Hello, my name is Monica Wahee and I'm going to present for you this presentation which I also presented at the Fourth World Heart and Brain Conference on August 27th, 2021. The title of the presentation is, Data Collection for Healthcare Quality Improvement for Diabetes and Heart Patients. So here's what I'm going to talk about. First, I'm going to talk about trends that we've had in healthcare quality, like how do we figure out what is healthcare quality, especially for chronic disease patients. Next, I'm going to talk about patient-centered key performance indicators or KPIs, what those are and how we should probably think about them. After that, I'm going to talk about implementing the Plan-Do-Study Act or PDSA model for quality assurance and quality improvement or QAQI in healthcare. And I'm just going to quickly review. I'm not going to get detailed into the model because I know some of you are really into that model. I'm just going to skim the surface and talk about the implementation of that model and what it's done for healthcare, at least in the U.S. And then finally, I'm going to propose my new approach, which you've probably read about on my web page, which is a different way of looking at quality insurance and quality improvement in healthcare from the point of view of the healthcare QAQI department. So I have this new model called SPRAB. I guess that spells SPRAB. I'm trying to like make it make a word, but it's not really a word. But anyway, it helps you. At least you can pronounce it like PDSA you can't even pronounce. So I'm going to start the talk by talking about what we were thinking about in the 1990s. So I'm 50. Okay, I'm just going to say it. And when I was in my 20s is the 1990s. So what was I doing? I was a research secretary in a cardiovascular unit at the University of Minnesota. We're studying cardiovascular disease and hypertension. And so we were wondering like, how do we know if our hypertension patients are doing well? Well, obviously, their hypertension is controlled, right? But is there more to it? Because we were giving them like beta blockers, which if you ever take beta blockers, my mom took them, they make you feel like crap, like a lot of them do.   So what other metrics can we look at? And that's what we were talking about quality of life. So the same thing with diabetes, right? We can look at blood sugar control, but at what cost? Are these people able to move around and do stuff? And so in the 1990s is when we were talking about evidence based medicine, like, you know, what is the actual measured evidence behind these treatments? But really what counts as evidence was the other thing we had to struggle with. Next, while we were struggling with those ideas in the 1990s, as the 2000s came on, we had these ideas of patient centered medicine, which is a great idea. Like who's going to argue with that? I'm a patient. I want medicine centered around me. So it's a nice idea. But like, how do you apply it? I mean, I'm different from other patients. All the patients are different. They're not uniform. And also research shows that patient satisfaction is not always consistent with health care quality. I've seen research where parents bring their kids a pediatrician, and they're like, my kid's sick, give me drugs. But the kid has a virus and the antibiotics are not going to work. So the parent is dissatisfied. But this is high health care quality to not give out antibiotics. So the metrics we collect must be important to patients. And they may come from the patients themselves, but they may not be a measure of health care quality. And also patients all feel differently. So how do we do patient centered medicine? So we were still stuck. So now I'm going to give you a little quiz. Okay, this is a big picture quiz about what the whole literature says about health care quality and cost. Okay, I said it's a quiz. It's kind of like a game. Okay, so for each row, you have to state whether the relationship is true, possibly true, false, or it's complicated. All my relationships are is complicated, right? But these relationships can be A, B, C, or D. So the first relationship is if you improve this, you drive up this. So if you improve quality, you drive up cost. Is that true, possibly true, false, or it's complicated. Then let's look at the next one. If you improve quality, you reduce cost. Okay, so is that true, possibly true, false, it's complicated. How about the third one?  Is that true, or possibly true, or false, or it's complicated. And then the last one is if you ignore quality, you reduce cost. Is that true, possibly true, false, or it's complicated. Well, let's just see. Okay, here's the answers. And this is again, the big picture of the literature. If you improve quality, you drive up cost. Well, this is not always true. It is usually true. This is because it is work to improve health care quality. If you've ever tried to do it, it takes like hours. And there's tons of paperwork. It's just work. It's good. It's good work. But it takes money and time. So it's going to drive up cost. Now the second line, if you improve quality, reduce cost. In some special cases, that's true. And that's when your money is literally flying out the window. Okay, so for example, in the US, we have Medicare fraud. If you reduce Medicare fraud, which is people billing Medicare for not health care for lies, okay, if you reduce this, you improve health care quality and reduce cost. Okay, but that's because Medicare fraud is really costly. So most of the time, if you're improving quality, you're on the first row. You're not on the second row. But if money is bleeding out the window, I love saying that about health care money bleeding out the window. It doesn't even make sense. But if money is bleeding out the window on the topic you're studying, then you can probably reduce cost. Now looking at the third row, if you ignore quality, well, this is what's ironic, you almost always drive up cost if you ignore quality. Because health care is kind of like a clockwork orange, like if anything goes wrong, it breaks, right? So if something goes wrong, like your ER doesn't work right or your ICU doesn't work right, something goes wrong in there, everybody sues you in the US. And everybody sues each other. So that drives up cost. Then finally, if you ignore quality, can you reduce cost? And the answer is, yeah, you can. What you do is reduce health care access. So that's how we do things in the US is that if anything costs too much, we just make it so very few people can have it. So if health care costs, as it starts to cost too much, we're going to just reduce access. And then if it is any good quality health care, then only like maybe the elite can access it. And so that way you can get to it. But pretty much, if you ignore quality, you're going to drive up cost. So then the question is what side are you on, right? Okay, so I mentioned KPIs, like key performance indicators. So let's say you're like, okay, I want to improve quality and reduce cost. But if you focus on reducing costs, I'll tell you what the problem is. Okay, so look at this slide. Let's think about somebody who gets in a car accident, but they actually get good health care, and they get put back together and discharged. Okay, so we start out with a car accident, and then they get in the ambulance, medical transport, they come to the emergency department, and then they go into surgery. Then they go to the intensive care unit to recover after surgery, and then they're discharged. So this is a happy story. It's a story with a happy ending. Okay, now let's look at where things are costly. Okay, things are costly in surgery, and in the ICU. And what I mean by costly is that's where if health care goes wrong, we all end up paying. So in surgery, if there's a mistake and there's a surgical infection, that's a problem. And also if they're catheterized in the ICU, and there's a nosocomial infection associated with that, that's a problem. So where you see the labels A and B is where health care quality can go wrong and really drive up costs. So how do you reduce that? How do you prevent that those things going wrong and the costs going up? Well, the first thing you do is make it so nobody is burnt out in surgery in the ICU. And you might be like, well, then I have to hire just tons of surgeons and nurses. And I would say, no, all you have to do is go back and reduce car accidents, which is at letter C. And that's where I am in public health.  And then secondly, in the emergency department, if you have more efficient handling or somehow people don't have to go to surgery as much, you can do ambulatory surgery there or something, then you're going to reduce the caseload at D, where it's labeled D at the emergency department, you'll reduce the caseload at A, which is surgery. And again, people won't be burned out there. So it's about managing resources at C and D and doing things better at C and D in order to save money at A and B. So if you make KPIs to reduce cost, they're probably going to be on A and B's budget. But A and B's budget is probably going to go up. In fact, everybody's budget's going to go up if you try to reduce costs at C and D. So the problem is that if you're looking to save money from doing QA, QI and health care, the whole system saves money. But the KPIs can't be played. It's really hard to know where to place them. So you can place KPIs on the whole system. And if you don't like how the system's running, it's really not clear where to add money to improve that KPI, if that makes sense. Philosophically, improved health care quality reduces overall costs, like I just demonstrated on the last slide. But it's across the system. So we need to not use these KPIs about costs. It's just going to cost money. If your department's going to do something to improve quality, it's going to cost money. So now that you believe that, let's just focus on quality improvement. Because if we focus on cost reduction, the approach may cause health care quality concerns that in the end end up wiping out any cost savings, right? Let's just face it. We need to prioritize what is wrong in health care and improve it, okay? And all kinds of things are wrong in health care. So we need to prioritize the ones that are the most wrong and try to reduce those. And if you try to reduce the ones that are the most costly, often those are the most wrong, but maybe not the same. So it's better to just focus on what are your problems and make them go away. Because I assure you that will reduce some costs somewhere in health care if you make priority problems go away. Okay, now that I've convinced you that we need to focus on health care quality and not cost, how do you improve health care quality, right? That's actually a really hard question. So like I said, you can set system level policy, you know, like medical record to use, but how do you improve it? Like what KPIs do you use? And each component ranks slightly differently in health care, like you just saw on the slide, the ER and the ICU. So what exactly are you trying to measure? And you know, I talked about my experience with hypertensive patients, you know, increase the percentage of our hypertension patients on medication, right? Like let's say we're at clinic A and we're going to set a KPI that we're going to increase our hypertensive patients on medication to X percent. But what should X percent be? And what is X percent now? Like how many people are already on medication, right? And then why did we even pick hypertension in the first place? Because I was talking about hypertension from my past, but is that really the priority?  Well, you know, each one, each metric you're following, each KPI has to be measured and it drives a cost. It doesn't cost nothing. Like people are going to have to do data entry. Somebody's going to have to do data analysis. Somebody's have to write a report. So even if you can figure out what KPIs you want, like how do you even do them? Well, whatever you do in health care, you're going to have to use two sources of data. Okay. And these are just philosophical sources. The first one is one you all are familiar with. It's administrative data. It's data created as part of a business process, such as health care billing, right? Because we have billing data, but also like medical records data. Whenever you're scheduling people for like an MRI or an appointment, any appointment, you know, medical transport data, you can tell I'm a data scientist, right? Like this is where I live is in this administrative data. Okay. But the problem is, you can't use this data for health care quality unless you apply a study design to it. So now we're going to move over to the right side of the slide, which is called research data. You can convert administrative data into research data. You can also just collect your own. So if you are collecting like a cross-sectional survey about maybe patient satisfaction, then that's research data because you have a research question. Or maybe you do a provider survey. You know, whenever you have a research question, you're collecting research data. And so if you have a research question about what's the percentage of your hypertension patients adhering to medication, I'm sorry, honey, that is a research question. And so you're going to have to dig around in your administrative data and put together research data. So that's called data abstraction. And I have actually a course online you can take in how to do data abstraction that I'll link you to. But you have to do that. You can't just take that raw data from the administrative data, from whatever database it is, and do something with it. You have to create a research protocol operationalizing. How are you going to take data from that and turn it into research data so you can do health care quality metrics on it? Okay. So pretty much your administrative data is just sitting there. And your research data is what you make to answer your questions out of that data. But also, remember, you can just ask questions of people. You can just do qualitative studies where you interview like clinicians and find out what's going on. So you can add to your research data from outside that's not administrative data. But you pretty much have to turn everything into research data if you want to answer a QAQI question. So the dominant approach in health care quality assurance quality improvement. I call it an approach. I guess it's a model. We hear a lot about agile as being a management approach or module. That's dominant in management. But for some reason, in health care management like QAQI, we have this other model called the PDSA. I did research on this. The PDSA is promoted by the Institute for Health Care Improvement, or IHI, which is from Harvard. And Harvard's really invested in this model. But the model is not based on agile or any sort of management model that is current. The PDSA is based on the scientific management principles model, which was popular in the 1930s through the 1950s. And I actually met an engineer who's really intelligent. He taught me a lot. And I said to him, what is this PDSA?  There's a factory problem. And so he said that when you are managing a factory, which is like a big thing that's got a lot of stratification, like you've got people at the top planning the whole factory, and you've got people working in the factory. So in that situation, you can make subtle changes in like workflow and stuff and prevent systematic problems with the car. But this is not the same as what I just showed you on that other slide where somebody gets in a car accident and pretty soon they're in the medical transfer then into the ED, that's like all these little factories right next to each other, these little business processes that are separate. It's not like one big factory where somebody makes those wheel and somebody makes this car door and eventually this is going to go on a car. That's not how it is. Okay, we don't know what's going to happen to this person. They're going into surgery. They just had a car accident. Okay. And so the PDSA model is based on a model that works in a factory setting, but why would it work in healthcare, which is a totally different setting. I just explained to you the conceptual problem with coming up with a management model based on something that works in a factory and trying to apply it for healthcare. Okay, so there's a conceptual problem with that. But aside from that, I just wanted to jump ahead and say, what does the PDSA actually do? Well, the first thing I have to tell you is what it does not do. Now, you'd think IHI, if they're going around and teaching all these QAQI departments how to apply the PDSA, that they would be thinking about all the things the QAQI department has to get done in that healthcare system. But the PDSA does not address a whole bunch of things that QAQI department has to do. It just is very focused on just a certain part. So here's what the PDSA does not cover. It doesn't tell you what surveillance systems you should set up and how you should run them in your QAQI department. And that's not trivial. Like it depends on what your issues are in your healthcare system, what you want to track. And the PDSA is not going to help you figure that out. What issues in healthcare should you prioritize? The PDSA does not tell you that. You have to do other things to figure out that answer. And then how do you set your KPI numbers? And how do you benchmark the change? So remember that thing about percentage of people who have hypertension on medication? Like should you choose that KPI? If you do, what is the number now? And what should the number be? And how do you figure that out? The PDSA does not explain any of that.  Like case control study, cohort study, and clinical trial, systematic review, meta-analysis. So those of you who are familiar with that will notice that the PDSA doesn't have any of that in it. And those study designs are about causal inference, like what's causing stuff. So if you can't use those, how can you figure out what's causing your healthcare problems or solutions? And how do you polish it? Like you can't. And so how do you do all the functions of a healthcare quality assurance quality improvement department and use the PDSA when it doesn't even answer these questions? So I'm going to tell you what the PDSA apparently does from the basis of evidence, from what I found in the literature, okay? So I'm highlighting this article called The Problem with Plan-Do Study Ad Cycles. And it's from 2016. And so if you remember correctly, since the 1990s, the IHI has been promoting PDSA and everybody's been trying to implement it. So we have a lot of projects that have happened all over the world, not just in the U.S., but all over the world. So we should be able to tell, like, what the PDSA is good at and not good at. And this article kind of summarizes what I have seen as well. And that is that the PDSA looks deceptively simple, like you've seen that diagram, that circle. It looks really attractive. But it's not an evidence-based approach. And so we don't really have any scientific evidence against it or even for it. Like, we just don't have any scientific evidence about it, which is a problem for me. Because I don't know how to implement it if we don't have that. I don't know how to replicate anything if we don't have anything that's been evaluated. So what this paper says is we know the PDSA efforts are expensive. And we do not know if the PDSA efforts actually help people meet KPIs or help healthcare organizations meet KPIs. We don't know this because this information is not in the literature. So the four things that they seem to be able to feel comfortable stating, the four findings, are this, which I put on the slide, is that PDSAs require significant time resources and staff investment. And if you don't make the huge investment needed, all of your work will be a total waste. So it's kind of like when I tell people you can't buy half a car. If you budget for a car and you only budget like half as much as the cheapest car, you're not going to be able to buy anything. And so the PDSA cycles are kind of like you better have a big budget when you start or you won't get anything at the end. And unfortunately, the PDSA isn't appropriate for most problems in healthcare. The ones that cross subsystems, like the one I showed you with the person coming in to the ER and going through surgery and being discharged, maybe if you tried to improve your emergency department function, like within the emergency department, you could do a PDSA, but you probably couldn't do it to cost all of those subsystems. And here's the big kicker is that even if you do the PDSA right, it doesn't always work, meaning it doesn't always get you to the answer. What was the cause and how do you make this rate you don't like either go up or down? This comes to the new proposed alternative model approach that I am proposing that I guess you would pronounce it SPRAB. And that is a different way of looking at QAQI in healthcare from a department perspective, where you just consider the functions of a healthcare QAQI department.  I decided that you do S for surveillance and monitoring, P for prioritizing issues, R for research studies, A for action to introduce change and B to benchmark change. Now explain how all these functions work together. I know that if I were to go to anybody's department right now, they would have certain surveillance. Maybe you have like an incident database where you keep track of incidents. I know in radiology, they'll have a database where they keep track of errors, like if you inject the wrong dye, those kind of errors. I know that there can be databases of falls where they keep track of falls. And in any case, if you're keeping track of anything in some sort of database or on a spreadsheet, that's surveillance and monitoring. And that's work, right?  Now P is for prioritize issues. So one of the things is that those things you are tracking are obviously prioritized because you're putting a lot of effort towards them. You do need to continue to prioritize things. Like if you're tracking something and it's not really worth tracking, maybe you should take that down. Also, when you're prioritizing issues, they don't just come from inside. If your patients start complaining, you can prioritize those issues. You can start tracking things, for example. So this is really a different function of the same QAQI department. On one hand, you're doing surveillance and monitoring. And on the other hand, you're prioritizing issues. And you might be doing that based on what you see in surveillance and monitoring. But you might also do it just based on other things like maybe your political leaders have come to you and said that this is an issue and they want to give you funding for it or whatever. The third function is research studies. And I want to emphasize the word research. A lot of QAQI departments tell me that their research is exempt from the IRB or from ethics boards. Just ignore that. I will tell you your research if it's research is probably not exempt because research is about systematically understanding what's going wrong. And the only way it actually gets exempt from an ethics board is if the ethics board thinks what you're finding is not generalizable. And most of what we find in healthcare quality is generalizable. If you have a slippery floor, people are going to fall. If you don't train people out to put catheters in, they're going to do it wrong. Like that's unfortunately systematic knowledge and you're probably doing it. So whenever you do a research study in QAQI, you need to read a research protocol. You need to do that because that's evidence-based medicine. And you need to put it through the IRB and maybe it'll be exempt and maybe it won't. But if you don't do this and you give it to me, I'm an epidemiologist in a biosatistician. I cannot make sense of your data. I cannot make sense of your study if we don't do this together. Like write this protocol, explain what we're trying to research, and then do it. Because I do causal inference. I'll tell you what's wrong. I'll tell you what's causing it. I'll even tell you what to do about it. Right? And we can even publish it because it's evidence-based medicine. So this is the big message from my model, is research is research.  Because why? You need to move on to A, which is action to introduce change. We need to make evidence-based changes in your system. And I cannot even tell you how to do that unless we get research from evidence-based protocols. Right? So let's say we do a research study.  And they said, well, let me go talk to them.  So there, like all they have to do is fix that at the cancer center and they'll have better metrics. And so that's what I'm saying is action to introduce change literally becomes obvious if you do research studies. And in fact, you can write like another research protocol to introduce the change like a field study and then do B, which is benchmark change at the end. So what I have helped people do is go from, we know it's a problem, but we don't know how big it is and we don't know how to fix it, to actually studying it, fixing it and showing that it's fixed, like doing a research protocol and studying where it is and why it's that bad. And then figuring out what needs to be done to fix it and then restudying it, like fixing it and studying it again. And then you can like think about how many publications that is and think about how many people don't get sepsis. You know what I'm saying? And this was the failure of the PDSA. You really just couldn't get through all that and have any numbers and know that you did anything. And so my model is not deceptively simple. It's as complex as a PDSA, if not more. But it actually reflects what you're supposed to be doing in your healthcare QAQI department. It takes into account all the functions. And at the end, you do evidence-based research so you can publish, maybe even get promoted. So there are advantages of my model to the PDSA. As I just summarized, issues are tracked in surveillance and are prioritized, okay? But you can get prioritization from patients or whoever is complaining. Actual research takes place when necessary. We use protocols, the IRB, the ethics boards, evidence-based medicine. And we can do system-wide improvements. We actually have numbers we actually can publish. And it's just as expensive and complex as the PDSA. But we get more useful outcomes and we can move you along and make your healthcare system so much better. Data collected from records or patients must be part of a specific evidence-based effort when you use my model. So one of the things that grew out of the PDSA was this need to just collect tons of administrative data. Remember that? That's not research data. That's raw. And so it needed like people to apply research designs to it. But there was all this extra data lying around. And this is just not efficient. It's much better to just make a research protocol and just pull in the data you need from the administrative data. And also, if you're going to work with patients and use patient data, it is the most respectful to just take the least you need. And if you have questions for patients, it's the most respectful to really think about those questions. Have a real research protocol before you sit down and interview them or give them a survey. In the PDSA, there was so much data maintained from these administrative systems. And there was just this constant data collection, as was described in that article I was showing you. It was just not patient-centered. So I may not be able to tell you what is patient-centered, but I know collecting a ton of data about chronic disease patients is not patient-centered. That's not cool. Okay? And most of the time, if you're dealing with patients or providers or anybody, you're doing research, so you really should go to the IRB. You should just write a nice protocol and go to the IRB. It might not be exempt. It might be exempt, but just don't care about that. Just care about the quality of your research. So in my approach, the SPRAB or SPRAB, any data collected is part of a formalized protocol. Either it's a surveillance effort, which is ongoing, or it's a research effort where we're studying the original level of some KPI, or we're trying to benchmark a KPI, or we're trying to do action to change the KPI. Everything is written in a formalized protocol, and we just have to prioritize the issues for data collection. And again, that comes from your department. Your department sits down with me, and I can help you decide. But this way you can actually solve your QAQI problems across your big systems and not get stuck like in a washing machine in the PDSA cycle that never ends. So in conclusion, historically, there's been confusion over what KPIs to select for healthcare and how to do QAQI to meet them. And this has led to the use of this PDSA and this over-collection of data from chronic disease patients, and it's not really beneficial. And doing all this data collection under these PDSAs doesn't really take into account what the QAQI departments actually have to accomplish in the big picture. In my new model, the SPRAB, Functions of Healthcare QAQI Departments approach, it's more applicable. It's streamlined data collection to only the necessary data. And yes, it does take a while to get through a few cycles of like doing research and making action to introduce change and then benchmarking the change. But the good news is you can publish it and you really know what happened. You know causal inference and you can feel really comfortable with your numbers at the end. So if I've made you really excited about QAQI and healthcare, just contact me and I'll help you out. We can implement the SPRAB model in your system.  Okay, well, I really hope you like my presentation and feel free to connect with me on LinkedIn or to see my blog on my website, which is probably where you got this, or to follow me on YouTube.


Why 2.54? Imagine Good evening, our viewers. Welcome to Why 2.54 News. This is business. Choose there with me, Jo and Diego. And to kick us off today on our news highlights, Kenya's credit bank took home the best small, medium-sized enterprise partner bank of the year in East Africa at the recent European Global Banking and Finance Awards 2019, held at the United Kingdom. Take a look. The company is in its campaign towards enabling the growth of SMEs in Kenya through its entrepreneurship hub, EHUB. Formed in 2016, EHUB provides a platform where entrepreneurs can engage, learn and find mentors who help them prosper. In addition to this, entrepreneurs have benefited through learning, networking and personalized coaching sessions. The hub has looked at seeking in place system and processes that give business benefits such as being investor ready. And on to other stories, Likipia County has signed a memorandum of understanding with Nairobi-based K-Energy Renewables Company to set up a 6 billion shilling solar power plant in Rumuroti town. Marki Vava has more. Likipia Governor Nde Ritu Murevi and K-Energy Chief Executive Kinla Dohia on Monday signed the pact for the project expected to kick off early next year. According to the governor, the location of the county along the equator is very ideal for the continuity of the project due to availability of sunshine throughout the year. Nde Ritu Murevi said the 40 megawatt plant will be constructed in turn. Public Service Youth and Gender Affairs Secretary Margaret Kobiya has appointed four members to join the Youth Entrepreneurs Development Fund board amid ongoing reforms to make the struggling agency vibrant. Take a look. In a special gazette notice dated October 16th, Prof. Kobiya picked Dr. Susan Mambo, Dr. Mugendibirundi, Ms. Kathrin Kasimu and Mr. Emosi Soi to serve at Funds Board for 3 years. Their appointment took effect on October 16th. The previous board had been tainted with theft scandals, particularly 180 million shillings allegedly transferred into tranches of shillings 115 million and 65 million shillings to a company identified as co-random limited. Most of the 180 million shillings stolen from the Youth Fund was used to purchase luxury homes, pay debts, and line the pockets of powerful individuals, including law firms and companies. And to market produce, earnings from horticultural produce are on the decline as major buyers of Kenya's famed flowers, fresh vegetables and fruits card speeding. The latest data by the Kenya National Bureau of Statistics shows that income from the sales of card flowers a key export especially to Europe has been on the decline this year. Hila Dereva has more. Earnings from flowers reduced to 69 billion shillings compared to 77 billion shillings that the sub-sector and over the same period last year. Earnings from the sale of fruits on the other hand remained flat at 10.1 billion shillings over the eight months while vegetable posted a marginal growth to 17.8 billion shillings from 16.8 billion shillings over similar period last year. The performance by Horticacha Miras that of tea which has been on a free fall with the earnings going down to 73.7 billion shillings over the eight months to August this year a 24% drop from 96.2 shillings over the same period last year. In addition, industry players see the political crisis that United Kingdom is going through as it is six to leave the European Union is to a large extent to blame for the decline in Horticacha earnings. The stories are taking us up a small commercial break. We'll be right back. Remember to comment on all our social media platforms. I beg your pardon at Y2Four Channel. Stay tuned. Welcome back our viewer. And as we continue with other stories, President Uhuru Kenyatta deemed plans to build refinery for Kenyan crude. The president said that Kenya would use the Lamu pot to export crude oil from the Turkana oil fields adding that Kenyans oil would be exported in form of crude. The government had earlier announced plans to build an oil processing facility following assessments that the country's crude oil deposits were insufficient to justify the construction of the refinery. Mr. Kenyatta added and said that the project would be supported by a special economic zone that is expected to attract investors from across the world to undertake various economic activities and create jobs for our people. And on to other matters, the Kenya Revenue Authority used 57 shillings on debt payments and aligning the heavy burden of mounting government borrowing for every 100 shillings that Kenya collected as taxes in the three months to September. Data from the treasury shows that 214.7 billion was used for loan payments in the first quarter of the financial year making it the single largest expenditure in the period to September. The repayments accounted for 57% of the 372 billion shillings that the Kenya Revenue Authority collected in taxes in the period under review denying the state the cash it needs for projects like building roads, power plants and revamping the health sector. Kenya has ramped up spending in recent years to build a modern railway line, new roads and electricity plants driving up borrowing to plug the budget deficit. The public debt crossed the $6 trillion shilling mark in July up from $1.89 trillion shilling in June 2013, a growth that has sparked consensus that ballooning loans risk cutting the economy due to the huge debt repayment. All right, lawyer and ICT practitioner Adrian Kamodo has used, has sued telecommunication operators for illegally depriving consumers of their unused data bundles. In a complaint filed before communications and multimedia appeals tribunal, Mr. Kamodo said he was aggrieved by the high cost of data and frustrated by the abitrari, abegyopadon, expiry and hard and bundles. He wants the tribunal to order safarikom, Airtel and Telkom Kenya to finish him with their current data tariffs or prominently display the current data tariffs on their websites. All right, our view, that's what we had prepared for you on our business news. That's tonight. My name is Joenda Gwa. Have a good night. God bless.


So here I am at Mountain View Dodge. The folks here have been extremely nice to me from start to finish. Couldn't be happier with the experience. Guys are great. Melissa, ask for Melissa. She's wonderful. Yeah, there she is. Is that enough?


Did you know that there are over 2,200 known religions in the world? We are all born into one belief, religion, or faith, which influences how we see the world and everything and everyone in it, including ourselves. Do our beliefs divide and separate us, or do they bring us together in greater harmony? When you look up with awe on a star-filled night, do you ask who or what created all of this? Have you ever had a profound or deeply challenging experience in your life that changed your beliefs at the core of your being? Enlightened Pathways takes us on a journey of discovery to understand just how spiritual transformational experiences impact our lives and the world around us. Join us now as we deeply explore all that nourishes, heals, and inspires us. Welcome to Enlightened Pathways. My name is Robert Kibbeke and I am your host for today's show. Today, our special guest is Stephen Brent. Welcome. I've known Stephen for at least 20 years now and have had the privilege of watching him grow through his spiritual evolution over those years. Stephen lives in the Hudson Valley just north of New York City, where he makes music and visual art at his home as his work-life schedule allows. In his latest short film, Imprint of Light, won the Best Spiritual Mystical Film Category Award at the Amsterdam International Film Festival in 2021. How cool is that, right? He is a student and practitioner in the Western esoteric traditions and seeks to bring this perspective to the work of creating art and living life. Please welcome my dear friend and special guest, Stephen Brent. Thanks, Robert. Great to be here. I'm glad you're here.  I was just driving by and I saw that you had a TV show, so I thought I'd pop in. It's a little 300-mile detour. Let's go into the supermarket. Okay. Okay. You know, some detours lead in very interesting places. Yes. And you have certainly landed in one. We're in it now. Yes. You know, Stephen and I have been talking a lot over the last 24 hours and we're both afraid that we've run out of things to talk about. Yeah. We'll find something. Well, why don't we start with the easy stuff? You know, it's like, why don't we talk about, or you just talk about for a couple of minutes, like, you know, where you grew up and the kind of belief system that you were born into and what kind of impact that had on your early life? Sure. So I grew up in the suburbs, kind of really close to where I live now of New York. Middle-class Jewish family without much in the way of religious indoctrination or practice. There was kind of, it was kind of like the reform temple around there. And that was, it was pretty, it was fairly secular. Like the one, I wasn't really exposed to hardcore religious belief or anything. And in my house, it was more, it was more about irreverence than anything else. There was nobody ever told me what not to believe or to believe in. But for me, my religion was really mad magazine and Bugs Bunny. And I was really into UFOs and big, it was like a golden age for paranormal stuff in the late 70s. Yes, it was. And so, so I was really into all that stuff. But I didn't really grow up with any kind of beliefs or disbelief in any, in either direction, to be honest. I remember the Bugs Bunny religion as well, Saturday morning cartoons.     So we see things on TV and it's, wow, it must be TV, it must be real, even though it's a cartoon, but the messages get imprinted, right? So a lot of time, I know for me, that was a lot of the case, right? But when you, well, maybe like how old were you when you started to realize that, I might realize, but maybe there was a time when you started to look for a belief system that actually supported you? Well, there's a couple of things that happened. One was in my late 20s, I entered recovery for drug and alcohol addiction. There was a real spiritual component there. It was non-denominational, but one was encouraged to find anything that one could cling to that was greater than oneself, you know, just even as a, just as a survival tactic, whether you believed it or not, then to just sort of act like that. So in other words, there is something bigger than me. I can sort of give up my troubles to that. I can sort of unburden, reduce the burden of self and just try not to, you know, learn how to not be so wrapped up in myself and my own perspective and sort of take a higher perspective. I never, you know, early on I got pretty hardcore into that and it carried me over like the most difficult period in the years since that didn't really stick so much. And I kind of went back to being more curious about things and wanting to keep exploring. Probably it's in the last, right, maybe about six months before the pandemic. I went through some difficult times with my mother who had suffered an accident and needed a lot of care. And there was a lot of uncertainty and turmoil around that. So we were all kind of caretaking for her. At the same time, I was trying to start a new job and I was kind of failing at that because of the stress. And I started to feel like I could feel my identity breaking down through crisis. And so I started to get interested in, I wouldn't say belief systems, but I got interested in finding other perspectives and other practices to sort of, for mental health reasons, if nothing else. And so I discovered a lot of the traditional teaching, the esoteric teachings of a lot of different religions and have continued studying that and doing some practice around that. And that was really, so it was really over the course of the pandemic. I think that brought me back to that. And it's not that I've settled on any belief system because I don't put much stock in belief. I think belief is just another word for opinion. And I don't hold opinions sacred, not mine or anybody else's. I'm really more interested in practice. I'm more interested in discovery and finding out the truth for myself. That's fantastic. And there's a couple of things that I want to pick out of that. First of all, is that you mentioned that up until you got into recovery that you did not have a religion or a belief system or faith that you followed. What was it that you thought was, I don't want to say supporting or keeping you going emotionally, mentally or spiritually? I couldn't even tell you.  And I didn't really think about these things too much. It was more like when you're focused on pain management, psychic pain management 24 hours a day, it doesn't leave a lot of room for genuine introspection or taking any kind of, again, I use the word perspective because for me, so much of spirituality has to do with being able to shift my perspective and literally see things from different angles instead of trying to figure everything out from this very limited perspective. Right. And yeah, I'd like to kind of delve deeper into that a little bit in terms of not attaching yourself to the word belief and looking more perspective, and you also mentioned some of the esoteric type of practices that you discovered. Can you discuss a couple of those? Yeah, I'll keep it general. There's I mean, Western esoteric tradition, it's kind of a loose term. It's like a conglomeration of the secret teachings of all the major religions. So, you know, like at a restaurant, you have what's on the menu and then you have the secret menu and like there's all this really cool good stuff on the secret menu. So that's sort of like the secret menu of all the world religions. Every every religion has the exoteric stuff that they for the masses. And then they have secret teachings, generally, that are had throughout history been more protected. Now you can just get everything online. You can get it's in the bookstores. There's no secret anymore. The secret is in the is in the practice itself. That's where the actual magic is. It's not in the study is fascinating, but but it's really in the practice.  You know, meditation, yoga. So there's a lot of different there's a lot of different layers to that. And, you know, it's sort of it's sort of a situation where you can you have all these symbols available to you. These are symbolic systems. And there was an attempt made in the late 19th century to to bring them all together into some sort of semi coherent framework of theory and practice, right? And that sort of formed the pattern of all the kind of, you know, what you see as sort of magical practice these days. So for me, it's really a matter of learning the symbolic systems and being able to apply those as tools for for self knowledge and discovery. So it's not it's not a matter of worshipping some exterior thing. It's not it's not a matter of following a dogma or a belief. It's really just it's really just a set of practices for for personal growth. Well, you really. Convade a lot of information right there too much. That's so great. No, I'm just like crossing.   And it's got a, you know, a more generic societal judgment against it, you know, whereas as I know how I've seen how you practice it, it's like more of a meditative, you're bringing it, you're internalizing it. It's not just something external to do as, you know, as a sideshow trick type of thing.  There's a real energy to it that you tap into. And once you tap into it, you let that energy in and allow it to evolve you. Right. I mean, it is a very personal thing for me. So I don't I don't I'm not I don't pretend to be an expert. Any of this, I can't speak with authority on any of the things that talk about what I try to do is keep it to how my daily practice of this sure what it means to me. And it's really, again, it's just it's just having tools. It's like having more. It's like having a larger vocabulary, right? So the more the larger your vocabulary, the more the more things you can express, the more, you know, the more complex ideas you can express. So so for me, it's really learning that stuff and internalizing it through through practice. So there's that's with everything else. There's a few layers. There's even just when you think about something like meditation, there's a study of it, you know, here's what it's supposed to mean. Here's the history of it. Here are some practices I can do. And then the third layer and the stuff that's most important, the layer of practice, I think that's most important is when you when you get off the meditation bench or when you get out of the the temple and you bring it out into the real world, how does it, you know, so without that third piece, it's all just kind of, I don't know, it's like entertainment, you know, until you actually put it into practice, it's still very, you can still get very kind of wrapped up in your ego. If you're not testing what you're learning and practicing in in the crucible of the real world, well, it sounds very much to like, you know, in in active drug and alcohol addiction that, you know, I likewise am familiar with, you know, my life was run by my emotions. Right. I didn't have principles or practice. Well, maybe, you know, I mean, going out and finding a drink or a drug is certainly a practice when you'll do anything to get it, you know, but not in the sense that we're discussing here, you know, practicing means to literally try to do something in a quote unquote regimented or consistent way is a better word, a consistent way that produces beneficial results, right? That was not drug addiction and alcohol as a matter of fact, that did not work. No, I mean, there was, right, right. And I'm just making that, you know, connection lightly because I really want to point out that, you know, when we are looking at a practice based life or a principle based life, you know, it's no longer an emotionally based life. My emotions are no longer in charge of my decisions or my beliefs, perceptions, okay? So there's something more powerful in charge. I can learn how to use my emotions as additional energy instead of as the only energy. Well, yeah. And I think one thing actually I've started to just recently started to work with is like a lot of people I know who had issues with addiction. You know, I was very, I was very, I'm very sensitive and intuitive. And so I get a lot of information kind of in the background that I didn't always know how to process.  So in a way it is sort of like practice to the point where it's in the second nature and you don't even think about it. So unwinding that in the process of recovery and then learning new practices and applying that same focus and discipline rather to self-destruction than the self-realization, you know, it's sort of, it's a total shift. I mean, for what I realized recently about intuition is that even though I receive information in that way, I can't always trust that information. You know, I sort of went around being like, oh, I'm intuitive and empathic and I, so I know what's going on all the time and I know what everybody's thinking. And, you know, and like maybe sometimes you do, but I think it's just another, it's another wavelength. It's another frequency. It doesn't necessarily guarantee that the quality of that information is going to be good. So I feel like, like you're saying emotions, it's information, but I need to be able to turn my attention and my skepticism and my analysis towards that like everything else and not just, not just, I mean, yes, some of those times when you just have to go with your gut when you need to make a snap decision, but most situations in life aren't like that. In most situations you have the opportunity to sort things out and actually think clearly, but I think we just sometimes we react before we get a chance to do that. So a lot of the practice that I'm involved with has a lot to do with mental and physical control and just getting to a place where you can be still and quiet enough to really see what's there and not just be wrapped up in the story all the time, you know. Yeah, being wrapped up in the story all the time.  That's where, you know, the majority of my time lived, you know, for a long time until I learned how to affect that. You know, so what in your practices and learning about these different, you know, esoteric Western practices, what have you discovered to be difficult, the most difficult thing to practice, but the one thing that maybe or maybe one thing that you really want to learn? I mean, for me, the most difficult thing to practice is just keeping with it is really just the discipline itself of maintaining and building good daily habits, you know, because I tend to, with a lot of things, you know, it's easy to get into a pattern of really working to develop a habit. And there's this weird thing that happens to a lot of people where just when it starts to work, and then it's like, okay, well, I'll take a day off and it's sort of like creating that, you know, creating that little gap where you can backslide a little bit. So I'm really learning how to power through those and not let that happen. So and just in general, one thing that is necessary for for all of this stuff, no matter what you're doing is, is that mental focus and being able to either turn down the mental chatter and all this stuff going in or be able to just power through it. And so a lot of the time I do the latter. It's like, okay, I'm just going to keep letting you talk, but I'm doing this thing now and I'm going to focus consciously on this as much as I can. And that helps sometimes. I think in part of the, you know, part of the meditation practice is this, this asana that I think I told you about, which is really it's not relaxation. It's quite the opposite. It's holding, it's holding a, holding a pose and very having a very, a lot of control of your body and your breath and your mind to the point where there's not really room for anything else, you know. Is there something that you maybe started the practice that you started to find yourself interested in, but then during the process you're like, maybe this isn't for me? I think, you know, there's again, we're kind of, we're kind of lost in the spiritual supermarket. We have so many, we have so many choices here in this time and place in history that you can really get wrapped up in a lot of, chase a lot of different things than a lot of different rabbit holes. And so for me, I would say something like astrology is something I only find superficially interesting. And, but it's, it's again, there's, I don't put a lot of stock in it as a, as a determination of one's, the course of one's life, although I think it does have interesting hooks into your personality and character. And again, it's, so I can kind of use that as a symbolic, another symbolic language. That's another layer in the whole thing, right? And it corresponds to other things. So I think that's really cool, but I, I know people have a real facility for that and just seem to take right to it. And then they're posting on Instagram all the time about right at what different signs are like. And I'm just, I don't, I don't feel that. So that's, that's a specific practice. I would say that doesn't, doesn't really work for me. I mean, I think that works best for me really is playing the guitar. So when I'm playing the guitar, that's my most direct connection with spiritual energy. It's not ritualized as such, but practice can kind of be like that. You know, there's a difference why you're talking about practice is a difference between just doing something or picking up the guitar and really practicing with that, that sort of, that sort of focus. So I'm learning how to do that a little bit better to kind of bring more, bring more intention and focus to my, my guitar playing. And you were just recently at a nicer treat.  And so how have you begun to integrate those into your practice? Well, I think this is something that professional athletes know very well, which is that when you're practicing, you pay attention to very small tweaks to things. You notice just there, just, just something about the angle of the way you're holding the guitar or something when you're, you know, whatever you're doing. And that really, that's where the, that's where these huge breakthroughs can come from. It's not like, no, no, you're doing all wrong.  And so, and that's the kind of discipline I've sort of been lacking. I was, I, when I learned how to play the guitar, I just, I was very lazy about it. I was like, if it's good enough to make noise, that's great. But then I realized I couldn't create the kind of music I heard in my head. And so it wasn't really about becoming an amazing player. It was about, listen, this, this is a tool. This is a vehicle for, for spiritual expression. I should really honor that and I should really take the time to develop a relationship with that, these tools so that I can, you know, so that they can be of service to me and not just be a way of making noise. I saw, I, I so relate to that in, in a lot of ways, you know, in, in my own creativity that's been making itself present to me over the past couple of years, you know, starting to paint and do artwork and even playing music myself, you know, and writing music and what have you.  He's like, no, we tried to figure it out. And I started, you know, banging it out on my glock and spiel and the piano and then the synthesizer, you know, and then tried to figure out this is something that I heard somewhere and it's like, you know, and a lot of times I would dismiss my creativity, but because I didn't have the skill sets to actually recreate what it was that I wanted to create, you know, and, and that is something that I recognize in a lot of people. It's like, well, I don't know how to do that, so I'm just not going to do it. I've got a great idea to do it, but I don't know how. So, you know, so it's not about knowing how, knowing how is like the least, you know, so to speak, important thing. It's more about being willing and open to embrace whatever practices that enable me, right? And so once I've learned these different practices in myself and my own artwork and what have you, I've been able to create, you know, what I, to me anyway, it's pretty cool stuff, you know, it may not be anybody else, but just like everything's got a perception and an interpretation. And, you know, so there's no judgment there. My point is that, you know, I think that what I hear a lot from people is that, well, if you don't know how to do something, just don't do it. You know, don't bother, don't waste your time. You know, but that's not how us human beings are configured to evolve. We're curious. And I think curiosity is like one of the most powerful things. Yep. Right.  Yeah, I mean, you focus on your strengths, but you work to identify the gaps in your, in your strengths and focus on the weaknesses within your strengths and you zero in on those. The things that are easy don't need that much attention. It's the things that you tend to skip over or avoid because they're difficult. You know, anything I've ever achieved that was worth anything in my mind. There was a point during that process where I just came up against this difficulty and I wanted to stop, you know, maybe several times a day, you know, but everything that I've ever done that's that I like, there was an element of pushing, pushing through difficulty or fear, you know, it's almost like a cliche, but it's really true. Like that's like they say, don't quit five minutes before the miracle. Right. Right. That applies to so many things. You know, yeah, it does. So we've only got just a handful of minutes left here. Where's the time going? The time's just going, man. And you're afraid you weren't going to have anything to talk about. I'm going to do an hour next time. We do.  What was like, what's one of the most important, you know, quote unquote, golden nuggets that you've discovered that you might feel comfortable sharing with folks in your spiritual journey? I know that's one of those open questions. Yeah, you know, I mean, just based on where I am right now, if I was, if I'll put it this way, if I was talking to myself, you know, 10 years ago or maybe even in recovery, right, even during the long 25 years that I've been in recovery and been, you know, my growth hasn't been, you know, it hasn't been a straight rocket ship blast. You know, it's been, it's been a journey, but I would, you know, if I was talking to myself and giving some encouragement, I would just basically, I would just say, you know, you have everything you need already, right? You are everything you need to be already. Stop waiting for something or someone else to come in and complete you or to give you what you need, you have what you need, and you just need to learn the instrument of your body and your mind and learn how to use those and learn how to direct energy, get clear on what your aims are and learn how to direct your energy towards those. And really nothing can stand in your way if you do that. That's brilliant. I've never quite heard it said so perfectly. I had to scramble to come up with something that I'm glad that worked.  You know, because a lot of people are struggling, you know, a lot of people don't know where to start or they start and they fall down, start and fall down. You know, it's like yesterday we were, we were down at Eastern Promenade, you know, and grabbed a little Bon Mise sandwich and sat on the, that was so good, right?  I was walking slow because I was eating really slow.  You're like, well, you know, walking is this thing where it's like you're, you're falling and then preventing yourself from falling over and over again. That's a Laurie Anderson thing. Yeah. That was, that was her, her riff on, you know, on what walking is. Yeah. You know, and but it's like, isn't that the thing because it's like, what about failure? Oh, I'm afraid to fail. So I don't do anything because you're not going to do anything because you're afraid to fail, but it's just like walking.  That doesn't stop you from getting back up and walking again. Order fail and fall have the same root, the word. That would be really cool to find out. Failing forward, right? It's kind of failing forward. Just whatever you're doing, if you're screwing up, at least, you know, screw up in the right direction. You know, use the momentum of that to get you right to the next thing, you know, so falling back or to the side, right? Right. Just keep moving forward. Yeah. At least if you fall forward, you are going in the right direction. Exactly. I love that, you know, it's like, all right. So, you know, it's, um, and that just reminds me of my favorite Walt Disney quote, you know, it's just keep moving forward. Yes. You know, I just love that. I say, I'll just keep moving forward, you know, and the thing is, is, you know, keep moving forward even when you don't want to. Keep swimming. Just keep swimming. Just wait. We have to be careful. We can't say that too many times on TV. Oh, sorry. Yeah. We don't want to break any copyright rules. Sorry. Just keep swimming. Just keep swimming. How many times are you allowed to say that? I don't know. I'm not going to say it anymore. I know. Sorry.   And unfortunately, but thank you, Steven, for showing up. I will put links to Steven's music and his films on the website. So please visit www.deepbeing.org for more information. And thank you so much for being here. Thank you, Steven. Love you. Love you too, bro. And just a few closing remarks and a shout out to today's executive producer and sponsor Bridge to Heaven Healing and Lepin Lizards, which is the premier source for healing crystals and readings with four locations, including at the main mall here in South Portland, Maine. You can visit www.lepinlizards.biz for more information. Also, a big thanks to our co-executive producer, Dr. Anna Cabeca, the creator of Mighty Maka Plus, the daily nourishing supplement that improves metabolism and reinvigorates the body. Visit DrAnnaCabeca.com for more information. Also, if you would like to get more information about this show to reach out to us or to sponsor us, please visit www.deepbeing.org. We would love to hear from you. And a quick shout out to the crew, director, Patrick McCartney, audio and sound, Warren, and cameras, Travis Nadeau, as well as to the Portland Media Center and their team, Tom, Dino, and Warren. We wouldn't be here without them. Thank you for watching Enlightened Pathways and spending your valuable time with us today. Until next time, play, have fun, be happy.


What's up everyone? It's your girl, Kenzie here from Layton Sports Cards, and I am ripping a personal here for Jason C. We've got two 2022 Panini select WWE hobby boxes. All right, best of luck here, Jason. Let's see what we can get you, man. Let's see if I can be as good as Caleb. I don't know. I pulled a ringside. Here we go. We've got red on the premier level rookie of D'Angelo. Jane, rookie. Filler here. Rookie tri-color Von Wagner. Oh, yeah. Silver, Apollo Crews, Mastiff. Breaking Brad into building.  Would that be possible, though, with the light thing there? Come on, birds. Come on. The corner. We've got to 99 red auto of Eric. This is what Brad said he's going to dress up as for Halloween this year. Yeah. It looks like a dragonborn from Skyrim. Yeah, he does. A suga tri-color. Big E. Who is Brad? Just some guy who works here. Yeah. Kurtis was watching the Cowboys game last night. Yeah. Silver Sheamus. It was like 29 to 10 at one point. There was like three interceptions. They had two returns for Touchdown. Dakota Kai on the next 2.0. Scope of Ted DiBiase, Wilson Rookie. He's some stick, man. Oh, wait. Who tore their ACL and MCL? Guard on the box, yeah. Jeez. Killer Tri-Color Rookie Harlins. 3.1. And the Kansy. There you go. I have a bunch of them. I have Matt. We've got the miss on the patch. The miss. And I'm awesome. Is that Gibson Silver? He's got such a great entrance. Dean, I don't know which one's you. Dean followed me on that. We've got Blue of Umaga. Oh, I got you. I think this is you. Rod the Rousey has McGraw. We've got Tideye of Dewdrop. Nice. Dewo Drop, 2 out of 25. Dewo Drop on the Concourse. Tideye. Nice. Devlin. And last pack, box one here for you, Jason. Nice one here. And Raker Rookie Auto on the signature selections. There you go, Jason. What a box. Silver, Brett, Hitman, Hartz, and Lopez, Rookie. Yep, there's two autos in one memorabilia per box. It's a select, Eric. So no scene of Tideye in that, but we did get a Tideye. Let's see if we can get one out of here. Let's see if Sam can go super too. He did call that Gold Auto out of the HTA boxes. We've got Red, Kevin Nash on the Premier level. Rookie Ringside, Carmelo Hayes. Yeah, I got you. I didn't realize that was you, I'm sorry. Rock on the Championship insert. We've got Red of the Great Collie. Ron Breaker, Rookie Ringside. Oh, we do have another Tideye here. We've got a Queen. Zelina on the Tideye Premier level. It's time 14 of 25. Two boxes, two Tideyes. There you go, Jason. It's hard to do. Those Tideyes are a pretty short print. We have here, we've got a Ringside Action Signatures. Lacey Evans. Lacey Evans. Silver, Rookie, Grayson Waller. Brock Lesnar. Bianca Belair. Seth Frick and Rollins. I like saying his name. Yeah, no worries, Dean. Filler, we've got Tideye, Liv Morgan. Figured I'd let you know. Silver, Hitman Hart on the Premier level. All right, still looking for one more auto and your hatch, I believe. Here's the auto. Out of 99, we've got Red Ringside Action Signatures of Cantana Chase. It's a red auto there. Tricolor Cameron Grimes. Cactus Jack. Sassy Southern Belt. Silver of Diamond Dallas Page. Some color here. We've got Blue Jordan Devlin on the Concourse to $2.99. Strong, Undertaker. Tricolor of Fry, MVP. And Last Pack here for you, Jason. We have, nice. How about an Asuka patch? Asuka. Silver, Julius Creed Rookie and Mark Coffee. All righty, Jason, that will do it for your boxes. Congrats on some more. Very nice cards coming your way. We'll be getting them right out to you.


Hey, this is Brett, and this 2017 Ram 3500 Megacab Short Box Dual Rear Wheel is stock number 13903Z. I am here at Summit Automotive in Fond du Lac, Wisconsin. Your new and used heavy-duty truck and Ram headquarters. This one has the 6.7 liter high output Cummins diesel engine. It's paired up with the Ice and Heavy-Duty 6-speed automatic transmission. This truck has been fully safe eaten and inspected by our service shop. Has a fresh oil and filter change. All the fluids have been checked and topped off. And this truck is 100% ready to go. Somebody has definitely tricked this truck out. This was originally an SLT. Still is an SLT, but they've definitely done wheels, tires, different headlights, different tail lights, comes with aftermarket leather and heated seats and everything. So I'm going to go through all that stuff, go all the way around inside underneath, start it up, and take a look under the hood to give you the most accurate representation possible. This color is called Granite Crystal Metallic. I shoot all my videos in 4K, and if you like the video, you can subscribe to my YouTube channel, which is youtube.com slash Summit Auto. Click the bell notifications and you'll get updates on the videos I do each and every day of our great inventory, as well as having access to one of the largest catalogues of vehicle and truck walk-arounds on YouTube. This one comes with the 22-inch DDC polished aluminum wheels. They are in really nice condition, and it has Nitto NT420 tires. These are LT30580, or I'm sorry, 50R22s. They look like they got a really good amount of tread left. I'm not too familiar with these tires, but I would say probably 60%, 70% of the tread left on those tires frame and underbody is in really nice condition for a 2017. Front fender is in great shape. I didn't see any dents or dings on there. It does come with these aftermarket projector lamp headlamps, LED running lights. Actually, these headlights kind of look like they're out of a Laramie. Then it has some LED rings around it. Has the factory fog lights, front bumpers in excellent shape. You get the LED Rough Country light bar there. So dents or dings on that front bumper. The front grille is in nice shape as well, and that's a painted grille. I'm pretty sure that probably this one didn't come like that, so they probably did that too. The hood's in fantastic shape. It does have the blacked out clearance lights up top, passenger side front fenders in great shape, and the passenger side front wheel, no major scuffs or scrapes on there. Looks really good. Granite Crystal, one of my favorite colors on the Rams, has a lot of metal flake to it. It's got a lot of blues, greens, even a little bit of purple in there too. Really a neat color. As you go down this side of this 2017 Ram 3500, take note of how clean that body is, how reflective and mirror-like that paint is. Take these HD videos, so if you are far away or even if you're close by, just cannot make the trip down, but you're still interested in purchasing the vehicle. You can see the truck, hear the truck, and have confidence in the vehicle that you're looking at before you even get here. So when you do get here, there's absolutely no surprises, and you can make a smart and informed buying decision from wherever you're at. If this video helps you make that buying decision, let your salesman know that you saw the video, that it was helpful, and that brought sense. The lower rockers all look really good. It does have the 3M tape on the front of the dually tub here, couple little touch-up spots that have been done. I don't think we did that, but back wheels are just as nice as the front wheels. And the tires have just as much tread as the front tires, probably even a little bit more. This one does have the automatic leveling rear suspension, so there's the bar. You get a heavy load, it pushes up on that, and it tells those airbags to pump back up. Frame and body on this truck is in really nice condition, has all the remaining factory exhaust. There we go, looks really good. This one also has power running boards that somebody's done to it, so definitely tricked out. It has the LED tail lamps, those are aftermarket. They look really good. Rear bumper is in great shape, it does have the backup parking sensors. The tailgate is in fantastic condition. It does have the full towing package, of course, with the receiver hitch 4-pin and 7-pin wiring. Access, soft, roll-up tonneau cover, that's in really nice shape. Comes with a spring bedliner, 5th wheel and gooseneck prep package, LED bedlights, and 7-pin wiring back here. That bedliner goes onto the tailgate, and that shuts nice and solidly. It also has the cargo cam up top, coming around the driver's side. Dualy tub looks just as good as that passenger's side. And for full disclosure, this back wheel, just as nice as the rest of them. Really a good looking truck. And the more I go over it, the more I can tell that it was really well done. Whoever did all this stuff to it, they really knew what they were doing. Has the heated fold-up tow mirrors built in directional signals. They fold up like so. They fold in like that. Inside the SLT package, which would normally come with just cloth interior. This one has some really nice black and gray leather interior. Side current airbags, power driver seats, lumbar, and it does have heated seat buttons right there. Factory all-weather floor mats, auto headlamps, power windows, locks and mirrors. These mirrors do power fold in. I always like showing both sides, so you know that both sides are working properly. And we'll take a quick look at the back seats. They are just as clean as the front seats. No rips or tears back here. It does have the latch child safety system for any child car seats you may have. Power sliding rear window with the built-in rear defrost. So these mega cabs fold down two different ways. First way, the whole seat goes down. So you can see that the bottom of the seat goes to the floor. Backrest goes nice and flat, which is great if you got pets. You can put both sides down. They got a nice flat place to lay. Or if you want to just yourself take a nap back here, it's plenty of room to spread out. And then the other way that this back seat goes down is just the backrest goes down so you get a higher load floor and then you get a kind of confined storage area back here. So that's pretty sweet. There's a little storage bin back there as well. And the factory all-weather floor mat back here is in nice condition. You do get child safety locks on the back doors and the inside and bottoms of the doors are in fantastic condition as well. You can see the AMP Research power running boards. That's working nicely. I did want to show you the bin sticker. No Canadian trucks here and the tire and loading information sticker. We'll hop inside, check out the miles, the radio and everything that this truck has to offer on the interior. Get the 3500 animation right there and the 7-inch LCD display, digital spinometer, compass, outside temperature display. Looks like we got a parking light out. That might be from all those LED lights. And then a time display right there as well. You can change all those corners to read whatever you want. Instrument cluster is very nice and clean. Comes with the leather wrap steering wheel, cruise controls on the right, Bluetooth and information center controls on the left and audio controls on the back of the steering wheel. The Ice and Heavy Duty 6-speed automatic transmission, turndile 4-wheel drive has the 8.4 3C radio. You do get AM, FM and Sirius XM radio capabilities on here.  This one also has the Alpine Premium sound system in it so that's really nice to get the subwoofer and all the speakers especially the ones in the ceiling. Turndile 4-wheel drive, more tactile volume tune and climate controls. Factory brake controller that's your alternate trailer height so you can program a couple different trailers with the rear airbag suspension if you have a trailer that's heavier than the other. Factory stability control, tow haul, exhaust brake and parking sensors for the back. You do get 115 volt, 150 watt plug-in, passenger side format and seat are in excellent condition. The speakers in the ceiling, headliners in really nice condition as well and you get map lights up there. Power sign rear window button, home link buttons for your garage door security systems and lighting systems and 911 and assist buttons in the mirror. Here's the original window sticker just kind of wanted to show you this for all the options especially this one has the 342-axle ratio, the ISEN transmission, the auto leveling rear air suspension which was a $1595 option and just kind of give you an idea so that is a factory spring bed liner in here as well but feel free to pause that. Take a look at everything on there. Let's start it up and take a look under the hood and then we'll check out all the lights and everything. Starts right up, no check engine lights or anything like that. I want to show you these LED tail lamps. Pretty good looking. I would personally like to thank you for checking out the video today and hopefully from this HD video you've been able to verify the quality, condition, options and of course cleanliness of this truck all the way around inside and out. See all those lights are working nicely and actually does have the LEDs for the running lights there. Cab lights are working nicely too. Under the hood we have the 6.7 liter Cummins diesel engine and Jimbe's very clean runs very smooth. Once again this truck has been fully safe and inspected by our service shop as a fresh oil and filter change. All the fluids have been checked and topped off, shocks are doing a nice job of holding that hood up and this truck is 100% ready to go and there's the emissions sticker and I would highly recommend this truck to make quality and condition standpoint. Like I said this thing's been tricked out and very well done, whoever gets it, everything is really nice on the vehicle. And to see more pictures of this truck or one of our 550 new and used cars, trucks, SUVs, minivans, Wranglers, halftones, three quarter tons, one tons, you name it, we've got to go to that website right there, summitauto.com full pictures and descriptions of every single vehicle. All at summitauto.com. If you'd like to check out more HD videos you can go to youtube.com slash summitauto. Click the bell notifications to get updates on the videos I do each and every day. As well as having access to one of the largest catalogs of vehicle and truck walk-arounds on YouTube. In fact, in a second you'll see a link to subscribe to my YouTube channel, the upper left-hand link to more Ram 3500 truck videos that I've done in the upper right, link to this vehicle on our website and lower left-hand link to one of our latest YouTube videos in the lower right. Click those, check us out. We're super excited to help you with this ultra clean 2017 Ram 3500 mega cab short box dual rear wheel SLT in Granite Crystal Mattel with the high old clip Cummins diesel and the ice and transmission. Thanks again for checking out the video. I'm going to like subscribe and share on the YouTube channel. I really appreciate it. Thanks again.


Hey friends, in this episode of Code Club, we're going to take this slope plot and we're going to convert it into this slope plot. Notice the difference? Yeah, we moved all that text for those 15 different countries from the right hand margin into the actual body of the plot, so that we can more directly label each of the 15 lines. Of course, this is not a perfect solution because there's a lot of data there. But along the way, as we go about inserting the text next to those lines, we'll learn a lot about different geomes that we can use from ggplot2 as well as other packages to put text within the plotting window. So let's fire up our studio and you can grab the code that I'm starting with down below in a link to a blog post that's for today's episode. There you will also find the data that I'm using at the very bottom of that blog post. You can take that data if you haven't already and plopped it into a file called August October underscore 2020 CSV. Everything should work. Let's hope. Also in there, I'll put the final code that we finish with. But as you'll find over the course of today's episode, we'll do a fair amount of meandering. So it really would pay to follow along as best you can. So you can learn about these great options we have for placing text within the the figure. So here is the slope plot that we've been working with over the past couple of episodes. It still looks a bit garish with those 15 different colors for our 15 different countries. But what we see in the slope plot is declining intent to receive the COVID-19 vaccine. But it's hard to see what what line corresponds to each country because again there's so many different colors. And the legend is so far off to the right relative to the position of the lines. We're going to talk about that in today's episode and one strategy that we might use to help solve that problem. But before I dig into that, I want to come back and review something we discussed a couple episodes ago, which was how to format the text associated with the theme of our figure, the text that's not associated with the data. So things like our title, our caption, our y axis, and our legend text. So one of the first things that I'm going to do is come back to my R script. And you'll see that we loaded two fonts from Google font. So the first one's patch one. And that's what we're using as the title that nice bold, attractive font. We also loaded a font that we didn't use, but we used in a previous version of that dumbbell chart, which was Roboto. Roboto looks a lot like Ariel, which is the default font. So I'm going to change this and use a font called Montserrat. And I'm going to name the font family then Montserrat, make sure I've got that loaded and then go ahead and run that show text auto to make sure that that font family as well as patch one one are visible to ggplot. Now what I'm going to do is to modify the appearance of all of the text in the figure, I can add an argument which I'll call text. And so this text argument takes what kind of function do you think element text, right? So you could give it element text, element markdown, whatever you want, but I'm going to use element text. And so I will give element text the family argument to again change that family to be Montserrat. And that needs to be in quotes, because that is the name of a font family. And we see that that syntax is very similar to what we had down here for the plot title. Of course, I also needed a comma there. And we see that the font has changed in all of the textual aspects of our figure. You'll notice the title didn't change. And that's because ggplot's theme works on a hierarchy. So text you can think of as being at the top level, everything inherits from the top level. So when you get the plot title, it would use Montserrat, except we said to use family, patch one, and that's why the title is patch one, and everything else is that Montserrat font. One other thing that I would like to change is the line height of my caption. Do you remember how we could do that? Yeah, if we come back to plot caption, we see that we used element markdown, which again is very similar to what we see for element text as well as element text box simple. And the argument that we can use, we see that we used up here for plot title, which is line height. And so I don't want to and wanted to be double spaced, I do want a little bit of separation between those two lines. So maybe what I'll put in here is 1.5. And now I can see a little bit of separation between this first line of the caption and the second line of the caption. And I think that looks a little bit more attractive than having those two lines compressed together. The third thing that I want to review with you is how we can change the color of the font in our labels. So looking at our y axis, this is a black font, which to me is pretty bold. Obviously, it's not as bold as the title, but it kind of stands out. And I don't really want the y axis to stand out so much. I want I want the data to really stand out. And then if somebody wants to go look at the value on the y axis, they can see that I want their eyes to be drawn to the title, and then to those slopes. So we're going to go ahead and change the color of that font. And we don't have anything here for the axis arguments already. So we'll go ahead and add that. And we'll do axis dot title dot why because I'm going to change something about the title on the y axis. And here again, we can do element text. And I can then use the color argument to change the color of that y axis title. And I'm going to go back to my hexadecimal and I'm going to do pound and I'll put in six eights here. That gives a nice medium gray color. And so now I see that my y axis title is gray. I'm especially you can kind of see that relative to the color of the numbers. I also want those numbers to be that same color gray. So I'll add axis dot text dot y element text. And I'll again do color equals that 88888. So now our y axis labels and title are that more subdued gray color. And I think that does a pretty nice job of allowing us to really focus on what's going on in the main body of the figure. Yeah, you know, we could also change the dates here. But I want it to be clear that the dates that we're looking at are August and October of 2020. Again, all of these are matter of personal preference and your own personal sense of style. And so I'd encourage you to play with this to get kind of the appearance that you want. Okay, enough review. Let's talk about moving these country names inside of our plotting window. So I'm going to start by using geom text to move these country names to be right next to the lines that they represent. I can do that by coming back up here to my pipeline for where I'm building the plot. And I'll do geom text. And so geom text takes x and y and label and a number of other aesthetics. But those are the most important ones for us right now. I will go through some of those later. And for my label, to set my label, I want that to be the country name. And so I can do AES label equals country, because I want the label to be the country name. So oh my gosh, we have a lot going on here, right? We have the country names right on the points that are at the, you know, the August and the October of the data. We also see that we still have this legend over here. One thing I want to point out about the legend is that it's adding the text, a character for the text. So A, to indicate that the A, the red A on top of the red line is India, as if we couldn't tell because we have India written right there. So let's go ahead and get rid of this legend, because one of the purposes of putting the text on the line, or at least next to the line, is that we don't need the legend then, because the data, the text is going to be right on top of the data. Again, to do that, to remove that legend, we can come back up here into our two geoms and say show dot legend equals false. And we can then do the same thing for our geom text. And there we go, we've gotten rid of the legend. And now we have our country names on top of the point that is represented for the August and October, you know, willingness to receive the vaccination value. So obviously, this is a hot mess. It's very busy. There's a lot going on here. And so what I want to focus on is how we can use geom text and a couple of other related functions to help clean this up. The first thing that I want to try, though, is to alternate what side the country name is written on, right? So I don't really need China on both sides. I don't need India on both sides. It just kind of, you know, makes it more busy than it really needs to be. I think we're already going to have a few problems because I think right here, we have USA, Spain and Italy, all like right on top of each other. So if I can maybe leave Spain over on the right and put, I don't know, is that Italy there or whatever, right? If I can kind of free up some space on the on the left and right, that'll make it a little bit more attractive and easier to read. So to get those country names to alternate left and right, I'm going to come back up and we'll review what is in our data data frame. The data data frame has the country as well as the month and the percent, right? And so that way, then on the x axis, we can put the month, the y axis, the percent, we can group by the country and we can color by the country. I'm going to create another data frame that will be used for plotting the name of the country. And so we'll say data, and we'll pipe that into a pivot wider. So we just made things longer back up here on line 21. Here, we're going to pivot wider to make it wide again. And I'll show you why, but let's do this first. So we'll do pivot wider. And I will then say names from and I'll say month and values from and I'll say percent. And so now what I see of course is I've got my countries and my two months, which is good. And what I can then do is I'm going to mutate to create another column. And the column is going to indicate what row each of the countries are in, because I can then use that value to indicate whether it's an odd or even column and whether or not I want that to be on the left or the right side. So I'll say n row equals one colon and parentheses. So that n parentheses function tells you the number of rows in the data frame. And now we can see that we have n row. So now I want to indicate the actual month that I want to report back for each of those countries. And to do that, we'll then say month equals, and I will do an if else as the function. And so if else, and row, and I'm going to use a special function called the the modulus function, so it's 2% signs to equals equals zero. So that's actually even. So the modulus function tells you the remainder. So if I do five modulus two, the remainder should be one, right? Good. If I did five modulus three, the remainder should be two. Good, right? So if I do five modulus two, and I get back one that tells me that five is odd, if I do four modulus two, four modulus two, I get back zero because that's an even number. If the row is even, then I want to turn August tick 20. And then if it's odd, I'm going to then give it to the October. So that will then be October tick 20. And we have these poorly formatted month names, because we use labels up ahead here. If you remember the last episode where we talked about factors, we now see when we look at this that we then get our country, and then the month that we want. We also now want to get back the percent that we want, right? And so we can repeat this to have a column percent. And I'll grab this same statement, bring it down. So if it's even, I actually want the value that's in the August 20 column. And I can get that by using those back ticks to indicate the column name. I'll do the same thing here for October. And now what I see is I've got new columns month and percent to indicate what position on the x axis I want and what position on the y axis I want. And I can then do a select to get back the country and the month and the percent. And that's exactly what I need to then place the country names next to the data. So I will go ahead and plot this as country labels. And so now I've got that data frame loaded. And then I can come back into my geom text. And I can say data equals country labels. I then have my AES for my label equaling country. I still have these AES values up here for month and percent. So that should work very good. So now we have our country names alternating left and right. Again, that cleans things up a little bit. And I think we'll hopefully help to make this plot a bit more attractive than it is. One thing that we notice, of course, is that our country name is smack dab on the middle of the point. It's not exactly what we want. What I'd rather have is the points on the left to be right justified so that that A in China is right next to the point for August 20. And the points on the right side to be left justified so that I in India, the first I is right next to the October 2020 point. We can alter the alignment within geom text by using a special argument called age just. We've seen this before when we're formatting the positioning of the caption at the bottom. Recall that's naturally right justified. We made it left justified. And so we can make things left justified by using a zero. And so we see now that all of our country names are left justified. Alternatively, instead of that zero, we could also put in left. And that gets us, again, left justified, if you can't quite remember the numbers, or you could use right to get things to be right justified. Instead of right, you could also use one. And you could also center things like the default by writing center, or you could write 0.5. So again, the age just values are zero for left justified, one for right justified, and 0.5 for center, or you could use left, center and right for that justification. So there's also two other special keywords that you can use with age just. And so one is inward formats things so that the things on the left are left justified and things on the right are right justified. We could also use outward to make things outward so that the things on the left are right justified and things on the right are left justified. And this is what I want. Very good. And so again, this is pretty nice as a way of cleaning up the text a bit. We still see a bit of problem with say like USA and Italy writing on top of each other. You know, it's really hard to read that Canada and Japan are not so great either or Australia, Mexico and Germany, Africa. It's a lot better than what we had. But it's still not as desirable as we might like something we could do to help clean this up a little bit would be to make use of two arguments in geome text, which are nudge x and nudge y. I'm going to illustrate this for nudge y. So I'll add a column for nudge. And I'm going to create this nudge column value using case when. And so case when I'll then do country equals equals USA. And then the amount I want to nudge it will be three units. And for country equals equals Italy, the amount I want to nudge it will be minus three units. And then for everything else, so I'll say true, I want a tilde to be zero. So the nudge is nothing. Alternatively, instead of changing the nudge value, we could change the percent value to kind of bump things a little bit. But I want to demonstrate how to use those net nudge arguments. And so now if we look at country labels, we see that I didn't export using select the nudge column. So it's always good that we check those things here. So I'll add that to nudge. Now, if I look at country labels, I see that I've got that nudge value. And I can then come back down to my geome text, and I'll add nudge y equals country labels, dollar sign, nudge. And so now I see, well, that's a pretty big nudge, I probably didn't need to nudge it three, maybe I could do it by one. So I'll come back up and modify that. So that looks a lot better. It's not perfect, of course, but, you know, it looks a lot better than them being on top of each other. We could, of course, come back through and do the same type of thing for Canada and Japan, Australia, Mexico, Germany, and South Africa to give it a little bit more separation so that the things aren't writing on top of each other. I think I'll save that for you to work on as an exercise. Okay. So again, that is how we can use geome text and some of the arguments, specifically thinking about that nudge underscore x nudge underscore y we use nudge underscore y, but you could use also nudge underscore x to move things left and right. As you can see this approach to labeling the lines using the information from a legend is quite a bit different than what we typically do in the scientific literature. It's perhaps more akin to what you would see in the popular media in the popular press. What do you think? Do you think there's a place for this type of labeling in the scientific literature? I kind of think there is. One of the things I really like is that it puts the label right next to the data so that my audience member doesn't have to be scanning back and forth from the data to the legend to figure out what goes with what. I think this is pretty nice. Of course, we still have some overlap of our labels and we have all these different colors, which makes it kind of hard to see what's going on. So again, this isn't a perfect figure. At the same time, if you've subscribed to this channel and you've clicked on the bell icon, why haven't you already? Come on. You will find out that in the next episode that I have ready for you, we're going to use the Gigi repel package to go ahead and automatically separate those labels that they don't overlap on each other. And we can make it a little bit more clear what line corresponds to each of the countries. Keep practicing with this material. See if you can't implement it with your own data. Be sure that you've subscribed to the newsletter that I have. Each week I put out a newsletter. It typically kind of tracks along with these videos. So if you want extra practice problems that correspond to these videos, you need to check out that newsletter, which you can find if you go to riffimonis.org. The bottom of the page, there's a form that you can fill out. The newsletter is free. It's not spammy. And I think you'll really get a lot out of it. Anyway, practice with those and we'll see you next time for another episode of Code Club.