushing the envelope bringing some new therapies which clearly we're not tuning everybody with kidney cancer with these therapies so hopefully we will do better in the future so the here is a slide summarizing if you want some of the novel treatment approaches that we have right now and I don't I will take a whole hour to speak about each one of these or most of these so I'll be selective in what I will be speaking about but there are two novel exciting immune therapies that are different than the immune checkpoint inhibitors that you will hear about from Dr. Gao next and that one of them is Pagulated IL-2 or Nectar 214 this is the IL-2 that you know about that's been around decades this is a an improved version if you want a new formulation of interleukin-2 that doesn't have to be given in the hospital in the ICU setting but more in the outpatient setting and it can be more importantly combinable with something like Nevalumab for example or Pemronuzumab so I think we are conducting studies with Pagulated IL-2 and I think in combination with Nevalumab it's showing really impressive results and then that we have planned to move forward with this agent in combination with immune checkpoint another one that has been shown also to show good results as monotherapy and as well as in combination with immune checkpoint inhibitors is Pagulated interleukin-10 or AM-0010 this is Armour Biosensit a small biotech company out of San Francisco there is a class of exciting drugs HIF-2 alpha inhibitors from Piloton and we are going to open a trial that Dr. Yonesh will lead at our institution in using a couple of these you know agents that block HIF-2 alpha which is downstream from the VHL and upstream from VEGF so it's a a new class a new way of treating kidney cancer at least again clear cell where this will be most relevant but an important class of of agents that we are now going to push forward with is a class of H that target the the metabolism the metabolism of the tumor cells and the first in this class is a drug called calythera biosensis or CB839 glutaminase inhibitor and then there is a new sort of a different axle met VHF inhibitor that's called MGCD516 or Citrovatinib and that we will be doing a study with at MD Anderson so in the interest of time we just go quickly here this is a cartoon rendering of the tumor cells and how the tumor cells take its nutrients sugar as well as the amino acid glutamine so cancer cells require both glucose and glutamine for growth and survival the TCA cycle or CREP cycle is a critical source of ATP for cellular energy and several key biosynthetic intermediates for production of amino acids نقلوتات and fatty acids so in the absence of glucose the amino acid glutamine is the primary source feeding the TCA cycle so cancer cells become dependent on the glutamine metabolism for efficient growth and survival and glutaminase is a mitochondrial enzyme that catalyzes the conversion of glutamine here to glutamine that enters into that TCA cycle and the drug CB839 is here that's the one that's put in the brakes or blocks the conversion of glutamine to glutamate it blocks that enzyme glutaminase so here is the design of the study we're going to be launching here at MD Anderson this is a multi-central trial and it's a 252 patients who were treated with any number of prior therapies including Nevolumab including Cabosentanin and they will be randomized to receive everolimus which you heard about already another you know a trial taken using Nevolumus as a comparator but in combination with placebo versus everolimus again in combination with this drug CB839 that glutaminase inhibitor the primary endpoint is progression-free survival so the trial is not open anywhere in the nation yet but this trial will be open in the U.S. we will be leading it along with other sites and it will be open in Europe as well as Canada so this is an investigator-initiated trial meaning that we are opening it at MDN only we are leading it I'm the principal investigator of this trial and we decided to take the best two drugs for kidney cancer in the salvage setting Nevolumab and MGSD516 or Citrovatinib which is this drug that's similar to Cabosentanin so we wanted to take the best drug that targets the immune system which is the Immune Checkpoint Inhibitor Nevolumab and the drug that's the best for targeting the cell the the signaling that the tumor cell uses and we combine these two so patients who had one or two PRAR therapies with either Citrovatinib Pazopanib or interleuk into but as long as they did not have an immune checkpoint inhibitor mTOR inhibitor or Cabosentanin they come in and they get treated on this trial and we have this is a trial that we're going to collect a lot of blood and biopsies before treatment is given and on therapy and at the time of progression this is going to be a very informative trial and we hope that if we show that the combination is better than Nevolumab alone or better than Cabosentanin for example what we know of these two drugs because I showed you data we pretty much know what you can expect if you treated patients with kidney cancer in the salvage setting with one or the other drug we pretty much know what to get if we get here double the responses with the combination then we can expect to get with either one alone then this trial is going to move forward for a phase three and we hope that that will be a positive trial as well so what is my forecast for the next say one two three years how do I see the landscape shaping up so you heard from Dr. Yonesh that Cabosentanib could be FDA أكبر in the next few months if the review of the scans confirm the results that were reported by the investigator and if Cabosentanib then gets an indication not just in the second line third line but in the first line that's going to shake up the field but there are several trials and maybe Dr. Gow is going to mention about these trials in his talk that basically are in the first line setting and they are using combinations of an immune checkpoint with an immune checkpoint inhibitor or an immune checkpoint inhibitor plus a target agents targeting this angiogenesis the blood vessels and here are those six trials نيولوماب plus ايبيلوماب versus سونيتينيب we participate and led that trial here at MDN and the results are still pending there's another one that also complete accrual using this immune checkpoint inhibitor اكبرزلوزوماب or the centric plus بيوزوزوماب versus سنيتينيب and these are three trials that are now ongoing using an immune checkpoint inhibitor with the same agent اكبرزلوزوماب here and these two trials and what I showed you here previously نيولوماب plus ايبرلوماب so and this is a trial that hasn't opened yet but it combines نيولوماب كبرزلوزوماب versus نيولوماب ايبيلوماب and كبرزلوماب again in all those trials the comparator that's being used is سنيتينيب because first line so I think the results of these and what the FDA is going to do with كبرزلوماب regarding its position in the first line will really shake up what will happen in the very near future maybe in a year or two years certainly by three years what was going to happen in the salvage setting but there will be also entry of new investigational agents in the second line space will affect the field so some of the trials that I showed you that the group timing is نيولوماب cb 839 نيولوماب نيولوماب نيولوماب the drug that I showed you نيولوماب cb 516 so if these get FDA approved they're going to come here and occupy space but there are some challenges and unmet needs particularly predictive biomarkers we still give all these therapies to all patients say with yourself and we don't know if they're going to respond or not because we don't have biomarkers we don't have predictive factors whether it's from the blood or the tumor that we can take a piece of the patient or the kidney tumor that tells us they're going to respond to this drug better than the others so we don't I showed you that PDL1 was hopeful that it would be a predictive but in رياساكس نيولوماب unlike lung cancer it was not a predictive factor so there is really a pressing unmet need to identify predictive biomarkers to help us select these therapies to patients better to bring us to really the era of precision or personalized oncology rather than give the the same drug to everybody knowing well that only a percentage of patients will respond and not all patients respond and then the the really unmet need and it's a subject that's near and dear to my heart which is the variant histology because I've been focusing on this this group diverse group of tumor types that so far we have not an industry has not really paid a lot of attention as well as academic centers because they're rare tumors and I'm talking about chromophob I'm talking about pepillary I'm talking about renal medullary carcinoma collecting tuck or bellini's tumor so those are they constitute about 20 25% of tumors of kidney cancer but unfortunately a lot of the data a lot of the trials I showed you and Dr. Yonah showed you and what you'll see you'll hear from Dr. Gow has been conducted in clear cell the most couple of time but there is hope we are we and others are and finally industry is listening and has come on board and we will be launching some of the trials in these variant histologies such as pepillary we have already launched some trials in the renal medullary carcinoma a devastating rare kidney cancer that afflicts young african-american with sickle cell trait thank you very much


Ever wonder of turning your highlighter into a flash drive? Basically, I do these things to prevent someone from snaking into my personal data. So in this video, I'm gonna show you how to do it. All you need is any highlighter that can fit in your USB flash drive. So we will start by cutting a top by using a hacksaw. After that, you might need to remove any casing from your USB flash drive if you find that it can't fit in very well. Then you sure need to fill hot glue inside of the highlighter and put it together in place. For the highlighter cap, you might need to remove the transparent tip inside the cap so that you will get enough space for your flash drive. And I used a female USB port that I took from my old product to make it as a cap holder. And now, you're good to go. Thanks for watching, guys.


Good afternoon everybody, I'm Tommy O'Brien, coming to you live from TF9 headquarters in St. Petersburg, Florida, 2pm Eastern time on Thursday, two hours left to go on the trading day. We have a pretty calm day in the markets out there. Right now, we've got markets in negative territory but barely. S&Ps, negative 4 points, trading at 2790, Dow Jones, negative 24 points, trading at 25960, and you get the NASDAQ basically flat, trading at 7554. Goal contract, negative about $5 on the session, trading at $1316, you got oil, up $0.15 at $0.5709, notes and bonds, lower price, higher yield, 10-year note, negative 6 ticks, $12123, 30-year bond, negative 16 ticks, $140502 and the dollar index basically flat, trading at 96060. Start off the update, let's take a look at the futures markets with two hours left to go on the trading day, and as I said, pretty tight, tame trading day all over the place. So higher end of the range, just after the opening bell, $26,020, lower end, I guess you could call it $25,920, $100 Dow points, but realistically, since at about $1130, so you're talking about the last two and a half, almost three hours, the Dow has been within a span of 40 points. That is quite a tight range for where we've usually been in the Dow. NASDAQ 100, a little bit different story, trading higher from the lows at 10 a.m. of $7,085, we're now approaching 40 points above that level, $7124 in the NASDAQ 100. S&P's near the higher end of its range as well, trading at $2792, higher the day, $2793.99, so we'll call it $2744, about two or three S&P points from this level. Low contract pulling back, we were up here at $1328 at 7 a.m. Eastern time, now $13 below that level, making a low at about $1030 this morning, just kind of hanging at that level since then. Crude oil, volatility as well, spikes to a high of $5741, trading lower in the last few minutes, $5688 in the price of April crude and Euro-US dollar, getting volatility on both sides, but kind of jumping right back to where we started all the action, 10 a.m. Eastern time, $113.70, we trade all the way up to $114.20 as we saw some dollar weakness, Euro strength, and then we flip it around, we get dollar strength, Euro weakness trades all the way back down, $113.76 on that Euro. Stay tuned folks, we got Tom O'Brien coming up live from 3-5 Eastern time, we're going to have a replay right now, the 10 a.m. show, Tom and I, and then Tom will be live from 3-5 as he wraps up this trading day. Stay tuned folks, we'll be right back.