ut Pretty well and worked out pretty well by grade level. In other words, we don't have a first year first grade teacher Who all of a sudden is now teaching sixth grade, you know, we do have some some changes, right? It's not it's not perfect. And as I mentioned, we have some intervention staff and some other folks Who are taking on different roles, but it's no one's making, you know, the first to sixth grade leave and we tried to keep As many students with their classroom teacher. So in other words, if students are Chosen person and their teacher is coming back in person They'll be in that same teacher's class and likewise if a student shows our family chose remote and the teacher's remote And there's a match we made all the matches where the day logically could be made But any time you're expanding the number of sections That means someone's changing the roles, right? And in order to make Our remote class sizes to be consistent with our what we would normally have as well as our in person Even smaller because of covid it means we needed to increase the number of sections and that did impact and some people will be Playing a different role than they're playing Have played throughout the year last year and staff as I mentioned tomorrow afternoon are going to get much more information on an individual level In terms of classroom teachers anyway about what their assignment will be Thank you for stating that Any other questions Thing then okay All right, I'll go ahead to the the next the last slide next the last slide So our timeline is you know, we'd like to keep to that same timeline You know what that would mean this week we'd apply for a waiver from desi I did informal conversation with someone at desi and suggested, you know, we're coming from remote and And this was what we were thinking about and this isn't anything official But I think there was some acknowledgement that this is a reasonable waiver request. I think what they're worried about waivers is Yeah, we're going to start with Hybrid and we'll get to five days in person sometime this spring. Like that's the thing or like may 31st When I suggested this there was no shock that I experienced in terms of the response So we would be doing this. This is also consistent with Pellum Which actually does matter because there's some shared staffing and students there Um, and they met about this last week. Um on thursday, so the voluntary turn as I mentioned earlier In a different context continues. So this week we saw three students start at fort river in the building blocks program And fourth grade start at crocker farm Next week, we'll see a couple grade levels start at wildwood. So that'll continue and expand While we're planning for this which is making things a little complicated so to speak but but um You still think it's a good thing Placement is just about done. Um, so all you know 900 some odd students or however many works out to a thousand students We're just about done with placement and we'll share that with teachers good Tomorrow and we'll have that out to families once it's fully finalized. I think the date is a week from tomorrow. So the 23rd or 24th, I think that'd be the 24th We'll send out placement For all families. So they're aware of who the classroom teacher will be I want to be really clear that the survey was binding Right, I've got a number of questions saying is it really binding and so anyone who's watching this that survey is really binding about in person or remote It's not something that we are going to change And so We've this took the most intricate planning and I want to think the principles the system principles were huge in this as well as many others We're moving forward with the plan And you know went as far as to get legal guidance in this question because we knew it was bound to come up And and what people chose for in person or remote and their placement is the option that they have you know for the rest of the school year And we're not you're not going to hear us about changes in placement or You know things like that In the future for the next couple months We're doing spending a lot of time in transition planning a number of our school leaders as well as district leader attended The bright program which we talked about it's it's now a national program And they had a great workshop today about how to support adults through that transition So a lot of tomorrow also will be about how to support our our staff Through the transition because if they feel supported they're going to be much more apt and able To support our students through that transition because this is a lot for students and families as we've talked about It's a tremendous amount for staff So we want to make sure that we're taking care of their needs answering their questions Gets the schedule. It's a little adjusted from our original schedule which we voted but based on the desi requirements of time On learning we do need to start a little bit earlier Not a huge difference, but 15 I think 20 minute difference 20 minutes earlier Than in the original plan, which is 9 50 I believe but with the time on learning requirements that desi has and you know peter reference We are needing to adjust that to a 9 30 start As I mentioned earlier rupert and randy are hard at work on bus routes We're going to try to keep as consistent bus routes as we can From what typically was there so that kids who typically rode the bus together will at least see each other On the bus there'll be fewer students obviously on the bus than typical but 43 percent of kids taking the bus and it's 43 percent of 78 percent of kids returning or 76 percent of kids returning We feel pretty good that our buses won't be overfilled and that we'll be able to space them appropriately but that's what um the folks in transportation and sally who Runs all the routes and the versa trans are working All the time on since I gave them that list yesterday afternoon They're already making progress and we'll try to get those out to families as soon as we can But there's a lot of work that goes into that Um special ed ELL schedules. This is again one of the most complicated aspects of running parallel programs It's incredibly daunting of how to meet all students educational needs Within the confines of school days that are happening on parallel tracks. So Dr. Brady Joanne Smith and the special ed side and kitty richardson and the ELL side are doing tremendous amount of work on that HR is Gathering lists of substitutes and our plan is that permanent subs two to three a school So that they're consistent. They know the safety protocols. They can kind of walk into the situation and be able to fill in You know, we'll have a pool of subs in general But we're trying to get people who can commit five days a week full time To us and we're just about all the way there to have permanent subs in our buildings for us a year Thankfully, we haven't spent much of our sub budget. So this is not going to impact, you know, financially Where we where we would be and from a health and safety perspective, we feel like it's a non-negotiable that we have this in place We also the the principals are leading family and student training on in-person protocols So before students return in person, they'll have an opportunity to be trained on, you know, what it's like And our principals doing a great job trying to organize this with our nursing staff our nursing staff also next Wednesday During an early release day We'll be doing training for all the in-person staff on safety protocols and they're finishing up a document for them tomorrow But they're going to do some some training for everybody and that leads to staff training and support Which is going to be the critical piece of all this and that's why we're doing that We are going to have an asynchronous day Before the in-person return and there's two purposes for that for people returning in person That's so they can get their room ready and meet and work with their fellow teachers And also work with remote folks. We have a significant number of students I don't have a percentage because we literally finished this up this afternoon But uh in terms of placement We have a significant percentage of students who are going to be working with a different educator or different set of educators They were in the past and we do need to give our educators time to be able to talk about those students to smooth that transition And it can't all happen off the clock just very bluntly like we do need to give people time To be able to do that So the way it's being organized right now by the principles is that Grade levels would have the same asynchronous day before The return so that all the fourth grade teachers Yes, some of them are going to be in person some of them the remote folks in particular have the largest amount of Change in their classes that may be coming from other schools But they have an opportunity to read IEPs read ELL plans read student profiles and then be able to talk to counselors And teachers who have worked with these students all year And I know it's hard to think of an asynchronous day now, but I think that's going to really be beneficial On day one two and beyond when this transition happens for students, you know, I'm hearkening back Some of you don't go back this far But when we redistricted and how critical it was that there were conversations between educators About students as that transition was occurring Um, so, you know, I can't put enough stock into our nursing staff Who have been fantastic and fabulous and been great supports But also giving staff time to be able to coordinate on the most important thing, which is our students You know, if we were having this conversation in january It might feel a little different because you'd be like, oh, well, they've got Six months left to make those new connections and get to know these students, but we don't, you know We're starting in april, you know, we really have to get this right very very quickly to support our students In that transition because there's not there's not much time for recovery mode to to happen So that's that's sort of our next steps. Um, it's a daunting list. I'll be honest with you I want to publicly thank all the staff members all the staff members supporting but you know People I work with the most of the leadership team and you know countless, you know, couldn't sleep about this one last night I'm thinking about this and how many times we've went back and and revisited decisions that we thought we made two days ago You know and now we're at it's like a pretty settled place Which feels like a good thing, but just when you're settled one thing then you go on to the next thing Okay, now that we have placement done how we do in el how we do in special education Uh, all those pieces are really critical but I think that the the thing I'd leave you with with the presentation and open up for questions is Um, that we have to really think through and what we are really thinking through is how do we make this transition? Which is massive work For the adults and the kids, you know, so there's all the like nitty-gritty logistics But all those really implement if we can be orderly on arrival in dismissal That's going to have an impact on how students and families and staff experience the whole school day and the whole transition So it's not just for the sake of being orderly. I know I can get critiqued of that probably fairly So that I always like things to be organized and structured Uh, but this isn't that this is about there's a lot of um anxiety Whether it's in people staying in person people staying, you know people going in person people staying remote and the more we can be structured organized and Coordinated that's going to be the best outcome for students. So that's really the attention on the focus and You know principal assistant principals. I apologize for how much I'm pulling them for meetings It's every day all the time it feels like but this is the work that we need to do for our staff and our students so I'll I'll stop there and see if there's comments or questions that anyone Questions mr. Demley Yeah, I mean, I just want to echo I guess what mr. Lord said earlier, which is just gratitude for such a thoughtful Plan that is faithfully implementing What is a very tall order? from Well from the school committee really um to implement this and um, you know, I just it's it's been interesting Watching things unfold around the state this past week. Um both on school committee listservs and In the news and whatnot and you know, it's we're we're asking you to do A lot and to hold certain attributes As a priority and not lose sight of any of them in terms of the pace So that you don't slip the deadline the the safety obviously the support for for staff And and not to deprioritize Our smaller student groups particularly EOL and special Need students and um You know, um, the reality is that some districts aren't doing so well on one or more of those and are either slipping the dates or they have Not a lot of support for for staff for the transition or Or the they're really aren't putting front of mind EOL and special needs students. I really I really appreciate the thoughtfulness and and the pace um, uh, and and the structure of the of this plan. It's um You know, this is exactly what I wanted to have happen a couple weeks ago So I I really appreciate then, you know, I gratitude also extends to your team and to district leadership and of course all the staff because this this literally takes a village from From the the lowest level Uh, uh frontline educator, you know, all the way up. So um, just a lot of appreciation Dr. Morris, thank you. Thank you so much for saying that and I really just want to stress the assistant principals and principals of the schools I mean literally I want the community to know they're looking when we were doing placement They're looking at I mean, we were thousand kids. The reason it's taking so long. We're looking at every individual kid You know and every individual student and every individual staff member And how to balance all the variables as best we could so when we finish this afternoon, you know, and by finish It's kind of our initial Uh placement piece, you know, we were like, you know, it's getting the point where I feel like Derek Shea can just start describing, you know, some kids at Fort River now because we're getting at that level of granularity About, you know, in particular focus just transparently on the remote students today And how do we balance those 12 classrooms and and how do we retain as many of those? You know, um in person, you know The supports that those remote teachers have had What's the right grouping of students if there is going to be a mixed group where there's Students from Crocker Farm and Fort River in the same class You know, how do we balance those? What are the special schedule look like? Uh for students in remote classrooms and they've just been doing just incredible amounts of work And it's just it's my honor to facilitate the meetings, which is primarily what I do But um, it's a really strong team, but I do want the community to know we we're at that level of granularity And how the principal approached it and assistant principals have been critical as well Wow, thank you miss fitzer Yeah, I I will I won't go on about it, but I would also like to Think everyone involved in this process. I'm highly impressed by the The amount of Work that must have gone into this and how quickly everything seems to be coming together. Um I guess One question I have is so I see the timing changed a little bit from 9 30 to 3 10 and when we originally Way back when we're planning this we had Asynchronous learning potentially taking place in the morning or at some other time of day Is that still going to be something we're going to need to offer our students in order to meet? Desi requirements are we going to be able to Just have those be the hours and not have the expectation of students engaging in other learning outside of the The time I know that our remote students will still be starting the day at 8 45 I'm thinking right now just about our in-person students Now this would meet the desi requirements of five hours of instruction a day, you know It we're structuring our schedules a little differently. It's something I didn't mention here Is our principals assistant principals working on the schedule of the day? Um, and it looks a little different in some ways because we're not using the cafeteria So even some of the lunchtime, you know, we can do a lot of social emotional learning and structured social time, you know, which is part of A part of structured learning time and it gets the hours because it's not sort of Going to the cat for cafeteria without a professional staff member there Um, so there are some some differences with it But this is to accommodate so we're not doing asynchronous time because we're really worried in reality We worried a lot about the buses, right? So, you know, if a student's getting on a bus we can expect them to do asynchronous work While they're on a bus and if if that's not true, then they're starting to do their work pretty early In the morning, so this would fit it And the number of our instruction hours, you know Roughly matches because if you think about the asynchronous or the excuse me the remote schedule You have that long block middle block of the day So it sort of shifts the time so it sort of ends up being a bit of a wash So I think everyone is getting kind of sufficient amount of high quality instruction Can I ask just two follow-ups? So the the other question I have is just thinking I think even the Clarify me if I'm wrong on this Provide a clarification if I'm wrong so for For those students who are in person, they may still be receiving some remote instruction while they're in the school So, you know, for example, I'm thinking my son's taking cello lessons I'm assuming that the cello teacher if those are to continue I mean, I don't need to go to music in depth But he might still continue to receive those that level of instruction remotely The other follow-up question I have is just going So the survey had two pieces one was all about in person or remote and That was finding the other piece was about the bus option. So I'm just wondering could you clarify if Wants to drop off in the morning pick up in the afternoon Is that an option if they need to on a day when they have a A need to pick up their child in person after school Is that's still going to be an option the way it was pre Pandemic to kind of pick up occasionally use the bus occasionally and just some clarification on that Yeah, and I meant to mention that we talked about this. I apologize miss spitzer So absolutely what I would encourage folks to do we're going to be in that I'll take the bus sometimes and and pick up sometimes is get in touch with the school and the principal or the office staff Because they will have a number system which helps things flow more efficiently Where families we had this in the fall where families were assigned a number that went in their fresh dash board and it made for staff matching students and Families just go a lot smoother and then we were more assured in terms of you know, not everyone working at dismissal might know every single child So it just it made things There was it made things go a lot easier But we know that some families and we did get that question after the survey Should I fill out transportation if I need it in the mornings, but not the afternoon and the answer was yes Because from a safety perspective, we want to know the maximum amount of students They would ever be on a bus, but that doesn't mandate you to Like send your child in the bus or else you can't come to school. We certainly are flexible with that But because there's a different protocol and this will come up in this the family and student trainings that the principals are going to lead We just want to make sure that that every family who's interested in that gets assigned a number and knows the protocols because it Is going to feel really different than it did in the past Any other questions? Did you have one more slide or was that it was at it? That is it actually Um We are meeting again in two weeks. Oh, so we'll segue right into the next agenda. I know much is future agenda planning So I would imagine that we'll We probably would want another update on that at the At that meeting in two weeks because it'll be a week before the youngest youngest grades return um I think I'm gonna pull up Define the document. Um, so right now all we have uh on the 30th. Um, and I'm Not saying that we need to add more. Um, is our FY 22 budget vote and discussion. Um, and so based on our earlier discussion Um, I think we will have continued discussion on that at that point not just A vote as well as then Um, I just added in person return update Mr. Deming Uh, whenever it is appropriate Given that the district is a little busy right now. Um, the uh, sibling policy for our specialized specialized programs at forever in Wildwood would seem to be a timely opportunity to review Looks like uh, dr. Morris is tentatively adding that to our may meeting That works. I think that one Could you share the link to that in the chat so we could have a visual on it? Yes Oh Oh, sorry So, um, just with regard to I've been hearing a lot about the middle school grade span report and next steps related to that that may impact the Emmer school committee as much as the regional school committee. I see it's on the agenda for the April 6th for the regional school committee. I'm one just wondering if we could Make that a joint meeting potentially to discuss it. And if not, could we create a time when the we could talk about its effects on Yeah, this is the um Yeah, we can Talk about sort of the the reporting of it. Um, the initiative Was initiated by the regional school committee and the region school committee will need to vote to Welcome sixth grade into that Program into their building Before this committee can have a discussion about whether we choose to Move our sixth grade to the middle school. So it is that is it's not a joint decision. It's a Region decision and assuming the region approves that then it would come to the individual member districts elementary districts Um, so I don't know um Because there isn't a vote being taken on that at the April meeting it Could make sense to and invites the Amherst and Pelham Dr. Morris, sorry No, no, I didn't mean to interrupt you you can finish with that Oh, I is going to say. Um, I think it could um Uh Be helpful to have um other elementary schools there A joint meeting that said because it's four towns. I'm not sure we want we're inviting also Leverett and shoots very so it may become I don't know maybe we we'd take that offline about whether we Do that separately or not dr. Morris. Yeah, so here's what I'd recommend is that Um I do think it makes sense to the region. So what's weird What's awkward is that you're all in the region and that's not the case for any of the other towns, right? So, you know for another town is one member of the region They can then bring it back to their membership whereas you're all of you sit in both both groups So my recommendation would be let the region have their discussion and then The representatives from all four towns can at that meeting discuss what next steps would happen at their relevant Elementary school committees whether it's a joint meeting or whether it's a separate topic But I think that way it keeps everybody all four committees on level footing Um, and I think in this particular situation Having the region discuss, you know, because the region's not going to make a decision as miss mcdonald said, right? It's just it's probably going to be an organizational conversation of like where do we want to go from here? So I think after that regional discussion all four communities can then figure out what the next steps would be on their elementary municipal school committee level if that makes sense Yes, much better said than I could at 9 30 Any other um thoughts mr. Harrington Yeah, I'm not entirely sure how to frame the the discussion, but um We talked about like like needs for crocker like capital needs for crocker farm I'm just thinking like as far as informing the conversations that are going to be happening about, you know Building a new school building thing like that should happen at some point. I'm not sure exactly the when or the how though I don't have a Fixed idea just just that we should at some point discuss the There are significant needs there. So Those are my thoughts Dr. Morris So, uh, I think at this point my recommendation would be, you know That would be good feedback for the folks in jcpc in the short term um You know, I mean good feedback is in a good discussion to have to inform their role on jcpc I think the building project Is its own thing and we will talk about that the next couple meetings. Uh, i'm benosomist mcdonnell. Maybe I just added that Right, there's not that much new to share as mr. Harrington knows other than you know, where we are at opm And we get but I think that's I shouldn't say there's nothing But there's nothing like that's huge about crocker farm to share about where we are on the building project There's a lot of work that's gone into it wasn't minimizing But I think to your relative your particular point I wonder if you know At the next meeting in two weeks if we can come back if there is some discussion about jcpc because it is In my opinion, it is relevant discussion For the relevant for the members who are on the joint capital planning group I don't know how if people be a mean able to that agenda item being added You know Mr. Demi Yeah, I mean I mean, I guess I kind of throw it back in your court dr. Morrison to a lesser degree mr. Roy Clarkson Doug mr. Slaughter's and but You know the what our committee wants to do vis-a-vis capital investment in crocker is part of All the other capital leads across our district right and so um Which then feeds into the capital budget every year and so it's this is good timing But but it's the timing is happening right now And so like if we look at that the line items at jcpc for the schools. We do have Certain money allocated in different fiscal years for at crocker farm for for different things and one would one would presume that When you and dr. Slaughter put that together and mr. Roy Clark That you were considering not only the needs of crocker, but the needs of the district and So are we focusing on crocker enough? I mean that is we could we could certainly have um A discussion here about that and then have that inform what we propose for our um for for the capital Portion of the budget proposal this year But I would I would imagine that that would have to happen pretty quick if we were going to make any changes To what you've already presented for for this year So, you know, I think that's a really good point. I don't know how mr. Harrington feels of Separating out the current capital year from what I understood in your comment to be long-term capital investments needed at crocker farm Is that an accurate read of your comments mr. Harrington? Yeah, absolutely. Yeah, so maybe we could slot that later in the spring So that it'll inform because our capital plan work actually starts in the summer when we start thinking about the next year But that'd be amenable to you mr. Harrington Okay And thank you for raising that because it's definitely on our minds. So appreciate that Miss spitzer I think given the um preschool update we got today, which was great because it was covering This year, um, we've had a really big change in the way Delivered preschool this year because I think we're only focusing currently and for the plan for the students with ip's at some point I'm not anytime soon, but it would probably be good to return to We had a conversation about preschool and potentially reaching out to the town to expand it And I just know from personal experience with other parents who are trying to secure preschool for their kids in the fall that there's a Seems to be a shortage of open preschool slots for typically developing kids um in our community right now, so it may be worthwhile to to talk about it And what it means for the 2021-2022 school year Yep, we can add that that's a great idea. Thank you, miss spitzer. Um, so I will move on but um, if anything if anything occurs to you afterward or Over the weekend and you can always send an email doesn't have to be just at the meeting um I think we have one gift in the Um The deck so I will Okay, um, I'll make a motion that uh, we accept a gift from um, a rps pgo incorporated number 995070 to support macauliffe virtual space program at wildwood in the amount of 100 dollars second Move by mcdonald a second by spitzer any discussion Seeing none. We'll move to a roll call vote. Mr. Demling. Demling. Aye. Mr. Harrington Harrington. Aye Miss lord Lord. Aye Miss spitzer Miss spitzer. Aye And mcdonald's. Aye The motion passes unanimously five zero um, I do have three warrants um that I will Read Oh, there it is second page. Okay. Uh, I off I also mcdonald authorized by my signature to payables The amount of 51,666 dollars and 73 cents for a warrant dated march 5th 2021 This included general fund expenses of 18,534 dollars and 19 cents revolving fund expenses of 23,122 dollars and four cents Grant fund expenses of 3,253 dollars and 44 cents behavioral mental Good thing. That's a grant for funding. Um, in the amount of 6,690 dollars and 89 cents and a gift to the schools of 66 dollars and 17 cents And I signed that on march 11th I also Authorized by my signature payroll in the amount of 640,901 dollars and 90 cents dated um March 10th 2021 and I signed that on march 11th and I signed um a By my signature pay out two payables in the amount of 54,518 dollars and 90 cents for a warrant dated march 12th 2021 This included general fund expenses of 54,018 dollars and 90 cents and grant fund expenses of 400 dollars And a gift to the school of 100 dollars and I authorized that Um, I signed that on march 14th 2021 and with that I will move that we adjourn second Move by mcdonald second by spencer. There's no discussion mr.  I miss lord Lord I Miss spitzer spitzer. I And mcdonald. I we are adjourned. Thank you


So you have started your visa process, well the first thing that you are going to be doing is to fill your DS160. The DS160 is a six page document that the visa officer is going to have in front of him before you appear for the interview. So needless to say filling this the right way is extremely important. And one of the most crucial parts of DS160 is the work information. This is also the part where I see people make a lot of mistakes. So in this video we are going to be discussing about the four really important things that you should know before filling the work information part of DS160. And before we start I have something for you. So we have a free PDF and this PDF is a template which will help you prepare answers for all the questions asked in the work section and make filling this section really easy and hassle free. So do check the link in the description box below and get your free PDF. Hi guys, my name is Shachi and I am a travel and visa coach. On this channel you will find tons of useful videos on the US visa process right from filling your DS160 to clearing the interview. Make sure that you check them out. So let's dive straight into this video and let's get into the four really important things that you should know before filling the work information part. So the first thing to keep in mind is that the DS160 is going to ask not just for your current work information but also for the previous ones. And a lot of times people realize this once they start filling the form. And then what will happen is that you will start hunting for the previous work information and this may lead to either making mistakes while filling the form or the system idling out and logging you out. And once it logs you out you will have to do the entire process of you know entering the security question entering the application ID and logging into it again. So to avoid all of this and keep the long story short prepare your entire work profile before you start filling your DS160. So start from the first job that you had and prepare everything till your recent or your current job. And to help you do this we have a template which I told you about earlier. So this PDF has the work template and this will help you to keep all this information ready before you start filling the form. So make sure that you download a copy of it and use it. The second thing to keep in mind is that your current work information is extremely important and the outcome of the US visa process is largely dependent on this current work information especially for B1 visa. So it's really important that you take a lot of care while filling this and make sure that the information is accurate and as latest as possible. And there are two fields where you need to give a lot of importance. The first one is your work phone number. So a lot of times people leave this blank but please do not leave this blank. It's important that you fill in your work phone number even if it's a landline number. And the second part is your annual salary. So there's a lot of confusion as to what exactly to put in the annual salary. And my advice to you is that it should match with the salary that is getting credited to your bank account. So whatever is the salary getting credited to your bank account that is what you should be entering in your DS160. And now we come to the third point and the third point is really important and I want you to pay special attention here. So when you fill in your work information the DS160 will ask you to briefly describe your duties and it'll give you a small para for filling this. So this is a descriptive answer in which you need to describe your current job and your current role. And the way you fill this is very important especially for B1 visas because in B1 visas the purpose of your visit is linked to your current job or to your current business. So I have three things that you should include while filling this part while describing your duties. The first one is do mention the number of years of your work and your current designation. The second one is you have to talk about your area of work and your current role. And the third one is you need to link your current role to your purpose of visit. So you need to link what you're doing currently to the reason why you want to visit the US. And doing all these three things will make this part that is briefly describe your duties complete. It'll make it comprehensive and also make your profile more credible. Now to make filling the work information part and in fact the rest of DS160 really simple and hassle-free. I have something for you. This is called the DS160 toolkit. This toolkit will have a 45 minute video guide in which you can fill your DS160 with me. I share my screen and I show you exactly how to fill each and every answer. It'll also have a lot of other useful resources such as templates to prepare your answers and a FAQ document. And all of this will make filling DS160 so simple and hassle free for you and you can do it on your own right from the comfort of your home. So do check the link in the description box below and get a copy of your DS160 toolkit. And the fourth and the last thing that you need to keep in mind is not to skip any jobs and not skip out on any information. So you need to list all the jobs that you've had right from the first one till the current one. A lot of times people either skip the first job because it was way too long back or they skip jobs in between because either the duration was too short or they don't want to show it on their profile. But I would advise you strongly not to do this. List all the jobs that you've had even if the duration is short. It's better to be honest and upfront about it than something coming up later. And another source of confusion is whether you need to list the part time jobs and the internships. And I would say that you can skip this just stick to your full time jobs your full time regular jobs and all the internships and the part time jobs can be skipped. So guys these were four really important things that I want you to keep in mind before you go ahead and start filling the work information part of DS160. I really hope that these tips have helped you. If you have any more questions feel free to leave them in the comment section. I will get back to you. You can also DM me on Instagram. My Instagram handle is at shachi.mull. I will respond to your questions there as well. Apart from this, do check out all the links in the description box below. You have the link to getting your DS160 toolkit. A lot of people have used this toolkit and it has made the process of filling DS160 really simple and hassle free. So do give this a try. And there's also a link to book consultation session with me so you can talk to me personally one to one. We can clear all your doubts. You can get my help in framing your answers and also get some special insider tips for the interview. So all the information is in the description box. So do give it a look. Thank you so much for watching. Do subscribe to this channel and do give this video a thumbs up. Signing off for now. I'll see you in the next one. Bye.


You know what I mean? All those executives up there, they feed our children debauchery and filth. You know what I mean? They let them talk about everything. They let them talk about killing. They let them talk about games.  Like they get a little Wayne 300 million for putting a tattoo on his face in a red, red, red, red in his pocket. They get a Snoop Dogg, hundreds of millions of dollars for screaming Bloods and Crips.  But you know what I mean? They don't know that that's affected our children. You know what I mean? Nipsey Hustle said to himself, man, Snoop, the reason why I want to be a Crip. We on Boss Talk 101, 101. Yeah, we gonna talk.  No, go ahead. Listen, man, you had East Coast versus West Coast. Yeah. Death Row versus Best Bed Boy. Yeah. Don't limit cash money and so on and so forth, right?  You know what I'm saying? That's the visser. It is. Why do you think the word hip hop and fraternity, I can show you, I got the trademark. They just officially approved it today. I've been fighting for it for two years. Why do you think it was available? Because they never intended for niggas to come together. You know what I'm saying? All those executives up there, they feed our children, debauchery and filth. You know what I mean? They let them talk about everything. They let them talk about killing. They let them talk about games.  They get a little Wayne 300 million for putting a tattoo on his face and a red, red, red rag in his pocket. They get a Snoop Dogg, hundreds of millions of dollars to the screaming Bloods and Crips.  But you know what I mean? They don't know that that's affected our children. You know what I mean? Nipsey Hustle said to himself, man, Snoop, the reason why I wanted to be a Crip. You know what I mean? It's brothers out here. They Bloods because Wayne is a Blood because everybody else that's rich is Blood. So remember when we was young, we wanted to be. Crips? No, no, no, no. When we was young, we wanted to be Dr. J. Yeah, Dr. J. Yeah, yeah. Erd Julius Erdman, Muhammad Ali. Charles Barkley. Charles Barkley. No, not Charles Barkley. So now these kids, they see these rappers rich and having a way they want to be rich. So they say, okay, to be, get a hundred million. I got to put a tattoo on my face. I got to go to jail. I got to, you know, shoot up the block. I got to shoot the opposite. This is the narrative that's been fed, you know, from the top down. But I know you're telling the truth because when I said people want to be Crips, it was a time when Snoop and them first came out. Everybody was trying to be on that Cripp wave.  You notice that whole wave, I seen the whole wave change to everybody want to be Crips at first. And then they tried to be Blood. And you look at them. I made that wave positive just now. But if you look at them, look at the kids, man. They look so innocent. Yeah. They straight killers. These are kids we used to be like, you know, we used to see them walking.   Like, you know, life going to do them well. And they just straight killers, straight killers. You know what I'm saying?  They don't know you. They don't do respect. I kind of beg you, they respect me. That's what I was about to say. Certain leaders that get in position that they look up to because they know the foundation was built correctly. When you can relate to a pimp and kin who have been locked up, who have been in these situations, they'll respect that because they know that. I don't have no problems. But they know that. So all the young kids know you. No, the one thing. If you walk with me through the mall or around some young people, you will be totally apart. These young people, we go to Big T's right now. I'm talking about from 18 to 80. They love me. You know what I'm saying? Because they know I'm real, mommy. You know what I'm saying? I'm a real dude. You know what I'm saying? Like, you know, I'm different. You know what I mean? Like, I don't act Hollywood or Hollywood. You know what I'm saying? I'm just different. You know what I mean?  Let me say this. Little Ronnie said when he was on here that he used to, man, I used to go over there and see Pimp and kin made show me so much love. We met, man, on Big T's. Am I stoked? Man, he loved it, man. He brought you up on the show. Another kid, I talked to a kid earlier today, a youngster, 3G Slash. She said, man, we was at South by Southwest in 2017, man, I dropped my necklace, man. We was running. He said, if Pimp and kin gave me that necklace to him, bro, I say, he say, man, he probably on, he remember it. I remember, man. I remember. I remember. I'm serious. I remember. Slash, Slash, he gave my necklace to him. It was like a little dough boy. It was a dough boy. That's my boy. That's it.  That's what it was. And the niggas just ran out and the girl, she fell and she grabbed his chain and it fell out. So I chased him down. I said, man, dawg, you lost your chain. It probably worth about 40, 50,000, you know what I'm saying? You know what I'm saying? It ain't got nothing to do with me trying to get, cause I didn't know he was going to say this. This is two years ago. No, yeah, I told him this. That's good. That's cool for you to, cause some people would have seen us fell and took it in pocketed or took it in soda or whatever. And you ran after him and gave it back to him. A lot of people wouldn't even do that. But I can't, you want me to tell you how many murders I didn't stop? You know what I'm saying? How many niggas I didn't, you know, I didn't, I didn't saved. You know what I'm saying? I got it kept from getting stabbed in the penitentiary. See, they don't know these things about me cause I don't want no credit for them. You know, that's why the people that's my friends that's been down with me, they still cool with me. I don't have a jealous bone in my body. My partner, he got a million dollars on property. We was on the phone today. My man, JD, I'm studied prison. I'm like, bro, you doing good, man. Woo, woo, woo. And he want to hear. He don't want to hang up because he said, damn, it's a nigga that they hate. You know what I'm saying? Damn, I always tell them good stuff, man.   You know what I'm saying? Quit talking to motherfuckers. Everything you see behind my back going to come back to me. I said, don't trust these motherfuckers. They going to put you in the twist. So you know what I'm saying?   I'm, I'm addressing the situation. Like, bro, I understand.     But he ain't got you yet, you know?  You know what I'm saying? A lot of people got the Little Dude and Little Mama complex. So Little Dude, right? He's a, he's a rapper.   The DJ's playing this music.  You know what I'm saying?     You got three, four baby daddy. You know what I'm saying? Me, she meet a gentleman at the mall. You know what I'm saying? Me, who compliments her and tell how beautiful she is. And then he started taking her out to eat. He started opening the door for, you know, he's doing all the men thing that women talk about men don't never do. What she do? Her baby daddy call her. You know what I'm saying? Me for booty call. She go get a booty call. You know what I'm saying?  Me, he's tripping. And now Little Mama is self-sabotage. And she ain't with this dude no more. I got two questions for you. The first one is, you go through a lot of situations. You have a lot of people who have bit you in the back over the period of time. How do you learn how to trust somebody again? Do you trust anybody around you? Well, you know, I gotta say, most people start at your feet and they end up bit your throat. You know, whoever can do you good can also do you harm. Where there's a little, at least appearance, irrespective of the greatest amount of danger. That's my principle.    You get past 25%, you know what I'm saying?  You know what I'm saying? So you know what I'm saying? Let's keep it at a minimum. You know what I'm saying?  So you know what I mean?   I'm meeting your representative. This is not really you, the makeup and you know, all that stuff is all that. But you know, when it comes down to it, you know what I'm saying? You know, you're living on three cans in the 40 hours. You know what I'm saying? You got 90 kids. You know what I'm saying?  You know what I'm saying? So you know, you can expect that. But when you see it in the club, you know, she looked like Miss Universe.  She looked like her mama should have had triplets. She's so fine. But you know what I'm saying? When you really meet the person and the same thing with these dudes. Everybody, Kim, man, I die for you. Woo, woo, woo, woo, woo. Yeah, we on boss talk, one-on-one, one-on-one. Yeah, we gon' talk.


Cameron and his colleague have looked at what are the prominent positive practices in various organizations. The study which was quoted in the previous slide was exploratory in nature. They compiled various positive practices being discussed in the literature and based on the existing literature, they prepare the battery of 114, 114 questions about positive practices. They run this data through a large number of respondents in a financial sector company. In their first study, we are going to look at that study in more detail in just a minute from now. Based on the responses of the data from a financial company and the many, I think about 40 units, 40 subunits of that organization, they culled out these 6 positive practices. These positive practices are about caring, compassionate support, forgiveness, inspiration, meaning, respect, integrity and gratitude. These were the 6 factors emerged through exploratory factor analysis, exploratory factor analysis of the data collected on 114 items related to various positive practices. Caring here means people care for and are interested and maintain the responsibility for one another as friends, not as competitors. Compassionate support is about people providing support for one another, including kindness and compassion when others are struggling in their professional or personal front. Forgiveness, many a time people are not able to give their best and even at times with their good intentions, intentions for the benefit of the organization and the stakeholders, these at times make mistakes and make errors. Be a practice of forgiveness about those errors, that is another very important practice identified as the positive practice in the POS. Inspiration, people being inspired to contribute to the greater cause, people being inspired to contribute for the greater cause and inspiring each other to give their best performance to realize that cause, to meet that cause. Meaning is another positive practice, that means people finding their work meaningful, they are able to see that their work, they are not just a cog in the huge wheel call organization, but they can see their performance, their role has a positive impact on their organization and also on the society. Respect, integrity and gratitude is another practice, another set of practice rather, it is about people treating each other with respect, with dignity and helping each other to maintain their integrity. They are having trust in each other and having gratitude towards organization and towards each other. So, these are the positive practices dimensions identified in the Cameroon's work, in the work of Cameroon and his colleagues and they conducted this study on two very different sites. The objective of this study was to look at whether positive practices make business organizations have to unprofit, if they do not unprofit, they cannot survive, they cannot conduct their business, they cannot exist and if they cannot exist, what good they can do to their employees, to their internal, who are the internalistic holders or to their customers, suppliers or society, which are the externalistic holders. So, we need not to look at positive organization practice as instrument to earn more profit, but nonetheless, we need to examine whether, we need to examine that profitability and positive organization practices need not be at the lower head to each other, they should not be the zero sum game and this is an open question whether, these good things are also support or at least do not hinder earning profit and achieving business results. So, the first study was in the financial service business unit, paper authors write that they chose financial service business unit because by nature of the business, organization processes and organization conversations were predominantly focused on wealth creation. For them, making profit is the most important objective because of the very nature of the function was like that. So, they conducted the survey in that organization, where by nature people have to talk about money, people have to be very conscious about the financial profit and generating financial wealth for the internal stakeholders and when they conducted this study in about 40 sub units of the financial service business unit, they found that there was a significant association between financial performance work positive work climate and that has a negative association with the employee turnover and turnover intentions and also senior executive evaluation about the organization was higher where the positive practices were more prevalent. So, this was one study and second study was conducted in a all together different unit which was by nature aimed at providing care and concern to the internal and external stakeholders that is a health care unit. The health care unit we know the main internal stakeholders are the doctors and nurses, many of them or we can say most of them join this profession out of their love for humanity, out of their inspiration to serve humanity. So, this was naturally an organization where some of the positive organization practices would be followed. So, in the that is why they looked at this study they looked at the positive organization practices in the health care unit as well to see whether it is relevant these practices are relevant and add up to the organizational effectiveness for the health care units would be about customer satisfaction, service delivery and quality of the care managerial support etc. So, those things are the outcome for the health care unit and in this study also authors found that positive organization practices result into improvement in the record in improvement in the lower numbers means the intention to quit amongst the employees whether doctors or nurses that were that was lower in those health units which were having more positive practices. And satisfaction was high organizational climate were more was more positive employee participation in the organization was higher where the positive practices were more prevalent quality of care management support and resource adequacy were also higher in those units where there was more positive organization practices. So, we can see in this study that positive organization practices have positive impact on the or positive association on organizational effectiveness whether it is organization which by nature focuses on wealth creation financial wealth creation or whether it is an organization which by nature is oriented towards service and care. We need to understand as HR student why these positive organization practices have positive impact or favorable impact on organizational effectiveness. So, in the same paper Cameron and colleague talk about three lines or three aspects of the effects of the positive practices. Amplifying effect buffering effect and heliotropic effect. Amplifying effect comes from a very basic theory of positive organization scholarship or positive psychology that theory is known as broadening bill theory. Broadening bill theory suggests that our ability and propensity to experience more positive emotions increases if we experience few positive emotions means if I experience one positive emotion like gratitude there is a my propensity and ability to experience other positive emotion like wisdom or like courage that increases. So, that logic also applies in the organizational setting when there are positive practices about respect, care or compassion or forgiveness even these few practices if they are started that result into other practices and other positive behaviors naturally. So, one positive characteristic build or leads to next positive characteristic and that virtuous cycle goes on and that is the amplifying effect of the positive practices in organizations. What is the buffering effect? Buffering effect is that a respect to of the nature of industry or the nature of market or the economy any organization or any organization faces or organizations have to sometime face some downturn it may be because of the novel technology may be because of the increasing competition change in regulation or they can be so many other factors because of which organization face challenge. The positive practices in the organization also work as buffer against negative factors and activity within and outside of the organizational environment. So, that builds the sense of solidarity and positive culture and resilience which is very helpful in the difficult times. So, it is important for organization to keep on looking keep on investing keep on promoting positive practices because it is not only helpful in the good times it builds resilience and solidarity which is very useful in the tough time in the challenging times and no organization can say that they will never face any challenge a respect to of whatever resources they have or whatever attract however attract to market they are operating. Third effect is helotropic effect helotropic word comes from helio and tropism helo means light tropism means movement helotropic effect is related to human tendency to be attracted towards positive aspects of life that is why it is compared with lighting. So, when there are positive practices organizations result into fostering the positive energy amongst the members and positive energy produces elevated performance. So, positive energy naturally results into better performance because the concentration is higher people have less hassle about their work people are more helpful to each other naturally and they feel like contributing. So, helotropic effect is the another reason why positive organization practices result into organizational effectiveness.


Good afternoon, everyone. Thank you again for joining us for today's webinar, lung nodules and lung cancer screening, understanding, managing and finding clarity with Dr. Kilal Patel from JFK University Medical Center. If you have any questions, you may ask them anonymously by clicking on the Q&A button at the bottom of your screen. But please note that if you type it into the chat, it will not be anonymous and all attendees will be able to see your question and name. We will make sure that all questions are answered at the end of the webinar. This webinar will be recorded and sent to the email address that you registered with along with being uploaded to the Hack and Security and Health YouTube channel. Thank you again for joining us today and I'll pass the floor over to Dr. Patel. Thank you. Hi, good afternoon, everyone. I'm Kilal Patel. I'm the medical director for the lung nodule program for Hack and Security and Health in the central region as well as the chief of interventional pulmonary over here. Today we're going to talk about lung nodules and lung cancer screening, understanding, managing and finding clarity. The objectives which we hope to achieve during the talk would be what are lung nodules and why do they require attention? What are the common causes and risk factors associated with the development of lung nodules? What is lung cancer screening? How is lung nodule detection and diagnosis achieved through screening? And what are the available treatment options for lung nodules and how are decisions made about their management? And in the end we'll have some time for questions if anybody has anything. So what is a lung nodule exactly? It's commonly referred to as a spot on the lung or a shadow on the lung when you get a report and your primary care physician or the ordering physician goes over it. In vague terms, if you're not describing it, it is a small abnormal area on the lung, usually seen as a white opacity, usually less than three centimeters in size. That's slightly smaller than a quarter. This is a chest x-ray for those who are not familiar with it, so that's usually in black and white, as you can see, I just wanted to give you guys an idea about what the spot looks like. On this side, this is the right lung.  The white lines that you see are your ribs. This is a heart in the center and over here you can see it's not completely black, but there's a white spot that is a lung nodule. Mind you, and when you do a chest x-ray, you're only taking one picture of your chest. The other times, sometimes you might have heard somebody getting a cat scan. And if you get a cat scan, what we are doing in a cat scan is we are taking pictures of your chest and slicing you like a loaf of bread. It sounds a little bit morbid, but that's exactly what we do. It gives us a better idea of what's happening inside of your lungs. Compared to a chest x-ray, in the x-ray you only do one picture, and a cat scan can be anywhere from 100 to 200 or 300 slices or 300 pictures that we take. This is what a cat scan usually looks like. On the bottom part, that's the back of the patient. This is the front. This is the right side and this is the left side.  The white lines that you see are blood vessels. That's how your body gets the oxygen, gets rid of the carbon dioxide. On this side, as you can see, this is a bigger spot over here and that's what a lung nodule is. So now the question becomes on what are the common causes of lung nodules? So you can broadly classify them into four different buckets. It could be secondary to an infection, secondary to inflammation, or it could be secondary to a scar tissue from a previous infection or inflammation or to some sort of an injury that the lungs got exposed to, like it could be a gas, it could be smoke, it could be chemicals and that caused some scarring. Scar tissue is dead tissue or it could be cancer. That's the most worrisome, obviously. How common are the lung nodules? Nodules are found in about 30% of people who get chest radiographs. Could be an x-ray or a cat scan. They're quite common and majority of them are not cancer. What are the symptoms? Majority of them don't have any symptoms unless it's from an infection then you might have some fevers, chills, some coughing or from inflammation then you can have it from that inflammatory condition. But most of the times they're not symptomatic and it's found on a test done for some other reason. Somebody might go to the emergency room for a belly ache and they get a cat scan over there and when they're taking a cat scan they can get the picture of the bottom part of the lungs and they might see a spot on there. That's called an incidental pulmonary nodule. So most of the nodules are found incidentally or when you get a screening cat scan which we'll talk about in a little bit. So as we just spoke about this nodules are very common per se and most of them are not cancer. Then why are we having this conversation is because of the elephant in the room per se is because of lung cancer. Lung cancer is the second most common of cause of cancer in the United States and it's a leading cause of mortality from cancer both in males and females. The good news is the lung cancer incidence rate is going down as you can see in this graph and males it peaked around in 1985 has been slowly growing down and females it is plateauing out and has been has a slight decrease but not too much. However, the deaths from lung cancer is more than deaths combined from prostate, breast and colorectal combined. That shows the magnitude of it. And the reason for this is because lung cancer usually doesn't present at an early stage because it doesn't cause any symptoms. This slide shows you when does lung cancer usually present it? The blue is early stage. The orange that you see is only the cancer has spread only to a regional area. The red is if it has distance spread or stage four disease as we call it. Majority of lung cancers, 57% of this presents at late stage. The below graph shows you what's the survival of it and the survival is very poor when it has spread. Mind you, this slide is based on data in 2010 and cancer therapy has come a long way so the numbers are slightly better for survival compared to that. However, if cancer is caught in an early stage, that's the blue graph, then the survival is very good and sometimes you can even be cured of cancer. This cancer is in a very early stage as we call it. Then you can sometimes cut it out or you can even do some unique radiation therapies. And that's why we come to lung cancer screening. So when do we do lung cancer screening? Lung cancer screening is advised in patients who are in the age group of 50 to 80 years and at least have 20 pack year smoking history. So what do I mean by that? 20 pack year smoking history means if anybody smokes one pack a day for 20 or more years or even if they spoke two packs a day for 10 years, that's when you multiply the number of years smoked into the packs per day and that's the answer. So if anybody who has smoked more than 20 pack years then we should do a screening on that. And they should be a current smoker or quit less than 15 years ago. That the last recommendation, American Cancer Society just came up with a guideline saying that that's not a prerequisite. If anybody meets the top two, they should go ahead and get a lung cancer screening scan. When do we stop screening? We stop screening if they develop a health condition which severely limits their life expectancy then there's no point in doing the lung cancer screening scan. This is a concept just to show you how important it is so to screen. So normally whenever we do any kind of testing in medicine person, we look at how many people we need to screen to save one life from that disease. So the first one is a mammography. So you have to screen about 1,900 females between the age of 40 to 49 to save one life from breast cancer. The number gets a little bit less. We only have to screen about 1,300 between the age of 50 to 59 and only 377 between the age of 60 to 69 to save one life from breast cancer.  But when you look at lung cancer screening, you only had to do 130 screenings or only 130 patients need to get screened to save one life. That's pretty big discrepancy if you look at it. This slide even shows it even more. This shows you how many patients who are eligible for screening are actually getting screened. The dark blue line is the people who are eligible for breast cancer screening and who are getting screened, which just looks very good. The second one is cervical cancer screening, which wasn't that good early on, but it picked up quite well and now almost everybody's getting screened for it. Holorectal cancer is the exact same thing. It started off at 40% and now it's all on its way to 80%. Lung cancer is all the way down here. So breast cancer, about 76% of patients who meet the screenings, go ahead and get mammograms regularly. Cervical cancer is the same, it's about 72%. Colorectal cancer is about 72, too. However, lung cancer screening is only happening in 4.5%. The various reasons for that and why that happens.  That's not true for everyone. There are a lot of non-smokers who also get lung cancer and there are smokers who do not get it, but the whole point being, you need to look out for it. There are screening modalities available which have shown to make a difference and that's why you should encourage yourself or any friends or family members who might qualify for lung cancer screening to go ahead and get screened. You have a long way to go to save lives on that. What happens if at all you get a lung nodule on any of your scans? It could be an incidental finding or it could be from the lung cancer screening. As I said earlier, that does not change. Lung nodules are very, very common and majority of them are not cancers. When we see a lung nodule, we look at the clinical part. What history do you have? What occupation you do? Do you smoke or not? Do you have any family history of any kind of cancers? And then we marry it with what does the nodule look like on a cat's cat? We see the size, the shape, the location, the appearance of it and then marry them together and come up with a pre-test probability or how likely is it that that nodule is cancer or not? Is it high, medium, or low? If it's low, sometimes we don't even need to do anything or we will just get surveillance to repeat its scans, to follow the nodule, to make sure it doesn't change. It doesn't develop any high-risk features. If it's moderate, then we might even do a blood test to see how likely is it that the nodule could be cancer or not. If it's on the high risk category, the high-risk features, then we might go ahead and do a biopsy or maybe a resection or some other invasive modality to confirm it whether it is cancer or not. There are various treatment options for nodules depending on what the cause is. If it's from an infection, get antibiotics and that should fix that and the nodule should go away. If it's inflammation, you get medications for it and that should fix it. If it is scar tissue, unfortunately that does not go away and it stays there for a while. It's like a scab that you get on your skin and it's there forever. However, if it is cancer, then there are various options depending on when we find it, what stage it is. It could be a resection and you could be cured of the cancer if it's early stage or you might require some chemotherapy or something called immunotherapy in which we utilize your body's own immune system to fight the infection. So the cancer in this case, our radiation. So there are various modalities what can be done about it depending on what it is. The point we should all consider is we shouldn't be an ostrich and stick our head in the sand. We need to figure out what it is and then just follow it. Kind of nodule care at JFK. So we run, we have a very extensive multidisciplinary program in which we have interventional pulmonary, thoracic surgery, thoracic oncology, radiation oncology, radiology and pulmonary. We all come together and we go over all the nodules and figure out what needs to be done about that. I truly believe in more brains are better than one. Everybody can come up with some sort of an idea and then we decide on what needs to be done about the patient per se and how we can help them. And what's the best way forward in that regards. There are various other new things that I just wanted to give you an example of somebody who was in a lung cancer screening program. If you look at it this is a vertical section of the lungs per se. There is a lot of amphysema and you can see there is a spot on it. And this patient, because of the size of the nodule it's about two centimeters in size so we got something called a PET scan. What we do in a PET scan is we inject some radioactive sugar inside of you then take pictures of your body to see if it lights up. Cancer, infection and inflammation. All three of them love sugar. And if they take up the sugar it appears bright like it does over here. However, it's not too bright. If it's too bright it appears more whitish or yellowish. In this case it is a little bit less. We went ahead and we have a special procedure called robotic bronchoscopy in which we go in with a small camera inside the lungs and we try to biopsy it. So patient had navigation bronchoscopy but think this in this case and was diagnosed with adenocarcinoma. But however there was no lymph nodes involved. What the robotic bronchoscopy does is we take a CAT scan and we use it and put it on computer forms a three dimensional free as you can see over here. Then which works as a GPS. Tells where we have to go and what we have to biopsy. As this was an early stage cancer our thoracic surgeons were able to resect it and have the patient cured of cancer. There are very few times in cancer world that when we can say that we could cure you of a disease. Even high blood pressure, you have to keep on taking the meds. You don't get cured of it, we're just controlling it. So that's why it's very, very important to catch this thing in a very early stage. That's all I have kind of for now. Anybody has any questions for me? All right, our first question. I have two nodules in the lower right lung found on CAT scan for another ailment. I went to a pulmonologist and he said he never wants to see me again. He called me a nodule baby. I smoked but more than 15 years from the time of scan. Do you agree with not having a follow-up scan? My dad has melanoma and his four millimeter nodule grew 1.7 centimeters after six years of scans from original diagnosis. So as I said, it depends on the size, the shape, the location and the appearance of the scan. I don't agree with the other lung doctor who had mentioned to you about that ways. So we don't ignore it for saying that regards, but you have to look at all those things. That's specifically if you are high risk for it because you have a strong family history of the same. So that ways I wouldn't completely ignore it. Even without looking at your scans, you would have qualified for at least one follow-up scan. But if you have any high risk features, then maybe it would be even more. Strongly advise you to have it looked at and make sure somebody takes a look at those scans that gives you right advice about the same. Our second question is, what type of blood test can be done for lung nodules and what do you look for to determine if nodules are infectious slash inflammatory versus cancer? So it's two-part questions. I'll take the second part first about the infection and the inflammation. So we look at the clinical part of it. So if you have signs of an infection like fevers, chills, body aches, or you just had an infection and you're getting over it right now, then the nodule could be most likely from that. In that case, normally if you do a course of antibiotics, if it's appropriate, then repeat the scan a few weeks later. As soon as you're done with the antibiotics, the nodule will not go away because your body takes time to heal itself and for that nodule to disappear. So normally we wait anywhere from six to eight weeks and then we'll repeat the scan and then it should disappear. That's the second part. Going to the first part, so we have various blood tests. The main two ones, what we do is if at all the nodulus cancer, it's not normal. So it has abnormal proteins in it. So whenever it's dividing rapidly, it keeps on the cells, keep on rupturing and releasing protein in your bloodstream. We look for those proteins per senior bloodstream and if you have them present, then we can say that you are higher risk for cancer and then we should proceed with the biopsy. The same token, we know certain proteins which are seen in benign conditions. And if those proteins are found in your bloodstream, then we can lower the risk of cancer and then say that it's less likely that you have cancer. Normally, as I said before, when we look at the size, the shape, the location, the appearance of the nodule, we have calculators which give us a probability on how likely that this is cancer or not. And when we do the blood test, we either increase the likelihood or decrease the likelihood. If we decrease it, then normally we would just go with conservative approach of just repeating gap scans to make sure that it's okay. However, if it increases it, then we would proceed with some sort of a biopsy to just confirm the diagnosis so we can treat it before it spreads anywhere else. Our next question is, I was diagnosed with breast cancer at 39 years old. During tests, it was found that I had numerous pencil eraser size nodules in my lungs. I never smoked. Should I have some type of surveillance testing and or monitoring? Yeah, so it's a complex question per se. So whenever you are diagnosed with some sort of cancer, they must have been staging for it at that time. If you have that conversation with your oncologist, they would be able to answer that question more because if this was present at that time and it was deemed related to your breast cancer and then you are in remission right now, then the nodules should not increase in size. So most of the times we do a repeat surveillance scan, not just for the nodules itself, but just to make sure there's no increase in it if it was related to your original scan. If it is really thought to be because of something else, then that's a different ball game altogether because we want to see why it's there and it's not changing per se. So just because of the breast cancer diagnosis, I would strongly recommend to speak with your oncologist and they would have access to all your historical data so that they can compare it and then advise you accordingly. But a quick answer would be yes, there would be a follow up scan about it to see how quickly you have to do it. It depends on what the original scan showed and how many of them were there. Our next question is, should you look at vaping the same as smoking? Vaping is actually worse than smoking in a way but I have a personal bias about that. So if you think about vaping people who are not familiar with it, it's an electronic cigarette. Usually it comes as capsules or ampules per se or cartridges, what they put in it. One cartridge of vaping is equal to roughly about 100 cigarettes, 100 packs of cigarettes or so per se. Some, most people don't realize it in that regard. And now when you add vaping with flavors which is very addicting like lollipop or whatever bubblegum with sugar in it which is very addicting by itself, it gets even worse per se. So what's happening right now is initially vaping was introduced saying that people can get off cigarettes and which works, but however the amount of smoke that they're taking in is exponentially higher because people don't realize what's equivalent of. Like when they were smoking a pack of cigarettes they would just stop at the end of the pack because they think, okay, I finished a pack. It's a material thing which I can look at. Whenever you do the electronic cigarette they don't realize it. They just take a puff every now and then and it keeps on going. And that's why we're seeing a lot of young people who vape quite a bit who has lungs which are like they're 20 years old but the lungs are 60 years old per se because they have got so much damage in them. But the same token, if you use it as a tool to quit smoking, yes it works in that regard but I would use more caution in that. Vaping usually still has nicotine in it which is the addicting part per se and depending on what the other things that they put in the vaping, that's what if you get exposed to because what happens in vaping is you're not burning anything it's basically suspending it into small droplets which you breathe in and that's how it works. And so that's why I would say like no vaping is sometimes actually even slightly worse but if you use it as a crutch to quit smoking then yes it's worthwhile. Our next question is my mom had nodules and PET scan however she was 91 and we left it. However she did pass about two years later. I feel that we could have done something we were going to get an NFA however the pulmonologist said that she could get a collapsed lung. So you're absolutely correct about that so it depends on how we biopsy it. There are multiple ways if you have a nodule which appears high risk so you do your homework about that size, shape, location, appearance and then the clinical part and if it appears that it's high risk per se then we talk about different modalities on how you can do a biopsy. One is we can give you some local numbing medication to go from the outside. And the other one is we go from the inside that's the robotic bronchoscopy what I was talking about. So depending on where the nodule is actually located we choose the modality. The risk of lung collapse is roughly about 20 to 24% when you go from the outside and it's only about four to 6% when you go from the inside. But the downside of going from the inside of the robotic bronchoscopy is you need general anesthesia so you should be stable enough to get that. So there are a lot of caveats in it. Yes, lung collapse can happen and but there is more to it than that. Sometimes most of the times it can be done in the same manner per se. Personally, we have if it depends every 90-year-old is not the same. We have apseed 88 or 1992 is my highest which who look like they're 70 years old they're pretty vibrant and living life per se then you go ahead and do that in those cases because you want to preserve the quality and the quantity of life as much as you can in that regard. So it's a mixed bag. It depends on a lot of variables per se. Yes, it can cause lung collapse but we have various strategies to mitigate it or reduce it but it doesn't go all the way down to zero. Our next question is are you finding COVID instead of cancer within these nodules? So let me reframe the question a little bit. So are we finding other diagnosis? So we cannot find COVID on biopsies per se because it's a virus usually and by the time we do that it will be gone by we can we don't we cannot culture it that well the virus doesn't survive that long. But as I said earlier or early on in my talk most of the nodules are benign. So if you biopsy let's say everyone we find get 100 people with scans which have nodules in it only 4% of that would be cancer. So forget about the risk factors and everything. So if you think look at it most of the other stuff is either an infection inflammation that's why the push is to really look at the nodule itself in a multidisciplinary manner. You look at it from multifaceted approach we look at the size, the shape and location that sound like a broken record you marry all of them together and when somebody who's like has looked at it all their life and that's what they enjoy doing then they will be able to tell you you don't have to put a needle in each and every nodule that regards to try to figure out which one is higher risk and then you do it that way. So yes to answer your question majority of them are not cancer but and no we cannot we have not detected COVID there is no way for us to detect COVID in that because the virus would not survive processing. Our next question is my lung cancer was caught at a very early stage and I had a low back to me. There was no spreading and I've just completed two years of CT scans. Do I still fit into the 54% survival rate that I saw on one of the slides? It's actually much higher now so if you're an early stage cancer the rates are if I'm not wrong and you went between the high 70s to low 80s per se. So as I said, that slide was a little bit older but I liked the graphic representation it was from 2010. So yes, if you're very early stage cancer then you fall in the 80% range per se in that regards and if it has not anywhere else congratulations on that that it was found at an early stage and you could cure cancer. Our next question is can a scan be used to diagnose the specific kind of COPD a non-smoker has? I've been told I have COPD that it's not emphysema but not which specific disease it is. So there is a condition in which non-smokers can get COPD. There are a lot of genetic conditions that you should be looked at depending if you have a European descent per se. So that there is more that goes into it you will require some sort of a workup I would strongly urge you to do it sooner than later because what happens in most of those conditions is that you can have progressive damage of your lungs properly that's what's happening right now and that's why it showed up on the scan and you need to figure it out what it is so you can arrest it and reverse it as much as possible per se. You need your lungs to breathe and you need to breathe to live so there's no other way around that. So yes, there are conditions about it you are able to usually say whether you have lung damage or not from the CAT scan but you cannot say how much the damage is because it doesn't tell you anything about the functionality of it.  Our next question is can we get a screening from our regular doctor? How can we go about it?  I can share if you can shoot me an email my email address is right there and I can share the fire where your primary care has to share. Send the paperwork to but most of places do it and we do it at JFK and all the central region hospitals do it the lung cancer screening scan. So your primary care should be up to date about it but otherwise shoot me an email I can share the data with you. I believe this next question is in reference to the previous question on vaping. They asked cartridge equals how many cigarettes? So there is a flyer on FDA's website which I'm quoting for a sake that shows that 100 cigarettes one cartridge is equal to 100 cigarettes. Our next question is have two or three nodules for over 20 years also have emphysema how often should I get CT scans? So if you're not smoking right now or have quit smoking for more than 15 years then you don't need to get scans for the nodules itself. However for emphysema if that is progression then your lung physician might order a CAT scan to look for other treatment modalities. And our last question is if one sees a pulmonologist affiliated with JFK are those clinical findings discussed in your department? Majority of the times they are so usually they bring up the nodules in which there is a clinical question which they cannot answer or they are not comfortable with. We encourage all pulmonary physicians to bring their cases over there and talk about it as much because everybody can then chime in. All of us bring in cases at that time if it's a straightforward case then usually no but otherwise yes. We had one more question slip in. On a CAT scan and subsequent PET scan it was confirmed that I have several small nodules but also bronchial status. What is your advice? So most likely your nodules appear that they are from an infection. Bronchial cases means you have damage of your breathing tubes per se. This is usually secondary to a chronic infection or some kind of injury that keeps on happening over you. Months to years at a time per se. I would strongly advise you to get that infection under control so that you don't have progression of your bronchial cases in that regard. So you would not need CAT scans to follow on the nodules but at the same token if you have high risk behaviors as if you are smoking or you have cancer industry then that's a different question but other than that no, you don't need CAT scans to follow on those nodules because you have a cause which appear most likely from an infection. Are there any further questions before we end the webinar? All right, if there are no other questions thank you again everyone for joining us virtually here at Hycon-Security and JFK University Medical Center and thank you again to Dr. Kilal Patel for sharing your expertise on this topic. I hope you all have a wonderful rest of your day.