Right. So good afternoon everyone. So welcome to the final session. No, I will kind of repeat it's not the final session. It's a final conference session for the day because we are going to have some exciting poster presentations once we finish this last session. So this session is going to be on immunization. I must also mention this is not anything to do with the COVID immunization, which we have talked for so many times. So this is just going to be about routine immunization. So the arrangement for this session is I will do a quick introduction about the DHS2 EPI toolkit. So that's the immunization package as most of you are aware. So I will mention briefly like what are the components which we have. And then we are what we are going to do is to listen to two countries, all this and Bangladesh around their experience in implementing these packages. And we will see like how they have implemented their these packages and what additional changes they have to do and what are the challenges. Right. Okay. So we have the team all these will be joining remotely and the Bangladesh of course is on site. Right. Okay. Next slide please. Right. So I guess like we also mentioned about the DHS2 packages when we talk about HIV. So we have the packages for the main disease areas in the in health in the DHS2. So the main objective of having these packages to make life easy for the people who are implementing DHS2 in countries. But I must emphasize these are not plug and play. Right. So we have software that we download from internet double click and it gets installed. So it's not like that. Right. It will make your life easy as implementers. But when you're adapting it to your country context, you will have to do some modifications. Right. So we will listen and we will hear more from the countries. What are the challenges they have in using these packages. So that's why we mentioned so how these packages are developed is that the quality will gather requirements. And then we will also get field inputs and we do the configuration. There is a testing and then release these packages countries are using implementing and we continuously get updates from the countries and there will be new versions of the package that will be getting released. Next slide please. Right. So what you are seeing here is the countries that are using this WHO packages. So when it comes to EPI, we have 45 plus countries who are using DHS2 for EPI program data. And we have 30 plus countries installing the standard WHO EPI package into their national HMIS. So I'll be now in this presentation, I will briefly talking about the different components that we have in the package. Yes. So what you're looking here is like a couple of different components that are required in routine use of immunization data in our countries. So we generally have this we have the immunization registry and in addition we have other components such as surveillance like VPD. And then we also have as various campaign related data LMI is and we also need dashboards, sometimes dashboards, which are getting information from multiple sources. And then we also have components such as AEFR. Next please. So in the DHS2 EPI toolkit, we have all these components, right? So we have aggregate packages, which we usually have the EPI metadata, logistics, VPD, dashboards and analytics. And we have some applications. These are like even we have the WHO immunization analysis app, bottleneck analysis app, scorecard. And then we also have individual data packages, mainly the electronic immunization registry we call as EIR and the VPD tracker. And then we also have other related packages, which include AEFI and vital events. And also we have the documentation to support this configuration of these various components. Next please. Right. So let us look at various components very briefly. First is the aggregate package. Next please. So aggregate package mainly supports monitoring of vaccination activities, their progress within the target population and informs operational strategic adjustment based on evidence. So it captures the estimates for uptake and coverage across target population and it helps you rapidly detect trends as much as red flags and dropouts. And it also provides the key geographic information of the evolution of the vaccination activities. And also it also promotes the standards for data collection and analytics. So these are the kind of broad objectives and goals of having this aggregate package. Next please. So now when it comes to the aggregate module, there are various components. So what you are seeing here is a screenshot of the aggregate package. And then we have inside that we are collecting outreach sessions and vaccination with various disaggregations and even include AEFI series and non-seizure. So these kind of different categories of data we collect in this aggregate package. Next please. And also there's provision for collecting LMIS related data related to stock and the call chain also in this aggregate package. So you see here like what you're seeing here is a screenshot of some I mean the standard stock details that we collect but all these are customized. It doesn't mean that what you get in the package is the only thing that you can use you will have to adapt it to your country context. Next please. Yeah. And the good thing is we have this new updated dashboards. So these are improved dashboards. Previously like some of these outputs were mainly available only through the ANDIS application for immunization. But now with these dashboards we can really make ministries and you know like whoever implemented these programs get the real data for their information requirements out of these packages. Next. And also we are doing this triangulation. So we have some triangulation dashboards especially these event gaps and the program performance where the main characteristic is we kind of combine data from multiple sources such as IDSR, EIR, VPD, EPI and so many other sources. So this kind of provides some rich analytics in the dashboards because they are coming from multiple data sources. So we can always do these comparisons. Next please. Right. So the most important thing like even us as in like the senior implementers that you see around here. So all of us use the documentation. It sits because now VHS2 is keep getting bigger and bigger and it is very difficult for us not to get I mean to do something without getting updated. So whenever even we get stuck what we do is to refer these different documentation. So we have three different types of the documentations for use, design and implement. So use will kind of highlight all the available packages, apps and tools and how we can use them in configuration as well as analyzing data. And design will mainly focus on configuration of the VHS2 when we are implementing the packages. And the implementation is mainly for the non-configurable aspect of a campaign. So these include components like performance testing, user management etc. Next please. So what I have been discussing so far is mainly related to the aggregate component. Now let us look at what are the features available in the individual data collection module for immunization, which is mainly the EIR, electronic immunization registry. Next please. So here we are so basically the purpose of having this EIR is mainly to improve routine data collection and also it supports increasing the data reliability because we will be getting more granular data at individual level. I mean initially when we are implementing aggregate we are mostly looking at the counts, coverage and things like that. But here we can look at what really happens at individual child level. And when we are designing these resources there are so many inputs that are coming mainly from the I mean recognized institute like WHO, Norwegian Institute of Public Health and many others. Next please. So this is kind of high level architecture of the electronic immunization registry. So we have one program called immunization, which kind of we can divide into two components where we call them as program stages. So one of them will focus mainly on the birth details, which is a non-repeatable type of program stage. We call it in DHSU terminologies. So this will mainly focus on capturing all information related to the birth. And once you collect that the DHSU also has these features available to send notifications. For example to CRVS system if you have it as SMS and email. And in addition we have another component which is a repeatable one where we are actually collecting all information related to particular immunization events. So here we can have birth notification which is optional. And then we can always also ask pre immunization questions before giving the vaccine and that can be collected in the system. And then of course routine immunization. So everything that we generally collect about vaccination we can also include. And the other thing is there is also provision to override some of the configurations. Next slide please. So the thing is now here in addition to collecting data it gives us a lot of functionalities and control over what we do in use interfaces. For example we can hide and show program rules. I think you all are familiar with skiplogics. So this is really important especially in immunization because we have to decide based on which vaccine was given and the age some components are meant to be hidden. So all this we can do using these program rules. And we can also display warnings and contraindications. And we can generate SMS notifications which can be sent to beneficiaries such as parents. And also we can have if we are using tabular data entry we can of course have a kind of vaccine card like we will have rows and columns. And then of course we can also have work English where we can see like list of children what we vaccinated any dropouts the children we are expected to see for vaccination in this week. Things like that. And in addition of course we have analytics and indicators which is of course the most powerful feature in DHS2 in general. Next please. So what you are saying here is how program rules are working. So basically like next please. So here like for example now depending on if the BCG vaccine is given for example if I take one example. So we can show it at date of birth and hide once the BCG is given or hide if the child is for that 12 months old. So likewise we have so many rules which already are configured in the standard immunization package that is already available. But now next after I do this presentation we will listen to countries to see how they actually use this package in their country context. So we have the package the default one but it's quite interesting to see how difficult for them to adopt it and what are the changes they had to make when they actually using it in the countries. So what we usually do is to get this feedback and probably there will be a next in our next release we will address some of these issues. Next please. So what you're seeing here is this working list concept. So for example you can see now here maybe the next one. Yeah so you can see this different working list. So probably like if you want to see everyone who all the immunization patient here that's what we are seeing because that's the one that is highlighted and we also have options for the schedule appointment this week today and the missed appointments. Next one please. Right so the thing is like this EIR is kind of complimenting but we are collecting in the aggregate data. So we have the aggregate package which is kind of having all the core indicators that we are generally monitoring in the immunization campaign in the country. So what we are actually doing with the tracker is to mainly focus on cohorts right and then this data we are kind of pushing into the aggregate indicators so it's kind of complimenting the aggregate package that we used to have in most of the countries. I think traditionally we have been using aggregate so here we are more mainly focusing on cohorts in the EIR and we also have some specific dashboards that are coming in the EIR for example for overall rollout, age ranges, dropouts and things like that. Yeah next question. Right so these are kind of high-tech fancy new features of VHS too. So here what you're seeing from 2.37 onwards with this enhanced maps application we can have organization unit profile so meaning like when you click on a health facility you are able to visualize the key information as well as detailed population estimates. So in case even if your country doesn't have population estimates we have these integrations and data coming from RIN3 and WorldPop which will generate these nice visualizations for you to get an idea about different areas and the estimated population. And from 2.38 onwards we also have these features such as structures map and then facility catchment area layer where again like some fancy new features like we have Google Earth Engine integrations and there are these new apps like RIN3 and this crosscut which we can use to kind of generate and draw facility catchment areas inside VHS so of course with the help of these applications. So there are some exciting new features coming up every day while we are having the basic requirements that all of the countries require need. Right and of course we have Android application so one thing we have to keep in mind these features available in web and android may be different okay so for example you may have some very new features available for data capture and visualization in android application which may not be really there in the capture application in the web interface. For example we have so many new features like so when we use the android application we can do the basic things like registration and tracking patients over time and we can do dynamic data collection based on different workflows and we can also have task listing and for example we can also have this barcode and QR code scanning function at least these are also there it is android capture application as well as maps views and card navigation so you have some fancy analytics as well as view I mean different views which are available in android application which is not quite there in the web and also we all have the data validation right so now that you have a kind of overview of various features available in VHS to aggregate and the case base for immunization like if you at any given time if you want to read more because this is just a basic introduction you can read the documentation which is available so these the links will be available and the presentation also we will share with you so now the most important thing is so these features are available now let's hear how the countries are used in these packages and what are the challenges they encounter and how they really overcome all these challenges that we face in everyday implementations so we have two countries presenting today first is Maldives so the ministry of Maldives will be joining with us online so two persons from the ministry of Maldives one from HMIS and one from immunization will be presenting and followed by that we will have a presentation from Bangladesh so shall we get the Maldives team connected yes Shyam I think we can see your presentation if you can put it on presentation mode right we can see your presentation you can start please also introduce yourself because we have two presenters joining online Dr. Pomod can you hear me yes Nasia we can hear you fine please present you can introduce yourself and then start yeah thank you Dr. Pomod for a very comprehensive presentation from your side and also a very good afternoon to all the participants I'm Nasia from National Immunization Program and with me Ms. Sharma from Health Information Division of the Ministry of Health will be presenting the details of EIR implementation in our country in this presentation we will try to give an overview of the country reason for having a system like this and our main theme time the key activities current status of the system main features of the system and future plans for EIR how this will be how the beneficiary portal will be just a sneak peek of the beneficiary portal which is under development and of course the challenges why I work in on the EIR development and implementation stages Maldives is a small nation because I would like to give a details of how our country is like then only I think the participants will understand how this will be benefit to our country like this way first is an introduction of the country I would like to say the Maldives is a small island nation located in the ocean geographically the islands are highly dispersed the country consists of a total of 1192 coral islands among these 1192 islands have only 182 islands are inhabited and most of the remaining uninhabited islands are used as tourist tourist resource and for other commercial uses our population is around 500,000 which is included in expected and one third of our population is living in the capital city Malik the annual birth court is around 7000 as I said before in my presentation due to these dispersed island nature of our country there is a challenge in managing vaccination records this is the main reason why we need a system like this the our current practice of recording and reporting of immunization data or manual mostly using hard copies Excel files and Google sheets and it is very difficult for us in the central level to follow up in the completeness and the accuracy of reported numbers also it's very difficult to generate analysis reports dashboards for regular monitoring of the system and there is no proper and easy mechanism to assess previous vaccination records of our child especially if multiple vaccinations vaccination centers are involved in Maldives we are like mostly traveling abroad as well as in the entire country also traveling a lot so most of the parents have multiple vaccination centers involved in their child's vaccination so and when in event of her loss of child health record book it is a huge challenge to the vaccination centers and parent guardians to treat the child's previous vaccinations from other centers and therefore there is a need an easier secure and timely mechanism to assist the pulmonization record of her child in a system like this after several discussions with a technical expert and policy level persons we had come to an agreement to solve the difficulty in managing our reporting and recording system which is shipped from manual to real-time digitalization which includes these as I said transition from reporting of aggregate numbers to name this immunization data available real-time at all levels including achieved through implementation of EIR system this will allows longitudinal tracking of a child's vaccination status regardless of where the child receives the vaccination in a secure platform the dedicated team behind these mainly two players the core team basic based in central these includes members from health protection agency mission immunization program members from health information management and research division consultants based at W. Chomo this country office members from history Sri Lanka team and also the one of the main player which are the data entry users our champions actually they are based in vaccination centers across the country then let's look under the timeline of key activities is of 6 December 2022 in june 2022 we have started this work and from until March 22 we have initiated the customization of make a package modified and conceptualized to the country consists and enrollment registration birth details pre immunization questions and before the vaccine schedule replaced with national vaccine schedule and additional fees were included to capture many bits and bits number details and from March to April 2022 the initial design was introduced to potential users is a form of a hands-on training user feedback obtained during the training and post training using Google feedback forms in the Google feedback form we have had one question which was asking do you think that the tracker this is mainly for our users so we have this question do you think that the tracker like this would be useful for your work and 21 has responded and 21 users has responded saying yes to this one therefore we have understood that this is actually not only for the central team but for the atoll team also they feel that this EIR is very important in their daily daily work and based on these feedback forms for the modification was brought they brought and it was updated and shared to the end users in May to mid-June 2022 the piloting initiated in selected facilities we have personally the central team has visited some of these islands and we have piloted in the selected areas and our Viber based user support group was created where the users have in any difficulty means they will write in the group and one of the central team will attend to these shows and in late June to July 2022 the tracker design was turned off considering the pilot feedback and the users are reoriented pilot and the piloting facilities staff to a new design data migration and initiation the use of new design by existing piloting facilities from this slide on words Shama will be present in the details Shama please can you continue thank you Nashia um I hope everyone can hear me yes we can all right thank you so Nashia had mentioned that since January until July for six months we made a lot of customizations at different phases so what I'll do is I'll quickly run through the key customizations we made to the existing meta package so most of the customization we made based on our core team input initially when we tried to play around things that we started to notice and then we went to the training the initial training we had where we sort of like introduced the one and then we got feedback and then we also did the piloting where we fed live data and when we started putting live information then we got more input as well so based on these three set of information we started to get we made these changes so the changes happened on and off we did go through many like we went with the change we went back as well so when when I'm explaining I'll go through a bit in those aspects as well so let's go through first the changes we made to the enrollment or the registration form that is available so in the enrollment initially in the default meta package you actually have date of registration but in all these contexts and I think this is applicable to many other countries as well since vaccines are given at birth and we have hepatitis B which we have a target to ensure we gave the hepatitis B vaccination within 24 hours so for us it didn't make sense to have a separate date of registration in a separate date of birth especially when the initial vaccination record should be fed into the system at the time of birth itself so we sort of replaced the date of registration with date of birth and this is the number date that we'll use to do all the program rules because it will calculate when the child would be eligible for the next vaccination and it will also prompt if the child is being you know scheduled to give a vaccine a bit earlier then it will somehow prompt the healthcare workers a message to inform that the minimum duration is not made so this date is really important for us so we made that change for our EIR and then we went through the whole profile which is part of the registration form again and we kept on making further modifications as well so in this side in the left side you are seeing the modus customized registration form and in the other side you are seeing the default form so we started with making changes even to the unique identifier so going forward in time we are currently rolling out electronic immunization registry but we do have a plan to keep expanding the use of THRs too to incorporate other trackers in the system as well so we wanted this number to be very unique to the individual so that going forward we can start enrolling the same person in multiple other programs but this number would be attached at system level to the person so we have that is an additional unique way to identify the person that is enrolled in the system in multiple other programs as well and we modified it to cater to more this context so we have MDB which is our country code and then we have a serial number so it's very different from what you see in the default where it's like a year-based serial numbering and the other thing is in the default form you have the name of the person broken down by first name middle name last name but for us in modus we don't usually differentiate between first name second name things like that and we just usually refer to the person fully and then we refer to the last bit of the person's name and when we sort of deliberated on this we thought that since we have multiple other unique identifiers attached to the person maybe having three fields where the data entry user have to run through each one of them separately and enter tries to get the full name of the patient or the child it might be easier if we have one only one field to capture the full name so for us it is enough for us so we made that modification as well and we also changed the way the language is in the system for instance like for gender we are more comfortable using sex and also village is not a concept that is specific to modus so we change it to at all and islands because it's more relevant we have at all and then in each at all we have islands so we change that and rather than having a field text we change it to like a full option list so once they select the at all of residents then at the island of residents it will filter out only the islands in that at all so it's easier for again for the users to capture the information so those are the things we made in the changes in the system and one other thing that we included a new field is to differentiate between a foreigner and a national and why we had to do is because the unique identifier again attached to the patient or the child would be very different if it's a foreigner or a national local person so for locals in modus each local child or any local resident would have a national ID card number so this is very specific to locals but it's not going to be relevant for foreigners because they won't have this they will have their passport number as a unique identifier so from here if that person selects that the beneficiary is a foreigner then we will hide the beneficiary national ID and full more phone number there is a birth registration number and only it will display the passport number so we made those modifications as well so going forward there are other bits in the registration form we will quickly run through them as well so in the default form when they capture the mother's information is sort of like merged with capturing mother slash caregivers information but in our context what happens is we had a huge challenge when we initiated the data capture you know especially because we wanted to capture legacy information for the past three years that was our target and the issue that we faced was there even though we say that birth registration is initiated at the time of birth in our our local birth registration system the CRS system unfortunately due to some minor delays it always takes a few days for the complete form to be filled and submitted so there is a delay in the child getting the child's own national identity card number but we cannot delay entry in data into the system because the birth will happen at the time and we were trying to push for real-time data entry so we deliberated a lot and we tried to find a solution and the solution we have so far is that why not we try to identify the child initially with the mother's national ID card number and the date of birth so if these two is used and if we enter it we will provide a leeway for them to not capture the child's own national ID card for the coming two months but when the child comes for full-off vaccination at two months then from that point onwards the national ID card would be mandatory so from that point onwards they have to identify the child using the child's own unique identifier but to do that in the first two months we relied a lot on mother's information so we need to ensure that the mother's information is mandatory and it should be separated from the caregiver's information so for that reason we sort of separated that in our registration form and we made made the mother's information mandatory now the question will come is what if the mother is unknown yes it happens in Morise as well there are some children who are looked after by state and some children their mother is really unknown so for those we have sort of like found a workaround where we can give them a specific way to code them but then the caregiver's name and caregiver's information is mandatory for those situations but that is not going to be fully reflected in the system because we we should not somehow like compromise the whole system to cater to few percent of people so that is the thing that we have done so far all right so going back and here is the major change we made to the registration form so during Dr. Palmer's presentation he mentioned about having two program stages in the EAR number one is optional more program stage which is related to birth details and that is going to be a non-repeatable one and then you have the repeatable immunization program stage but for us when we rolled it out initially with the birth component as a optional program stage we found that for the users it was a bit difficult because they have to first register and then they go back to the birth tab and then they enter it so for them it felt like they're going through too many stages so we wanted to cut down at least one stage so the thing that we found was what if we move this non-repeatable program stage back to registration so that when they do the registration they will do that bit as well and then they will be done with that so they don't have to go back to the birth area anymore so with that in mind we did that modification we moved the whole birth component into the registration form and we also aligned the option list available for different categories like mode of delivery number number delivered birth attendant to what is captured in our birth certification form which is linked with our local civil registration and vital statistic system and the reason why we did that was because we are still working with the team to make sure that we can integrate with that system so going forward in time hopefully that integration will come and this will again reduce the workload from our data entry users but for the time being we wanted to minimize what is captured and we wanted to align it so that the future when the integration happens there won't be much of a hassle all right so that's it for the registration. Sorry to interrupt just a quick reminder due to the limitation of time we have for the session we may have to finish in like five minutes thank you so I'll quickly go through the rest of the things thank you Dr. Parmat okay so I will try to rush through the remaining parts so this slide is very important again because we made a huge change to the program stage the way the data is captured for the immunization component as well so in the actual default package you have only two tabs here you will have the if you have the optional birth information captured there you will have the birth at birth details and then you will have the immunization one which you keep on repeating by using the plus sign you can base a lot of events but in more days for us again our users found it a bit difficult to use that because they are more familiar with the tabular listing that is available in the child healthcare core book and the tabular listing is usually based on at birth two months four months six months it will specify which vaccines needs to be given so we made the huge overhaul of how the vaccine component would be captured as a very separate multiple program stages so we aligned our vaccination schedule to at birth two months four months and so that's how we did this one and another important thing we did was for happy we needed to identify that vaccinations are happening within 24 hours so we captured that is a additional field as well and one more thing we did which is different from the default form is that we have the BCG sorry the manufacturer and batch number being captured for all routine vaccines not for the non-routines only for routine vaccines and the reason that we did that was because we wanted to embed the AFI or we wanted to have AFI module also within our EAR so it would be easier once the report comes they can go back review the previous records and identify the batch number they don't have to go back and try to look for other information to identify this the system will already have the information as well all right so we also made changes to the pre immunization questions the first important thing we did was initially in the default form pre immunization starts from at birth as well but for us we couldn't figure out why it's so important to do that especially if no vaccine was given previously there was no need for us to do screening so we moved it to capture it from two months onwards and we also deliberated like there are things that will not change that often like the child's allergy status the child's immunodeficiency status so unless and otherwise if they want to make a change they can click to make a change and then they can do it the only pre immunization question we continuously will ask is about their the child whether the child has a fever because it's important because we have to defer if the child is having fever fever for some vaccinations all right so this is the timeline i'm not going to go through this one but the important thing is in august we started national training we did an atoll and regional training and we went with national rollout and in october we officially launched once our target of having all the greater mall region bigger birth facilities and all the atoll and regional facilities on board and life and this is the current status that we have so we currently have within the last three months we were able to scale up and capture 9700 per student and our target for 2022 birth cohort 54.5 percent is already in the system and from 2020 to 2022 for the past three years already one third of the population is in the system and for the vaccination centers we have 191 facilities and from that two third of the facilities are already on board and we do have a plan to scale up and ensure by end of this month to reach out to the other remaining one third of the facilities so this is very classic you will also know most of the features in the initial design most of the time i won't go through this one but uh what i would like to emphasize is the additional features that we we are thinking of having and we we already have some of them like the travelers vaccination so when we initially started we wanted to focus only on child component but when we realized that there is potential to even capture travelers vaccination we decided to incorporate that and we also roll it out and AEFI initially it's usually not a program directly embedded in EAR it's a separate one but we are trying to pilot test whether it works but if we incorporate it in EAR so we will hopefully pilot it in January and we also have a VPD module which is coming on which will be separate from EAR but we are trying to pilot it in January as well and another important thing that we have is the beneficiary portal so until now the everything that we are doing is very much linked with data entry users and us but there is nothing useful for the parents or others so this beneficiary portal will provide a view access a user interface for the parents to access and check the child's vaccination status so within one minute i'm going to quickly go through the sneak sneak peek of the beneficiary portal so this is how the login page appears so you can easily like login and then you can actually enroll your child and the beauty of the beneficiary portal is you can see a very similar tabular format of your child's vaccination record as you can see in the child health record that is being carried in modives and it can also have a print digital vaccination print view as well where you can use a QR code and another personnel can actually scan the QR code and verify whether the record is actually from a verifiable source and not modify all right so i won't touch too much on the challenges given the time constraints but i will conclude from here thank you Dr Parmar the nephrologist for going a bit over the time thank you thank you so much any any questions we have from the audience both online and on site for the modives team in the meantime i think no questions right so it looks like there are no questions at the moment so thank you so much once again so now that we have heard from the modives about the challenges and the approach in implementing EIR, BPD, AEFI and all the integrations and the beneficiary portal let's hear from the Ministry of Health Bangladesh how they approach their immunization program and how they implemented it what are the challenges and what is the current status so for that i invite my colleague team leader from his Bangladesh team Hanat Khan thank you Pramod so here i am again immunization program in Bangladesh is one of the successful program of our Ministry of Health immunization is started as a quite long ago and we are starting the data entry in 2014 so let's come into the screen then this is the Google easy for me to describe so immunization actually expanded program of immunization started with the initiation of WHO so with the help of WHO we started immunization program in 2011 i think in 2014 12 13 and in 2000 next so in 2014 the immunization aggregate data collection format already developed by us so the immunization program aggregate data collection and similar aggregated logistics already start by 2014 please so Pramod discuss about the WHO standard package but WHO standard package is released in very much later we started in 2014 so most of the team we already done by this time so the the component we already implemented in the BPD surveillance routine immunization which is aggregated for AEFI tracker aggregated that code and aggregate at ELMS so after that as we most of them are we implemented so we started implementing the remaining part micro planning immunization campaign and real-time monitoring immunization registry so i am actually focusing on the recent MR campaign which is a huge success for Bangladesh and is a larger scale implementation and we try to use the DHS to as a full component next so MR campaign or business rubble a campaign will run last in 2014 and between 2016 to 19 85 to 95 percent of children received first dose and 80 to 85 percent received second dose of MR vaccine during 2016 to 19 surveillance data indicate that the measles incidence increased from 1.6 per million to in 2015 to 29 per million 2019 so government decide to go for a MR campaign to mask a vaccination campaign for the whole country children's so left confirmed cases similar and due to COVID-19 situation of Bangladesh we actually rescheduled in 2019-20 early but due to COVID pandemic we have to shift it to the this 12 December 2020 to 3rd February 2021 next so why we choose or government choose the DHS2 as a platform specifically for all components first thing in 2013 we implemented whole country with the api systems so our all user from top to bottom are used to with the DHS2 well trained personal at all level if the community or vaccinator level mtpi that was medical technology tpi always trained on DHS2 because every year the government of Bangladesh have two setups of training on the DHS2 refresher and so all health people from the managers to worker are trained on DHS2 so that is the one measure strength of DHS2 organization unit required for our campaign already exists the DHS so there are no need of creating new organization unit but during this campaign we have to make several temporary organization unit which we manage differently plan to use the same form same platform routine api macro pan so that they don't have to use the multiple systems to have a hassle for them so with this campaign we use the two things a monetary so this we call government policy real-time monitoring this actually we use the DHS event capture will show you later which is component for what we use so this the real-time monitoring is there this tracker component event capture component actually give us an online macro plan daily vaccination reporting including vaccine and lost accused session supervision through the android app in the household visit the first time supervisor to the android app have it convenience monitoring and rcm the second line supervisor to the same similar and the same android app under one DHS2 app next please so for this mr campaigning we have several key achievements to show you we can the managers and the ministry can monitor the daily coverage against the target and all level and providing so if you see the coverage is low expected rate they can communicate to the field to look at the issue why there is not enough children coming to the visit vaccination site identify area of miss children and mop up session those are missed to bring them somehow so find a way out how could they bring them to the facility why they don't take session quality issue and monitor and address identify miss children from routine immunization so therefore this we use the real-time monitoring so what is the outcome we vaccinated within this this week 35 million 35 million five hundred eighty five six hundred ninety one two within this seven days so that is the actually we show how the DHS2 use for this to make mx vaccination campaign and for the first time we use for real-time monitoring the DHS2 most of the countries in Africa isn't they use the ODK to collect the primary data and send it to DHS2 we use the native DHS2 Android app and with that we use the event capture to do the sampling next please so how did the real-time monitoring so aggregate data set we have the micro planning daily vaccination loss distribution daily vaccination reporting event capture session supervision also visit rapid confidence monitoring so all three for three level of user with same Android DHS2 app and all those things is summarized in a daily online reporting daily online reporting not it's a real-time reporting through a public dashboard because in DHS2 if you run the analytics that's actually sometimes the data entry process is stuck sometimes we find deadlock so what we did through the API we pulled the data from the PHP framework and here we show the real-time dashboard in every 15 minutes that is refreshed so that is actually we made up the challenge in previous campaign earlier all campaigns the all monitor is down to the paper and pen so that's why we have the gap we have the reported gap we realize the gap later on so that's cannot be addressed so this time managers work up everyone use the same DHS2 system so in summary if we see the results of the campaign 2021 which is for seven days online micro plan data set this is I tell you there's vaccination site and data the major components are the target children vaccinated supervisor volunteer porter name and their mobile numbers so this we took from the online micro plan is a part of that and we pulled and put it in the dashboard the vaccination logistics management which is session wise vaccination and logistics planning and vaccination reporting daily coverage vaccine and was six years excuse me and this is the data defaults so supervision and monitoring team this rtm is previously done mostly by odk they collect the data through the odk our few african countries also do the same thing and send data to the DHS2 for our case we are using the android app and use the event culture even capture data entry in the android app so that's how we try to monitor those supervision and monitoring issues so through this monitoring issues we observe qualitative and quantitative aspect by supervision apps session observation also visit apps cover us and miss children in the rapid convenience app of rcm this quality covers miss children in the community awareness this is the three component these apps work both online offline that's why we use the DHS2 android because we have many places there is a hard to reach areas and some places you don't have internet even some places we even has a photograph of vaccination on the reader on the boat because there is no way you can go there so there's some area we have to go to the boat for vaccination as well all national and sub national analyzer use the android apps for the campaign supervision and monitoring so most cases our field work up already have the tabs or personal smartphone so there's two devices are using for those all those daily analysis of supervision and monitoring data help the local and national level managers because this data is every evening is monitored by the managers so decide the next steps so if the coverage is low under the expected coverage then they will ask so who are missing why is not coming to the facility so what they did actually they do by union and what there is a pretension center they compare with the micro planning whose children are missing which area which household so they go to the household and try to bring the children which is called mop up mop up to the center next day so that's how that is achieved previously all checks in forms so that is actually takes a long time and actually does not be a result at all we know the what is missing earlier but for bhs too we know the dead day those are missing so next day the people go to their home bring them to the facility or they go to their home because usually what they do in the village if there is children missing they bring all children in one home and the vaccine to go there and so this methods we follow then this mr campaign next so this is one example of the public dashboard because for that we make several public dashboard components this is one of that so from that up is the summary where they can say that you see the coverage is 104 percent means those were expected more than that we achieve so because with the targeted with the estimated value how much children we should we should vaccinate it but at the end we've vaccinated 104 percent so this is one example of the bringing but this is we are not in that case we are not using the wjo dashboard component this is actually our national requirement so we build as a way for them so that the managers can see directly from here but that is a filter option divisional coverage supervision so they can filter down which one they want to see so manager can see his own district and find out so what is the missing or what is the problem how that can be addressed next please so lesson learned from our implementation each of this technology our case in dhs to to stand the national health and management information system is a best way out so if you want to do something we first try with the dhs to if we can do then we'll do full of this so if you cannot then we look for the other system because we know the water force is habituated they can implement very quickly so anything we can introduce just make an online training and everyone can ready to do the same thing for mr campaign there is a specific need because the first time they are using the tab or mobile at the remote vaccination so that is the challenge but that was quite well done government ownership to support the sector as and the partners is the key so in that case the all partners unicef wjo especially unicef has a key role and the we will say that the success for the success the major credit goes to the wjo unicef because the unicef use their field staff all feel consulted to supervise and communicate with the managers on the regular basis second thing is that the blotcher second partner and the government of course that's time to all epi managers they are not find anyone in the office almost in the field third thing which are designing user friendly apps so we try to make a convenient way to interface in bangla so that the people can understand the ui was in bangla so that user can quite easily understand what we are asking for and they can do and the minimum key stroke they should we we try to capture so that's how the we make the app is user friendly also we are using dhs2 and not providing any additional devices dhs2 android f can be used for the large scale this is the we proved that with the dhs2 android f you can you can make a large scale implementation and this is the proof because 35 million more than 35 million lower in the world is trying to use the dhs2 android f dedicated technical team is required because that time we have a severe preference issue and unicef team we and oslo team as also is involved in here especially bob is very much involved with the whole process dedicated technical requirement to continue a troubleshoot technology based real time system support in intensive monitoring and achieving despite pandemic even during covid pandemic we can achieve the target protocol which is a government actually want to delay more because they say that during uh about due to pandemic people might not able to reach the facility or you cannot achieve beyond 85 percent here we have actually achieved 104 percent which is that even the success for the organization so this is from my presentation i think thank you thank you everyone if there is a question yes so thank you very much hanan so it's time for questions so we invite both on site and online yes very good morning i don't know if it's a good one i'll go back down on there uh first i want to congratulate for the presentation secondly i have some questions related with experience that uh they had related with the campaign i would like to know what was the big challenge that you guys faced during the the campaign related with the with the data data synchronizations and uh the the really update of the dhs2 regarding with the mobile devices if you guys didn't face any problems related with uh when you guys are on the field capturing the data okay thank you i got uh if i got clearly that you are asking the data synchronization issue of the dhs standard right yes the synchronization of data uh of course like what i understood like you guys have a online and offline mode on the mobile device and uh while we are capturing capturing the data uh sometimes we just have some problems um i have this experience from Mozambique actually i'm using dhs2 as well and we are using both systems uh offline and online but sometimes we have this challenge of synchronization of data and actually we are having facing some problems related with uh with uh android and uh i don't know if the new version of dhs2 if thank you the thank you for your question so in dh and android synchronization the first key thing is you have to very careful about designing as is synchronizing offline means when you are working you are entering how much data and how you design if you design too many texts too many use load of data that will definitely take time to synchronize so try to minimize your load so that's why we do we are collecting a very small amount of data as much as low as possible one second thing we are not capturing any emails or any use heavy data number two and third of all we are trying to use the newer version of the dhs2 and the android app because the newer version has a lot of optimization at the back end and also at the android part as well and so in the front end so if you are using the older version like before 36 you might have the you might have the problem with the performance but if you are using the new version of android the newer version of the dhs2 you should not have the issue issue with the synchronization if you have then you should review your data set or your tracker or capture and you should try to design as concise as minimum load and also you have to care about the cohort so it is the user business those users log in only his part of data is synchronizing so if i am logging as administrator the whole country is under me this is really impossible because we cannot synchronize 35 million data one together in a tag or mobile phone so you should be careful about design the cohort how much data for that specific user so for one api vaccinated he's hardly have 1000 so it is quite low load for a tab or pc and it's quite easily synchronized so it's both way as color client and you have to careful also at the server end you have to make your network and accessibility of server is quite wide so that there will be no bottleneck the server end as well thank you all right thank you so we have a few questions from online participants but before that we will take one from the audience here thank you very much really interesting presentation i have actually two questions but i don't want to take the others on waiting online and what is the baseline data you calculated or you use to measure the missing children that were not vaccinated you miss you mentioned that there are missing number of children you calculate what is the baseline data and what is the effect of the h i s on the vaccination coverage is it like increase decrease the state the same and this is like a practical implementation of the system what is the impact of the real implementation of the vaccination coverage thank you thank you for your first question actually the first baseline is the our micro plan so micro plan is supposed to collect the data from the field what is the h topic initially what we do we will do the population based projection and accordingly we will do the micro plan but this macro is higher level because we have projection up to the sub district level but for this we do at the word and zone level after sub district we have the union union has word word has zone so up to this level we make the micro plan because micro plan is also very huge so it has the 85 000 around number of facilities or place what you do the micro plan so in the one union the health worker already know how many children is there because he is for his community so he knows there is 100 children in the village or not so that's why we do the first the micro plan then get the data and accordingly plan the all things vaccination logistics event so if there is a hundred children we need the hundred buyers so we have to send a hundred buyers to the specific facility with 10 percent addition or like this calculation they have so they send that so though there is some worst is because of open by losses and close by losses you know so that is the baseline for a second portion this actually the qualitative we still say there is an issue why the micro plan sometimes it's not 100 percent accurate they sometimes make assumption not always is a perfect because they do say okay I visited I find this is what you have children actually there's children maybe so that's how we find so now the next challenge for us is the finding zero-dose in Bangladesh so why is finding zero-dose and how that can we find this is quite difficult because we already implement DHS to another system to find out the gap but we don't find the still there is some children is missing so we have to find out because when we do the national level aggregation we find that we have the 85 to 90 percent progress that means we still have the 10 percent gap so we have to feel that so we have to find that how the next challenge is to find the 10 percent so next challenge for Bangladesh is the finding zero zero-dose thank you so we have two questions online and then I will come back to you sir so the two questions I will combine them together because they are again related to missing children so probably the only area that you may have questions is whether you are using GIS in tracking the missing children at the moment well we actually try this but the thing is how we do the micro plan there's the quite important so what we find for example there is a survey by PAP though it's based on secondary data so thus we are planning to make the detailed survey on a specific sampling area to find out why and how this happened because after we use a GIS micro plan we find still still still we find five percent gap so this M.R. campaign you see the 104 percent means is again is the target but when you make the survey you might find is not the 104 percent there will be 90 percent so there will be survey and we'll find out how much actually left behind so that is the challenge so what GIS mapping we have if the data is correct GIS map can reflect that from that properly that there is correct but if data is based on the assumption is a data is based on assumption not counting the each children then it will not the real time thing and actually that's happened because when the health worker is going there he might not skipping several household so that's we don't know so this is not a problem with the system that's with that using the system thank you so I think we can take one last question Saurabh you want you have a question hi thank you for presenting your work I have a small query regarding the public dashboards because there's a lot of it's a common requirement in each region these days so did you face any challenges while implementing those dashboards as as you said that you refresh each 15 minutes to present the show the live data so how you manage that while doing the authentication or sessions how you were managing those kind of things or did you face any kind of challenges thank you the trick is we what we did actually we did there several steps so there is a scripting we make a separate data queue so we pull the data from the DHS to the separate data queue and that's what we do each 15 minutes so this is only read request so there is no lock the DHS to outside because this actually what we try to pull the one session on one day data always so they say comparatively low less of data because and second thing is we use the crown job so it's automatic so if there is an failure that will show us why the fail usually there is no fail because we this only read request but we make an intermediate data queue where the data will be stored and the challenge is that because the data queue means whole data set is here so that's the problem so we have to make the vastness of resource the server resources for this but we this is the something better than nothing if you do the directly from the DHS to sometime DHS to system is quite becomes slow or hang or if their analytics is running that time is not possible because if they are updating the data or deleting data and pushing the data there's no request so for safety reason we do the reverse way we make a separate data queue from that is pulling and GIS or the data visualization showing from there because sometimes the problem with our decision maker if you cannot show them you may lose his job so there's a director level challenge so if they go to primary office they make sure the system is running so yesterday I got a message the prime minister visiting boxes buzzer make sure the process whether vaccination system is okay COVID vaccination system was that okay we say it's okay now up to you people to give it okay so yes we up to the dashboard each 15 minutes so we pull the data each 15 minutes and update it because that's what the real time monitoring means is real time so they have to but you cannot make it the exact real time then so first we try try the continuous analytics and we find that there's there is several deadlocks so we skip the idea so we go and then this okay so thank you so much Hanan and the entirety from Bangladesh for their nice work so thank you so much so again thank you very much for both the ministries who presented today so what we discussed in this session today was to give you a brief idea about what is available in the administration package in the hs2 which covers both aggregate and individual based data collection and then we heard from two countries in the asia region now how they are using the hs2 for collecting their vaccination information and the challenges they are encountering in using the packages and how they overcome this challenge so that's what we have discussed in this session but I know there are so many of you joining here on site as well as online who has stories to share about your implementations in immunization and one thing we have noted when we are observing the community of practice so a question are you all familiar with what community of practice is I hope yes yes so if you if by any chance if any of you are not familiar with community of practice please google right the first link that will be coming up with the search results is going to be our official link for the dhs2 community of practice so if you have any success stories or even the challenges if you fail implementing dhs2 for immunization we would still like to hear that so please post your stories in the community of practice we would love to hear those stories and probably you may also get the chance to maybe present in all these conferences that we are having throughout the year so once again thank you so much everyone and I think we can move to the one final session that we are having don't worry it's not going to be any presentations but should Rajit so actually it's not it's not an actual session yeah so we just have a question and answer lounge for anyone who wants to stay now I know it's been a long day for all of us so if you would prefer to take a break don't worry we have a dinner tonight I'll ask Hong to explain in a moment all about that but we can come sit around with you during dinner just have a like discussion on you know any questions you might have and of course we can answer in more detail when we're together in the morning tomorrow as well you're a bit more refreshed so you know I know it's been a long day we're happy to stay around of course if you have any questions for us but if you would prefer to kind of take a little break please feel free to do so and we'll make sure to kind of come check on you guys during the dinner and see how you're doing and if you have any questions then we're more than happy to answer them at that time of course we have a number of other sessions that we're going through in the next couple days and if you see your topic might be addressed there you might want to wait until that session but we're also happy to answer any other other questions you have about any implementation concerns or if it's a more technical consideration as well so okay I'm just stepped out but we'll just wait for her real quickly so she can explain the dinner so also for the posters they're also here so if you would like to chat with any of the team members about the posters they will stick around for a little while and you can feel free to ask any questions about that as well once again no obligation this is optional but we will be here and are happy to answer your questions so just go grab on real quick and you explain the dinner Good afternoon everybody I do hope that you will enjoy the day so as I mentioned this morning this evening we won't have a gala dinner the plan is that we would have a barbecue party on the beach outside the restaurant where we have a lunch today but the restaurant does call me to inform me that it's sound that it's win-grain soon so in that sky you look outside there no rain at all but they are the local people they can breathe the weather I don't know they call me that is win-grain in 5 minutes so I do hope that by the time we have a gala dinner the rain will stop so we can enjoy the beach outside but unfortunately if the rain doesn't support us we have a to move inside the restaurant where we had lunch okay so I think we would have a group photo here I think I think now it's better that we have a group photo here in front of the backdrop in case tomorrow the weather is very nice the sunset is amazing so Grant can have to have another photo on the beach okay thank you all right everyone let's come up real quick and let's let's take a photo and we'll take another one outside if we can tomorrow and for those of you online thank you very much for attending and we'll continue the session tomorrow at 9 a.m vietnam time and we'll open the same zoom link and all the details for the sessions are available if you're having trouble accessing any of the material please let me know or any of the other team members know and we'll make sure to sort that out for you the session is also recorded so if you missed any of the sessions earlier in the morning due to time differences or you know whatever the case may be we will make sure to share the recording with you as well and you will be able to view that at your leisure when you have more time thank you very much for attending and we'll see you guys online tomorrow at the same time


The study reveals that Circular Ionae, Circa Ionae, Circular Syntaxon 6, Circus Tx6, strives malignancy in hepatocellular carcinoma, HCC, through the heterogeneous nuclear ribonucleoprotein D, H9PD, it's activating transcription factor 3, ATF3, its axis, while its encoded protein promotes HCC progression independent of Circus Tx6. This article was authored by Jehualu, Jongnan RU, Yunhao Chen, and others.


For problem number four, we're going to see what happens to the climate model in response to a brief change in the solar constant. We're going to increase the solar constant for a little bit and see how the model reacts. But before doing that, we're going to try to set the model up to begin with in such a way that it represents something like our Earth. So we're going to change the emissivity first to .6147. That's an emissivity value that kind of represents the strength of our greenhouse. We're going to change the initial temperature of our planet to 15 and we'll leave the other things in our Earth. So we're going to change the emissivity first to .6147. That's an emissivity value that kind of represents the strength of our greenhouse. We're going to change the initial temperature of our planet to 15 and we'll leave the other things the same. Then we're going to go to sew constant here, and click on that, and right here in the middle of this graph, I'm going to position cursor right here, click one little tick markup there. So I've made a graph now of the sew constant, so it's steady, 1370, and above, so it's 1372 here for a little bit, and it drops down like that for 1370 for the rest of the time. Hit OK. And now we're ready to run the model. Let's see what happens. So it's evaluating it, and we're about to see the results here. So we see in gender now, the temperature of our client model staying constant at 15 up until the point where the solar constant starts to increase. And then as it increases, the planetary temperature increases to 15.05 at peaks there. Notice that that peak occurs at 16.6 years, 16.7 years, something like that. So about 1.7 years after the peak in the solar constant value, so that's what we call a lag time, a difference in time between the peak of some kind of forcing like the solar constant and the response, which is the planetary temperature. So it peaks at 1.7, 1.8 years later. And then it drops back down. It doesn't quite get back down to 15 after we restored the solar constant to 1370 because the system takes a while to settle down again, and that's a function of the kind of thermal mass of the climate system, which is related to the ocean temperature. So what we're going to do in this question is to change the ocean depth from its default value of 100 to different values by simply typing in a different value here. So there's 200. And then running the model and comparing the response of the model to this kind of control version here that we're looking at in this little video. So you might want to, in fact you should, take note of the maximum temperature rise of the model following this spike in the solar constant and the timing of that as well.


When people think of glorious film-making disasters, the first movie that usually springs to mind is Tommy Wiseau's masterpiece, The Room. You are TAMI PURDLYSAR! But what if I were to tell you there's a film possibly even more disastrous sitting right under your nose and you didn't even know about it? It's got the same name as a video game, but it has no relation to it. I'm of course talking about the evil within. Truth be told, no one knows this movie exists except for one man, a man who told me about it on Patreon at patreon.com. His name is Gregory Coburn. Gregory's a myth roll member, it's the top perk, it's only 30 bucks a month, and with it, you get to make me watch a movie and review it.  Before I dive into the glorious train wreck that is the evil within, we have to go back to the beginning, all the way back to 2002 when production started on this film. By the way, the movie came out in 2017. It's a rocky road. This movie was written and directed by Andrew Getty, a trust fund baby with lots of money and lots of time on his hands. It was originally titled The Storyteller and all the thoughts and ideas came from Getty's own mind and his own nightmares. This movie was also largely funded by Getty and his production company, A-Rork Productions. I don't think they made anything else after this. To say this lofty production had some setbacks would be an understatement. It costs roughly five to eight million dollars to create and Getty's wouldn't even be alive to see the final product. Because this unfinished piece of cinema sat on a shelf for 15 full years. Getty's was described by his peers as your classic shut-in. A recluse who was suffering from depression after a messy breakup. This location he bunkered down in would also be the main setting for his feature-length film. Frederick Holler plays a handicapped 30-year-old named Dennis Peterson. I'm going to quote Robert Downey's insensitive character from Tropic Thunder.  This performance is incredibly cringy. Watching this guy artificially stumble through lines comes off as insensitive, borderline insulting to the handicapped community. I digress. This is what we have to work with. Dennis Peterson has a tough life. His parents are both gone. He lives with his douchey brother in an ill-lit room in the house. And he has visions. Often nightmarish creatures show up and scare him. One in particular is a guy that looks an awful lot like Uncle Fester. He's not scary in the slightest, but he's there. He's there. This film doesn't fire up on the wrong foot. It fires up on the wrong feet. We have a 10-minute, unbroken monologue by the lead character as we have an entire buffet table worth of visions through this guy's psyche.  He's going through weird nightmarish moments. The whole thing is unsettling, but not because it's creepier disturbing, but because it's low budget and clearly hacked together in the editing room. But before I 100% destroy this movie, I want to point out it's easy to tear something down. It's hard to create. I do give props for him at least trying to put his vision onto the screen, even if he really didn't have the skill set, budget or talent to pull it off. After the 10-minute ramblings that sound like they were pulled from the architect and Matrix Reloaded are done, we finally get to the show. Finally get to this main event.   You'll grow to like it. Why? Why does he have to have a mirror in his room? Why is it so large and who puts a mirror in the center like that? Anyway, I don't like this mirror and I don't want it in this room. I just, I couldn't even get on board with this idea. But that's the rest of the film.  He meets with shrinks, he meets with friends and it's kind of like a woe is me tale about John had to raise this kid and he hates him. Basically, he doesn't like the life that he's been saddled with. But he also feels guilty. We're gonna find out why later. Spoiler, John pushed him down some stairs and that's why Dennis is the way he is. A genius on the inside unfortunately saddled with an improper body to get things done although he kind of does get a lot done as the movie progresses. A bewildering amount, as a matter of fact. As I pointed out, Dennis does suffer from multiple personality disorders. He has a guy living inside him and evil within, you could say. He does his best Michael Jackson man in the mirror conversations for a while. It comes off as very awkward, very just very touch and go there for a while as to if I could even get through this movie.  Get a taste for blood, a taste for the knife. And so he does, multiple times. The next time we see Dennis, he's got a cooler full of him. My wife, bless her heart, tried to watch this with me. She's a teacher and she just couldn't get over the fact that Dennis was left alone for multiple hours in the day. Someone that suffers with Down syndrome or a handicap to the level he does should not be unsupervised. It's just kind of unheard of. Again, his brother's trash for sure, but it seems like the state would step in and see if this guy's mentally fit, which clearly he's not.  It's a typical Tuesday at this point. Oh, and he also has a kill room in the basement. At one point, his brother, John's a little sus about it. He smells stuff. He hears instrumentation, drills, and whatnot going off at all hours of the night. He would think he would check. So he does, like any plausible person would do. He goes down to the door, and that's far enough for John. Hey, but I didn't know you knew how to do anything involving woodwork. John says, you know what? I don't need to go in here. I trust this kid. He's 30. Dennis has a good head on his shoulders. I'm just going to walk away, ignore the smells and the sounds in the middle of the night in a weird way he's acting. We're good. What? No rational person acts this way. On occasion, the production kind of slips up and starts to look good with shadows and lighting placed properly, but for the most part, it's a pretty somber, ugly affair with soap opera-esque lighting all around and definitely acting. The acting is not good. That's sugarcoating it. We're at the point where Dennis is now leveled up. He's got bigger game to hunt, and that comes in the form of children. That's right. Now we've got kids in coolers, and Dennis doesn't even try to cover it up. He walks home many nights covered in blood.  Again, John just kind of laissez-faire about the whole thing. It's remarkable what this handicap guy gets away with. You know what? Whatever dreams you have, you can attain. You can. Dennis is an inspiration to all of us, really. Oh, Dennis. You would love it here. I will give the Killian scenes some credit. They are incredibly comical. My favorite is at a local Chuck E. Cheese rip-off where we have a nice family sit-down accompanied by some of the unintentionally scariest animatronics I've ever seen in my life. Those were all done in-house. And you can tell.  This whole scene lasts five seconds. He then picks up the body, and there's a convenient human-sized window that's a jar. He just throws him out. It's just... washes up quick. And then he's back to his meal. That's fantastic. This is also one of those movies where you have the actress that you just know in the back of your mind. She will get topless at one point or another. And thankfully, Ice Cream Parlor Girl does deliver on the promise. It's not great, though, because she's, uh, dead already. So she comes back as a hallucination of sorts. A zombified version of herself. It's still okay. It's still the highlight of the film. But before you know it, it's over, and we're back to more miserable stuff. The scene where she dies is also fantastic.   I don't even really know how it was humanly possible, let alone for this dude to pull it off. But again, anything's possible, kids. Follow your dreams. Tim Begley's the biggest name in this film. He shows up randomly for one scene. Pete, you gotta call the cops. I don't want to. The end of the film is completely off the rails. The last 15 minutes, I have no idea what's going on. Cops and psychologists and all sorts of walks of life are showing up at the home where Dennis is now running around Kevin McAllister style, picking these people off like they're burglars in an R-rated home alone film. It's awesome. Just as the fun starts, though, it comes to a screeching halt. All momentum is put on hold because we have to go back to John and his fiance now, arguing about Dennis, and then she decides she's gonna live with them. They've patched things up. Everything's going great. She's gonna take off, leave John at the bookstore.  He'll maybe walk back home if the mood strikes him.  And she does. How she dies is great, though.  It's quite a sight to see. I wouldn't recommend it, though. I think the last five minutes is where all the budget went because we have a genuinely pretty cool sequence where there's different marionettes and a whole stage play going on. Dennis reliving his life events, all the pinnacle moments, and where things are headed. And it's not good for John. It's not good at all. John does what the audience wants to do at this point and swallows a bullet. Dennis is tackled and he winds up happy as a clam in a straight jacket. That's right. Nothing's happy for Dennis. He's gone completely out of his mind and he's locked away in a padded room where he can't hurt anyone ever again. At least, not until the sequel comes out in 17 more years. Well, that's evil within.  Thanks for watching the video. Let me know if you've managed to watch this at some point in the comments below. Like the video if you had some fun and hopefully I'll see you next time. Wow, you even made it after the bumper. This is where I just kind of stand around and wait for you to click on other things and remind you that you can find me on Twitch at twitch.tv where I play games and even record some of these episodes live and you can become a YouTube join member. These are the things I usually say but I'm not going to do that here. Not this time.


That's fine for his generation, but for our generation like the Millennials and the Gen Z's They're not getting the benefit of the inflation from 1970 to now where they were just printing like crazy And it was actually going to help people Millennials are the first the first generation Obviously, I'm just speaking from a bell curve here. So there's there's rules. There's there's extreme left is extreme, right? I'm just talking about the bell curve the medium norm in the middle Millennials are the first generation to not acquire their own assets because they can't Yeah, I saw a stab recently somebody had posted on Twitter It was that when you compare the Millennials at our age to the boomers at our age There's the difference of like 5x the amount of wealth that the boomers controlled at our age as Millennials Yes, like we Millennials own something like 2.5 to 3% of the world's wealth. Yes, and at our age The boomers controlled like must have been like 15% or something like that. So, yeah, it's just But here's another mindfuck. Here's a my Millennials will be also the first generation if you take this linear line of thinking that their parents are leaving them their assets, so let's say whether it's primarily a house some type of Residency so condo house it might be some government bonds They had from the early 60s and 70s they still have but more or less assets in general So let's let's use that linear line of thinking their parents which are roughly in that age category right now Well, you know, maybe 70 80 years old, right? They're leaving all these assets to the Millennials. It's going to be one of the greatest wealth transfers of a generation. However people There is an elephant in the room. A lot of people don't talk about If you look at the cost of living you look at property tax levels and you look at the roughly declining Salaries of people have been getting for the last ten years a lot of these Millennials that do Inherit their family assets will not have the necessary cash flow to even maintain these assets Yeah, and even though they they may inherit like a place that could be worth a million dollars or something like State in a city like Toronto, they won't have the money to fix it up if it needs repairs Well, yeah, you have one to it's called a one to three percent principal rule So you take the value so the condo is a bit different because you have to pay condo fees So condo fees goes towards maintenance. Well, let's say you get a house a Million-dollar house in Toronto. You do one to three percent You need roughly you need to at least do three thousand to ten thousand dollars a year for maintenance shingles fix that Electrical plumbing whatever there's a bunch of stuff that how constant fixing of a house So you need you need that principle down on a yearly basis Property tax people forget, you know on a standard million dollar home in Toronto property taxes was six thousand seven thousand give or take roughly Depending on the neighbor neighborhood you at okay. You have insurance on the house to get a pay Then what else you got to pay you got to pay electricity on the house You got to pay water in the house. You got to pay hydro on the house You got to pay your year it all adds up So like the the the cost of actual the cost of the actual house And I have rough estimates because I did a whole different deep dive At least Toronto so Toronto similar to some areas so the Vancouver we pass Vancouver for valuation and we're slowly creeping up to areas in California we're about four seventy five to five sixty five a square foot here, which is quite expensive a Million-dollar standard home in Toronto semi-detached without a garage. So that's a standard You're looking at rough overhead to keep on a yearly basis around 18,000 just to keep it You've done these calculations just to keep it just to keep it. That's it. Nothing else and That doesn't go into is there still a big mortgage on the house that your parents leave you Right oh They're gonna sell yeah, yeah, yeah exactly That's exactly it.  There's a lot of lobbyist groups out there Even fact when Airbnb for example, there's areas up north because my area where my cottage is we allow it But it's kind of broken up into townships like you go to Collingwood and people who are listening to this who are not familiar Ontario just pretend we're talking about cottage country about an hour and a half north of Toronto.  Yeah, I was gonna buy a place in Nova Scotia actually and there was restrictive covenants in Nova Scotia on the property by the water We were gonna put a little tiny home It was a nice huge a like couple acres on the on the on the ache on the river the Myer River Which is really sought-after place But yeah, we found out when we were about to close that there was restrictive covenants thing You couldn't build a tiny home on your own land us thinking like why am I gonna? I'm gonna like Build this property that's this dream property and I won't even be able to like put a tiny home for my brother to come Stay with me and stuff like I'm like screw that.   So I'm just gonna disconnect from it but going back to that original topic of the inflation Yeah, it's an interesting Thing I always like to think what what what is it gonna be? What is it gonna be like in the next 10 years because? They've been printing so much like the last the last The last 10 years I've been learning about money and the value of money and fiat money and how fractional river of banking work And the money multiplier and all these complicated quant math things that are basically building up giant bubbles in the economy and causing The house of cards to grow taller and taller and less and less stable One thing that has continually happened is printing money and I'm surprised even as a bit coiner I'm surprised at how much money has been printed relative to GDP and relative to the previous debt size Even though we just had like six trillion dollars be printed in the US and Canada's in worse shape than that like in terms of percentage wise It's not unheard of we're we're basically back to the same levels of debt to GDP as World War one times like the Depression era times. Yeah. Well, look here's the numbers the United States printed more money in June This June then in the first two centuries after its founding So that's a reason why you have like institutions coming in and taking a serious look at Bitcoin as


Vote the number one candidate for counsel. Hi, I'm Leon Miller, a curator in the Special Collections Division of the Tulane University Libraries. This die-cut campaign handout was created for Martha G. Robinson's 1954 race for New Orleans City Council, a race she lost to Vic Skiro, who went on to become mayor in 1961. Such handouts are meant to be glanced at and then thrown away, and so are intended to have a brief or ephemeral lifespan.  All kinds of people or organizations create brochures and other handouts, but a special category is political ephemera. During election season, we're all deluged with campaign flyers that we mostly ignore, but political brochures and campaign cards can preserve a wealth of information that is often simply unavailable elsewhere, such as a candidate's offices, platforms, sometimes information about her family, religion, race, even club memberships. Political ephemera is therefore invaluable for studying not only Louisiana's admittedly unique brand of politics, but a wide range of other subjects, including civil rights, religion, gender, and much more. Special Collections preserves extensive political ephemera from 1860 to the present, and all of our political ephemera from 1860 to 1920 is freely available to everyone. Learn more online via the Tulane Digital Library at digitallibrary.tulane.edu, and please remember to vote.