We have a guest, Elliot Wellenbach. Elliot's the Senior Vice President with Institutional ETF Strategy with Direction, and we're going to talk some markets. Elliot, welcome to TFNN. Thanks so much for joining us. Hey, Tommy. Thank you for having me. Excited to be here. Boy, so we spoke last week. We were talking about the interview, I was excited to have you on, and we got some fireworks today, man, as may have been the case. I know we're going to talk, you know, some treasuries. We got some action today. We'll talk a little bit of gold. But just on the first glimpse, what do you think about the Fed?  We're at 5.25 to 5.5%. But yeah, the market reacting a bit as we got record prices across the board right now. We have yields reacting, and I know we'll talk some gold. You have gold spiking with the dollar kind of cratering a bit. What do you think of this market action today, Elliot? Yeah, I know, definitely an exciting day. An exciting day around FMC meeting, you know, always going to be some calm before the storm.  And of course, once you get Powell on speaking, that's going to move the markets, which we did see, you know, broadly moving higher and sending rates lower. But that being said, I mean, there's not too much new that's come out from the rhetoric of that they still need to see greater confidence in cuts before they have cuts, and inflation is still running very hot, and they need to see that tick down. And you know, one thing they did mention, which they have before is, you know, if they see a weakening or continue weakening labor market, that could, you know, instill a response from them. So you know, pretty moving markets here, and you know, we do have ETFs for traders, short term tactical trading, mostly in the leverage and inverse space. And we've seen a lot of traders going into, you know, our 20 plus year bull treasury ETF, TMF, which is actually a contrarian view compared to TMV, which is the inverse. So we've seen a lot of actually the largest inflows out of all of our ETFs into, you know, the bull fund, TMF on the 20 plus year treasury. And I'm glad you went there, man, because that was going to be my first question yields in focus. It's Fed Day. You got the chairman speaking. They adjust some of their forecast potentially on a longer term basis. So it's interesting when you talk about maybe 20 year plus, you know, the 30 year right now, we got actually rising in yield, the two year, a little bit of a different case when you look at that yield curve and how it's reacting.  If you could go over your list of them, but the TMF, I got it up here right now. You're down about five pennies. But for those traders, if you go over it again, those ones in particular for traders looking for action when you're looking at US treasuries, kind of some of the options that you guys at Direction have available for those traders. Yeah, yeah, absolutely. Yeah, like we mentioned, we specialize mainly in leverage and inverse ETF, short term trading vehicles. So, you know, as I mentioned, TMF, that's a 20 plus year treasury bull fund. And we also have TMV, which is on the 20 plus year treasury. That's a bear fund, both three X ETFs. So these are short term trading vehicles. If you're looking to trade the shorter, you know, end of the curve, we do have the seven to 10 year bull and bear, three X products, TYD and TYO, which we've seen a fair amount of action in, you know, this year especially. Nice. And we got a jump to gold, man. I had mentioned that, boy, we got a lot of gold bugs in the trading room over here. And I was just jumping around even to nugget before you came on the air. Look at that chart of nugget, folks, up 9.4 percent. So we have the dollar pulling back quite a move on the dollar, man, even with, you know, a great summation, not a huge surprise from the chairman or the Fed. We, you know, they still got three cuts in the picture right now this year. Some adjustments later, but boy, the dollar just pulled back earlier today from 104.15 almost, we're at 103.46. You got gold spiking the record territory and you got nugget, man, up almost 10 percent. So for traders out there, you got gold right near highs. The miners, man, sometimes they move just magnificently when you get that type of action in gold for the traders out there looking for some action in gold in the miners. If you go over some of the options, I know I just put one out there. But for traders putting some money out there looking for some action in the miners, the products you guys have available there as well. Yeah, no, definitely. Yeah, gold has been hovering around, you know, all time highs kind of waiting for this Fed decision. Like you mentioned, we saw a nice pop after, you know, the announcement and especially with the Powell rhetoric. We've seen gold miners actually move kind of lagging behind gold. Of course, these gold mining ETFs, they're invested in equities and not in spot gold. But as you mentioned, we have our gold miners, ETFs, they're 2X. NUGT is a bull fund. DUST is the bear fund.  We have 2X funds, JNUG is a bull fund and JDST is a bear fund. And we've seen the gold mining stocks and equities kind of rally, like I said, delayed rally behind the spot price of gold. But we saw today, especially with gold and the gold mining stocks, a pretty strong rally, you know, around 2 to 2.15. And, you know, these are short-term trading tools. You know, last week, after the pretty strong rally over a couple of weeks, we saw some larger outflows in JNUG, which is the 2X junior gold miners fund. And that's really short-term traders taking profit from the run-up that happened over the past couple of weeks. But we've seen a lot of activity, especially in the bull products today, JNUG and NUGT. Oh, man, it's pretty remarkable seeing these percentages. I was jumping through the charts as you were talking there.  But sometimes it's interesting, Elliott, especially the miners, right? You start approaching these lofty levels. And sometimes, man, these companies are pulling gold out of the ground. And every single time gold is going up 50 bucks, 100 bucks, it's just going right to the bottom line of some of these companies. So it's amazing when you get these types of runs folks in the gold contract that, yeah, you might see some huge accelerations. And, you know, we're seeing it today. Nugget up almost 10% and looking at the juniors as well. They are rocking and rolling. Now, speaking of rocking and rolling, we got to talk about some of the magnificent seven. I know you guys have a variety of ETFs. You got the single stock ETFs, of course.  Microsoft right now, you're up about 1%. I'm looking at up another $4 approaching all-time highs. That stock holding out so, so well. Apple been struggling a little bit, but they got some news with Google this week. And then, of course, NVIDIA, the poster boy. But for those investors that are looking for, you know, whether it's individual ETF equities and exposure to the magnificent seven as this run, you know, there's a lot of people out there talking about, you know, it's tough to call at the beginning of the run right now from where we've come. But boy, we are at the forefront of some pretty remarkable technology and the stocks are paying attention. If you could just talk about, you know, direction, the outstanding ETFs you guys have and how you've gotten into some of those around the magnificent seven as well. Yeah, absolutely. And, you know, it might be currently the magnificent six right now with Tesla's performances here, but we'll go with the seven. Sure. But that being said, yes, we do offer leverage and inverse single stock ETFs. So these are providing on the bull side, 1.5 daily exposure to these individual names. We have it across Apple, Amazon, Google, Microsoft, NVIDIA and Tesla. So we have six out of the seven, with the exception of we're missing meta of our suite. And then on the inverse side, we have their single inverse more used for intermediate short term hedging, concentrated position. But yeah, as you mentioned, we're seeing Microsoft trading to all time highs, you know, kind of seeing it being perceived as, you know, one of the AI leaders and a recent rotation out of NVIDIA. We've seen a lot of action in our, you know, our single stock bull Microsoft fund MSFU is a ticker and we've seen some key hiring for in-house AI capabilities, actually a couple announcements today coming out of Microsoft. And with, excuse me, Apple, you know, their AI efforts have really yet to materialize. But earlier this week, we saw a report of Apple licensing Google's Gemini AI to power the iPhone AI. So, you know, their AI for Apple is kind of yet to materialize, but they're making strides and efforts, you know, to partner with some of the leaders like Google and Alphabet. And we do have, again, single stocks for both those products. But one of the more exciting things, you know, in kind of the magnificent seven space is the QTC Global AI Conference that NVIDIA has been hosting this week. NVIDIA has been a very popular name last year, running into this year.  And, you know, outside of if the single stock space is not a place, you know, you're really looking for, which our newest fund, we've launched a concentrated Qs, Bull and Bear ETF. The Bull ETF is 2X, the Bear is a single inverse. And that's taking the highest market cap weighted companies within the NASDAQ 100. See, as you can imagine right now, that's made up of all the magnificent seven names. But we've recently launched that. And it's a great way to trade short term if you're looking to trade not the single stocks, but, you know, the concentrated, you know, NASDAQ 100, which just happens to be, you know, the magnificent seven at the moment. Right. And I was pulling those symbols up as you were talking about it. Those are QQQU and QQQD. And if you don't think Tesla has the legs, folks, they got the bear on Tesla as well. So you don't got to do all the all sides of it. Elliot, I appreciate the time and coming on the program, great discussion on a busy day. And we look forward to having you back on TFNN. Thank you for having me looking forward to it. Always a pleasure. Folks, check it out. Don't forget, you can always find out about the production products. Click on that direction banner on the front page of TFNN.com. And we'll be right back.


Hello and welcome to urban.org 20 research website one platform and three developers Thank you for taking the time to come to our showcase at the very first session at Rufal con. I Am Farnoosh Johnson. I'm an associate director of Rufal development At urban Institute. I'm at urban since 2017. I build I build Architects maintain and support all of our Drupal sites Hello, everyone. I'm Joseph Patterson The web applications analyst at the urban Institute. I started in October of 2022 and My role primarily involves the development and maintenance of Drupal websites for the Urban Institute Hello, everyone. I'm Josh. I'm the director of web development at the Urban Institute and I've worked here since 2021 I oversee the technical side of web development at the Urban Institute And I just want to say a personal. Thank you all for coming to the very first session It's so cool to see that we have more than five people here. We didn't know All right, I'll hand it off. Oh Actually, I've got the next slide of course So we said this was a three-person team in the description. That's false. That's patently false And I think everybody probably already knew that We have a whole communications department at the Institute That includes data visualization artists and developers digital communication specialists directors We have hundreds of researchers and data scientists There are of course many of you in the audience Are some of our partners and vendors that we work with and of course, I want to acknowledge everybody in the Drupal community Especially the those that have mentored us over the years Farnoosh and I especially have been in the community for many many years and we just think the world of everybody and With that we have Four parts of this presentation the first is a question that Farnoosh is going to try to answer It's a very tough question. It's a 40-minute presentation. We have 50 minutes on the schedule We will make sure we have time for questions at the end And the key notes right after this there's a little bit of a break So we want to try to end promptly Of course, once the time's up, you're welcome to come up here and talk to us as much as you want And I will hand it up to you Farnoosh Thank you, Josh Well, the as Josh mentioned the first question is what is Arab Institute as An immigrant from a country without a research organization like urban Institute I found it challenging to explain to my family What the urban Institute does and how it benefits the society? On the other end, I was thrilled that my work would have a meaningful impact in my new home country When I was preparing for this talk initially, I had a Paragraph that was answering this question that anyone can find on About page on urban org after receiving feedback From the team. I decided to come up with an example story To help illustrate the urban's impact My story is about Maya Maya is a fictional candidate pursuing a php in economic Economics she's researching the consequences of the pandemic on a rental housing market in America To kick off her research She turns to Google to find data and resources to support her research In this slide, you're seeing that she discovers the urban Institute's collection of Publications data and insights on the rental market and home prices She finds interactive tools and maps like rental housing affordability tracker Which helps her to explore rental affordability by state county and metro areas She has access to various data sets that are expertly analyzed on Housing policy and the market While searching on urban org Maya can get a solid grasp of the topic. She's researching through evidence based data sets Eventually she can collaborate to address these complex issues in research projects This is just one example of the many ways that urban Institute Wants to make a difference in the society But the urban Institute isn't just for research research groups like our friend Maya Imagine you are a congressperson or working in a senator's office and you're preparing for a to plan strategy or a policy discussions our Research could be your secret tools to your compelling argument But today will our focus remains on Maya's journey Not because the others are not important, but to show you that what we do Urban isn't just about high-profile policy discussions It's about helping folks like Maya who are digging deep into the numbers new insights making new discoveries and Working their brains off to get a better grip of on complex issues She's making a difference just like we strive to do every day at urban Well checking with Maya Later when I look into the features we added to our website and See how those features help Maya during her research at urban like any other organizations We have different offices Like technology and data science Communications or human resources. We also have 12 research and policy centers our technology and data science has a small team of Three developers who are presenting today We create the web dev team the team is responsible for the web for the development of our websites in In the communication office, we have our main content editors We're lucky to have them here with us today We call them our super users because they're just pretty super at what they do so welcome and Also, we have our product manager. We have our designer and our director of digital communication And they are considered the web dev team in the communication department So in total there are ten of us that are core contributors to our Drupal projects in addition, we have a team of data visual visualization developers is who are responsible for Creating visual representations of our complex datasets Ultimately all of our Work is visual We also have user experience specialist in the tech and data science office worry They join our web dev team spring planning and projects based on the need And occasionally based on the project's need Well, we have a lot of work and we are not a big team so I'll give and also and I'll have Joseph to explain how we're managing all of this work All right. Thank you furnish All right, so now let's delve a little deeper into what our work is We strived to effectively manage projects and track issues with within our organization We adapt the agile methodology for building and maintaining Drupal websites This approach involves organizing our work into bi-weekly sprints allowing for iterative development and efficient progress Drupal serves as our platform of choice for website development And we leverage the robust features and flexibility of Drupal to create powerful and customizable websites that meets our stakeholders needs We ensure effective communication Issue tracking to ensure effective communication and issue tracking we utilize a variety of tools. We understand That the stakeholders and team members may have different preferences, so we strive to accommodate them all We hold meetings and discussions and tools that best support each team's workflow and communication style So our team is comfortable with the pantheon as our hosting platform So we rely on on it for website development or hosting Lando helps us create and manage development Our development environment efficiently and we utilize composer to streamline streamline our dependency management process for our websites Urban takes security very seriously So we employ a web application firewall and DDoS protection for enhancement and security It also provides additional features or additional measures, which includes your offense and then traffic rules But josh will delve into this A little bit more in the leader section So now let's shift our focus to how we handle documentation within our organization As it is a very pivotal role in our projects We are committed to creating comprehensive and document We're committed to creating comprehensive documentation for our projects and specific features One way we achieve this is by attaching readme files to our projects including Our custom modules These files serve as a valuable source of information and we prioritize keeping them updated Within with any change in code Maintaining current Detailed documentation is very crucial given the various development developers that join our projects at different stages So this ensures smooth transition and a shared understanding amongst our team For meetings and general communications. We make effort to effectively manage across the different cities and time zones So due to our our teams our collaboration with teams primarily located in The eastern time zone we establish core hours The respect and accommodates everyone's respect of time zones. So this approach enables seamless communications And collaboration regardless of the geographical and time differences I'd also like to highlight Initiative called no meet and tuesdays Which urban has implemented to combat zoom fatigue as well as foster focus work time so this initiative aims to provide Dedicated time for deep work An uninterrupted focus Allowing our teams to meet significant to make significant progress for task being worked on So We'll next we'll explore how we're advancing our strategies with some key initiatives So first we adopt Implement and improve our process to drive great efficiency and effectiveness secondly, we embarked on Drupal 10 upgrades to leverage the latest features and enhancements of the platform and lastly We implement automated testing Automated testing using tools like behat to ensure robust quality assurance And by adopting implemented and improving our strategies we can optimize our operations and achieve better outcomes This commitment to continuous improvement enables us to adapt changes Adopt to change in needs and maintain a competitive edge The Drupal 10 upgrades will help provide us with enhanced functionality and security While future proven our digital infrastructure These upgrades ensure that we can leverage full the full potential of Drupal's capability for our projects and initiatives With automated testing we can streamline our testing processes improve efficiency and identify any issues Used at early stages and behat helps us validate the functionality and consistency of our digital assets All right, so now we'll look we'll explore some of urban's lack subsites So in 2020 in 2020 we've successfully launched Workrise using Drupal 8 and this marked a significant milestone for our team And demonstrated our ability to leverage the power and capability of Drupal and deliver an exceptional websites So workrise.org is a site that focuses on expanding opportunity and economic mobility for workers And in 2022 we experienced an impressive 322,000 unique sessions Indicated in a strong interest in our in our work Moreover in the ongoing pursuit of knowledge sharing we probably launched a work work and knowledge page in 2023 I would also like to take a moment to acknowledge the value of the contribution By phase two with the expertise and support to be able to achieve our goal And has our The overall experience of the sites so special shout out for the available contribution All right, so the next site is policy for action.org And back in 2016 we accomplished a major achievement by launching policy For action.org using Drupal 8 This work site serves as a platform that awards millions of dollars for Funding for research which plays a crucial role in supporting and informing a culture of health and racial equity So by providing funding to impactful research, we contribute to positive change and advancement in these areas In 2022 the website policy for actions that already attracted an impressive 26,000 Unique impressions or sessions and this significantly leveraged the engagement And it indicates the interest and relevance of the research and resources available on the platform It also demonstrates the impacts of our efforts in reaching and connecting with a diverse audience So as part of our commitment to technology advancement We recently upgraded from Drupal 9 to Drupal 10 for policy for actions at work And this upgrade enhances the functionality and use experience Allowing us to better serve our visitors and partners This transition to Drupal 10 also signifies our dedication to staying at the forefront of technology and continuously improving our online presence I would also like to express our sincere appreciation for Canopy for the available assistance throughout the upgrade process The XOTs and support Definitely helped in the success of implementing the transition to Drupal 10 So we are grateful for their collaboration and continue and contribution that they made for the website's improvements All right, so Another site that we maintain Is urban urban Another site maintained by urban institutes is tax policy center dot org And tax policy center dot org has an interest in history So it actually originated back in 2002 And it was using code fusion at the time which showcases our expertise in that technology at the time However, as our needs And the industry evolved we made a strategic move to Drupal to Drupal Which helped us to leverage the flexibility and skill ability of the platform So this website plays a pivotal role in Informing decisions about critical physical issues and support and better policy outcomes Through comprehensive analysis and research The site empowers policymakers and stakeholders to make informed choices In 2022 the website received an impressive 1.69 million league sessions And this substantial level of engagement Demonstrates the relevance and impact of the resources and information provided by tax policy center dot org so It underscores the influence of the website that the And that the website has Has in shape and discussions and decisions around physical matters And to ensure that we remain at the forefront of this technology We also plan to upgrade the site from Drupal 10 to Drupal From Drupal 7 to Drupal 10 soon and this upgrade will help us to actually enhance the functionality and performance And user experience of the site as a whole so Yeah, so also this site was Worked on an effort with phase two for they helped with Maintaining support for the site and also for improvements of the site as well All right, so last but not least urban upward mobility Upward mobility that urban that org It launched in 2021 using Drupal 9 and this website is dedicated to the concept of upward mobility and seeking Provided valuable insights and resources for individual striving for improve social economic status Upward mobility serves as a hub for information and tools to support individuals in their journey towards upward mobility Play on the words there It offers a wealth of resources including research findings policy Recommendations and interactive tools all aiming at fostering economic advancements and social mobility Um, I'm pleased to share that upward mobility also has been successful in attracting significant engagements as well And this plays a vital role in track and tackling the critical challenges Related to upward mobility and we extend our heartfelt gratitude To form one for their valuable contributions to enhancing the site's success as well So now I'll hand it back to farnoosh and she'll take a little bit of a deep dive into urban that org She'll provide a comprehensive review of the platform and its functionality. So over to you farnoosh. Thank you, Joseph So, um as um, Joseph already mentioned we have Dedicated dedicated website at urban for each of our funded projects. Some of them that joseph Walked through and and others like boost technical education collab And we should a carrier and technical education collab housing crisis research collaborative and several others We also have two flagship sites tax policy center dot org and urban dot org last year we relaunch our urban org and Which was the process was including the redesign and relaunching and migrating over 120,000 different types of content including files from Drupal 7 to Drupal 9 This effort was the result of Of many years of work across multiple teams The previous version of urban dot org was which was on Drupal 7 was based on The site was structured using content type For instance a publication was a content type And it was referenced to a policy center, which was also a content type so So we listed all publications that was That on the policy center landing page If they are tagged with the policy center So it was a lot of reputation to structure the site um, so what one of our improvement was and using that taxonomy term to improve the structure of the site So now we're using taxonomy terms to create landing pages for each policy center This allows us to link publications to other content more accurately and and to the corresponding To the corresponding policy center making it easier for our user and super users to manage and Find what they want This is from our lead urban dot org content editor. He's with us and the new taxonomy structure significantly enhances the visibility of Pages on the site offering multiple ways to find content and making it more accessible Additionally, the overall site structure is intuitive and user friendly Making it easy to train new users who can quickly become familiar with the site another improvement feature we added to our new site was the menu system The old urban dot org like many large organization Had a lot of navigation bar navigation bars. We had primary secondary Um fooder and on-page navigation that when many layers deep On the new site we reduced the navigation to three primary links at the top and organized a lot more items in the Expander hamburger menu at urban we often Need to for a number of pages to live and to be interconnected with each other So on the site so we use a note hierarchy module which provides an entity reference field that we call it parent field and this parent field allows our Site manager and content editors to reliably and quickly build sessions on the site That are interconnected with With each other we call them projects or apps We use this field To render tokens For paths to help with search api index and also for breadcrumbs. So we're using In different scenarios as well The next one Is how we're handling our landing pages on urban dot org With them with the new site site manager have the power to create and manage these landing pages without a need of um us a developer This has given them a greater control over the content displays on these landing pages We have implemented a variety of custom blocks That they can place it as an inline blocks inside a layout builder and These custom blocks are very customizable They can the content editors or site managers. They can take advantage of the different view modes and Or they can choose the number of Contents they want to display or if they just want to display a featured content So this uniformity is in how we are managing and structuring these landing pages Give the site manager and content editors to manage thousands of Pages without having to remember different ways of setting up Or editing up editing a page on As an example on our preview site on drupal 7 We had different ways of Setting up these landing pages and all of them They need a developer to come in and then create those pages For example, we had one landing page uses panelizer another one uses Custom paints or display suites. So it was a lot of ways and just remember just to having to remember different ways was Not an easy way So urban.org Is hosted on pantheon and we're using pantheon solar eight servers For our search for our search functionalities We're indexing Over 20,000 pieces of content including full text PDF search The output of the search is based on relevancy or can be sorted by date We have several filtering options that are facets. So they're allowing users to Filter the search results based on the authorship content type Based on the subclassified publications and also taxonomy terms After we launched the side Side we added a new feature to our search functionality. That was that is called auto complete Search so this This feature enhanced the website search search functionality by a lot So users, um, they can type Their input and the user in the input search Section without needing to hit enter or any page reload you get a five The most five relevant content And then a button at the at the end to take you to the search path for filtering more results and On the search path Going back to Maya. Maya used this functionality the search auto complete to look for the rental housing She clicks on a rental housing. This is a taxonomy term landing page. She clicks on the A content a publication and then she scrolls down to the bottom of the page. We have more We're using a taxonomy terms more tags on the bottom of the page to take you to more Related resources of the topic you're researching. So that helps Maya and her research and To pull a list of all Related resources she's looking for Urban design system. So before I dive into the new design system, um, let me Review the old old way old one Um, so on previous projects, we used pattern lab For our front end design system, which was based on the atomic design concept This approach is was great at the time because it allowed us to create A small reusable component in pattern driven approach However, there was one limitation That we could only use these Small reusable components inside our Drupal projects like basically whatever it renders The tweak or mustache um So that's why when we we were In the process of redesigning the urban org We knew we needed a new design system that was more flexible And could be used across any applications at urban and not just Drupal with the help of phase two the agency that was helping us to With the rebuild of the urban org we created a new design system That uses a js framework standstill js to create the the custom to generate custom web components That um, these these are all also reusable Components that you that can be rendered on any template that output the html format We call it linden And named after the u.s president linden b johnson Under his presidency the urban institute was established In addition to standstill js we're using storybook js to showcase our web components To our qc Team and our designers before we implementing those components into our site Our senior director of digital communication once said using the components designers and site producers Can create essentially any page layout they can dream dream up There's so much more complexity to our design system that we could easily fill up the entire session Discussing about it. But also we had several pain points that we need we still need to tackle Well, I'll be more than happy to dive into more of the design system question at the end of the session For now, I'll pass the mic over to josh He's going to talk more about the stats funding security and a lot more Over to you. Hey, uh, thanks again for everybody coming here We're about 33 minutes in just for everybody to note. We're going to talk about some statistics Oh, i'm in control now. So I can do that. Cool. Uh, so we're near the end Um Seen here Are uh, it is a graph that let me tell you if you work at Institute where we have data visualization artists There is like a 17 page document that describes how you make graphs In microsoft excel. So good luck making a graph for a presentation These are the websites, um, and I think I followed all of the coloring requirements that we have at urban institute Um All 24 websites are up there some of them are duplicated because we have drupal 7 sites that are still live drupal 10 sites That are about to go live and I wanted to get those drupal 10 sites on this graph Many of them are going to go static Uh, and many of them are migrating soon. You can see we have a ton of websites that are Either going to be migrated soon or already migrated and just haven't gone haven't launched yet and Those that that is one of the main problems that we have at urban is keeping these websites up to date We've only shown you a couple of them, but we have 24 ish That are running drupal And we have far more than that hundreds of them that are not running drupal And of course technology keeping it secure is very hard to do that So this is a huge This is this is going to be a huge win for us because most everything that was initially developed at urban was drupal 7 And getting from drupal 7 to the next iteration of drupal is a big deal And from that point on it's less of a big deal and even further on so if drupal 9 to 10 is even easier Very excited once we get everything to drupal 10 by the end of the year knock on wood It'll just be we'll just stay on the latest Minor release for all these websites and all of our migration woes will be gone That's that's actually the hope and we're already starting to see that almost all of our drupal 9 sites We're very easily upgraded to drupal 10 In a matter of days The drupal 7 urban org migration. How long did that take for a new she was that like Two years Three three or four years it took We're going to upgrade urban org from drupal 9 to 10 in like Maybe two weeks And that's a big deal and that's fantastic and hopefully this is essentially the evergreen drupal future that we've all dreamed of I want to share some aggregate website traffic numbers the the session was called one platform Because we use drupal. That's the platform. There's no like technology. That's connecting it all But it impacts the whole institute. So We have 19 websites that have google analytics I'm actually going to need to look into that because apparently some of our websites aren't using it where I don't have access So that's kind of interesting Over 2022 and all these numbers are from 2022 because it was a Non-moving time target and it encompasses all of all of a normal year of traffic So all the christmas traffic and everything that we didn't get is in there. So 5.98 million unique sessions What's a unique session joseph was talking about it a little bit ago? It's one person on one device at a single time. They might visit the website at a couple different pages That's what we're counting here. I feel like that's a pretty good representation of how many people Have gone to these websites not necessarily Um, how many hits that we're getting Uh, we get on average across all of these websites 2.3 pages per session So two or three pages somewhere around there that sounds about right? That's good. We're getting pretty good engagement And we have a minute and 30 34 seconds On average to keep these eyeballs interested and that's I don't know. I'm not a google analytics person, but that doesn't seem very like very much time Um, I did the math. I think I did the math. This is either this is either right or wrong. I guess, but uh 682 sessions per minute of 2022 that feels like a lot There's a lot of people going to these websites across the board. There's like maybe three websites that have the majority of the traffic Um, it's a long tail though that keeps going out there and finally Another interesting stat is we have 187 million google impressions That's one of our websites Showing up on google results for all of 2022 I think the click through rate rate was like Really low though. Um, not certainly not driving 187 million views to our website. That's for sure Some more interesting Looks into these statistics. Uh, we had 3.4 million unique sessions on urban.org alone So we're getting quite a bit of traffic there The longest time per session was upward mobility So if you're on upward mobility, you're more likely to Stay there twice as long as any of our other websites. That's I don't know I just find these kind of things kind of interesting Like look behind the scenes a little bit the most pages per session I have no idea why our next 50 urban.org if you go on that website, man, you're clicking all kinds of stuff I'm not sure why but eight pages per session. That's pretty interesting and um, the most clicks on google results This is not a Drupal site by the way tpc calc marriage calculator dot urban.org Is like our number one google result. I'm not sure why Maybe people are just looking for calculators I wanted to dive a little bit into the urban.org content that we have as well just to give you kind of a Sense of the amount of content we have on urban.org So there are 2,900 or so health care publications And this is encompassing. Um, I don't have it on the slide here, but it's encompassing most of our articles On urban.org have a publication date of 2012 or newer and we do I think it's like Three or 400 publications a year. So it's not one every day Sometimes it's some years. It's less than a hundred and some years. It's far more than that Pandemic we had far more than that But it is a pretty steady pace almost every other day. We have something new our Web production team could probably tell a little bit more about that 2,135 taxes and budgets 2,000 and usually these are all I chose some Taxonomy terms that are unique to each other So this kind of represents a bigger picture of our taxonomy that we have on the site Social safety net's pretty big Almost everything's tagged as research. That's kind of interesting 3,619 blog posts of those blog posts 3,297 are urban wire blog posts and none of those blog posts are tagged research So we just have a lot of content getting developed. We have a lot of writers. We have a lot of researchers Trying to communicate and trying to connect to an audience That's actually pretty big I wanted to shift a little bit here and talk a little bit more about security and Security is very important. Joseph talked a little bit about our web application firewall very interested if you guys have other experiences with that Maybe other q&a We had an incident response That I I don't have all the details Very clear in my mind and it's probably good that I'm not sharing specifics But it was I think last november urban.org went down and it went down because We were getting tons of traffic pantheon got ahold of us and said About a week before it went down that we were clocking in over a million views a month Which is far more than we normally would get Considering we only had 3.98 unique people 3.98 million unique people in the year alone a million a month is crazy We're not really sure because you know, it's people that are trying to take down websites Don't tell you what their agenda was or what they're trying to accomplish But it was a continuous traffic load That was like five to 10 000 hits a minute sustained for I want to say it was at least three weeks and within the first week we just We were fine. The website was loading. Just fine. No problems Pantheon got ahold of us and said hey your database is about to fill up past what we're going to support and it was uh, it was Almost 500 gigabytes of logs our log table Was apparently the bottleneck or the hair that broke the camel's back or whatever you want to say about that, but um, we uh cleared the log table We couldn't because the site was down because we were getting hammered with traffic as well and it it was a combination of Traffic coming in and couldn't turn the website off So that we could access the database long enough to actually clear it out ultimately, we were able to use a drush command to turn the website to maintenance mode and gave it a minute to breathe and And then we were able to clear the logs and that gave us about an hour of time and the logs filled right back up again Um, ultimately the final solution was twofold. We went over to redis. We weren't using redis That was my mistake. We weren't using redis and we weren't using A web application firewall. We did not have any any way to Mitigate ddos. It just hadn't happened before on urban.org and now we're set up with firewall across Many not all i'm not going to tell you which ones aren't many of our websites now have the capability to deny traffic When it starts to look funny And there are a couple countries where most of that traffic was originating. We looked into it But ultimately once we turned on the redis caching and we cleared our logs a final time We stayed online for five or six days before we got the web application firewall set up and we were able to maintain Some sort of interactivity on the website for most of the Uh for most of the time and that was fantastic. Thank you jerry for that little note there I'm going to jump into Website funding here real quick. Uh, and then hopefully we'll have some time for q&a Uh, we do the funding at urban is interesting. I'm still learning not for profit space. I've only been here for two years I came from a for-profit world Um, many of our websites are project based And those projects have budgets and maybe the budget is a million dollars to study something And a portion of that budget goes into a website to share that and majority of those projects that are bigger Have their own website. That's why we have so many websites Some of them don't some of them just end up on urban.org and they take advantage of the fire hose of traffic that we get there A number of other websites are collaborations with other Institutes for example tax policy center dot org is a collaboration with Brookings institute We are partnered together our team handles the website Brookings handles a lot of the research Effort and but it's a collaboration, of course. There are other websites that are collaborative as well And we also have a number of internal websites that support the Um organization as well So there's there's tons of websites that come that get funding from various locations. Either it's overhead That's the internal websites or it's funding based. That's the collaboration and project based We also have a lot of maintenance as you might imagine There's a lot of websites to maintain a lot of hosting that we have to deal with thankfully we have one host For almost everything and a lot of domains It's funny a domain's $14 for two years, but usually Those always seem to be the emails that catch everyone off guard when they come through though. I don't know why That takes us to the end of our presentation There um were four parts we answered furnish answered the question. What is urban institute? Joseph talked a little bit about what we do furnish took you into urban.org I wrapped it up with some statistics And that's the end of our presentation. Thank you so much for coming. We're going to stick around for a few minutes If you have any questions, thanks a lot And you can go and grab these slides If you go to urban.org slash 2023 Drupal con slides Does anybody have a question? Yes Speak up and we'll repeat it in the mic Okay, the question is we have 24 websites. How in the world do you manage? To keep them up to date I'm happy to answer that Okay, uh, you want to give it a shot? Okay, I kind of I'm curious what she would say because my answer is we don't I would love to know if anyone has ideas. Uh, no, we're spreadsheets, uh, we talk about things that are, um Big upgrades Frequently, we do meet every two weeks to talk about all of the website projects We just don't have a big big enough team to effectively, um Keep everything as up to date as we'd really want One of our major goals for this year is to get everything to Drupal 10 and then Keeping up to date from there should be a composer update away from Maintaining happiness in zen like serenity. That's the idea Any other questions You have to repeat the question. Oh, have you been? Can have you considered using the Sentry the external Login provider Okay I Don't have the answer. We have not So I've I've looked into it. It's expensive. That's the problem interesting Okay, so sentry opens an open source Self-hosted version. I'm just repeating it for the recording. That's really interesting. Okay. Any other questions? Sure, right there. I'm going to repeat the question then and hand it off to farnoosh and unfortunately That's the last one that we can do mic'd but we'll stick around for any other questions we have question was Interesting that we went from pattern lab to stencil j s and I don't remember the final bit Did we do the design work in-house? um Yeah, so Our new design system is also based on the atomic design approach. So basically it's smaller components So you kind of have that atomic design approach, but just the technology has is different Yeah, so that time we We work with phase two technology The agency that helped us with the with the rebuild and the redesign at the beginning as well the project of urban.org which Was started linden was started based on the During that time It took a multiple years across multiple teams. So We had phase two Some of their front end to help us at that time and but eventually Towards the end when we launched it was only in-house Developers and but your question was about designers, correct? Um, we did have we do have designers and yes our designer in-house in the comp comps team. Uh, she was Working on design Christina bear designed it and she's an incredible designer. We're very lucky to have her All right. Thank you guys so much for coming. We're gonna turn off the mics Come on up if you have questions. Thanks a lot


Hi everyone, my name is Helina and I work in Intel and I'm based out of Shannon in Ireland and I'm here to describe some collaboration work done between Intel and Nokia to integrate collecting and vitrage and then show an application of this work in noisy neighbourhood fault detection and correction. So today I'm going to give a bit of background onto why the work was done, then some information on collecting and vitrage technologies used and Intel Resource Director Technology is the technology that we're going to use to detect the fault on the noisy neighbourhood and then I'll describe how it all integrates together and then hopefully run the demo and describe what's happening. So why we decided to integrate collecting and vitrage was to enhance surface assurance on a virtualised platform. So to do this service assurance is essentially providing a good quality of service for predefined services. So detecting and correcting faults, degradations, violations on a platform will enhance surface assurance, so it made sense to do this integration. So CollectD is the system statistics collection daemon that is used to collect the statistics from the platform. It can be used to use on a virtualised platform, so this is why we chose CollectD. It's an open source project. To collect the statistics, it uses plugins, so you can write your own plugins, most of which are written in C. They read the statistics from the platform and send them to CollectD, who can then propagate them to other services. CollectD also supports thresholding and notifications, so there's a threshold plugin that you can set thresholds for other plugins that are reading the statistics where you can set the threshold for those statistics and if the threshold is broken, a notification will then be triggered and can be sent to other services. So the other services can then read these statistics by registering callback functions on notifications. To communicate with OpenStack Services, CollectD has a Python plugin because OpenStack services are generally written in Python, so it needs the Python plugin to be configured for the OpenStack service plugin. So Vitraj is the technology we're going to use as the fault management system. It is OpenStack's root cause analysis service, so not only provides event and alarm functionality, it also can detect the root cause of the problem. It can detect the cause so much that it can even detect the core that any VM that is created is pinned to, hence it can determine the root cause and also predict or determine the cause before it's actually been detected. So Intel Resource Technology is a technology used to monitor and control things like last level cache and memory bandwidth. So the monitoring technologies include cache monitoring technology and then memory bandwidth monitoring technology. The cache monitoring technology is what will be used to monitor the last level cache. To control these monitored cache and memory bandwidth, we then use allocation technologies. So cache allocation technology and the code data prioritization technology. The cache allocation technology also has a cool feature where you can define a class of service. So you define the class of service for your VM. You assign it the amount of cache that it is allowed to use. So if it's a higher priority process, it gets more cache allocation and if it's a lower priority, a lower cache allocation. So there will be no degradation in performance on the higher priority process. So how all of the technologies integrate together? CLECTE will be running on your virtualized platform. It will have the Intel RDT plugin configured. It will also have the Python plugin configured to read the CLECTE VITRASH plugin and it will also have the threshold plugin configured with a threshold set for the RDT plugin which will be monitoring the last level cache of the VMs. So if the last level cache goes below the threshold that's going to be set in the threshold plugin, the notification will be sent from CLECTE VITRASH plugin which will then post it to VITRASH itself. So now I'm going to run the demo and try and explain what is happening to do noisy neighbor fault detection and correction. So here we have the bare metal host command line. We also have on the top right is going to be your noisy neighbor below it to demonstrate how effective this is. We have a video stream that will be run on one of the VMs to show when the fault is occurring. The video stream will start to become interrupted and not work properly. We also have a VITRASH entity graph that will show us the whole deployment of the entire system. Then the Grafana display down on the bottom left has the last level cache values that are being read from CLECTE which will be running in the bare metal host. Then there's a display here for the alarms that will be triggered when the noisy neighbor is begun. So as you can see CLECTE has been started and it's going to check the data from the system. Check the COS so that class of service that has been assigned, it isn't assigned at the moment for either the media player or the noisy neighbor. So at the moment when the media player is running it's going to get all the cache because there's nothing, the noisy neighbor isn't being run. So the video stream will be clear and you can see the last level cache values that are being read from CLECTE down the bottom on the left. So then as you can see the video stream is running fine. The CLECTE is running and there's no COS class of service to find for either of the VMs. And down the bottom left you can see the top line is the last level cache values for the media player and the line across the bottom is the values coming from the noisy neighbor which doesn't have anything running yet. So we're now going to start to thrash the cache on the noisy neighbor. So it's going to increase its uses of the cache and you'll see the video stream will become interrupted. And immediately when the noisy neighbor has been detected the alarm will be triggered and you can see it in the VTRA's entity graph and in the alarm display down the bottom here on the right. So the alarm has been triggered over in the entity graph and it will now appear the CLECTE alarm and the VTRAGE alarm appear down the bottom. You can see that CLECTE has noticed that the threshold has been broken so it describes what has caused the alarm and VTRAGE can then specify what exactly has caused the VM to become what has caused the fault to occur as well. So this bit of the demo shows how the quality of the video will decrease and you can see the cache levels of the noisy neighbor will become high and the video player will become very low. So VTRAGE will then trigger an action that will allow a mistral workflow to begin. This will clear the alarms. It will also define a COS rule for the media player and the noisy neighbor so the media player is going to get a higher COS rule for more cache allocation and the noisy neighbor will have a lower priority so it won't get as much allocation. So even though the noisy neighbor will still be running the cache usage won't affect the media player. So you can see the alarms have been cleared and in a few seconds the video stream will come back and be as clear as it was in the beginning. And you can also see down the bottom left that the cache usage for the VM has, or the values for the cache, the last level cache of the VM has increased again and for the noisy neighbor and the bare middle host aren't using as much. This is because we have defined the COS for both and you can see up on the host where the COS is defined and it is two for the media player and lower for the noisy neighbor. So that was the demo. So just to summarize how that worked so the noisy neighbor is detected via the Intel RTT plug-in reading the last level cache from the platform and triggering the notification which has a threshold set by a collect D as well. This notification is then propagated to VITRAGE where VITRAGE determines the cause of the fault and does its root cause analysis. It then triggered the corrective action so it defined the COS rule for the cache allocation technologies used by the Intel RTT plug-in to define the higher COS rule for higher COS priority for the noisy neighbor. So below is a link to the demo which is online so anyone can go and watch it again if they want to read more into it. I would also say this is a prerequisite to a presentation that is going to be carried out this evening which I would encourage you all to go to. It will be carried out by Maryam from Intel and Afaf from Nokia. Also if you want to learn more about Intel RTT technologies the Intel Booth has a demo running at these times for that technology and if anyone wants to contact me or ask me questions they are welcome to and that is sort of my presentation.


What I'm going to focus on today, because you'll notice that we have the American College of Cardiology just after me, is really more of the complex genetics and where we are currently in the state of the field, just broadly in cardiovascular disease. And look at what we would need to do in terms of thinking about creation of a workforce that had the competencies that can address the issues of complex disease genetics more broadly. So we know there are a number of different Mendelian genetic diseases in the realm of cardiovascular diseases. We've heard hypertrophic cardiomyopathy mentioned, familial hypercholesterolemia is a second, long QT syndrome a third. So we have a number of those Mendelian conditions. So I'm just going to focus now on where we stand on the state of the art with respect to just common disease genetics and what we in the Functional Genomics Council are doing in this area. So we all know that it's hard to believe that genome-wide association studies just were named the Discovery of the Year by Science Magazine in 2007. Can you believe it? Just six years ago. And to date, these studies have grown and discovered hundreds and hundreds of interesting variants for common diseases. In the cardiovascular domain, one of the largest done to date is a genome-wide study of 200,000 individuals of European descent for the trait systolic blood pressure. What's interesting about these genome-wide association studies and how we really are at the, still at the precipice of understanding biology and still meaning the research to understand what these studies mean. We are long away yet from having things that we can even create appropriate use criteria for. In the world of systolic blood pressure, it's a common disease. It affects 70 million Americans' hypertension. And we really don't understand the complex genetic basis of hypertension. What's really unique about GWAS is that of the 28 loci on this slide for systolic blood pressure, 22 were in previously unrecognized areas that would contribute to blood pressure. If we look at stroke, a recent GWAS published just this month in January in Lancet Neurology reports on over 16,000 cases of ischemic stroke and 64,000 controls. And they identified several loci for ischemic stroke. What was really interesting about this recent study is that all stroke is not the same. So what they discovered when they broke down the stroke, which they could by virtue of this incredibly large sample size, is that the loci that emerge are different for large vessel disease at the top and small vessel or cardiothimbolic stroke on the bottom. So here on the top, you see that the HDAC-9 gene and the 9P21 are both important for large vessel disease stroke. And interestingly, the 9P21 is the same locus that shows up for myocardial infarction repeatedly across all GWAS studies. For cardiothimbolic stroke, the two loci that appear are both associated with atrial fibrillation, which makes sense in terms of cardiothimbolic stroke from a phenotypic domain. So what we're learning in the cardiovascular and stroke realm is that these diseases are complex, that we need really incredibly precise phenotyping to get closer to the genetic basis. And now we're moving into the realm, I won't call it whole, but of exomen genome sequencing. I don't know why that would confuse scientists, but maybe I'm just missing something. But the state of the science so far is that we really are just beginning to discover new genes using the technology of exomer genome sequencing in both cholesterol and blood pressure control mechanisms, and that we're really now just at the precipice again of taking these findings to their functional characteristics to understand what they mean physiologically. So our real challenge now is moving from all of these discoveries into what it means in terms of the phenotyping. We have an example here of how that has been done in cardiovascular disease with a sort one locus. So what are the clinical applications right now in terms of complex cardiovascular and stroke disease? We're really, despite this wealth of knowledge from a research domain, cardiovascular and stroke care has not yet been significantly impacted. Again, this is related just to complex diseases. And we expect that translation will ensue and accelerate over the next five to ten years. Where we think that will happen is in the development of risk prediction models using both common DNA variants and these rare exonic or whole genome variants. So in terms of what we know by common DNA variants, in most cases these have been discovered by GWAS. For those of us in the room that have dealt with common diseases, we know that each of these variants has very small effects and that not one alone is going to really help us use genetics for predictive purposes. But we can use them in aggregate to combine them into risk scores. And these genetic risk scores have indeed been tested in the cardiovascular domain. In aggregate, they show modest prediction for cardiovascular disease. For example, for incident coronary heart disease, the high genetic risk score in the paper that was on a slide a few back where we've looked at 95 different variants, it still only confers about a 70% increased risk. So really it's a limited clinical utility at the moment except if you want to better risk stratify people in order to understand those who may be at intermediate risk. In terms of rare variants, these have the potential to have very large effects to increase or decrease risk multiple fold, not just in the percentage range. But however, each of these rare variants, as we know, occur in only one or a few people at most. So it's making these creations of these common risk scores challenging because incorporation of those rare variants that occur in just a few people with these common variants, it makes it computationally challenging. So ultimately we're left with this needle in the haystack problem with the rare variants where our exome and whole genome sequence have identified hundreds of rare variants in an individual, but most of those rare variants are relevant to disease. And how do you sort through which of those are clinically important? And right now in the field of cardiovascular and stroke disease, this is where we are most challenged. And what we know of those that have been done, and Ray Hershberger who sits in the room wrote one of the first papers that really implicated going from exome sequencing in a family down to the disease itself and the mechanism. The genes that we're discovering for these complex cardiovascular disease also tend to fall in those genes that have already been implicated. So what does it mean if we do have a mutation? So here again I'm restricting my comments just to the cardiovascular and stroke domain. Even if we have a known gene, we have two problems. The first problem is that that particular mutation may or may not affect the gene function and those things are difficult to predict at the outset. And second, even if the mutation changes that function, the penetrance may be affected by genetic background and even by the environmental constraints in which the individual lives. And even within a family, some people with a mutation, the most well studied in our field is hypertrophic cardiomyopathy, may or may not develop a disease or set incomplete penetrance. So what are the dangers that we perceive in our area in the American Heart Association about genetic information? One of the real challenges, and we presented on this at our scientific sessions two years ago, is the concept of having direct to consumer marketing and how that is truly and fundamentally impacting clinical practice. So the direct to consumer testing informs patients of genetic risk scores for now, for common variants, but it can lead individuals, perhaps they have a high family risk, they get their family risk score, it can potentially lead them with this false sense of reassurance or possibly false worry. And so it may or may not be helpful in them to risk stratify for their own sake about whether or not they should pursue regular prescriptive and preventive medicine. And we think the problem will increase as more genomic technologies are applied and directly accessed by consumers. And we feel that the providers still are really not aware of the limitations that are imposed by these direct to consumer products and they don't know how to appropriately counsel patients and our provider's lack of knowledge will serve our patients very poorly and we need education. And we've tried to crack this nut of education in many different ways at our annual meetings in November. We've tried to have courses called Genetics for Dummies. Well that really offended a lot of people. We thought it would entice people who felt that it was too beyond them to go and listen to a talk and so we created the Genetics for Dummies course. That didn't go over. So we've tried different ways to engage different clinicians, scientists to come and get information. But one of the speakers earlier said only 1% of the audience wants to be there if you're lucky. So we find that these sessions, even though very well put together and by the leaders in the field of cardiovascular science are not extremely well taken up on at our meeting. By far one in the cardiovascular area, one of the biggest beacons of hope has been in the area of pharmacogenomics. Basically thinking that we can use genetic screening to get the right dose of medication to the right person and at the right medication itself. And so we would be integrating this into clinical practices, Bruce Korf pointed out at the point of care. But it's not yet adopted in the cardiovascular stroke care, even though there are nine different agents which have some kind of FDA indication for testing. There are several emerging applications for the drugs that are listed here. And by far one of the most recent sort of wins, if you can call it a win, is with the story of Clopidogrel and SIPT-2C19. And the reason that this is a potentially important area is that for every patient that presents with an acute coronary syndrome, being an infarct or just an acute coronary syndrome, they're usually given a drug, an anti-platelet agent as a discharge medication. So it's a large number of people that are affected by this prescription every year. So the routine practice is to give Clopidogrel, which is a type of thionopyridine. And that reduces the risk of further cardiovascular events as well as the risk of having a stent thrombosis. So why do you think this is an important clinical question now for anyone in the room except Alan, who knows the question very well? Do you know why this is such a hot issue now in cardiology? Well, most things are driven by payment, right? Well, the issue is that Clopidogrel is now coming off patent, which makes it hugely more affordable. So it would make sense to use this drug if it's coming off patent, because it's affecting so many people. The challenge is that there is the Cip2C19 enzyme that encodes the major active metabolism of Clopidogrel. And so these reduced function alleles result in less Clopidogrel efficacy, which led to the FDA black box warning. And if you look at the clinical trial evidence, you see that carriers of that particular reduced function allele have a higher rate of cardiovascular events when they're given Clopidogrel versus if they're a non-carrier. So an important question, so what do you do then when you have a patient that presents to the hospital with an acute myocardial infarction? You can determine their genotype. You can, if they have a normal allele, just give them Clopidogrel and send them to the cath lab. Or if they have the reduced function allele, now you have options. You can give them a second or different kind of thionoperidine, or you can just double the dose, etc. And so we really are still somewhat limited because there's little point of care access to this genotyping. It's being piloted now by a number of hospitals. It has yet been validated by a clinical study. And it's unclear at this point which patients, if any, would benefit. So we really haven't even gotten to the point. We have an FDA black box warning for this drug. We really don't have a routine clinical use yet validated in terms of a systematic test. So adoption of pharmacogenetics will be still a little ways off in the cardiovascular domain. It will be at least five years. We do expect rapid adoption by academic centers and large health care networks for things like the CIP-2C-19. But there will be this much slower adoption by individual practitioners because we do have this real knowledge gap in terms of education. So we are involved in providing education to providers. We say here that although we have a lack of provider education on genomics issues, it's not really jeopardizing clinical care now because honestly we don't have in the common disease domain a lot of products that are ready for prime time. So we're moving now aggressively to provide this literacy in two ways. The first is we're continuing our scientific statements. We've published a number of these, our first one. I wrote Genetics and Genomics at Prevention. I think that came out in 2006. And those were just state of the science at the current time. We're updating that now. It should come out this year. And we have a working group that's creating a statement on the use of genomics and genetics in cardiovascular and stroke patient care, which is really provided exclusively for the provider to give them education. And this is the outline of that statement. And then finally, we're also developing a massively open online course monitoring the latest trends in education. We're formulating that course that will cover all the topics that are outlined on the prior slide in that use of genetics and genomics in patient care statement. And that course will be freely available to the biomedical community. And we're pitching it at a broad range from the undergraduate level. We really think that genetics and genomics is going to have to be adapted by many members of the health care team, not just the physician. So we're encouraging our nursing council and pharmacists to also become involved in this kind of health genomics literacy. That massively online course will be supplemented with modules for specific cardiovascular disorders that I've already mentioned before. And the initial versions will be done in English, which will be followed by translations into other languages. Our scientific publications like circulation are provided in a number of different languages. So we have the skill set to do that. So with that, I will conclude my presentation. And Terri, I did it in 20 minutes. All right. Sure. Questions? It's always good to be in the post-brandial phase when you're giving your presentation. Terri has a question. But I should defer to David since I talked a lot. I just wanted to make, I mean, I really enjoyed that presentation. That was really terrific. And one of the things that everyone should just make sure they're focused on is that about, well, when I'm doing a genome case, I'll often find maybe a quarter of the time I'm looking up some variant that's quote, known to cause a disease, and the literature is wrong. And so that's like a whole other level of problem. And particularly in hypertrophic cardiomyopathy, that's particularly evil in terms of the quality of the literature. I hope there are no hypertrophic cardiomyology. Researchers here will yell at me, but there is quite a. I don't mean to pick on hypertrophic cardiomyopathy, but there's a huge problem with the literature that supports all of the evidence that we're trying to build on here. OK, so let's see. I think we have Maron, but maybe I'll get my comment in real quickly. So Donna, thank you. And thank you for putting up with us all eating while you talk.  And I was curious about the comment you made that will be five years likely before pharmacogenomics. It'll be some years before these can be implemented, because these projects are being evaluated and validated. And so my question is, what is the basis and the criteria for your evaluation and the validation that you are expecting? Emy, where did I come up with the five years? No, really, what will it take for the AHA to say, yes, this is validated? So Bill has already mentioned that we, the American College of Cardiology and the American Heart Association, write joint guidelines. At this point, the warfarin trial is still ongoing. Allen's involved in the SIP-2C-19 trial with the clopidogrel. So we have trials that are emerging, but really they're first in practice kinds of trials. So without an evidence base, we would not write a guideline, but hopefully we can develop appropriate use criteria for these genetic tests. But we do believe we need the RCT evidence to get us to at least a point in making those statements. Yeah, and I think that's a recurring theme in the cardiology field that we don't see in other fields about the RCTs, because there are other types of evidence. And so I may ask, I know Jeff Ginsburg has spoken on this. So Maureen, if you're willing to wait while he addresses this specific point, Jeff. Yes, I just wanted to ask about the RCT level, because as we've commented on already in this meeting, that not all guidelines are at the RCT level of evidence. So is there some middle ground for a consensus statement maybe jointly between AHA and ACC to begin to create that path for getting some niche uses or some subsets of the populations, perhaps, in which a consensus group might believe that it's really ready for clinical use? Well, I'll make a statement. Then I'll have Bill fill in. We do have other methods, which are called the appropriate use criteria, which we use in that gray zone, where we don't have RCT evidence. But would we launch something while these two trials are still ongoing? We would have to take that to our guidelines committee and have them evaluate. Bill? I mean, there are other mechanisms, Jeff, beyond guidelines, which have a definite methodology that I think is very rigorous. There is consensus expert documents that actually we've done together. We've done one when the FDA warning, Black Box Warning came on Clopidigrel and SIP. And that was joined between the American Heart and the American College. So whenever there is more data to do that, I mean, the consensus expert documents are based on some data and some consensus where there's no data, but there's a clinical situation and you have to make a judgment. So I think that there is still tremendous value in that. And in response to one comment before, we hope that this would be an impetus to gather more data, more research, to have more solid evidence in that direction. And there's a whole other topic around which, I don't know if our eGap colleague wants to write about when we served on eGap, how do you know that you have clinical utility? Are they CLIA-certified labs? I mean, the whole concepts of the genetic testing, we really haven't dealt with effectively, I think, from a population scientist perspective. So let me ask Julie, were you speaking specifically to the clinical trial issue? Yeah, so, I mean, I think Terry's right in cardiology, there seems to be this particular RCT bar. And certainly for pharmacogenetics, and maybe for genetics more generally. I mean, I think there's a lot of concern about this genetic conceptualism. Somehow it's different. And so, I mean, for those of us doing pharmacogenetics research, I think we view pharmacogenetics as a tool. Just like serum creatinine is a tool to dose patients who have renal impairment to dose drugs that are cleared renaly. And so, pharmacogenetics can be a tool to help you better individualized therapy in that patient. We've never had an RCT trial that says dosing based on serum creatinine is better than not dosing based on serum creatinine. And so it's, I mean, at some level, I think we just have to change the view. Because if we have to have RCT level data for everything in genetics, then we will never ever use genetic data. And I mean, there's just really a disconnect.  And so I think, and in cardiovascular disease, we seem to be the most challenged with this concept because cardiovascular disease happens to have a lot that's driven by RCT evidence. But I think we have to change the discussion, at least as it relates to pharmacogenetics, but probably genetics more generally. So responses on this point. Martin, we will get back to you. Bill. I think we all agree that the RCTs are an important part of evidence in cardiovascular medicine, but I think in the study that I think Sid Smith did a year or so, two years ago, maybe where he looked at all of the recommendations from the ACCHA guidelines. And there was a surprisingly low number that were based on RCTs, and I wanna say 14%, but I can't be sure of that. But it's a remarkably low number, quite a bit of the recommendations that come out of our guidelines are not based on clinical trials. That's very helpful to know. And I think it's something that the clinician community needs to hear because we get this fed back over and over and over again, that there's not a clinical trial on Simvastatin, so for the variant on Simvastatin, so we're not gonna use it. Other comments on this, Alan? Well, I'll just add that for the CYP2C19 clopridic well story, the reason it's so exciting is also the reason why RCT of appropriate parable will never be performed, and that is that clopridic well is coming off patents. So there's no pharmaceutical company that has enough motivation to wanna fund such a study. Yes, one last comment on this topic. So one of the problems that genetics has is that everything we're looking at is so far in the future. If you're talking about someone restenosing after getting a stent, that's in a pretty soon event, that's relatively to what we're looking at with preventing a disease way down the road. Where I think this might be somewhat solvable is compared effectiveness research, which was spoken about at the last meeting, where you're looking backwards at data, where you have the genotype and look back at people's history along good phenotype information from whatever's happened in the medical record. That may be one way to get around this, but it requires a large amount of data and someone can actually go through it. Great, good points, Erwin, yes. If I may switch to... You can switch after Mara and us. Okay, but anyone else who wants to talk about the RCT issue, Rex? Yeah, I would just make the point that, and it was made earlier, but to reinforce in this case, the other paradigm difference that I think we're gonna be facing is, we may actually already have the genetic information in hand. At least many of us think that we're likely to have it. So, as Mary said earlier, I think in that case, it's a game changer because we're not asking anybody to go out and get a new test. We're simply asking them to act on some data they already have in hand. All right, thanks. So, Mara, take it. Great, thanks. Donna, thanks for the good talk. It was interesting. I was wondering with respect to family history and if that's gonna be a component of your educational program for, and including with regards to risk assessment for heart disease and stroke, but also in perhaps recognizing Mendelian forms of cardiovascular disease. Well, we have always listed family history as the first sort of first strike for any genetic disease. So, I'm not, I don't recall now if that was on that outline, but I'll talk to Karen and make sure that we do have that back. Good point. Great, Erwin. Yeah, Donna, great talk and I wanted to compliment you on focusing the educational aspects, not only on the physician provider, but also on the non-physician provider. And I think that's something that we still do not appropriately recognize. I can give you a comment from the ground up in New York City. We've recently engaged with a number of community health centers and primary care practice networks. And, you know, studying how the workflow goes there for care for most common chronic diseases that you're talking about in cardiovascular, in metabolic endocrine, et cetera, diabetes, et cetera. You know, the physician provider is really only a small part of the overall operation. And, you know, much of the care is actually delivered through non-physician providers. And I think that deserves considerable emphasis in our educational efforts going forward. We concur. Great, good point. Jean. Donna, you made the point that there are two active trials in relevant areas and that is a barrier to issuing a guideline. And I agree with that. Do you take it further and say that prior to doing a guideline, whether or not there's a clinical trial that we really need to wait? So there are other, from the American Heart Association's perspective, there are other ways of communication that are not guidelines. So there are scientific statements, which we have been advocates for producing and the second one should be coming out this year. For the, when you have trials that are currently in progress, we have taken a more conservative approach. I'll let Bill weigh in if he wants to wait until that evidence is coming. If you know it's coming, then it would be wrong to jump ahead and write a guideline with something so close to being completed. In the sense that you might be really wrong. We might be, you know, we might be. Joan, Scott. Yeah, I would like to just riff for a moment on a couple of the last concepts that came around, which is around generating the evidence base for practice, as well as a comment about the complexity and the level of the healthcare providers who are providing that practice. And not just the need to generate evidence for practice, but to generate practice-based evidence when it comes to educational efforts. So what we've been hearing as a common theme this morning is there's a very complex system. There's lots of genomic applications more increasing with all different levels of evidence around their use. And across the wide range of medicine in very complex healthcare systems with lots of providers who have different spinach levels, if you will, around their motivation for consuming this information and actually applying it in practice. And someone said this morning that there isn't a one-size-fits-all. And I think that's absolutely correct and what we need to be thinking about is generating the evidence about how to do this education in different clinical settings. And it may be that there's different levels different levels from point of care to traditional CME or some combination therein that's gonna be different for different practice settings and different providers for different needs. Just a bill on that, you know, years ago when the transformative R01s first came out, I put in an idea, which was triaged, but many were, I won't. So it may have been a great idea, but I wanted to partner with places like 23andMe and these direct-to-consumer companies to work with them to iteratively refine algorithms for treatment for pharmacogenetics or disease prediction that could be ongoingly updated as new data came on board as a new novel way of evidence generation. Because I do think we have to step away from the traditional ways if we want to move this more quickly into practice. Okay, any last comments? Not, we should probably have, I should have asked before, Bill and Robert to head up to the podium and we'll be hearing from the flip side of the heart disease community at this point now, the American College. The right side and the left side, that's right. The oxygenated, no, we won't go. No. No. Collaborative side. There you go. We're very collaborative.


This baby was born five days ago, but instead of being home with her parents She is here in a neonatal intensive care unit for premature babies Weighing just 1.5 kilograms. She remains in a critical condition At this mother and baby hospital in Rewari a rural area about 100 kilometers southwest of Delhi, India Four to six babies are delivered per day two of which are admitted to the NICU The most difficult part of working in a rural area, especially for a critical care setup is the absence of resources manpower poorly trained nursing staff and basic infrastructure Dr. Gautam Yadav was desperate to find a technical solution to fill staffing gaps and help him do his job in this challenging environment there is a myth and misconception that Poorer setting can do with poorer technology Actually the poorer a setting the better technology you need Because you have to fill up all those gaps because I am a busy doctor I would want Data algorithm to help me see patterns that I would otherwise miss To meet this need this new real-time data flow has eliminated guesswork and improved care Harpreet Singh and Ravneet Kaur a biomedical engineer and computer scientist by trade started INCU a Platform that provides doctors with a harmonized overview of the child's vital statistics The program was personal for the couple who felt helpless after losing their own child who was born premature at 28 weeks Today Harpreet got to see the platform in action being in my office I don't know the kind of impact this technology brings to these small children in a city rural city like Ravadi and Coming here and seeing how their life is getting saved brings a lot of pleasure and happiness to us The goal was always to help other parents in their situation This mother is hoping her son will be able to leave the hospital in one to two days She has prepared everything at home for him As well as caring for their own children All mothers at this hospital are actually contributing to advancing infant medical care in India The data collected on the INCU platform can be shared with other doctors with the same everyday issues Most Doctors in smaller centers are like me who do not have time to do enough research With this platform we hope to bring Many centers in the country together and they have enough research on common diseases to be able to save lives In a country with 3.5 million babies born premature every year the highest number in the world Only 10 to 15 percent are born in cities It's it fits like a glove. It's very good resource-limited setting and the setting where you have poor record keeping poor monitoring of a patient if a systematic thing like this comes in it would definitely save us


Hey, hey there guys, it's me Nogan back again with another reaction video. Now tonight we're going to be doing two straight kids reaction videos. The first one is episode three, funny and cute moments. And the second one is going to be to one of their final performances. I decided that I'm just going to react to the final performances because I've only seen them once and holy moly, they are good. And I just want to see it again. So I was like, why don't we just do a reaction video to it? So we're going to be reacting to GRR after this. So stay tuned for that. And that's why we've got the red lights in the background because straight kids, they, for their logo, their name is in red. So I'm like, yo, let's do this. Let's have red. I think it's in red and part of it's red. I know a part of it is red. But anyways, this just gets straight into this. I'm freaking excited to see where straight kids have gotten stuck with us today. And I'm feeling a lot, lot better today. So that is awesome. And also it's the first of 2018 and it's awesome.  So I'm feeling better and we're getting into straight kids. So this is just a good time. So this just all the years. Oh, what I've made it to. What happened? Okay. Oh, yeah. They recorded the music video for this one. Oh, I remember this. The mic quality wasn't that good. This was Charles kind of said about. Oh, I have no words for it as well. Yeah. Yeah. Why is it? I forgot what's happening soon. Oh, it's so funny. All the girls probably got flustered over this. I just cracked up laughing. It's so funny. Those look so much fun. Can you guys give me one? Come on. Can you guys just come in and burn me one? It's so gatoring. The mosquitoes. The trot songs. Ah, school life. Nine member performance is awesome. We might do that tomorrow. Oh, what have been? Oh, the shoe throwing. The scene is about to come as one of the best scenes in the show. You've been hit by a curtain. Oh, I've already been borrowing that one. Once or twice in my life. Not that many times. Yeah. John, man.  There. I actually want to know what that's like. Drive it. Drive it. I'll check after this section. I'll check after this. Gotcha. Oh, damn. I can't even do it. Get down. Did you hear that Alex was doing a strike? I forgot. Oh, that's right. Someone goes on a massive streak, doesn't he? I'm still waiting for the funniest part for me. The funniest part in the whole show. Erica, you must be real fun. I've never done it before. I took me a second to realize what you're doing.   Julie is in the strike, mate. It's Felix's reaction. Holy moly, Felix's reaction to that is just so funny. That was the part I was waiting for for this entire video. Oh, my God. It was worth it. It was just so freaking funny. I love it so much. It's just so funny. There's so many funny moments in this show. Show, not series. Show. Series, show. Both. There's just so many funny moments. Oh, man. It's just so good. But yeah. I mean, this is going to be all of this video. If you guys didn't tweet and if you guys didn't, definitely show some support by leaving a like and also comment down below if you guys still know what their freaking third figurine from episode two was because I still want to know what it was. And also comment down below your favorite moment for this video. And also subscribe guys and new to jumpers. Because there'll be more straight kids reactions come to you guys in the near future and there's going to be one coming out about an hour and a bit after this video comes out. I'm going to be doing a reaction to their live stage girl. I've already seen it, but I want to watch it again and be like, whoa, because it's freaking lit, man. It's freaking lit. So stay tuned for that. And yeah, other than that, this is going to be all. And yeah, other than that, I hope you guys have a great day and just keep on smiling and adios, amigos.