So, good morning, good afternoon, or good evening from where you are connecting with us in the world. And thank you very much for the colleagues that took the time to register and to actually attend this webinar. As some of you might already be familiar, we call this Knowledge Dissemination Dialogues on Webinars. It's a series of webinars co-organized by the AMR Working Group of FAO and the FAO Sustainable Livestock Technical Network, where we promote different colleagues work. And at the end, we call it dialogue because we like to be able to look at time for the discussion and potentially open new doors for collaborations between the speakers, FAO, the colleagues attending, etc, etc, etc. So, today we have the pleasure of having our colleague Peter Tambork, he's based in Denmark and he will be presenting some of the work that he has been doing in Denmark with a network called N of Art and the topic will be optimizing veterinary anti-virus use through development of treatment guidelines and clinical breakpoints. Just follow-up rules, please keep your microphone on mute. If needed, we name yourself with your organization and country, followed by your name, the name of the Zoom participant. Please note that the views presented are those of the speakers and not necessarily endorsed by FAO. Please refrain from advertising or services your company or any other commercial product or brand. And please post your questions in the chat. At the end we will read them out and if it's not possible to answer all of them during the webinar today, we'll follow up by email afterwards. A quick note that the meeting is being recorded and that the video and the PowerPoint presentations will be posted on the FAO YouTube channel and shared with the participants. So, with this said, I stop here. Thank you all and the floor is yours, Peter. Okay, thank you George. I will try to share my screen, hopefully it will work. Okay, can you see it? Yeah. Okay, yes. I have the title here, Optimizing Veterinary Antibiotic Use Through Development of Treatment, Guidelines and Clinical Breakpoints, as George said. And I'm very pleased to be here today to present some of the work that I and a lot of colleagues have been doing as part of the Innovate Network. I'm from the University of Copenhagen and Associate Professor in Veterinary Clinical Microbiology. So, what I will talk about will be first an introduction to Innovate to this network that George also mentioned. Because it's, you can say the frame for a lot of the work we have been doing on treatment guidelines and also to some extent the clinical breakpoints that I will talk about afterwards. And it will not just be the actual work on treatment guidelines and clinical breakpoints, but also some of the issues pertaining to that to development of how to do it and also some of the issues and some of the problems of doing it. And then of course afterwards, I'll be happy to take any questions you may have. So Innovate is an abbreviation and acronym for European Network for Optimization of Veterinary Antibiotic Treatment. It's a cost action network funded by cost, which is also known as the European cooperation in science and technology. So it's a EU funded networking. And what is funded is various networking activities including meetings, workshops, training schools, short term scientific missions where particularly young researchers can travel to other labs or other scientific environments to learn new methods and use and do something for Innovate. And then also funding for dissemination activities including publication feeds, webpage, press releases and so on. It's all about networking and no money for research, so that has to be attracted from other channels. Quite often it's existing research being done already in the different labs or different research environments that is being, you can say, put into a higher frame with this cost action network. Currently, we have more than 260 persons from 45 countries attending Innovate. And here you can see a map of the Innovate consortium. You can see most of Europe is covered. All the countries in green are what is known as cost countries, some of them are light green and known as near neighbor countries. A lot of different definitions that I will not go into too much detail about but you can see most of Europe is covered at the moment. People included are microbiologists, pharmacologists, veterinary practitioners, epidemiologists. We have some communication experts and so on. It's essentially no limits as to who can participate and both from academia and private organizations. We also have international partner countries not shown on this map but we have people represented from Australia and Canada, South Africa, Caribbean Island and United States. And it's an open network and a growing network. So it's possible to join the work. If, for example, any of you attending here today will be interested, you are more than welcome to either contact me or to go to the homepage innovate.eu to ask or to subscribe to a working group. So that was a bit about the frame for innovate but the aim of innovate is written here it is to optimize veterinary antimicrobial use with special emphasis on the development of animal and PC specific treatment guidelines and refinement of microbiological diagnostic procedures, combining this with diverse educational activities the action will contribute to build a larger critical mass experts in veterinary antimicrobial stewardship throughout Europe. So, a very long aim, as you can, can hear and see, but I tried to highlight the important parts here it's about development of treatment guidelines of practice guidelines for, and it's my global use. It's about diagnostic procedures, particularly development of clinical breakpoints but also multi tough criteria for bacterial identification, and then about education. And cost actions are known to. Well, if you have a cost action you need inclusiveness so it's a lot about including young researchers it's about geographical diversity, and it's about gender equality gender balance. So, so yeah, we have, especially the educational activities training schools and so on targeting the young scientists. So this is a per chart of the, the work being done by innovate the five working groups, and I'm not going to detail with with all the different squares you can see here. Just highlight some of them. See if I can get a pointer here. Working group one, we have, I will go in, I will mention in a moment as survey we have done on available treatment guidelines in Europe. And then I will mention some of the work we're doing and working group for to develop treatment guidelines, new treatment guidelines, and then I will end up with some of the work from working group three on development of clinical breakpoints. So let's start with antimicrobial treatment guidelines. So, as probably most of you are aware that quite a number of treatment guidelines available. A lot of international treatment guidelines, some of which you can see here books can be web pages it can be. Well, it could be anything leaflets it could be. Yeah, something you can only imagine what it could be. So some of the examples are shown here. And of course these are broadly available, and many of them are made by leading experts in the different fields. And they may be widely used. And because of that may also even establish consensus among beds about how to use and spot it for different purposes. I guess they're good, but there are also some limitations and probably the most important of which is that they don't take into consideration local factors. And some of these are listed here, it can be local resistance patterns, local availability of antibiotics, but also availability of diagnostic tools, local legislation. So different traditions and culture can also affect how these may be used or the effectiveness of these international treatment guidelines. So therefore in many ways, national treatment guidelines are preferable to the international ones. So here's an example of national treatment guideline how it was made using an example from, you can see my own backyard from from Denmark, where I was the editor for the treatment guideline for companion animals in Denmark. And this was some work that started back in 2010, where the Danish Veterinary Organization wanted a treatment guideline for companion animals, dogs and cats. And they gathered a lot of experts from Denmark on different fields or an expert on urinary tract infections, skin infections, and so on. Each of these experts had to write a chapter for their own expert field, and then they would need an external reviewer to assess that everything was fine. And then I as editor I tried to glue it all together and make it into what was in the first edition of the treatment guideline. I was inspired from the Swedish national guideline for companion animals at that time. That was because I was one of the few ones available back then. Then five years later, we wanted to make an update. So first we thought it would be a good idea to make a survey on how it had actually been used and if there was any impact on on this treatment guideline. And this survey was conducted amongst veterinary practitioners, and it showed that at least according to their response that there had been some impact that those who had actually used it and read it actually had a different practice towards use of antibiotics and in a good way, we would say. That was of course based on their responses, but we also could see from the Danish surveillance system, Dan map that you may know that the use of antibiotics that also changed in these five years that actually use of sephalosporins for companion animals had declined by two thirds in that time. So based on all that we made an update using more or less the same approach, almost the same authors told them to look at the available evidence see if there was something new, and an update the chapters and I think I also a new chapter was made apart from that. And you can see here this is a Chinese version you can see on the right here. And of course we didn't decide to make it in Chinese from the beginning we made it in Danish and then later we translated into Chinese, Polish, Slovene and English based on requests from from other veterinary organizations. And of course we are we are proud of this we are we're happy that it's being widely adapted but it's also, as I told you before it's not necessarily a good thing. Because Danish standards Danish drugs are not the same as necessarily the same as in other countries. Of course this may be better than nothing in some of the countries if no other guy exists but it's not ideal. And at the same time. This was even you can question the approach we used for making the guideline it was not. Well, it was our own approach. This was what we thought would work. And I think we have a good guideline but well it was not a standardized systematic approach. And this leads me to the next to the study here of innovate. This is a study by working group one, looking at the available guidelines in Europe for also for companion animals. Sorry, it's a lot about companion animals animals right now I promise there will be more on food animals later. But but this is a survey that was done and published last year. And this survey was to see what is, what are these, which guidelines exist what is how are they made what is the structure and what can be what can we learn from that. And here on the right. Maybe I should first acknowledge focus Alison you can see in the lower left he was from the UK Dr focus Alison was in charge of this study. We exploited the network of innovate, we had country representatives who checked in their home country if a national guideline existed and report it back. And then we, we, well, we tried to see what was out there in Europe and also contacting people from other countries not in innovative. So 40 countries were contacted, as you can see here. And then we had to omit some of them for not being sorry. First of all, I will say we got a response from seven 17 countries with some sort of guidelines. Afterwards we had to omit some of the available guidelines because various reasons are not eligible. Maybe they didn't provide specific recommendations for more overall general approach to antimicrobial stewardship. So, we ended up with 15 guidelines from 10 countries. And these were evaluated both in an objective and a subjective way. And here are some of the results some of the things were found from the evaluations on the objective results you can say it was shown that 11 of the 15 guidelines had suggested dosages. 14 had three suggested treatment durations 11 had potential adverse effects listed offense microbial use. And then we actually showed examples of when not to describe as microbes, because of course that's an important part of stewardship it is also to decide when it's not necessary. And then this table here you can actually see some of the examples of when and microwave should not be used at least some of the recommendations here, for example acute diarrhea and dogs. And one thing that all of them recommended not to use was another indication subclinical bacteria was something only approximately half of them recommended. And I can just mention, when it comes to treatment duration urinary tract infection in dogs recommendations was anything from three to 14 days for sporadic urinary tract infections infection.  And we could see that the newest guidelines with those with the shortest durations recommended just showing that over time recommendations actually change. So the authors raised some concerns based on this survey. First of all, relatively few countries in Europe have national guidelines. They were initiated were initiated by government mental initiatives that were all by other initiatives could be from veterinary organizations or something else but not from governments. There were large differences in structure and recommendations. Anything from leaflets to books were published. There was general failure to declare the evidence base and conflicts of interest. And then there was not enough follow up on implementation and effects of advanced microbial use. So it was concluded that the study provided a framework highlighting some of the fundamental stewardship principles that should be integral to future stewardship guidelines. And that a greater awareness of the need to use a structured approach to guideline development could improve the quality of such guidelines in the future. And this structured approach is actually what is central for working group for of innovative because working group for has the objectives you can see here. First of all to draft a standard for veterinary practice guidelines, and this has actually been done already and available on this link you can see here on how to make these guidelines. And remember here I call them practice guidelines, because it's not only about treatment is also about how to handle animals with infections in a broader context. And then provide high quality species and disease specific veterinary practice guidelines in a structured and transparent process and here, again a highlight, it should be a structured but also transparent way it should be made. And then promote these innovative guidelines international or local guidelines. This is work being done collaboration with different organizations we have the estimate study group for veterinary microbiology, the world small animal veterinary association and then also the international society for companion animal infectious diseases being involved. The organization of the work is shown here. In fact, you can see the spirit and yes, who is the chair of working group for coordinating all the work. And she is chair, you can say of seven drafting groups you can see below here. So the drafting groups are post weaning diarrhea, bovine mastitis, born respiratory disease, poultry coli bacillosis, surgical prophylaxis and hygiene, canine acute diarrhea and canine pyroderma. So, each of these groups I have to make some recommendations for for these different infections and so on. And they're not just let loose during their own thing they are under the control you can say of a methodology task force led by Dr. Lewis come. And this task force is made is established to ensure that it's done in the same way in a structured way. How did we select these topics. Well, they were based on the criteria you can see below amount and critical importance of antimicrobial used for treatment of the disease condition. Potential to impact animal and public health from antimicrobial use and then lack of similar European guidelines and I think you can all realize that for example, in cattle mastitis and respiratory infections are some of the most important infections requiring antimicrobial treatment. So the persons involved in each of these drafting groups were carefully selected by the leaders to have complementing expertise, both pharmacology and microbiology but also clinical clinicians were important, or are important. Had to fill out transparency declarations to make sure that it's all clear what what is their interest and what is their work. And then the group should include animal owners. So, not just scientists necessarily but also animal owners, for example, farmers, small animal owners and so on. I don't think any of the groups have them involved at this point, but they will have to be involved according to the process later when the guidelines are being evaluated. So this is the process. You can see here of the guideline development and sorry it's a little bit blurry but but I will just guide you through what we're doing. First of all, initially, the groups had to all the seven groups had to make foreground questions on management and interventions of infection. So, to raise all the questions of what do we want to achieve. What do we want to, where do we want to make an intervention and so on. The questions raised then had to be reviewed and first they prepared a protocol to be together with this methodology task force to make the right search strings and so on. And then, this is where we are now the groups are making reviews of the evidence pertaining to these questions. And finally, which will be by the end of this year and next year. This, these reviews will then be used in something called the great approach which is, you can see down below here grading of recommendations assessment development and evaluation. This is a systematic approach used previously for human treatment guidelines but now for the first time for veterinary guidelines, where the evidence for different recommendations are rated as good moderate or low direction of the recommendation, are we for or against this recommendation, and then the strengths of recommendation is also evaluated. And finally, after this great process the guidelines should be ready. And just to mention that it's okay that not everyone in a drafting group agrees but it will be transparent will be evident from the final recommendations if there is some disagreement in the groups. And finally just want to mention here that these reviews will be available, as I said, later this year or next year, and then the guidelines will follow in separate. I think articles, everything to be published in the veterinary journal. So, so look out when, when they arrive. Finally, we want to take these a little bit further because these are European, we call them treatment guidelines from European stakeholders. But we also want to make them national we want to help countries to adapt these general recommendations and make them international treatment guidelines and of course it's a European initiative but it's something that could go beyond. So, so I would just say that this is something that hopefully can have an impact beyond Europe. Okay, and I can see time is running fast but I will hopefully not go too much over my 30 minutes, I will jump to the next point which is clinical breakpoints, which is the use of zone diameters used by diagnostic laboratories to cast grass susceptibility testing results as either susceptible intermediate or resistant. So whether or not you can treat an animal based on diagnostic tests treat with antibiotics. So the clinical breakpoint should be specific for animal species, infection science bacterial species and the dosage you intend to use. Just an example here, we have a breakpoint here it's for pastorella motocida from respiratory infections in cattle. It's morphinical and here the breakpoint is MIC below or equal to one milligram per liter means that an isolate pastorella is susceptible to this drug. So just highlighting we have the bacterial species infection animal drug and the dosage. So I think in the interest of time I think I will go quickly through this is better on how breakpoints are defined using the vet cast approach. I'm chair of that cast which is the you cast veterinary subcommittee for susceptibility and this is the approach used to make clinical breakpoints you need three cutoff values MIC cutoff values and essentially based on these you decide on the clinical breakpoint. And instead of explaining a whole lot about what these cutoff values are just mentioned that it's actually a lot of data needed to create them a lot of MIC data pharmacokinetic data for animal trials and and so on. So the internationally recognized clinical breakpoints existing. Well, it's not a lot. We have we have, I would say, in my view, what I know of, at least is the CLSI breakpoints that you can see here this is the latest edition as I recall the beta one s. And they also have other documents CLSI but they're not the breakpoints there are not as you can say validated as a once in this beta one s document. A bedcast is also working on clinical breakpoints currently you have one for floor clinical and we are working in progress to create other clinical breakpoints. So this table you can see here on the right. It shows the available clinical breakpoints in veterinary medicine for from CLSI. And you can see on the top row here can see the different animal species. And then you can see on the left you can see the different antibiotics for which breakpoints exist and then you can see in the actual table, which target pathogens and which infections these breakpoints are directed at. I think it's pretty clear that there are some gaps. So, some of all the empty fields means that there is no breakpoint for this animal species, for example, for cat and cifridoxin it's empty meaning no clinical breakpoint. And in some cases it makes sense. Because some of the drugs are specific for more or less only used in some animals, for example, go down to some of these to less from icing for example it's not used for companion animals. So it makes sense we don't have breakpoints for for those, but instead for production animals, food animals, but in other cases, well we need the breakpoints so what do we do when we have a situation where breakpoint is missing. And we just use another breakpoint, or what. And this is not super easy answer question to answer, I will just mention that it can create problems and I have an example here illustrating this. So here you can see part of this CLSI breakpoint table you can see on the top here we have breakpoint table for pastoral and we'll talk to that in cattle. And below here, we have a table for actinobacillus bleodemonia in in pigs. And the table here, the tables are both actually show breakpoints for to less from icing against respiratory infections, both for cattle and for pigs. But at the same time they also show different breakpoints. So here, you can see the breakpoints for this diffusion, what corresponds to susceptible intermediate or resistant is not the same as you see in in pigs so cattle and pigs are different. So this means that, for example, if you have a zone diameter of 12 millimeter when you test susceptibility to to less from icing. Pastoral and will talk to that would be resistant. If it's from cattle but if it's an actinobacillus bleodemonia it would be susceptible. In other words, you can say this is fine. I mean now we have the breakpoint so why care about this but just imagine if we didn't have the breakpoint for for example cattle. There would be a risk. If we just use to the pick breakpoint that we would have it false susceptible and we would treat with an antibiotic when it was not possible. It's a situation that you risk when you use breakpoints from other animal species or other infections. So what to do when you lack a clinical breakpoint. Well, what you saw is actually one of the possibilities to use a clinical breakpoint for another animal species, but also it could be for another bacterial species in the same animal. The infection site for humans could be an egg off. It could also be for another dosage or though that's not really recommended because these breakpoints are highly specific for certain dosage. Actually the best thing would be to report no interpretation. If you lack a specific clinical breakpoint. We're not really interested in that it's diagnostic labs we want to report a result. And I just want to highlight here again CLSI has made a document called the bed online, giving some general recommendations and suggestions on what to do when a breakpoint is lacking. So this is at least one way to go where you can see what would be recommended in a specific situation, but even that document has no real solution so we need to develop new clinical breakpoints. And one of my last slides is just to highlight that that cast is working towards new clinical breakpoints of course CLSI is also continually doing that but I'm not from CLSI so I cannot mention too much about what they are actually doing or planning but the cast is prioritizing clinical breakpoints in different ways. Of course we're looking at the data gaps, where do we have the gaps in the table. What is highly needed, what would be have a big impact if we made a breakpoint here. So we need to be realistic and look at what do we have data for funding for because it's expensive to make breakpoints and that cast is not funded in any way, except for donations or whatever we can attract, but it's not. It doesn't have a basic funding for anything. So we have to look at data being available already, or we have to design new research. Of course we also have to consider what we have the expertise for, because it's not always that easy to make clinical breakpoints for animals, because we have to consider other things. We have to consider flock treatment, which is of course not a thing in human medicine, and so on. There are a few things that are different in veterinary medicine. And we produce data, pharmacokinetic data from animal trials, MIC data, and then we model data, PKPD modeling, and then we make the PKPD breakpoints, and then decide on the clinical breakpoints in the end. And this work is done in collaboration again with Enovat, this time the working group three. And you can say there's a lot of overlap between bedcast and this working group, some of the same people being involved. But Enovat has a capability to also fund training schools. So we have Enovat has made a training school, this is what you can see here, a picture from part of last year, where we had just over 20 people attending a training school in basic PKPD. So one of the quite important topics to make breakpoints, for example. Working groups three of Enovat has also made a survey to ask what breakpoints would actually be needed or wanted by end users. So clinicians or microbiologists from diagnostic labs and so on. And I will just end up with the results here, because this is not yet published but this is what came out of this survey. Because one thing is what a little steering committee wants in terms of breakpoints. Another thing is what the wider community would like for breakpoints. And here you can see results for cattle and pigs. So for cattle. First of all, there was a demand for breakpoints for respiratory tract infections and mastitis and for pigs, mainly for gastrointestinal infection and respiratory infections. And here you can see the two figures here, you can see what drugs, which drugs the responders would like breakpoints for. You can see, both for pigs, but also for cattle, the two most wanted drugs are sulfur, trimethoprim combinations and penicillin. This is actually, well, it's understandable, because sulfur TMP is something for which there are no veterinary breakpoints at all. So whenever you test for sulfur TMP susceptibility using veterinary isolate, it would be a human breakpoint. So yes, I understand why it's in demand, but it's also complex, because it's a combination and there's a synergy between the two drugs. So it's not very easy to make a breakpoint for this combination. But it's, at least we have noted, hopefully we'll publish it and maybe we'll have the time and the funding to use or to work on such breakpoints. Also for gastrointestinal infections in pigs, it's interesting because there are no breakpoints for gastrointestinal infections. It can actually be considered topical treatment almost because you take a pill, you ingest powder, whatever. And then it ends up directly where the pathogens are. And actually, this is not a typical, you can say, way normally is for systemic use of antibiotics when we make clinical breakpoints. So this is also something new that we need to have a look at if we can make breakpoints for gastrointestinal infections. Okay, and that cast is of course the European initiative under the under you cast. But again, I would like to emphasize here that is not a closed group European group is something anyone can contribute to probably a lot of you know already that you cast is also expanding worldwide and that cast I don't see any reason why that cast cannot do so also. So if anyone is interested, we're always open for people interested in collaborating, providing data. Helping with modeling of data, providing input, expert input or questions on some certain topic, but also for teaching, we can, of course, consider people from outside Europe. And of course, when our breakpoints become available, they can be used anywhere as long as the protocol and guidelines of that cast are followed. And I think that's it from me and I apologize for going a little bit over time. But yeah, I'll be happy to take any questions. Thank you very much, Peter. It was excellent. And you made it. I think many colleagues both clinicians and working on regulatory aspects, for example, could relate with many of the aspects that that you raised. You opened some interesting doors for collaborations in the future. So thank you very much for that. We have several questions about minutes for questions. We'll try to address most of them. And if not, as we said in the beginning, the materials will be shared on the field channels and we'll follow up by email on the questions that we cannot address in the webinar. One of the first questions that came in was if you could please clarify the relationship between if there's any between NOVAT and the clinical laboratory standards institute, the CLSI. If NOVAT is affiliated with CLSI. No, it's not. So you can say NOVAT is about... Well, we have the working group three working on clinical breakpoints, as I mentioned, and you can say actually originally NOVAT was the idea came from bedcast that we wanted to make a cost action. And then it was just broadened into something with treatment guidelines and so on. So it's based on an initiative from bedcast. But it doesn't, of course, exclude CLSI. So I mean, bedcasts in general, but also NOVAT is interested in collaborating with CLSI. And we have contacts. I have contact with Mike Papich and other people from CLSI. We regularly interact. But of course, they do their work and we do our work, but every now and then we exchange views and so on. Okay, thank you very much. Then we have a question that many clinicians face in the field. If there's any guideline about when you should switch to a second or antibiotic, meaning you are thinking, for example, a respiratory tract infection, you tried the first antibiotic of your choice and then it didn't work. So the colleague was wondering if you came across guidelines on when should I switch or should I try something else? Yeah, that's a good question. And actually, I sometimes wonder myself because we have in Denmark a treatment guideline for horses where we have the first, second and third choice. And sometimes I wonder when did you ever select the third choice? But I would say, first of all, I am not aware of the specific guideline because they can be made in many different ways. But in general, I would say a second choice would be if you have tried before treating an animal with the first choice and you have, you've seen it didn't respond and you want to treat it empirically again. I think then you can argue, okay, maybe I should use a second choice because the first choice didn't work. You can also say if it's an animal that it's from, I mean, it has an unknown treatment background. You can also say, okay, well, we know it's been treated many times it failed. So maybe we should go a little bit higher this time. But it could also be a seriously ill animal. It could be an animal that where you cannot, a failure is not an option, a highly valuable animal maybe. And then it would be worthwhile to go with the second or third choice, which would usually be more broad spectrum or more critically important. I don't think there's a clear definition, but actually it's maybe some one of the things that should be more clear from from the guidelines actually when you can go for that. I think this is an important point. All right. Thank you very much. That's there's some questions that several colleagues asked if the CLSI guidelines are available for public download my impression is that they aren't. But can you please clarify if the colleagues that are interested in downloading them. The last question that you presented, are they publicly available or not. Well they are. I think they're not. It's not easy to find them but actually you can go to the CLSI homepage and then you can. I'm not sure you can download them as such as a PDF, but you can actually go page by page and see the recommendation which is a little bit tedious. But I think that should be possible. But I would recommend that you contact the CLSI to to get that information but but certainly actually after that cast started some years back. This was actually a criticism of CLSI that was only available for purchase and then since then, to my understanding it has been available. Access and public availability. A couple of questions on alternatives if you if you have come across if there are guidelines for any alternatives to antimicrobials in the treatment of animal species so guidelines for alternatives to antimicrobials if you have any experience on this or availability on them. Well, I'm not sure I have a guideline specifically on alternatives. At least I'm not aware of that. But I think definitely guidelines like I mentioned before that they should. As I wrote, as I mentioned before that 15 out of 15 guidelines had examples of when not use antibiotic treatment, and they should, of course, also mention what could be done instead. And I know for Danish guideline for companion animals, for example, acute diarrhea. I think we've listed six or seven other alternative options on what to do when you face an animal with this problem. We don't just say, don't, don't treat with antibiotics and then find information elsewhere. So I hope that most other guidelines to the same, but I'm not aware and I'm not aware of any specific guidelines for completely alternative treatment. All right, great. There are several places which is wonderful to see many colleagues are interested in further collaboration, and also engaging in teaching and research. So you mentioned that the colleagues can join via the website that you mentioned and we will share the presentation. And at the end, we will also share the contact information if colleagues want to follow up. So that's, that's very good to see the purpose of one of the purpose of this webinar. I have a question from a colleague that is mentioning that they are monitoring the prevalence of resistant commensal E. coli from dairy cow feces through microbroth dilution method. Can they use the forecast clinical breakpoint. Well, that would be then for for human infections and actually, well, you can use whatever break point you want. I mean, you can say, you can argue here that if it's a commensal, it's not for, I mean, you're not talking clinical treatment anyway. It doesn't matter so much if it's a veterinary human breakpoint. I think the most important thing is that you're whenever you publish something that you're very transparent about the breakpoints you use and mention why did you use these and not those. And then for surveillance in many cases the, it costs the epidemiological cutouts would be a good choice, because it shows the distinguish between wild type and non wild type and I think that, at least for surveillance purposes would be a good choice and that's you can say universal that's not between veterinarian human. One is sometimes confusion on this and I think that you can help all of us clarify in this point. What is the relationship between the clinical breakpoint and the antimicrobial susceptibility testing. So there are two words that use a lot and we hear a lot. If you could clarify what does it mean or how they are related determining the clinical breakpoint and when we speak about antimicrobial susceptibility testing. I'm not sure I understand the question. Can you repeat it or I mean the relationship between clinical breakpoint and susceptibility testing. Yeah, that is the question. I will try to answer but but I mean you do susceptibility testing you get an MIC you get at this diffusion zone diameter, and that you need to interpret. Of course you can say one is lower than, than 18 and then something. But what does it mean. So you need some of these limits to define whether it's susceptible or resistant or intermediate meaning that you could probably increase the dosage and have an So that's the sort of, yeah, borders of when it's on how you can interpret your results but but it's a good question and it's something. I think a lot of people, I mean, I know personally vets who do their own, for example, this diffusion in their own practice and then they look at the zone diameter of the plate. Okay, there's a large zone diameter, okay, it's susceptible and a small zone diameter or no inhibition zone, then it's resistant. And, and this is something I mean that you can say it makes sense intuitively, the more inhibition, the more efficient the antibiotic is, but it's just not good enough you need, because it doesn't correlate to necessarily what happens in the animal. So you need some breakpoints and also the needs. I mean it could depend on the strengths of the disk you use on the disk diffusion. So you really need to use some breakpoints when you want to use it for guiding treatment. Okay. So this is, you come across these different guidelines, and a click is asking, okay, so that has these different possibilities, and which standard to use when performing antimicrobial resistance surveillance the your cast and or the CLSI and why. So that that might be a question that comes up. Like, we know the options, which ones to use and why. Yeah, I think again it depends on the scope of the surveillance. I think if it's, when we talk surveillance of indicator bacteria again it could be you can use it. And then depending on the logical cut offs and then I think those that you can find publicly available often you cast but they inferior they should be universal they shouldn't be different between organizations. But when it comes to clinical breakpoints, I would say, I mean, the only validated clinical breakpoints are those from CLSI when we talk about animal infectious agents about animal bacteria. So, I would say then use those whenever they are available. But then the problem is if you have, let's say you have a Nikolai from whatever pig thesis, for example, from from infections from diarrhea and pigs and you want to make a table of resistance. So let's just face that we made something similar. Just a few days ago for the Danish surveillance at Denmark report we have 150 clinical E. coli from pigs diarrhea. And then we want to publish resistance data, and it's not easy because you don't have a breakpoint for. First of all, as I said, we don't have any insertic breakpoints. And then we have to use other breakpoints from veterinary side, but sometimes we don't even have a veterinary breakpoint. If it's from a, you know, some drugs are only for human use. Then we have to use a human clinical breakpoint or any cough. And it's actually, I don't have a universal idea of what is the best approach, except to write what breakpoints you actually used. And especially if you want to compare data to previous years like we are doing, then you have to calculate it in the same way or if you want to compare between studies, be very careful, because often when you compare between studies breakpoints are different. So it's a lot of potential risks of over under interpreting data. Yeah, I know it's another is not very clear answer, but it's also very complex area. Since we have a global audience. The question is, are the guidelines that you have been mentioning location independent, that is, in the same guidelines be applied in any week and this is particularly relevant. So I think you mentioned this in your presentation, but could you please clarify this if there's guidelines in one region can or should they be applied in another region of the world. I think if it when it comes to the innovative guidelines that we are making now. I mean, they are, they, we call them European guidelines because it's a European initiative and most of the people working on it are European but they don't look for European literature. I mean they look for literature at the reviews right now across the world. And they also have experts from outside Europe. So these guidelines when they become available for these specific infections infections post weaning diary and pigs and cattle respirator infections and so on. Then they can be applied anywhere and be, you can say, adapted into national guidelines and the principles of those can be taken and used to make national guidelines. So, but, but of course if a certain drug is recommended and it's not available in your country. Well, then you would need to, of course, adapt it and maybe consult with those who made the guidelines and ask if it's not clear what could be another option for treatment here. Great. Thank you, Peter. A question on some some these two words sometimes get mixed and if you could please clarify the difference between a clinical breakpoint and they cough the epidemiological cutoff. And when do we exactly should use each one of them. I think this is a question about that many colleagues have so if you could please use this time to clarify that. Okay. Yeah, so I make off is is. Well, maybe I should, I actually omitted a slide on this because I thought it was a bit too complex maybe I should have included it as a backup slide but anyway, and it covers is defining the upper end of the wild type population so population of bacteria without a quiet resistance. So the highest MIC you have amongst the wild type without this acquired resistance, these phenotypically detectable phenotypic resistant that's the a cough. So it's very, you can say, well, it's not based on anything related to how the drug is absorbed and how it reaches a certain infection site and, and so on. So that's, you can use it for surveillance you can say well it's resistant or not resistant it's a quiet resistance or not. But a clinical breakpoint is something that's supposed to guide treatment of infections. So therefore you need to know I mean one thing is that it's, let's say it's susceptible according to an a cough. Okay, so if it's susceptible according to a neck of it's a wild type organism. But, but let's say if it's not absorbed from the God, and you want to treat it as respiratory infection. Then it doesn't matter if it's a set susceptible according to the a cough, then you cannot use it anyway, so it's resistant according to the clinical breakpoint, because it takes into account the absorption the distribution elimination and all sorts of other things that are not taken into account by any cough and this is also why the clinical breakpoints have to be specific for animals and so on because different animals have different rates of absorption and other pharmacokinetic traits. Thank you Peter and we are very thankful for all the questions that the colleagues posted that reflects the interest on these topics. And we will not unfortunately be able to address all of them policies in advance for that but we can follow up by email and Peter is available we are available to make the further connections. The last question before we close up is on the, you mentioned that one of the conclusions if I understood correctly was on the leg that there is these guidelines but then there's a still a lack on the follow up on the actual implementation of the guidelines and even more than that the actual impact on the different antimicrobial use. So the question would be, is there any planned work on to cover these these gaps that the implementation gap of some of the guidelines that you came across. And if they actually are reflected on the different antimicrobial use in meeting quantity or the different classes used if there's any planned work on these aspects. So I guess it's about the end of that guidelines of implementation of those. Yeah. I'm afraid we are running out of time when it comes to innovate also, because we have until the end of next year. So we have still one and a half year almost to complete the reviews ongoing and the guidelines. The plan is in the objectives is also to try and implement the guidelines in countries that don't have guidelines so, so we will help with that is a bit diffusely described in the application in the memorandum of understanding. So that's certainly the plan. So, so hopefully next year and actually we have a possibility to extend the action half a year so maybe with a bit of luck we have two years left. Hopefully we can, we can once the guidelines are ready try and help to move them a bit forward because one thing is to have a European and innovate guideline but it I mean you want we really want to implement them we want to have to make them work. I mean, it's not just a publication to us it's also something we want to be used. Yeah, so it's to. So it's not any concrete not any specific plans, but certainly something that we will end to do probably I would say in a year's time from now we'll start considering that because hopefully by then, most of these treatment guidelines should be available. So thank you for your presentation and for the fruitful discussion and all the collaborations that all the clarification I think it was very useful to some common understanding of terminology of the concepts and and the work that you congratulations to all the network colleagues that they've been working hard and as you said, this is a network so you have all have to put your own time to come up with these answers and find funding for the work that you do. I think we as a technical community can be thankful for the work that you are doing so thank you for participation on this. And just before we close up sharing what's coming up for next to this webinar the knowledge determination dialogue are organized always in the second Thursday of the month. And so the next one is 11 August, and it will be on antifungal resistance in agriculture by the colleague Lawrence could reach based on the anniversary of wealth in Canada so at the same time the lunchtime in the central European and August 12 also the second Thursday and many colleagues expressed interest in following up on different topics so you can always reach us via this email.com or will slash iPhone resistance at fio.org to if you have speakers or any other suggestion will be happy to take them on board. So thank you all, and we'll follow up in the field.


Network PFNN headline news update Good afternoon folks Steve Rhodes coming to you live from sunny delray beach, Florida. This is your 1pm update. Currently, we've got a little bit of a mixed bag out here. You've got the Dow up 255. S&P is up six points and NASDAQ 100 down 56. Spot polytonics is off a buck 11 trading out a 3108 that's below. It's 50 day exponential moving average that's bullish for the S&P 500. Gold's off a buck. Silver down 24 cents. Lights recruit is up 17 penny. So let's go take a look at some screens out here. Let me get the screen here going. Let's start by taking a look at the S&P 500 and see what it is we know. We'll focus during this a couple minutes here on the S&P and the NDX 100. So what took place yesterday inside the S&P? Well on the cash contract as we're looking at right now, it generated a roads momentum indicator top. It also generated a wave number seven. That's letter G out there as well as a TD nine count. So you got three. You got a triple. You got a triple crown out here inside the S&P 500 meaning a topping pattern. Now it's very possible that the countertrend rally is over. If we were going to pick a countertrend rally point, we would choose Stevie's green line that's priced at 3176 about the high of today's session. So an absolute sell signal because we got three different patterns out here. All that were confirmed yesterday and continue to be confirmed here with a with as long as price closed below Stevie's green line. If it doesn't, then price is just going to be trading in between support and resistance. That green line could become support right now. It is resistance. If we go take a look at the ES mini, the reason why first Stevie's green line on the daily basis would be a logical place for a countertrend rally to end. If we take a look at the 30 minute time frame chart here for the ES mini, this really helps us to draw that conclusion at least as of 1.02 in the afternoon. Why is that? Well, first of all, if you take a look at the high that formed out here, road's momentum indicator top. Now this is not a 30 minute time frame. So the patterns work on all charts, all instruments, all time frames. Take a look at this morning's bottom. This morning, we were going to go short in the newsletter this morning. And, but then all of a sudden there was a push down into the nine o'clock time frame that triggered the road's momentum indicator signal. And my message was no, no, no, no, no, no, we don't do that. Why? Because we should see some type of bouncer rally. And that's exactly what took place inside the ES mini at 10 o'clock. But look where price ran into resistance. The top of its European opening range, 3164. That's why in the S&P 500, the countertrend rally may be done. Hey, stay tuned, folks. We couldn't get to everything. Stay tuned for the one o'clock show of the trader's edge. If you're off to start your twos, they have a terrific one. We look forward to seeing you soon. Take care.


First question on this episode of question from subs came from my god Derek flocks. He said a engraving My name is Derek been watching channel for some time now First time I found you was back in Madden 16 era when you still doing madden content since then always kept up with team Keep it clean. I appreciate that Derek that madden yet Madden's will got everything started We had a lot of fun in Madden But of course, um, we still play Madden but just don't record it cuz I just fell out of love with recording it That's when it when it became like a chore. I was like, oh, no, this I'm recording this no more But yeah, so everything worked out in the long run, obviously, but I appreciate you for um sticking around. That's a lot of Madden 16 Oh, no, no, he said actually madden 15 era the one with Richard Sherman on the front. Oh, wow You okay? I appreciate you, man And he said also I was thinking maybe do's keep Mitchell Wasn't used much in the Browns game because we have to see the bingles on Thursday And we don't want them to have much film on them. We all know he's bound to break out So the less film they have to study on them the better So could that be the reason the Baltimore Ravens were hiding out Keith Mitchell in that second half of the game I have heard that before and I've heard some people say that too like oh, yeah, maybe they were just holding them out because we got the bingles but Both of them are division games Maybe it was the Ravens sort of overlooking the Browns That's one thing I could think of possibly maybe they were like, you know what Browns we whooped them already Yeah, they got the Sean Watson back, but we whooped them. Oh, we went up 17 3 on them Oh, we went up 24 9 we was up by the we was about 14 points. We got that keep it just chill Yep, you don't need to do nothing keeping Mitchell. You don't need to do nothing else wrong They lost So you need to bring out whoever you don't need to be keeping those secrets from nobody in this game coming up Against the bingles next question came from my guy Harry who was also a team keeping clean patron He said hey, what's good engraving and the team keeping clean family. Hope everyone is doing well and everyone is staying blessed I haven't really said anything this year because I've been content with the team for the most part My question for today is when do you fire Harbaugh? He has been the weak link for this team and has been for years He's bad at clock management. He doesn't call plays the situational awareness is atrocious, etc Just like up in New England. They are realizing it was more of Brady than Bella check We as Ravens fans need to realize it was more of Ed Ray Joe and Anquan then we give them credit for We have one of the most talented teams in football every year And I would love to see what we could do or we could be if we also had one of the most talented coaches I don't think really I need to say anything further. We all watch the games this season and seen why we lost the games Why didn't we run Mitchell more? Why use the clock? Why did we let up instead of applying pressure? So he's asking the question why or when Would or should the Ravens fire John Harbaugh? Now y'all know already John Harbaugh is probably one of the safest coaches in the league And there have been times when I felt like yeah that the my Ravens should have moved on Definitely points last year the year before last times too in previous years before that sometimes as well But we know that John Harbaugh is safe He is extremely safe The only way John Harbaugh is not the Ravens head coach is if he decides to hang it up if he decides to walk out on his Own terms. I just do not foresee any scenario What so ever like nothing? I don't see any scenario at all where the Baltimore Ravens fired John Harbaugh I just don't I don't and I know we heard the rumors about yeah everything going on up there in New England And he obviously his name holds more weight than John Harbaugh Bella checks does With all them soup bowls that they got him what not and they don't talk old. They could mutually part ways at the end of the year and Remember back in um, I think was 2018 when that report came out about John Harbaugh with the Ravens that they could mutually part way Remember that but anyway, um He's safe John Harbaugh ain't going nowhere unless John Harbaugh decides to go somewhere now this season I'm not like right now. I know a lot of people are but I'm not like oh, yeah Let's let's fire John.  How about right here right now now? Depending on how the season goes Then it could be a conversation But yeah, the losses have been atrocious stuff that's happened to the Baltimore Ravens gotta give credit to the other teams too but the losses have The self-inflicted wounds have been big I know it's been lack of preparation and some of them games that like you mentioned of the poor clock management of time management and whatnot But I'm not with I'm not on the old fireball right now. No, not after three losses. No now We we have been seeing patterns. We haven't seen some patterns at the Baltimore Ravens actually have been been patterns for years So what I hope the Baltimore Ravens can do and I know a lot of people gonna be like Oh, well, if you that's what you hope for just look at the past couple years Look what that look what happened but what I hope is that the Baltimore Ravens they can all learn from their mistakes and they can improve things moving forward Especially come postseason time. The offense is a big issue. Next question coming from my guy the legit goal He said ain't gravy with nothing but peace and happiness for you in the Baltimore community after that stressful game Appreciate that. He said defense play good in the first half But we can't expect the defense to be on the field for almost 40 minutes and expecting to continue to keep up with the Browns high-powered offense when you have weapons like a Mari Cooper and Jocu and Kareem Hunt plus the Shawn Watson you have to account for theirs only so much that the defense can do That's fair the playcaller wasn't great in this game If it wasn't for the pick six and a turnover by Pro Shate and our red zone the score would have been 16 to 33 Browns winning. Why didn't we continue to run Mitchell? Why are we using Gus on first and 10 knowing he's our goal line running back? See now with that part I disagree with that part. Are you use Gus Gus could run it on any down So yeah, I disagree with that part anyway continuing. He said why didn't well. Yeah, why didn't we continue to run with you? Knowing and he said why didn't we run on Gus with first and 10?  He's capable of doing that But these last two games have shown that Mitchell only needs one touch to make a big play Ronnie Stanley has been very underwhelming ranked almost at the bottom of the league in his position this year Something needs to be done. His injury issue is hurting the offensive line This is not 2001 or 2013 where you can rely on just the defense to win games At least not in today's football if the offense doesn't figure this out Especially with the turnover situations We're having don't expect us to get past the chiefs which has a way better offense than the Browns in a top five Defense in the league right now hope we come back next week against the Bengals because if not We will drop from first to third or fourth in our division which will put us in a hole especially with our remaining schedule Said a lot right here Now with the offense and yeah, you just again he was talking about how the offense is a big issue my opinion The offensive line is a huge issue when the offensive line crumbles That's when you see Ravens offense fall apart especially more specifically they're passing offense when offensive line crumbles because we've seen it like You give Lamar time. That's it. He did tell you apart, but teams like We willing to send everything we willing to risk it just so we don't give Lamar Jackson time now There are also times when Lamar Jackson When he doesn't have time and he still makes stuff happen, but that's a little bit harder But when you give him time this game over but teams been like We don't try to take that away especially the Browns now Lamar Jackson did have time on the first interception that he threw I know a lot of people saying that maybe he's since he got rocked Like I think it was the play before or maybe a couple plays before where he got rocked on a sideline Hit maybe they said he was feeling a little woozy or something like that because again that thought our shot Bateman like what was that? Well, that was terrible. That was Terrible all kinds of terrible So I don't know what that was but I think everything starts up front in the offensive line Ravens they lost the battle against the Browns and the trenches on offense and defense because on offense couldn't block for nothing on Defense they couldn't stop the run for nothing especially right right up the gut So the trenches got to get figured out now again They're seven and three so they obviously got stuff figured out for the most part So it could be a little deeper than the trenches like my guy Harry was talking about but The Ravens like they in a good position I'm glad we can have these conversations to where we were obviously frustrated at some stuff that the Baltimore Ravens do Frustrated in the type of games that they lose frustrated with the way that they lose But the fact that they're seven and three and we can have these conversations instead of them being three and seven And that's talking about this that says a lot So they have a chance to turn it around they got an opportunity to really get this thing right Thursday night that will be a perfect start over reaction or justified next question came from my guy Aaron He said a engraving until you keep it clean Hope all is well after Sunday's tough loss at Cleveland Browns the Ravens have received criticism much of it is warranted you right? But after watching Shannon shops comments on his shows nightcap and first take about the Ravens Specifically when it comes to Lamar Jackson Do you think his take is valid criticism and something to be concerned about or is it just another weekly overreaction by Shannon sharp on his Former team appreciate all that you do and hope you and family. I have blessed coming up. Appreciate that man Thank you Aaron now Shannon shot. I think he talked about that He said he can't trust Lamar Jackson now after that game He brought up all the Lamar Jackson's turnovers where they have been a lot of them With some are definitely his fault. Some couldn't do anything about it, but they're there They are the numbers. They are again, you got to have context though But they are what the numbers are but I'm he thought about how he can't trust Lamar Jackson if All it takes is one day and I know trust is one of the easiest things to lose is one of the toughest things to build up But just last week Shannon shop. Oh, yeah Lamar Jackson these Ravens. Oh, yeah, they're one of the best teams in NFL more Jackson playing like an MVP And after this one game Where they lost on the last second field goal He say can't trust him So with Lamar Jackson one thing that reader brought up the NFL check she made a really good point She talked about how with Shannon sharp He knows the game he knows the business of media and that he knows that Anything he says about Lamar Jackson is gonna get a lot of people riled up It's gonna get a lot of people upset and it's gonna have all eyes on whatever he's saying because it's Lamar Jackson And whether the Shannon shop used to be a Raven or not like I don't really think that has much to do with it Because he's he's in the media. He's in the media So that's his job to talk about whatever's going on with whatever player But with Lamar Jackson his name is very polarizing So I think Shannon sharp just taking advantage of that. So I um, I Don't like Lamar Jackson have an amazing game against the Bengals and then you'll see Shannon shop turn right back around Oh, man. Oh, yeah, that's Lamar Jackson that I know that that that's him. That's him That's the one Steven a so it'll go right back to the same thing So I mean you can't take it too serious and last question on this episode came from my guy flirting the whiskey He said what's good bro? Hope all is well per usual I hope all is well with you and your promotion that you got I hope that that nice office that you said you got you said are sitting pretty in there chilling put your feet up On the desk and whatnot drinking some nice orange juice in the morning or maybe some teal coffee if you do that I don't drink coffee though, but I hope everything going good with you my guy anyway He said now I know what you're thinking like man. He's about to come on here and trash me Donald for sitting in that young cover to and losing that last game You know what's funny while I was watching that game toward and I saw them sitting in that zone and I said, oh, oh, yeah That's yeah, I thought about you, but anyway, he said no, I would never do that I've been saying the same thing the last two seasons and no need to speak on it anymore Or the Steelers lost when you have a quarter cornerback one-on-one fresh off an injury one-on-one With nothing over the top with the game on the line when the only thing they could do was throw a nine route enough about him though Pettiness right there, but anyway, he said but I know this sounds crazy But I do believe that Lamar let the media get to him our line has never been good Let's be honest But all the years whenever he was see a lane if he doesn't see a good anticipated throw to make he would take off He stopped that he just pats the ball Lamar let the media accomplish their mission and as you can see That's all they talk about because that's all they can say, but I don't know if I said this before But what do you think? Okay? Before that that first part that's an interesting way to look at it The way that I looked at it is that yeah Yeah, I've said something similar Years past because I remember it was the Texans game and I want to say 2020 Yeah, that was the COVID year with the empty stadium But I remember Lamar he dropped back had the ball had a lane right in front of him wasn't taking that had it It was right there. He would have got a nice chunk of yards, but he didn't take it I saw it back then I'm like, what's like what's going on? Why is he not take so it seems as if yeah, his game has changed over the years But this year it's been different because he's been doing a lot a lot of that same stuff But I just think the way that I looked at it was that he was just preserving himself for the long haul preserving himself for the Rest of the season and whatnot and just hold him back But that could be something too that that could really be something too because we've seen that happen before We've seen that happen before like literally I think I don't remember in his rookie year We saw it happen We've seen it other times too We and we know that Lamar Jackson and and that's one thing about Lamar Jackson He lets it be known a lot of times that he does listen to what the media is saying now recently He hasn't really been letting it be known, but we remember times before he may make a comment or something Oh, not bad for running back right when he did all that like so he sees all that stuff I mean, it's hard for him not to see he go on social media for two seconds He's gonna be tagged in like a million different things But I know I didn't think about that like maybe little more Jackson letting the media get to him And that's why he's not running as much Good to like to play to play prove it ball to play prove it ball to the media and be like oh See, I don't need to take off like that So I know my guy Mike. He was saying it during the game last week against the Browns He like man Lamar like he has that ability use it use it That's what makes him extra special just use it so short show people So we'll see we'll see I think that's we'll keep watching as the season goes along I mean, we already got ten games of evidence to see that. Yeah, he doesn't just take off As much as he used to so I guess we'll see how things go moving forward, but that's a really good observation Something else he said, I don't know if I send this before but why do you think they didn't trade? You know no stone or Justin Madabique. He said I know he said I know I know why would you trade them? I was thinking they were gonna trade at least one when we all know they're both gone But at least one man Stanley gave me PTSD Why do you think they didn't send one of them off and just like Lamar was when he got flipped I'm out Let me just give that to get back to that trade question It would have been a bad move if they were to trade it either one of them It would have been a terrible move reason being because Madabique that's your sack leader. So you you would trade you would trade their sack leader and their interception leader Like this that the sack leader in their interception leader you get rid of them. No, man No, no, no, no, no, no, no, and I don't even think it's a given that even both of them are gone somebody asked a question last week and I actually picked both of them two to stay and Patrick Queen to unfortunately be the odd man. I would I would love to keep Patrick Queen. I would love for him to stay But I picked those two that I think the Ravens could get it something worked out with them Now hey, hopefully I can get something done with all three but Honestly wouldn't be surprised if they only got something done with one of them because it's a tough business man It's a really tough business and these guys they trying to make their money They ain't trying to take no discount like that and I do not blame them whatsoever But yeah, you don't you wouldn't it would it would be foolish for the Ravens to have traded one of them Especially as safety position Marcus Williams has been injured still is injured and if they would have traded Geno stone And then the only safety that you got is an injured Marcus Williams Well, not the only safety, but you know I'm saying that that he would it would just be on him No, that would have been a bad decision They were mad at BK It's like a lot of times you could struggle to get pressure when you don't blitz But you got somebody that can bring that interior pressure that has been a closer when it's been when it's come to sex And just a matter of being and you would get rid of you can't do none of that So I'm glad that Geno stone and Madda BK are not like the end of these videos and out


Okay, thanks so much for agreeing to interview with me for my research. I really appreciate it So I guess I'll just jump right into it my research is is about the relationship between digital governance and democracy Because like throughout the world obviously we're seeing like a huge recession of democracy Including in Europe in the United States But Taiwan seems to be the exception to this like Taiwan's democracy is only Getting stronger in a lot of the democracy reporting data shows this So I guess my first question is what role do you think that taiwan's digital policies play in this and how significant? Do you think they were in driving this trend? I think universal broadband access and universal healthcare universal digital competence and media competence in basic education These are the main motivators for inclusive digital democracy And I think we think about democracy as a form of social technology So it's not a fixed like three bits uploaded every person every four year thing But rather is a continuous thing where everybody can participate. It's everyone's business with everyone's help So I think it's not two things like internet democracy, but rather it's intertwined Exactly. So what aspects do you think of taiwan's like e-democracy and e-government solutions like? Radical transparency or these participation tools that you guys have put together What do you think are the greatest advantages of this of this approach that taiwan has? Yeah, it's now so prevalent that I don't think about the e-dash anymore, right? We would just say let's mail each other. We don't say e-dash mail anymore because that's kind of the default We will say paper-based mail if it's paper-based mail And so similarly we now just say the national petition website or the participation website Instead of the e petition website or the e participation website And that shows that it really is inclusive that's people of all the different age groups Especially the people younger than 18 and the people around like 60 70 years old They find a lot more to contribute in a day to day fashion to the everyday life Including as I mentioned through petitions, but also through participatory budgeting sandbox applications presidential hackathon Well, even just calling the toll free number 1922 to contribute to counterpandemic Effort and so on and all these shows that the government works now with the citizens not just for the citizens That is the main change Okay, so it's establishing this sort of like collaborative Ecosystem where citizens can communicate with the government. Okay. Um, so then what do you think what what kind of like policy ground work? Um, do you think is required before you start implementing these kinds of things these? Participation platforms and stuff. I mentioned universal broadband universal media competence universal digital competence And also healthcare since we're still during the pandemic. Uh, and and these are actually constitutionally protected in time Okay, interesting. Um, so that how How popular are you at these participation tools in taiwan right now and are you like do you have Any policies that are that you're going to get them to a wider I can't hear you anymore Shall we make another call? Center for computation and things like that. Uh, and I noticed that you just started recording, but it's fine I've got my local recording has been sent. Okay. Sorry And so, um, yeah, so so the point is that it's not directly Translatable to citizen engagement If you do not empower the public service to trust the citizens with those digital tools for pro-social communication Right. So, uh, what we're getting at with the participation office and network Among other things is to get a culture of starting a weekly survey right across source agenda setting As easy as you would starting a google farm Okay, exactly. So do you think that there's a little bit more? More work to be done here to get the Like the civil service and the bureaucrats and the government to really trust these tools a lot more Yeah, certainly. Um, so of course we use free software Polis is a gpl Sandstorm, I think is gpl or something. Uh, and so we make sure that they can actually Work to customize to their heart's content if they want to add new functionalities And also we make sure that the public service Work with professional penetration testers white hat hackers to make sure that there's no separate security issues when using these tools and so And so I think a healthy relationship with the civic tech community and the white hat hackers Community that is essential in getting people to trust these tools Okay, exactly. Um, so do you think that there's a possibilities for Countries in europe in north america to sort of replicate the success that taiwan has had in this if they Allocate for universal broadband health care and these kinds of things And definitely I mean polis is from seattle And participatory budgeting is inspired by among other things console and decedent From margaret and basalona. The petition website Is almost an exact adaptation of the better the kavik from island and many other things And so what we're doing is in some sense just making sure that the public service Trust this Method of listening at scale without getting tied to any particular form of technology So they may actually procure new technology when new technology is called for And so it's more of a culture change thing rather than a single piece of technology And so if a similar culture is being Deliberated in other parts of the world I'm sure that since this is free software Any place probably has their own self hosting capabilities and their own separate security auditing teams Exactly. Okay. So a lot of it has to do with The political will more social technology And and also the norm the the habits of policymaking because in the public service What's important is to reduce the risk, right? If you collect far more noise than signal, you're actually increasing the risk And also the another interest is to save time if you collect a lot more Controversy and polarization than workable feasible Shared good enough consensus that you actually waste everybody's time. So without Increasing anyone's risk or wasting anyone's time the public service is much More willing than to work on the mutual trust part, which is the part we want to get to right But you can't trust one to the other the three Axis of reducing risk and saving time and improving trust cannot be traded against each other Exactly. Okay. And this one, I guess is is it Not directly related with the participation but on Especially in the west on social media and online forums They've often become sort of the host of very toxic communities that engage maybe in hate speech traffic in Conspiracy theories and these kinds of things So how can a government in collaboration with citizens Work to reduce these anti-democratic influences while still maintaining the right of free speech I mean, I think there is a Room for the more antisocial or tension Oriented conflict oriented parts of social media. Just like there is a room for the non-live district very loud bars In the city, right? People go there for entertainment. I'm sure and Even though it's, you know, selling addictive drinks private bouncers very loud music You have to shout to get hurt. There is of course a population a a cultural Meet for have such places. What's not good is to try to hold town hall meetings as such places right and So what the government should do is to Fund and give substantial social sector control to the equivalent of public parks of public libraries National parks even for this sort of things, right? And this is what we call digital public infrastructure and is classified since 2016 As infrastructure, even though it's nothing concrete like not made out of concrete Still it provides the digital equivalent of the town hall like places for people to act in a pro-social manner for deliberative democracy But we're not banning or chasing down, you know, the antisocial corner of social media That's for entertainment that has its role in the society exactly, okay So then my next question is how do you find this balance between The the various actors that work to sort of moderate Um content online, especially like for example disinformation and these kinds of things How has taiwan sort of like built this balance of Civic society the private owners and the government to uh to effectively counter it Yeah, by creating a strong norm, uh, it's just like counter-spot, right? If sufficient amount of people flag things as fun then organizations such as one house has sufficient signals to contextualize each part of the email To kind of find the fingerprints that will then divert further emails from a spammer to people's junkman photo rather than inbox But this doesn't work if any single actor from this multi-state holder situation Suddenly says I want to be the intermediary and all your message have to pass through me that of course would not work In the email case. Uh, and so I think in taiwan We have a really vibrant ecosystem the leading anti-virus company trend micro for example offers the farm jar darin or the virus buster uh the scans for scams and um like um conspiracy theories also this information packages and so on because it's a journal purpose system for flagging and for a real-time contextualization And also in the private sector, there's the who's call, uh, which is a unsolicited caller it identification app And they also offer a maybe which is a similar service for even in into an encrypted channel They can scan incoming messages and contextualize it on the social sector There is zero with the covax community like a wikipedia like community for real-time fact checking and there's also For example, um, the town fact check center, which is by a professional journalist Providing the service so that's the Widely spread rumors can be actually investigated upon and again Providing the kind of mandatory what we call notice and public notice So on the private sector the companies such as facebook are strongly pressured by the social norm so that they have to Show the contextualizer Services whenever anything that is trending or goes viral And so what we found is that if we provide clarification and counter disinformation context Within a couple hours of each viral piece of disinformation then they tend to not to make too much Of a negative social impact is what we call humor over rumor The memes to make people kind of laugh as a contextualizer that also helps a lot Awesome. Okay. Um, so my second last question actually is um And feel free to speculate as wildly as you want on this one But how do you um, how do you foresee the relationship between citizens and the state changing as more digital technologies? like for example Cryptocurrency are adopted that are taking sort of the power away from the state Where they used to have a monopoly over, you know currencies and commerce these kinds of things And it's being sort of democratized in a in a new way I think democracy as a form of technology as I mentioned at very beginning is what I'm seeing And it's not in a far future. I mean, um, for example, the aetherian community Now that they're under a very strong social pressure to adopt a net zero climate impact transition, right and that is Like changing the the governance priorities for that particular crypto community They also Navigated a good coin experiment pretty well using new forms of funding called quadratic funding Which is then inspired by quadratic voting, which is a new voting system So democracy is a new form of technology. It's not some abstract thing Right, it's something that's being experimented in the crypto space as well and we take Though not yet Best but better practices or maybe we should call it next practices and then use it in our Government functions like the presidential hackathon their presidential cultural award both has been used in quadratic funding now Sorry, quadratic voting now And so I think a lot more kind of cross-pollination of the democracy as a technology Is now happening between the digital spaces and the more traditional state functions And so I think this is pretty good in the sense that this iteration makes people think of government As something that people can fork and also merge back And so I think this fork and merge relationship is what I have in mind when I think about future what I call people public private partnerships Okay, awesome That's actually all of my questions that I you answered them amazingly. It was great Okay, excellent, uh, and we should talk about the Recording usually I just uh posted on youtube under creative commas attribution if you're okay with that Yeah, that works perfectly for me action Okay, okay, and it will continue your audio, but not your video. It will continue just my video because it's a local recording Sure. Okay. Okay. Excellent. I'll just send you the links. Okay, perfect. Thanks a lot Okay, cheers. Bye. Live long and prosper. Thank you


Can you look at what you guys did against them last year and how you kind of got to Brady and shook him up early? Because I think once you did that, he just couldn't get back in the rhythm the rest of the game. Yeah, I would definitely say that would be, that would be the blueprint to try to beat Brady and really get into the middle of the pocket, get him off his spot, flushing him a little bit, give him the throw the ball away and not be able to get into a rhythm like we did two years ago in the playoffs. But you know, that's easier said than done. That's why a lot of times Brady don't lose twice in a row and stuff like that. So, but at the end of the day, I think that's watching that film. It's a good film to watch, to see that, hey, if we, if we get pressure in the middle of the pocket and we can kind of get him off his time and, you know, he's not going to be as dynamic as he's been for, for a very long time. D&P's just set out there. We need to be disciplined. We need to just keep things simple, not overthink. Right. How big is it in a game like this where you know that this offense can do anything, can have some tricks up their sleeve? Yeah, I mean, the details are going to be very important. I think one of the things we're going to have to do first is, first off, is stop the run. When you're in the playoffs, stopping the run is a really big stat and getting turnovers. I think we can hunt the ball. I think most of the games that you see they've lost this year, you know, Brady threw it through a pick or two. It was fun with a ball or whatever, whatever. But you know, getting turnovers up there in New England is going to be crucial to give our offense more possessions. And so, Derek Henry and all those guys can get in the rhythm. So, like I said, we're a confident group going into this game. But at the end of the day, it's all going to be about executing. As you guys have gone through the season and had some ups and downs, what maybe has stayed consistent about the makeup of this team? I think the confidence has stayed consistent. We definitely had our highs and lows, especially on defense this year. But at the end of the day, the dimensions has always been continuing to improve. Keep doing what we're doing, keep trusting in the process, keep trusting in the defense. And it's gotten to this point. But at the end of the day, man, we know for a fact we're going to have to take another step as far as playing defensively up there to get a win in Foxborough.


Arrogant season is back in in San Francisco. Look, this is this has been this team forever. This has been this team when nobody believed in them. No, this is fun. I like this. It's you know, is the camaraderie back? Sure. I mean, they stuff issues that aren't out.  So but look, this is what the Timberwolves are doing to teams. They're just making them feel great out there. The Warriors are fine. They're they're three games out of the one seat. It's crazy that sounds. They still have defensive issues, but they were always looking towards May and June. They were never worried about what's going on right now. So yeah, this is fun.