And I'd love to welcome everybody back to the Independent Investor here. We are kicking off 2023 with a bang. This is the first exclusive interview we have with the Co-Founder CEO of Aduro Clean Technologies, Mr. Ofer Vaikus. He has been kind enough to parlay from his busy schedule and speak directly to the developments that are going on right now and they are exciting and they are vast. I want to take this opportunity to invite everybody to the description finding all the information for adurocleantech.com. Disclaimers and disclosures as well as my current share position will be disclosed in the description for full transparency. Please use these resources in understanding how we all have a responsibility in getting on board with what Aduro Clean Technologies brings to bear. Ofer, welcome to the channel. Please take a quick moment here and give us a quick rundown of the history of aduro and really the passion that drives what it is that you're trying to bring to the marketplace here in trying to solve the plastic problem. Certainly. Hi, Ryan. Thank you very much for having me and it's always an honor to speak out with investors. We are actually looking forward to do that. We want the opportunity to show our voice and explain our case and so yes, it's an honor but also a great opportunity to be here and thank you very much for doing that. As for the history of aduro and the passion behind it, its aduro's idea was found somewhere in 2009 much before it was conceived when I found this technology that came from Alberta and it wasn't entirely our technology, it was a nearby technology. I show it at the time to my partner today, my partner in crime, the city of the city of Marcus. The immediate question that he came back and asked is you know that whatever they do and everyone looks at it, it doesn't really happen. So I got intrigued and I said, hold on, what do you mean by that? He said, I just don't know why nobody else is reading the science the way I read it and so at that moment we pose and we took about three years to investigate quietly what's going on with the chemistry that we are promoting and it was a little bit like an onion case where you learn through your motion what's going on there. What we understood is basically that when you are promoting the chemistry that we think people thought that they are promoting, there are certain things that where they're hidden and nobody pay attention to that and so when you look at the articles and everything around the articles, the publications and the efforts to do pilots, everyone explained this in a certain way that to support some kind of chemistry that actually did not happen and at the fundamental basically when you take water and press it into a supercritical condition, it remains a supercritical condition unless you introduce foreign material and once you introduce foreign material, of course the environment is changing and water no longer has the same characteristic because you just introduced and most of the research to our surprise where continue with the supercritical condition and we've been immediately understood that we're working below that kind of open for us what I called a positive Pandora box where we looked at information, we had the opportunity to quietly look secretly at what the publications are, we realized what's going on there and then we thought okay we have to understand it a little bit and be able to develop it and understand exactly what's going on so that's for the history, fast forward into it we started with heavy oil and we realized that we could do some things in the heavy oil at the time we based our first patent to our surprise in a place where every the first patent that we found on record was 1930 and so there was a lot of players in the market at the time, all the big boys have been there, all the big companies have been there our patent with our first 36 claim which is quite a lot, sailed through and we were among the 10% of this audience, the examiner did not find any reason to push back and that was a big wake up moment because we thought okay there is some kind of a novelty that nobody else is putting and looking around and then we moved to investigate, we realized that we fast forward a few years, we realized we have to do some work on renewable oils and there is correlation between those technicians and from bitumen to renewable oil and I'll explain later what was the connection I'll just say that we've been ready to produce more patents and then we realized basically that there is a similarity basically between the bitumen and what's going on in renewable and bitumen in plastic and so what we did basically is took our knowledge from bitumen and renewable and just you know attack the plastic stage so the net result was eight patents in less than 10 years, seven of them are ours and are granted, one of them is pending and a lot of know-how, new science that came out that is really novel and hasn't been done before the way we are promoting it. Now just recently the third party verification that was provided for the technology what did that mean in way of verifying what it is that you guys had been working so hard over the last decade to get to this point? Yeah so you know in our hearts we knew of course but we needed the investors because the investors have heard a lot of stories before and you had to go somewhere outside and make sure that you are presenting the chemistry in such way that it's been confirmed that the science is there and I'll say that there is two level there that one maybe is more important than the other when we started it we said yeah we'll just produce a third party report which was at the time was in our professor that we've been working at the Western University but really Ryan the third party validation comes later from the operators and the potential partners that has been asking us many many hard questions you know lots of them and you have to protect and tell the same story again and again and again and you know we don't put it out there because we only produce in the news we only put out the news of actually material in that sense and we don't talk about you know engagement where we have with other possible partners we have a lot of those but we don't talk about them because it's not a deal until it's a deal and we really want to try from anything of you know the push kind of activity that maybe sometimes you could be mistaken to do of course these guys are pushing back left right and center and so we've been confident in our ability to do and to protect the the science behind it and for us what's remain is really beyond that was really to put it into the motion of moving it from the lab towards a commercial application so taking the science and wrapping it up and building a commercial process around it because there's no questions about the fact that the science is happening it is happening and I have to ask about the shell game changer program yeah the accelerator program it's in the share owner's best interest to get what it is that you can disclose I know you're in the process of you know the beginning stages of marching through 2023 with with shell being chosen in the game changer program yeah I want you to kind of speak a little bit generally to the share owners about what this could potentially mean for the aduro opportunity and more importantly we all know and we sit back a little bit and we identify how big this plastic problem is we're talking about in the neighborhood of 325 million tons produced annually we've got current technologies that are running at about 50 to 60 recovery efficiency and we've got you guys here now that really have had one of the most large validation that I've seen in in this market that that that has come about what is that going to mean in accelerating your guys's path to bringing this product to market and starting to really get this product in the in the hands of where it needs to be in solving the problem that we have thank you for you know asking it I mean it's of course it's critically important for us I'll start by saying actually I've been reserving and say we can only say about shell whatever there is in the market I think personally for me there is two levels of what does it mean for aduro the first is that you know Shell has been investigating the technology and you know in my heart I knew but the fact that we've been granted an access to talk to Shell this is the second largest company in the world I mean it's a huge honor and for us you know to be part of of and communicate with experts at Shell in general I mean lots of good stuff could come out of it you can of course imagine it and start thinking yeah what can be done with this so very very exciting so on the level of authentication or maybe acknowledging that the science is there that that is maybe the first element you know that of course Shell has the program has opened the door for us to work maybe on we develop it in in six phases and with each phase we're moving forward we show some things then we move forward and we show first some things and you know as we move into the the project we we advance our operation based on feedback that we have from Shell and by Shell's expert and Shell has a beyond that program Shell has a you know with the aduro a commercial agreement but it's it's it's confidential and I don't want to want to be very very careful and we want to honor Shell we don't want to be over you know promoting on this we just want to be reserved on one hand but we want to make sure that we are delivering to the letter at which this is what we intend to do as a company we are so hungry to this success the team is ready we have excellent team that is working 24-7 they've stayed so for so long in the company for this opportunity to show it to people such as Shell and so you can't imagine I mean there is of course now they have to you know they have to work for it right now and prove it but you can appreciate the level of excitement that that we have when we're doing it within Shell there is a bunch of experts that can help us and every feeder that we are getting help us shape our understanding both on the commercial side and and back on the technology so these multiple advantages for us working with Shell. Fantastic for the viewers that don't understand the Game Changer program I will put a link in the description to the one public announcement that aduro had in being accepted late last year 2022 just sets up 2023 is one of those many things to to observe for 2023 yeah go ahead perspective Ryan sorry to to mention certain volumes you know that out there in millions of tons you know the the plastic program is so big that you need 10 shells to to make a dent just if you really want to to this endless amount of volume there just to give some some understanding to the public what does it mean Shell really wants to to process about a million I think a million tons per year I think it's by 2030 well you just mentioned 340 of them so how many shells do you need to deal with the plastic problem so it's about working in many areas and with different collaborators to try and make a dent on a story that is definitely sensitive and and you know to all of us right we all get emotion about it in one way or the other I think for me I felt a little bit disappointed in myself when I started doing my due diligence on this topic in understanding that my understanding of recycling when it left my household as much as we all consume on a daily basis what actually was the end disposition there wasn't a cradle to grave it was really a generation to either the landfills or the oceans and it was my understanding that when it went in the green box that it went to actually be disposed of recycled and turned into new material that is that is not the the case and I think a lot of people are naive to and don't truly understand the magnitude of the problem and up till now the lack of technology that it goes into solving this problem can you speak a little bit about the efficiency and the cost and your technology which is hydrochemical and how it separates you guys from the competition in these companies that are trying to bring solutions to bear in the early stages of this of this initiative yeah so I'll start by saying that we we feel a lot not just about the competition we feel that we can work you know with the competition not just against the competition of course the competition for many many years you know there were several approaches been developed over the years to deal with with with recycling of plastic one of them being the mechanical which is the straightforward approach the other one being more of a solvent where you put some material in some kind of a liquid and you get something then the other one the the higher level would be more of the thermal approach which you're basically breaking breaking material and you can associate the thermal approach with you know there are some water-based technologies and hydrothermal liquidification and their pyrolysis and then there is higher level like gasification that you simply destroying things and bringing them back so overall it's accepting waste in general is really really tough because you're talking about different type of chemicals that are coming into the same pot and and they react to the same condition differently and so why you know no surprise if you put them in certain temperature you know some things will be you will behave x and the other things will behave y and these penalties associate with that and now what you see against it is that you know before in order to come up with a valuable some kind of a reasonable product you would have to maybe do some higher level post or pre-processing treatment so sorting and if because you've done your work let's say if you've done it to a certain level it's not enough and you have to do some post-processing at the later state now now you can see that you know this is a material basically plastic is very cheap it's everywhere and anywhere and so the minute you touch it you start accumulating negative cost but it comes immediately with the fact to to the reality that you have to you know collect it and sort it and do all kind of things with it of course it's easier to turn you know put it on on some kind of a fire or throw it into the landfill yeah that is the reality in general just because it's very very complex problem i'll differentiate also between areas that are more regulated and areas that are not regulated so i'm happy you're you're putting your material in the blue box in the bins and you think all is good we'll talk about that in a minute but we're not you know the center of the world the rest of the world you know we think most of the population out there it's not what what is happening you know you're talking about latin america and you talk about india and you talk about other areas that as much as they want there's lack of resources to do that type of operation and the operation that you're talking about like the blue being are more in the you know more advanced countries and so we are we seeing a differentiation there and so for example a lot of the plastic program you know remains the same in those countries and nothing happens there so in a way for us it's a market and i'll explain why is it a market uh going back to to the you know our our reality where you're saying i'm putting it in the plastic bin and i'm doing something with it um soon enough because the situation is so complex uh you start accumulating costs so in this environment the one that can work in a little bit less temperature the one that can work in you know take a little bit more contaminating the technology that can do higher yield and maybe that is obviously the technology that will be cheaper and has a higher chances to survive what's going on in our reality and what's going on in our reality is basically that uh competing processes has to go for size you know so they put build large and larger and larger and larger site but that's in in return create uh commitment and demand for waste uh for many years to come in in you know large radios that in return increase the value of the feedstock yeah and so you know this is a rolling uh stone that goes push you up more and more and more and by the way there's a lot of rejection as you mentioned so for example with those guys that are fighting for the for the best of the best of the material that is out there and rejecting a lot because aduro can work in the environment that has a little bit more contaminated material we see ourselves as complimentary to those you know we don't have to replace them we see yourself as as complimentary aduro can operate in a smaller scale unit closer to the resource or to the area where uh your your waste is there and so if i'll take you now to the less regulatory environment let's say nexico for now then of course smaller unit that closer to the edge or where the the the feedstock is there that create activity and higher value product while reducing the negative cost of transportation and everything that associated with the emission and footprint has a chance to become sustainable there without building multi-billion dollar operation so aduro is benefiting from both sides one in the higher regulator we absolutely you know we can compete and will be more efficient in many ways from the legacy technologies we see but we actually want to work with them and and the market will adjust itself and we'll take material that they they are rejecting and you know there'll be maybe higher recycling activity in that sense and with the market that is actually fairly open and not a lot of penetration is happening and you can look and into the charts and and see where are the big companies are operating they are more operating in north america in europe less operating in latin america in india although it's coming there our solution provided an opportunity to to do smaller operation a more localized operation and now you're talking about you know things that associate with esg because you are creating work and you're creating you know you're helping cleaning the land there's so much good stuff that goes on in this that you know you just don't want to stop and so for us it's just another secondary market and we are actively developing both so although we're getting attention from big organizations and such as shell we're actually pursuing smaller opportunities to sustain ourselves to understand how does it looks in in such a remote market because we want to learn that we want to create a it will create benefit you know monetary benefit for the investors but it's also create a greater good because you know you can operate in those organizations and this is what absolutely right working with everyone to create some kind of a good things out of it that's that's incredible um i i want to i want to switch a little bit and talk about pending mandates and i i don't necessarily like that word i i think that um in in what i've researched there a lot of these large companies know that there is going to be a cap on historical production and new production they're going to have to find out a different way to do business these mandates are looming 2025 is right around the corner how much in your sense does that play into the the the search right now that these large companies are on or is it a healthy mix of both knowing that they need to move in a different direction or is it a healthy mix of both can you speak on that a little bit over yeah i i think first of all it's it's health mandate by itself it's a it's healthy but it needs to be measured and the future of it it's very very very new at the end of the day you know those those costs will somehow trickle down into the product and you'll see a higher cost into it but what you know already what we know already that you know even if we let's say pay cheaper product then but then we eat fish with plastic product in it it may not be a good idea if you know what i mean so there's a balance there that needs to be you know to be handled the consumer or the regulation behind the mandate are such that produce the responsibility are such that organization that are producing let's say product and are responsible to to distribute those products into the to the to the consumer are taking some responsibility to aggregate and collect them and to find them another house and so there is a different it's not it's not one for all the concept is is is this you know distributing and and increasingly expanding even to territory such india and mexico by the way for you to know but it's it's deviate based on case by case but in in general what it means is you know in the case let's say of loblo and coca cola and others that are producing a lot of food packaging they will pay some fees membership fees to a non-profit organization that will be responsible to not just engage with the other organization to collect that type of product right also will engage with companies like us to find them a better better alternative than just incinerating so it is absolutely helping us in many ways on the other hand i can tell you aduro because aduro can work in in more of a there is a a little bit higher freedom to do it to work in in the you know the contamination material i feel that we are enjoying a bit of a both world whatever regulation will be there i think will be awesome and will be there and whatever non-regulation will be there we'll just you know we're trying to make money without the government right every time you you're negotiating and hoping that the government you'll make money with the government okay it may be true but we want to make money without the government and so in our business case we have models for both and i think aduro will benefit usually from that regulatory that are coming in i agree i i think now more than ever in 2023 i have seen a an initial focus especially from the younger generation of investors who put esg acknowledgement and the governance that exists around those companies like yourself that have these initiatives where it's it's much bigger than the stock ownership it's it's a lot about acknowledging the initiative that those companies are putting forward to reduce greenhouse emissions to lower working to lower those carbon scores for companies and really looking to to find that that that initiative it's not just about investing in companies anymore that are profitable it is really a renewed focus and understanding and people are making their investment decisions based on that that esg acknowledgement i do want to this is important and i have to say from time to time i do see positive news that are coming in about about you know us we we often are buried in our own world and are busy in our own things but you know i i saw on link deal today and advertising about you know great rift in australia that is has more curl like there are some positive impact that is happening although we don't see it sometimes the problem is so big that we don't see the end of it and that's generally the case i guess and it's very frightening and and what have you you know that those are the issues but uh you you can see that sometimes there is positivity that comes out of it we're definitely part of those technologies that i call the next generation at technologies that are capable of doing something in a maybe in a better form or less less impact and i'll say it again it maybe you know one day it will replace some technologies but often what you find out that you just work nearby and there is a deviation and you just collaborate and you make a lot of money do that and that's fine as well that's great the the plastic problem has compounded itself over many many decades and i think it's safe to say that the problem is not going to be solved overnight and and no my charge to aduro is take take whatever time you need i i know if we could have this tomorrow we could take it because the planet needs this tomorrow we'll do it trust me we've been the planet longing to to show it out and expand it yeah i think people if they would just increase their little bit of knowledge and to the magnitude of this problem i think they would be rooting for you the irrespective of whether or not they were a share owner in the company or not i i think that's true as we round out the interview here i do want to ask you about r2 that's been or completing if not completed now and doing the testing phase yeah fantastic what is that going to mean for customer engagements going into 2023 and over so let's say 10 years until today laboratory equipment so you know pots and pans and cooking and so people would ask you yeah what is this can you make a commercial product out of it so r2 is really the first time and it's not won't be the same reactor we already know that we have to change some things but it's the first time that you're thinking continuously so so this is a motivation so it becomes a lesser science experiment and now you're moving to the bigger deal and there's no way around it we have to go through the motion of building you know tackling small stuff and then going into maybe medium-sized stuff and then building bigger stuff that's what you know in every in a general in a journey of commercialization of a technology you have to go through those stages and you would be really you'll make a big mistake if you'll jump from one to the other thinking that you save money there's plenty of dead bodies all over ryan i can take you to alberta and i'll show you some of them if you like and basically because of that in the other end of it that sometimes people go to the safe so whatever it is out there like pyrolysis and the others and so we have to be very very careful in in the way you are you are moving through those stages the net result is that us running a continuous flow material process will teach us a lot about the possibility and what is required to do to move it from this current stage to a commercial project the optimism behind you know or the positive thoughts behind the fact that we think we can do it really really quickly is again embedded in the technologies benefit so if we're working in lower temperature if we're working with the higher level of contamination if we're producing you know higher yield we're doing more good things than bad things so we have less problem to solve yeah that's the concept it's not that we think we can jump to a commercial process immediately but we have this sense that if we're doing things right you can move it through the journey we haven't seen anything right now that tells us no it's always possibility it's a new science it's a new research trying we are yeah we're developing our own history right now there's no book about the things that we're doing there's a lot of book about everything else something you know everything you know gasification pyrolysis i do thermal liquidification whatever you want there's books and books and books you can find them you can do it you can google or you can develop some kind of improvement for us every step that we're taking is novel is novel yeah it's create a lot of interest and of course on this journey you have to move through the motion and and just do r2 and then r3 which is a bigger it's a ton per day so r2 is a few kilos per hour r3 will be uh two tons per day and we're even thinking now dare to think even you know larger units 20 tons a day which is becoming a you know a commercial like but it's just the thinking now right now our focus is just to commission and run uh the r2 because that is the milestone that we have we have to do in the next few months fantastic as we wrap it down i want to invite everybody who has stayed with us through the totality of the interview to visit a duro clean tech dot com there is too much to unpack with the duro clean technologies there are two other verticals that we didn't even discuss this evening we touched on them a little bit if you want to understand more i highly please yep wait please don't be a stranger because i tell you what uh it's going to be very exciting uh as we march into 2023 and beyond to really track your guys's progress i think the world um is rooting for you and i think for the most part the intention behind providing this awareness is to introduce what you guys are bringing to bear i i'm i'm passionate about it um i have been right now right i first of all thank you very much i mean i i just want to thank uh on behalf of my team that is working around i mean thank you for for the opportunity and thank you for the investors that actually put the trust in us and let us do what we do uh we're absolutely committed to uh deliver it you know through this uh journey and to bring it into a uh safe shore we feel we can do it and so far in 2022 we we talked about 2022 as maybe building the building blocks so giving the companies those tools such as the bitumen unit the flash drum that we needed building a bigger a bigger uh uh laboratory and and commissioning the the r2 or building the r2 2023 in our case is the integration of those building blocks in other words running those unit bringing it to to the stage where we can engage customers developing projects with those customers those customers needs to see this um through the r2 and going forward in order to understand how to integrate that going for you know in in there on their sides and as i mentioned there are small project and large project and so it's very bubbly and you have to learn a lot of information but anyway that that's kind of uh uh for us 2023 will be just the integration of those building blocks absolutely i'm expecting the investors to see going forward from us absolutely we'll be patiently waiting for those updates as they become available over on behalf of the channel here you heard it here in 2023 i don't know how we're going to top this but we are just getting started in 2023 looking for really really a brighter future here it's been pretty rough markets the last couple of years but there are pockets of value uh and it um it bright it shines no brighter than with aduro clean technology zoe for vicus co-founder ceo of aduro clean technologies thank you so much sir for coming on the channel we really appreciate your time thank you very much wine and happy new year to everyone same to you all for taking easy bye bye


On behalf of the Plain Center and the University of Chicago Trauma Center, I welcome you to the 12th lecture in our series on ethical issues in violence, trauma, and trauma surgery. It's my pleasure today to introduce our two speakers, Dr. Kimberly Joseph and Reverend Carol Rees. Kimberly Joseph is a retired physician who worked for many years in the Division of Trauma and Burns at the John H. Stroger Hospital of Cook County. Dr. Joseph received her MD from Columbia University College of Physicians and Surgeons in New York, did her residency in general surgery at the University of Illinois College of Medicine. Here in Chicago, and completed a fellowship in surgical and critical care at Stroger Hospital. Dr. Joseph cared for patients at Cook County's trauma program beginning in 1993. Reverend Carol Rees is chaplain at Stroger Hospital and a licensed clinical social worker. Reverend Rees also is a co-principal investigator and program director of Healing Her People Chicago. You may remember that the clinical director of Healing Her People, Rad Stibach, gave a lecture in this series about two weeks ago on the programs that is Healing Her People programs work to facilitate trauma recovery in children and adolescents injured by violence. Reverend Rees came to Stroger in 1986 when she was working at the Southern Baptist Convention. Until 2002, Reverend Rees was the executive director of the AIDS Pastoral Care Network. And in 2005, she returned to Stroger. And in 2010, became staff chaplain at Stroger. Dr. Joseph and Reverend Rees' talk today is entitled, as you see it behind me, crime and notary. When is it our moral duty to do more for our trauma patients in need? Please join me in giving a warm welcome. Thank you. So thanks, everybody, for coming. Carol and I are very honored to be here. We want to thank the McLean Center and Dr. Sigler for inviting us to come and speak with you all today. I need to do a shout out before I get started. Abner, Nympha, and Mary Lou, please stand up. Abner, Nympha, and Mary Lou are three of our very dedicated trauma nurses at county. And even though this is going for publication, at least I'll speak for myself, maybe not for Carol, but you're going to hear me refer to it as county. I have never, except when I had to speak for the media, called it Stroger. So I apologize in advance. We're going to be talking about county. I would like this to be somewhat interactive. Carol and I are going to tag team this a bit. We're going to ask some questions, not with the idea that there are right answers, but just to kind of get people thinking of some things. So the first thing I want to ask, which I think all of you are probably better versed in this type of thing than I am, in your opinion, what's the difference between morals and ethics? Moral is a general in everything. Ethic mostly is related to the conduct. What's good, what's not? What is right, what's not? What is justice, what is not? But the moral is in general moralities of almost everything like that, but often it's mixed together. One means something and means the other. OK, so I'm going to just repeat in case people didn't hear. He was talking about morals, sort of being a larger concept. Morality, ethics, and problem, what's right or wrong. So I think the conduct, as I've always understood, ethics, I agree with you. It's really something that is externally put on us in some way about how we should behave, what's appropriate conduct. Whereas morality, a lot of people to argue morality is something that is bigger and perhaps also more internal. But I would say probably also societal. And that's part of what we're going to be talking about today.  OK, if I don't trip and there's a couple of trauma centers, a couple of trauma surgeons here. So first off, we don't have any disclosures. What Carol and I are going to do is take you through some cases, but also take you through kind of the journey that we went through when we first asked to consider doing this. And one of the things that when we were trying to put this together, and we talked about this a little bit a couple of hours ago, is that the words have meaning. The language is important. And one of the things that Carol and I, I won't say discovered, but maybe rediscovered, was that we, a bit of it, is that we needed to go back and actually look at the language about what we do and figure out, number one, are we doing it? But number two, where does it come from? And by looking at where it came from, that also helped inform our answering, are we actually doing it?  Where does that word come from? What does it actually mean? What healing actually means, both the current use and also where it comes from. So we'll start with a case that I had many years ago titled Why Jeevan Bodderdock. So this is a guy who came in by report, jumped in front of a train in a suicide attempt. He was unstable on arrival. We ended up having to intubate him, all the things that we would normally do for an unstable trauma patient. His left leg was essentially near amputated. We completed that actually in what you would call your emergency department. We call it our trauma resuscitation area. He also had a very mangled left arm. We took him to the operating room, finished the amputation on his left leg, also did some repairs, muscle, debriefments, and things to his left arm. We get him through this process and resuscitate him, medically what we would consider to be successfully. We get him extubated. And the first thing he asked me when he woke up, we had him, took the tube out. First thing he asked me is, why did you even bother, Doc? Why did you even bother? By this time, we've had him for a few days, he knew that he'd lost his left leg. His left arm was essentially not able to be used. He couldn't use it. There was so much nerve damage. What do I do now? So if you had known that the patient wished to die when he arrived, now think ethically and morally, going back to what you're saying, did we actually do the right thing by this patient? If you would have known beforehand that the intent of this patient was to end his life, did we do the right thing? And I'm asking not because I expect that there is a right answer to this, but I'd just like to know what you think. I do. And I'm very patient. I am very patient. I've been an ATLS instructor for 20-plus years. I can wait you out. The basic premise by which we perform emergent treatment for patients who can't give us consent is that we presume that it would prefer to live and die. Yes. We presume to retain function rather than lose function of a limb or organ system. And you're basically suggesting if we don't have that presumption, can we still treat? Yes. Immersely. That's what I'm asking. And so I suppose using that framework, we have to say no, at least, or at least that we have to find some different framework in which to understand our presumption of the imposition of our treatment of the patient. OK. And I think that's absolutely legitimate.  So tell me what you're thinking. OK? OK. What if you knew that the reason that he did not want to go on living is that he had Huntington's, Korea, and he was going to, he knew he was going to die in a matter of a couple of years anyway, horribly, that there wasn't going to be any treatment? Would that change the way you're thinking about it? OK. I still think that I think it's more complicated to think, well, if he has a terminal disease and he wants to die fine, you know, I think it's an easy way out for us to not treat underlying depression and not treat underlying psychedelics. OK, and we're going to come back to that. Go ahead. So I'm not a physician. I'm looking at this from a patient's point of view at my own particular point of view. I very strongly believe in a right to die in an individual's right to make that decision. And I would say, if it were me, I would say the same thing as the patient had said. However, I've also seen studies that say that perhaps the majority of patients and a majority of patients who are saved from suicide are thankful for it because it's an impulsive decision and they wish they could take it back. So assuming that the physician has no way of knowing what this person's real feelings and real intentions were, I reluctantly have to say, yes, you did the right thing. OK. And I went through, yeah, well, and I have to say, I went through, in my mind, feeling pretty sure that this was intentional just based on the description that was given to me at the scene. And still made the decision of, well, for some of the things you talked about, was this something that if we had another chance at it, could we treat him? Could we have him feel a little bit different, not knowing the medical history? And ended up with this decision that I made, knowing that probably this was an intentional act. So let me take it one step further. You can see the second question up there. What if he had said, not whether or not treat me or don't treat me, but don't intubate me? I've seen people in my family, and they've been on life support. I don't ever want to be in life support. He's decisional. He's awake, and he can tell you, I don't want to be intubated. It's Bill, right? Yes. And again, I think that's legit, too. If you're saying his blood pressure's low, does he really understand what's going on? We use that argument a lot in people who we kind of suspect may actually be decisional, but we don't want to do what they want us to do. So we say, well, his blood pressure's low. He doesn't really understand what's going on. So the reason that I'm presenting this is because really, if you look at then what goes on to happen to him is that he has no real nerve function in his left arm. His left leg has now been amputated. We get him an electric wheelchair. It lasts for maybe two months. It breaks down. The insurance won't replace it. He's unemployed. He has chronic pain. He has difficulty now in all of his relationships. He's intermittently homeless. I follow him for about two years and then lose track of him. I don't know what happened to him. So I did find sort of at the end of this road asking myself, did I behave ethically in this case, which in some ways, for me, was an easier answer, but then asking myself, did I behave morally in this case, which was a harder answer for me. So I'm not going to read through all these things because this is really your area of expertise. For a lot of you, what are the domains of medical ethics, at least modern domains? And I would say that we did our best to do no harm. We really did not recognize his autonomy because we I won't say we. I'll say I did not think he was capable of being decisional and at first, when I first saw him, I acted in what I thought was a patient's best interest. We're going to get back to that also. Tried to treat him with respect, but again, there were circumstances that led to that not happening. The bigger question to me really is a moral question. Did we cure him? And that's when you have to go back and start looking at what's the origin of the word cure. So if we look at it from relief of a disease or something that we fixed, something that cures a particular medical problem, then yes, we cured him. But what do you think is the actual origin of the word cure? I heard wellness. Say it again. Cure is heart. It's heart. Cure is heart, sort of. C-U-R. It has like cardiac cure, OK? So it's interesting because when we were looking this up, one of the things that we found was that the Latin root of the word cure has to do with soul. So if you think of the old word for a priest, curates. It actually has to do with treating the soul. And I would argue that in this area, we failed miserably.  I think back on him a lot about what I would have done differently, and we'll hopefully have a chance to talk a little bit about that. And this idea of looking after somebody, and we'll talk in a second about care, Carol's going to talk more about healing. But we were entrusted not just with his body.  And I will, I call this a failure on my part, that I wasn't able to somehow help his soul. Now, some are sitting back there, and I have to admit I do periodically, just to get through my day, say, well, there's a limit to what you can do. And yes, that's true. I would like us, by the end of the time that we have together, to push that limit a little bit further back, and not use that as a crutch, and start thinking in terms of what are the things that we should be doing, whether you see this guy or not, to make sure that you are able to treat his soul. What are the things that we have to do? And for me, that's a moral question. That's not an ethical question. How about the origins of the word care? Did we care for him? Yeah, I think by some definitions, we did care for him. You can see some of the more modern definitions up there. But one of the most modern definitions is that the provision of what is necessary for the health, welfare, maintenance, well-being, and protection of someone or something. And again, I would argue that in this case, we failed to care for him. Not just individually for me as a physician, but there's some place upstream in this patient's course where we, as a profession, fail to provide care for this patient, fail to provide what was necessary for his well-being. And we'll talk more about that. These are some of the other definitions, but the one I really want to focus on, because we're gonna keep coming back to it, is this first one, the provision of what is necessary. Go ahead. Yes. So I probably would have done the exact same thing in terms of my medical treatment of him, and notice that I am not using the word care. That's deliberate. I would do the same medical treatment for him. The care of this patient actually needed to start before I saw him. And part of what we have to define for ourselves is what are we doing to care for people that we are responsible for, and we are now medically, as healthcare providers, as ethicists, we are responsible for the people who require healthcare in this country. And if that's our definition, then our notion of what care is changes. It's not just the medical treatment. It's what are we doing to make sure that patients have access to the kinds of resources that will prevent this from happening? And we're going to push into that. I don't want to take up too much time because I want to make sure Carol also has time to talk about her case. Exactly. So what I think has changed to some degree is my degree of agitation, disruptiveness, whatever the word is you want to use now, whatever the current word is about making sure that this guy didn't have to jump in front of a train to get care, to get care, not treatment to get care. And that's what we're going to be talking more about what's the moral, for us, for me, the moral imperative. So even if we pass the ethics test, and even if my treatment of him would have been the same, one of the things that Carol and I did as part of this journey, looking to see what are we doing with regard to cure the soul part of this and care what is necessary to maintain well-being, to maintain health. That's a bigger issue that I would argue is a moral issue, not an ethical issue. And this is basically what I just said. So we are, Carol and I, as part of this journey that we are on continue to be on, but really as part of putting this together, looking at what else do we need to do if we're going to reclaim the word cure as the care of souls, if we're gonna reclaim that, what do we have to do to make sure that that happens for our patients? And it has to happen upstream, but I'm gonna now turn it over to Carol. Well, I think the other thing that we're doing is trying to have us all kind of look at this language that we use a little bit more in depth and a little bit more broadly. Because if you go back to some of these slides, the connecting cure with the healing of a disease wasn't the original meaning of the word. It happened in English speaking countries as they began to, in the 14th century, they began to connect those two things. So it was probably healthcare professionals. Well, it happened because in the 14th and 15th century, there were things that could be cured. But if you think back, there were a lot of things that just could be cured. The only thing you could offer was spiritual support, right? And then we get to a point where there are things that, quote, could be cured. And that's the word now morphs into something different. And it's not that the new meaning is not legitimate. It's just that we've lost to some degree the old. And my argument and Carol's argument is that we've got to now put them back together. Great. So this is our second case study. In, at Stroger Hospital, I should use county, shouldn't I? We should be consistent. I've been talking to the press a little bit more frequently than you, so I've retrained myself. We've had the privilege of working with a lot of young people. And I find these kids, mostly young boys, quite amazing. And I want to introduce you to two of them, Jonathan and David, who are cousins. Jonathan is outgoing, always looking for an invitation to perform. David is shy but thoughtful. The two of them are inseparable and share kind, sweet interdependence. They lived just a block away from each other and they were both shot in separate incidents near where they lived. When our team of outpatient trauma intervention specialists first met the boys, they were both struggling with the physical and emotional complications of their injuries because it was just, we encountered them just after they had been injured. Neither of them was in school, neither had a job. They were both often hungry and looking a little bit disheveled. David used copious amounts of marijuana to cope with his PTSD symptoms. And I mean copious amounts, smoking up to 13 times a day. Jonathan immersed himself in rap music, writing lyrics and looking for places to record and perform. But during the spring and summer, we were able to help both boys and begin to deal with their PTSD symptoms and find support with a group of boys and girls who understood their struggles. And they began to blossom. They both got summer jobs. We were able to convince, control, drag, then both back to school. During the summer, neither had been in school for more than a year. And when the first day of school hit, David was sober and they were ready to roll. About three weeks into school received a call that there had been a fire at Jonathan's house. Eight people were asleep in the house, including both Jonathan and David. The only way out of their second floor apartment was to jump from the bedroom window. Everyone was panicky and not thinking or seeing clearly because of the smoke and the fire. David jumped first to encourage and to help catch the others. Now Jonathan's family is homeless, living with friends and relatives. Their already tenuous financial situation had become dire. But the most difficult thing they had to deal with during that period of time was that Jonathan's little sister, Brianna, died in the fire. She did not make it to the window to jump to safety and no one was able to find her in the house. The boys felt guilty and responsible. They should have been able to get her out of the house. They both told us after Brianna's death that she was the one person in their family who told them how proud she was that they were going back to school. It made her happy to see them doing something good for themselves. The boys said very frequently we have to finish school. We have to make something of our lives. Brianna believed in us. And while they have found strength in remembering Brianna in this way, both Jonathan and David remain in a very dangerous place, both physically and emotionally. They were shot. They lived in the same neighborhood where they were shot and worry every day about their safety and the safety of their families and friends. They went to sleep in the one place they felt safe and woke up to a house on fire. And the only person who really believed in them, a little girl, died. In the year or so since the events that I described, several other things have happened to these young men, now young men. Both of them have become serious artists blowing glass in our project fire program that I know Brad spoke to you about a couple of weeks ago. Both of them are peer leaders in our program. They help facilitate support groups and their trainers for the Healing Herp People program and our trauma-informed care training programs that maybe some of you guys have participated here at UFC. A couple of not so good things have happened. David was shot in an incident in which his uncle was murdered and died in their home. They were shot on the front porch of their house. Jonathan, while he's remained not unreinjured, well, that's an inelegant way to say that, but while he hasn't been injured again, he's had a couple of close calls with the police. He was arrested because he was sitting outside the home of a white woman who called 911 because she didn't know who that was sitting in the car outside of her house. And then on a second occasion a few weeks later he was roused out of the car by the police because he was again sitting in his car and was in a neighborhood where he didn't belong. Trauma teams care for people with physical injuries who've been knocked about and very often treated unjustly. We talk a lot about injury in our profession and talk about it in terms of often in terms of the physical harm or damage that's done to someone. But the other origin of this word, if you look at kind of the more archaic uses of it is that this is a wrong or an injustice or something that has done harm to someone which isn't necessarily related to a physical injury. And the word for hurt comes from an old French word, herder or to knock. So I wanna, it did evolve into a metaphor for wound and harm but I think what we wanna talk about for a little bit with you guys is that the young people that we serve primarily in our unit are young people as I said before who have been knocked about and treated unjustly. So I wanna talk a little bit about the broader context of our work. Trauma is a disease of young men primarily. 50% of the deaths among men of, young men of all diseases, I mean of all ages are due to unintentional injuries. You guys probably know these things. You may or may not know that the leading cause of death of young black men in the same age range is homicide. And you can see where homicide shows up even under as the second and third leading causes of death in younger black males. And then suicide and then heart disease. I mean kind of a twisted sense of reality sometimes but I think about this.  So we'll talk a little bit about the context in which health outcomes for young people are way more challenging than we would like to see. We were here last, a couple of weeks ago, I was here last when Brad talked about adverse childhood experiences. This is another context in which we are working with our young people. Adverse childhood experiences look like this.  A lot of our young people deal with these adverse childhood experiences. 70% of our kids have had three or more of these adverse childhood experiences and 21% have had five or more. One of the things I think we may not have talked about a couple of weeks ago is the impact of race and institutional racism in this country and the legacy of slavery. So there are a group of people working on these things who talk about racing aces that a lot of our kids have experienced the adverse childhood exposures that we talked about that I just talked about, but for many of them below, I mean, that's just the tip of the iceberg for a lot of our kids that just by being young and African-American in this country, you have, before you're even born, experienced trauma. Another thing that our kids deal with is a cycle of violence, past trauma. Within five years, 45% of our patients are re-injured just by being shot puts you at higher risk of being shot again and 20% are dead if this is without any intervention at all. The other thing that our kids deal with on a day-to-day basis, you heard that in the story embedded in the story of Jonathan and David, but these kids hear gunshots, they've been jumped, they've seen the stabbing, they've had family members who've been murdered. So this is the group of questions that we typically ask our kids to assess what their violence exposure has been. Anyone wanna venture a guess as to how many, on average, how many of these community violence exposures our kids have had? This is a list of 14, come on, some of that. 10, 12, it's not quite that bad. Seven, 0.7, almost eight. I mean, I don't know what happened to you when you were growing up, but those kinds of experiences were not part of my life. And I don't know if I would still be standing, if I would be standing here today at all. I'd like to think that I would be that hopeful and resilient and there'd been people in my life who would have picked me up and carried me through, but I don't know. And for those who have screened positive for PTSD among our patients, I mean, among our clients at County and Comer, eight, almost nine types of community violence. Prevalence of PTSD symptoms is very, very high. If you just take a look at this seven, almost eight percent of the general population you would expect to find, I just saw you. Hey, Carlos. Eight percent in the general population would screen positive for PTSD symptoms among our pediatric adolescent patients, almost 48%, so almost half of them screen positive. For those who had witnessed the homicide, 100% of them screen positive. And some data that I think Brad has been collecting would, the latest data that he reported, I think last week is that 65, upwards of 65% of our kids suffer from PTSD symptoms. Yeah. One of the things that gets lost as we're going through this is that you can get shot and you're not going to have 100% necessarily have screen positive for PTSD, but it can really get achieved. And that goes back to what we're talking about, right, the cure and the care. It's not that you didn't have the physical injury, it's that you've seen someone else. You had it happen. So your perspective now has to change about where is our moral responsibility. Why, thanks. Thank you. Thank you. Yeah. I think that was an awesome question. Whoa. A slide or so ago when you said that you were sharing with us that these children or young people had these various experiences, and you said, I'm going to paraphrase but that like you had not had that in your mind. I guess I, so as I think about the moral and ethics of that, I mean of the conversation, I go back to what relevance do you think you sharing making that comment has to the overall conversation about this? And I'm not saying yet one way or other. I guess I'm thinking that it made me think certain things but I want to be clear as to what your intention was because I feel like I wasn't sure and I couldn't keep going through the slides with you because I felt like that must have meant something because you said it, but I don't know what it means. Sure, what it meant for me when I said it is I don't know that I would have been able to be a healthy whole human being and still standing here today and being able to survive all of these types of exposure to violence. I don't know if I would have been able to cope with all of that. And so what I'm, for me, what I'm talking about when I, I guess the subtext that I didn't say is that these kids are incredibly strong, incredibly tough and incredibly resilient. They make connections with their families, with their friends that somehow sustain them through this.  And I think could be wrong, but that's why the same group you're looking at, flipping them 10, 15 years out and there's all this heart. Yeah, absolutely. Because what we know from Dr. Nelson's work at Rush, was that the same group of people have a really high rate of miscarriages and multiple miscarriages because of all of these systemic microstressers that the society continues to tell us these people are resilient. These people are not resilient. These people can, I mean, and I'm just, this is my opinion, but it appears that there is so much water that goes over that says these people are resilient, they do what you, you know, they can make these, and they can, yes, yes, yes, but I cannot leave that piece of the conversation without saying that there are extensive microstressers that are happening to these people, us people, whoever we are, that are real. Absolutely. These other, so I don't want you, I guess I'm challenging you not to celebrate that resilience, but to also acknowledge that in creating this strata of experiences for people that there is not just this violent downside, but there is this downside that they are carrying these generational stressors that are impacting us as a society, generation after generation after generation. Right, and that's what these slides were about. That, I mean, even just the list of adverse childhood experiences that in this study from several years ago, those stressors led to social, emotional, cognitive impairment, health risk behaviors, early death, and this even, it's even worse here. Maybe we didn't spend enough time here, but the history of slavery and structural racism, white supremacy, all of that. I mean, I was just, I keep having to look up this word allostatic load, but that's just the wear and tear on your body, right? Just from being born black in this country. It's interesting because what I'm hearing you challenge us on is actually the use of the word resilience, and that's good, because that's part of what we are trying to work through all the time is the meaning of the word, and what is it being used correctly? And I don't know. I think we want to, as you said, celebrate whatever is being used correctly, we want to, as you said, celebrate whatever it is that gets these kids far enough along that hopefully they get to Carol and to her team and Brad so that we can maybe change, interrupt that cycle. But you're actually right. If you read the original ACEs study, these were physical, you know, Kaiser Permanente population, right? And we saw that these types of exposures led them to physical problems, asthma, diabetes, heart problems. And then take this now where people have these additional exposures, and I would then challenge all of us, if resilience is not the correct word, what is the word that we want to use here? And maybe we want to use a different word. Well, I mean, I think resilience is not a bad word, but I think the problem with it is the whole idea that it normalizes what has happened in this population of people they can survive. And it's part of the social structure of the way that... So I think there is resilience, but it's undermined by the idea that this is the way it is. And that's the end of it. It's not, as you said earlier, it's not an ending, it's actually a process. And then what do we do with that? Well, that's part of the moral challenge then is going to be what is the resilience of the word that we use, is there a better word? And what do we do with that? It's a context, though. Well, and I think what we're talking about is in a different slide. I mean, part of the reason that we've been working on these hospital-based violence intervention programs is that you do something here while they're in the hospital. We make a connection. We offer some support, some intervention that's pretty intensive and as long-term as it's necessary. The young men I talked about before we've been working with, what, Brad, for three years. So they weren't resilient in and of... Well, they might have been resilient in and of themselves, but they're in a much different place than they might have been had they been left to their own devices and left to the continual exposure to trauma that their family has experienced. And maybe talking about... One of the things that struck me... I'm familiar with the case, but one of the things that really struck me at the time was that their first call was to Carol when this happened. Their first call was to get in touch with their electronic intervention specialists. And that was, to me, a building of... or capitalizing on whatever resilience they've been able to develop. Is it the right word? I don't know. But now I've got to think about that. Right. Well, and we... You here and then Brad... It's wonderful that you see the thing the way you see it. But suppose you were omnipotent person. You had everything in the tip of your finger that you could do. How would you cure this? Because we talk about cure. How do you cure it? So I'm going to defer that till the end because I think... She's going to defer that to me. It's like, oh, thank God. Thank God. But I think it's a good question. We got this question earlier today. Yeah. I'm going to change it a little bit. How do you operationalize what we're talking about? Right? That's the thing that we are asking you to do. And I do want to say that again because I do want to kind of try and put this together and say, here are some suggestions about things that I would say based on moral imperative, we must do. But they'll be my ideas and the challenge will be to have everybody start thinking about this. What are the... What goes to the first, second question? What is your moral imperative? If you were... If you have a look at the whole picture, how are you going to operationalize it? What's your moral imperative? So Brad... Brad. I think we have three questions. Yeah, one, two, three. Yeah. I didn't get your name, sorry. Just back to this resilience point which I think is really helpful for a particular reason. Yeah. It's very hard to communicate, especially to people who haven't had to deal with the things that our kids are dealing with, what they go through. But sometimes the result of that is the only thing that people see is the violence or the trauma. The same way, if we talk about the resilience and it erases the impact of what's been done to them by us, which is why we want to erase it, right? And then, we're really doing them a great disservice. So how do we go both ways at the same time, right? How do we talk about the resilience people who don't acknowledge and are not eliciting the rage, the grief, the pain, everything that they've had to overcome to make it to the point that they're at? So that was just my comment. I think we could spend far more time in this discussion than we would take any other time. I have a question here, and then... I'm just wondering, if the word republic in any healing were right here on a variety of treatment, resilience? Yeah. And I would, if it's a combination of the two, so capitalizing on whatever your inner resources are and then saying it is more imperative that there have to be extra resources. Well, if the definition of resilience is you use only your inner resources, none of us are, right? There's nothing that I have overcome and recovered from in my own life experience that I've done by myself. So if that's the definition, the working definition, then we absolutely need to excise that in our language altogether, because that really is not at all what happens. I'm going to throw up a suggestion about survivor. And I'm going to use the analogy of military combatants. When they're in a combat environment, they're surviving, and they develop tactics and habits that enhance their ability to survive an environment. And when they return, many times, they call themselves survivors of this environment. So if they're injured, they go back to the same environment and still out there on the streets trying to survive. And so I'll just throw it out. So they're not really survivors yet until they get out of that?  So I want to ask Dr. Siegler a question. We had sort of embedded conversation throughout the presentation, rather than stopping at five and then having a conversation. Is that okay to keep going that way? Yeah, and you guys have to tell us what it is. Okay. I know what time it is. We won't be here that long. So are most of you from Chicago? No? A lot of people. Okay, well this, in the blue and white areas are the city and the city limits. The dots represent homicides in the city. So what do you, and these two little, I mean the circles, yeah, the dots are homicides. The two red dots are roughly county and UCM. This was within a year. I think this was data from 2016. Commentary on the map as you're looking at it. What do you notice? About 11% of trauma, each one of them, equal homicide and suicide is equal, each 11% of all trauma. The only thing is that suicide is more serious because people shoot from close. So then, and they usually put it in their mouth or put it in their head, close or resistant, it's gone. So most of the suicide dies completely. But it's equally each 11% of trauma. All trauma. And for some trauma, but when you stratify for race and age, it's extremely more, yeah, it's very different. What else do you notice? A lot of dots. A lot of dots. Yeah, so what about here and here? Chicagoans, what are these neighborhoods? And what else do we know about those parts of the city? Yeah, primarily these are, our city is extremely segregated. These are mostly parts of the city where black and brown people live. It's also, you know, high rates of poverty, poor housing stock, food deserts. Some of the, I have taken some of our young men home after a group meeting and there's not a grocery store anywhere to be found within, you know, many, many, many blocks of where they live. There are few businesses, few jobs, the schools tend to be underfunded and underperforming even if they're Chicago public schools. All Chicago public schools are not the same. Transportation in and out of these parts of the city is difficult. And then of course, this community violence piece. So again, this is another just sort of visual way to think about the stressors that people live within this community. I didn't get to update this slide, but I was at a meeting over the weekend with a bunch of healthcare executives. You were at that meeting. Do you remember what they said about the life expectancy here in the loop? 85 years of age. So this is our hospital. It's just right out the Congress Expressway West. You get to about right here in the Garfield Park neighborhood. What's the life expectancy? Huh? No, what's the average life expectancy? How long? 69. There's a, so you go five miles west. Do the math. And to your point earlier, the stressors are there of all of these things. So, you know, if I had a magic wand, there'd be a lot of things. I kind of hate putting this slide up here, but you mentioned the military a little bit ago. One of the things I think we've been discovering with many of our young people is that they have for many years of their life been in situations where they've done things or been forced to do things that violate their moral code or their ethics. And they feel bad about it.  And that definition, they can no longer be regarded as decent human beings. Well, this is one of the areas that particularly for me as an Episcopal priest, I get really concerned about because that's, you know, that's a matter of who you are in the depths of your soul and your sense of who you are as a human being that has been damaged. Yeah, so I just said that.  But I don't know that we've significantly addressed their sense of injury and justice and the ways in which they've been knocked around in the world. Trauma people, are any of you guys in this? No, maybe not. We believe that with the right intervention at the right time we can save a life. And that's why we're doing this program in here at Comer and at County to try to intervene at some point to promote healing. And I'm going to kind of go through these quickly because I know Kim is going to talk a little bit more about it. But again, healing has been conflated, I think, in our minds with and not inappropriately with disease. But it also has talked that healing refers to restoring to wholeness or health or to an undamaged state. We are not going to restore ourselves to our undamaged states. It's an aspirational thing. But I think healing can happen for because I've seen it with our kids. I think we can hopefully restore some sense of wholeness, help these young people restore wholeness to try to ensure that they're not hurt more. And that takes, that's going to be a long term project. And then their restore sense of these are human beings as holy and whole individuals. And again, what do we do? So to be respectful of people's time, I'm not going to go through the third case. We're going to kind of go to the end because I know that people have lives. Do they want to get to? Yeah, that's fine. So let's turn the lights up again and see if we can sort of answer the question that you asked. So I'm going to skip ahead to go through all of this. This was something that was actually written in response to a set of incidents that happened about patients who came in who were obese and this idea that somehow they were at fault for what was happening to them and what was our responsibility. And the first responsibility was to care. And I would argue that the first responsibility was to care, to cure, to try to prevent or ameliorate injury, to heal. That all of those things were together. And the question is then how do we operationalize that? How do we, I'm not omnipotent, but what do I do? So my moral imperative that I'm going to share with you is that we have a set, we have a group of people who are systemically disadvantaged with regard to their health. And it is my moral imperative to change that and that I think it's not an ethical issue, it is a moral issue. So what does that look like for me right now? For a variety of reasons, one of which is sort of has to do with current politics. I have been in the face of more legislators in the past 12 months than I have been since I was 18 years old. That is part of my moral imperative and the thing that I'm talking to people about and I'm saying to them, here's my experience, use it. I can tell you from firsthand experience, this is what this looks like. My moral imperative when I talk to these people is we have got to look at mental health and treat it in the same way that we treat issues of defense, issues of national security. And that this has to be routine. This is not separate from what I do as a trauma surgeon. This is part of what I do as a trauma surgeon and it is your responsibility to make sure that I am able to do that. Now, ingrained in that moral imperative, we were talking about sort of what happens in a hospital or in an institution. Ingrained in that moral imperative is that you have to have a recognition that this isn't going to happen tomorrow. But I believe I'm morally responsible knowing what I know to make sure that it doesn't ever get dropped, that it is in somebody's face all the time. That's one moral imperative I have. Another moral imperative that I actually decided years ago and that I feel like I've had some success with is to make sure that everybody that I train has some part of my moral imperative. So in other words, everybody that I train since 1993 has been trained to look at things other than setting the fracture. So you get screened for child abuse, you get screened for domestic violence, you get screened for substance abuse. One thing that we only recently were doing is asking questions now about what are your community violence exposures and making sure that you get to those resources. That's another part of my moral imperative. It's not about ethics, it's not about the conduct of how I conduct myself as a physician. This is my moral imperative. Part of my moral imperative is to, and this I have not done well at all, is to force the conversation about societal racism. One of my mentors from DC, there's no such thing as race. You'll recognize, yes. Yeah, Dr. Callender. There's no such thing as race. But it's the term that is used and it's the only term that people are going to recognize. And we have to force that conversation, whether it be in regard to immigration or healthcare, which to me are linked. That I have not done. And that's something that, operationally, that's something that is my next part of the moral imperative for me. And I guess what I would say is the challenge that I would like to issue, and that I think Carol hopefully also would like to issue to all of you. I was your boss. So yeah, so yeah. She has no choice. But to actually ask yourself that question, with regard, we're all here because we're in healthcare. What's your moral imperative?  The treat is easy actually. The treat, we've got tons of textbooks that tell us how to do the treat. The care, the cure and the heal, I think are the hard parts. And we, that's our moral imperative. That's what I would like all of you to find to figure out for yourself what is the thing that you feel you have to do morally to get your patients healed. To do with resilience is the wrong word. To figure out what is that thing that we capitalize on that's intrinsic and then bring in the extrinsic factors in order to get people to heal. And that's going to be a different thing I think for every person. But it's a question that we both think you have to ask yourself. Because the moral injustice here, the injury here is that there is this group of people who have these exposures, who are systemically disadvantaged and systemically not healthy because we're just treating them. And we're not caring or curing or healing them. And let me turn this back over to you so you can. I'll just say one thing real quick. I'll stand close to you. Okay. So, I'm actually, I'm going to give this to you. This looks weird right? Yeah. That didn't mean to make it weird. But one of the things that I wanted to say about to follow up on what Kim was saying is that for me, inherent in the language that I use around healing and health and whole and holy is the belief that people do have, and we all have intrinsic within ourselves resources to do that. And we also, most of us have external factors that make that very difficult, if not sometimes impossible to do. And part of the conversation about cure and cure of souls, when I talk to my bishop about where I work, he asks me, where's your cure? My cure, my place where I do my work and care for people is the hospital. But that's the language that we use in my profession. And I would hope that part of what Kim and I hoped to get out of the day to day is just push us a little bit to think about the language that we use, how it's connected to our own values and belief systems and our own sense of who we are as moral human beings and let that drive what we do in healthcare settings where we work. And then this is sort of the second to last slide. This is really what we're challenging people to do. And as I said, it's going to be different. It's going to be different for each of you, which is good. That's how it should be. And we'll stop and we'll answer questions.


How's everybody doing welcome back to my channel today? I'm actually gonna be Opening up this box that ambition sent me the last machine They sent me was to really good quality shout out to ambition for sending me this this second machine And as you can see I am not really good at unboxing videos They sent me this machine probably like three weeks ago and because I was I was oh my nose because I was Sick, I wasn't able to use it and finally I sent him a message yesterday And I was like hey guys I'm ready to try your machine and record that video because I've been excited to to try out this new machine, so Feels like Christmas here we go. Their presentation is always Super good like super on point It makes me feel like it's fancy, you know like that oh Like this this kind of box here makes you want to take this machine everywhere That's I think that's my favorite part about the way their presentation, so they send me the ninja machine wireless tattoo machine and Oh look at that The way presentation is everything.  Oh See this is something that I really like about Ambition is that they send you an extra part in case your battery is not charged You can just you know pop it in and you connect it to a cable And I feel like that's something that I really like that you have the option to either use a battery or a cable and They send you a second battery that is That is freaking awesome this smaller battery is gonna last you five to six hours and This bigger one is gonna last nine to ten hours, which is a long time for a battery to last which I feel like that is Crazy, and I'm glad that there's a battery the last nine to ten hours It says here charging time. It takes about two hours to fully charge I'm gonna go ahead and put this to charge and I can't wait to put this to use because I mean It feels like a very solid machine and I'm gonna put the link to the in the description I'm where to buy this machine, and I'm also gonna add their Instagram here All right, let's start damn, but you never have no hair But you know I don't even have to shave you Here's my client Noah came all the way from Philly, and we're gonna be doing like a green reaper You're nervous. No, I'm a little excited for this right here. Oh, yeah This is where you have a ditch. You can't really see it. It's pull it down.  All right, so the idea that That he had was to Get the skull with the cloak, which is a new word I learned today cloak and We're gonna have the sternum in the bottom here of on the wrist So I was trying to customize last night, but I couldn't figure it out because this area kind of curves a little bit So there was no way I could customize a design Straight down. So what I'm gonna do is we're gonna free him today. Mmm. Yes, sir We're gonna free him. The only thing I stand so is the skull that I liked We had like really cool details contrast and everything. So I'm gonna place it and then the rest I'm gonna freehand it Yeah, I'm gonna have you kind of like twist your body real quick into like Let's see Just go at it. Don't even think about it Oh That looks dope that is perfect the ice-hack is landed right in the middle and then the cloak I like that word not even gonna work the cloak Let's do it. Let's go.  I ended up adding the cloak here on the top and then pretty much I'm gonna go based off my own knowledge as far as how to Execute the sternum here and then the cloak here. I really like how it's very wavy It's almost like neo traditional and then you got a realistic skull and then as I'm tattooing I'm gonna be making decisions. I like the placement. I like everything about it. So let's get to it Super crazy day I Ended up just doing the whole entire school because I was like I just got to get through it You know so throughout the whole entire video. I was trying to figure out what to go in-depth with and I couldn't figure it out I mean, I it's pretty much just texture solid black, but I realized that I've never done For or I guess I never explaining. I Never really explained with detail how I apply white So I think this is perfect.  I'm just gonna tattoo the whole thing and explain the white so a Lot of people apply white in different ways and different voltages different needles but what I found out that works for me is a is low voltage and sticking on my needle I try a Eight voltage nine voltage ten voltage and as soon as I touch the skin It just starts bleeding like crazy and I could never figure it out until I started using 5.0 and right now I'm gonna be using it with a seven round liner and So if I if I start on this area of the cheek right here I'm gonna go in super lightly And I can feel the needle just penetrating any kind of vibrates Where it lets me know that I'm that I'm packing in the the white super nice Now so you can see you see that super bright With because it is why you're gonna be able to see plasma a little bit of blood but It is not severe like if you apply white and it automatically starts bleeding like crazy I would say that you have the wrong hand speed with the wrong needle and the wrong voltage I'm gonna be doing it. I'm gonna be applying white like if I was applying texture There you go And as soon as I touch the skin it just goes right in because of my hand speed and all that Right in the middle here. I'm just gonna Go around just kind of see where it needs it not too much But in the spaces that have like blink or negative space That's where I'm gonna be applying the white to enhance it enhance it enhance it enhance it There you go I'm gonna do a bright line here to separate the the cloak with a cheek The cheekbone here Very bright so you know where it ends and where the cloak starts and just like you know have fun with the white It's kind of added where you feel like it needs it I really like when you add it like in between the here the the middle of the skull to make it look like it's It's moist Just kind of like step back and really see what you're doing and then you're gonna figure out where it's gonna Help you to make the tattoo look even better I'm not adding too much pressure because what I don't want is the skin to scar in any way because if it scars Then the ink is gonna turn a little yellowish But it also depends on People who spend a lot of time on the Sun if people spend a lot of time on the Sun you get a sunburn and Of course the white ink is gonna change with your skin So sometimes it's inevitable like for people who work in construction Definitely the white is gonna change But for some people they're blessed to be able to hold ink like crazy like white ink like crazy So just because some of you didn't have a great experience with white doesn't mean that other people is gonna be the same Sometimes it's just your skin There's no way that you can like Control that you know And that's how I would do white I'm gonna keep repeating the same process throughout the whole thing and finish up this tattoo and show you guys the results the final tattoo or the how would you say it the The final product Thank you guys for coming back and watching this brand new video. I really appreciate it had a letter Had a really fun day It was a really fun tattoo and as far as the machine that I used today. It was great Really good machine and I only charged it for about an hour I think I only charged her for almost an hour and he lasted me the whole entire session So that was that was amazing and a big shout out to ambition for sending me great quality machines I really appreciate that I'm not gonna talk for a very long time about this machine because all I'm gonna say is that They're great machines. They're affordable and you can tattoo very very comfortably with them So I'm gonna let you guys try it out if you guys are interested I'm gonna leave the link in the description and They're the Instagram as well. So you guys can get in contact with them Big announcement coming up so next week do not miss that video. I cannot wait to share this with you guys So see you guys next week and if you are tattoo artist I hope you learn something from this video and if you're a tattoo enthusiast, I hope you're going to attain Thank you guys for watching. I'll see you guys next week. Peace


Well for three years now Bagley Elementary School is practicing good habits with a unique initiative. Reporter Cheryl Moore tells us about their SOAR program for this week's Golden Apple. The SOAR is more than just a behavior plan in our building. SOAR is more than just kind of a passing model. SOAR is basically what we do here at this school. The kids at Bagley are flying high thanks to SOAR. It stands for Safe, Optimistic, Achiever, Respectful and Responsible. The acronym was born after a few medical professionals shared ideas with administration about socio-emotional learning. SOAR developed out of this behavior matrix and the trainings and it has just really grown and expanded and so we have been able to use the vision and the goals based on student input and so students take a survey we look at that survey and determine what areas of need and where we can expand on SOAR. These words were chosen because staff at Bagley felt they were the qualities students needed to be successful in school and the role world but it's not just the admin calling the shots. Fifth and sixth graders play a big role as well. You really have to think about ideas for the school like how our SOAR themes are and how I thought like how I kind of brainstormed the idea about the five B's. The kids have come up with some pretty creative ideas to keep everyone soaring. There's been anti-bullying campaigns and most recently a superhero campaign. Let's see how the B positive superhero helps. As a team we really we do skits and videos about how to be responsible, respectful. Now the acronym for SOAR is kind of hard to forget because it's posted all over the school but it still needs reinforcing and that's where the fifth graders come in. It's their job to make sure that their younger peers are always flying. Well we want to make them feel safe in the school and we want them to look up to us. We just talk to them like we're like they're older than them so basically hopefully they'll like to follow what we do. Soon the kids will have to come up with a new theme to make Bagley Elementary School a better place but one thing here is for sure if you can SOAR you can succeed. I like being there and teaching people how to be good because that makes me feel good about myself that makes me feel like I accomplished something. Reporting in Bagley with this week's school to Naples, Cheryl Moore, Lakeland News. The staff at Bagley frequently surveys the students to find out ways to improve the program. If you enjoyed this segment of Lakeland News please consider making a tax-deductible contribution to Lakeland PBS.


Good morning, good afternoon, good evening ladies and gentlemen. Greetings from IRC here in Kabul. My presentation will cover the Afghanistan context, the rationale, and I will jump straight into the key messages thereafter. Just a brief on the Afghanistan context. There have been several contextual factors over the last two years which have affected the protection situation and risk landscape in Afghanistan. These include political changes including the takeover by the de facto authorities in 2021, environmental factors including climate shocks and the earthquake in 2022, and social normative factors including the restrictions put in place by the de facto authorities curtailing the rights of women and girls and the involvement in social life and economic life. So the rationale here is driven by the fact that given that background we've observed that gender restrictions contributed to and exacerbated protection risks for women and other population groups including systematic discrimination. Therefore IRC and other protection monitoring partners through the Afghanistan protection cluster were able to prioritize five risks for protection monitoring which was in the case in the previous year. One of the key protection risks prioritized for protection monitoring and to be addressed collectively is on denial of resources, opportunities and services. For example the February 2023 protection analysis update showed that 36% of respondents mentioned that women and girls were denied access to services which was way higher in comparison to men and boys. We continue observing an increasing trend in this regard and this draws the need for an intersectional look and underscores the importance of desegregated analysis to understand who is affected by protection risks and how. As these will differ from women-headed households, women and girls with disabilities in rural areas, older women and marginalized minorities such as internally displaced persons. Also the restricted humanitarian space and ban on female humanitarians brings forth challenges of not only being able to reach populations facing systemic discrimination but also it influences whose voices and perspectives are included in the analysis needed to inform our response. These therefore leads me to the key messages and the first key message from our end is that is on realizing the localization of assistance communities should be empowered to conduct protection risk analysis, suggest program adaptations and monitor protection risks in partnership with local organizations. Following community consultations IRC made several program adaptations for example IRC's women protection and empowerment program was rebranded to family support program and women and girls safe spaces were rebranded to family support centers.  The second key message is that survival is an integral part of protection and an intersectional response is the way forward. We've observed that acute food insecurity requires immediate attention to discourage negative coping mechanisms and strategies leading to increased protection risks. We've observed changes in drivers to household shocks for example climate change that resulted to acute food insecurity and consequently survival related negative coping strategies such as accumulation of debt, selling of assets, street begging, migration outside Afghanistan and early child marriages. All these have heightened protection risks. Our last key message is that a well coordinated, integrated and multi sector planning and monitoring is fundamental towards a stronger protection response. Sector specific integration tools and referrals should be strengthened. These underscores the centrality of protection in the spots of IRC's integration strategy. IRC is collocating multiple services in the same communities to ensure that clients have access to complementary services and referrals between sectors to help address their needs. We've also observed that health and nutrition are a strategic entry point for protection while implementing women and girls programming through the family support centers where services such as food are delivered. I come to the end of my presentation. Thank you very much.