Well, what a perfect complement of a Q&A session to follow an excellent synoptic presentation and that brings us to something that's been mentioned multiple times and that is as seen through the lens of eMERGE, this major national initiative which looks like eMERGE raised to the next level and no better presenter than Steph DeVaney who is the heart and soul of all of us and its predecessor label, the Presidential Precision Medicine Initiative and we're very pleased to have her come and expand our context for the importance of the methods of eMERGE and the opportunities to accelerate this national program. Stephanie. Thanks again and nice to see you and so many familiar faces, I thought for sure Rex was going to scoop me when he started answering questions about all of us so grateful to solve stuff to talk about. So I have only 15 minutes, I'm going to blow through a large amount of content but hopefully more of this conversation can happen throughout the day. We do have, I will double down on Rex's comments about the infrastructure that's been built and the lessons that have been learned through eMERGE certainly did help set the path for all of us. So we're really grateful and there's a ton of overlap here in the room in both awardees, investigators, folks at NIH that we work with closely, members of our advisory panel, Maryland and even folks who helped us really build the blueprint for this large research endeavor that we're launching just now. So just as a reminder I'm not going to do too much overview of all of us because I think there's some familiarity in the room but our intention is to build a longitudinal resource with all different types of data on individuals that hopefully last for, hopefully last for many decades and we really are interested in making sure that we reach a diversity of people. So one of our major focuses is on reaching communities that have been underrepresented in biomedical research and maintaining them as participants over the long term. So engagement and retention really important to us and then also diversity of researchers. So building the data set that can be used and utilized by many different types of researchers, not a small challenge. So some of the areas I think where there are opportunities for convergence between the two programs and then some places I think where we'll learn a lot from a merge, you'll learn a lot from us and we can share and swap. I'm going to walk through each of these. So first of all just sort of the basic, we are building a very large data set. You guys have a very large data set. We will have EHR data and genomic data and ours in addition to other types. So this is a real opportunity to expand the data set for understanding many things, just a few of which are listed here, pharmacogenomic genotypes and drug response, actionable genes and variants, genomic medicine implementation studies and of course something that I care deeply about LC and policy research. I think there's a real opportunity here to use all of us and take some of the stuff that you guys have already learned in a merge and advance some of these really important ethical, legal, social issues research. So just a little bit about, while we're talking about data types, just a little bit about all of us, our core baseline of data that we're pulling together right now and the participants that have already joined and over the near term is asking everyone to go through a number of surveys. We have three surveys at the outset and we'll be deploying four more as over time so that participants are slowly answering more surveys digitally. We will be asking everyone to share access to their electronic health records. They'll be undergoing physical evaluation and we're collecting blood and urine samples to run genomics but as well as other assays. Ultimately we plan to incorporate mobile and wearable technologies and environmental data in addition to a number of other data types. We like to show this visual at the bottom to make the point clear that right now we're building version one of the platform but we really do intend to add data types over time as technologies evolve and as we understand with the science of the community needs or what types of research questions could be answered on a program and a sample set of this size and scale over time. So individuals can enroll either through a health care provider organization or as direct volunteers from any internet source. Here's a map of our health care provider organizations. A lot of overlap with the merge as you can see. I'm happy to answer any questions about this at any point. And of course right now what we're thinking about is how we're going to start to build out our genomic data set. We have an expert panel that has just finished their work and we'll be hearing their report over the next couple of days. Eric Green was very helpful in that process helping us to figure out what are the different options we could undertake as we think about ultimately doing whole genome sequencing on a million people but where do we start. So just a quick thing on our data access because this came up when Rex was talking and moving to a cloud based platform. So all of us research program is going to be our data set will be in the cloud from the start. We have we are developing we just just finalized our data access policy our framework for how researchers will access the data. We it's a researcher based access no data removal tiered access approval for developing a data passport model which I'll talk about. And we really are interested in broad access. So how can we make this platform usable by many different types of researchers. So essentially what happens is we will have all of the data in one place in a curated data repository researchers will ask for access from a board that are a committee that we have in internally to the consortium. And then once they get access as a researcher they can then launch a bunch of different studies. We'll be doing studies specific review. So a researcher can come in and launch three different workspaces or however many workspaces they want. They'll have to get really clear about what they're trying to do with that data so that we can post it publicly. We have to do that according to the Cures Act but also one of the things that we're really relying on to make sure that researchers abide by the code of conduct is transparency. And so the extent to which the public can see what researchers are doing with the data we think is is really important. There's just a real quick visual of our data tiers. We will have a public data set that will be aggregated data that will be open to anyone anywhere anytime no log in required this is a little bit like how the census does it. Then we'll have registered data set which is which is a little bit higher risk of identifying participants and will require a data use agreement identity verification ethics training and approval again researcher based not study based or question based and then control data is is going to include genomic data and some other higher risk data types again researcher based so once you have access you can sort of launch as many studies as you'd like to. So the next thing I want to talk about is innovative methods for integration of different types of health data for research. So as we move forward we're learning a tremendous amount from what you guys have already done with electronic health records. We also though need to collect EHR data on participants who come into the program from their smartphone or from their public library from a website and we don't necessarily know who their provider is and we don't have a direct relationship with their provider. And so we're going to have to get on the EHR front as well as other different other data types we're going to have to get pretty creative and build technologies in order to incorporate those data types. I think that this could ultimately be a place of interest between the two programs We have I'm going to talk a little bit about sync for science as well as data aggregators and different things that we're piloting to try and get EHR data in on our direct volunteer participants. But also we're interested in claims data. We have just been funded by the PCOR trust fund and a collaboration between NIH and CMS to deploy sync for science like technology on for claims data so that people who have Medicare Medicare beneficiary claims data can agree to donate that data to the all of us research program or really any research program that that will be available for the research community broadly. We're looking into getting data from pharmacy managers directly so that we can get a sense of what prescriptions are filled on participants genetic testing reports with the Office of the National Coordinator has started a project called sync for genes which will begin to help with genomic testing information and and there's there's many other different types that could be added to this list. We're starting to think about all different sources of data we'd like to bring in to the program. I think one of the big questions for us will be how are these data coming in? Are we are we relying on our primary consent and then and then pulling the data from the back end from these organizations or are we going to be entering more of our participant mediated situation where the patient says I want to share my data from shareships or I want to share my data from Medicare. And that's a really important we really like that model because it creates a it creates the situation where the participant gets to control their data and I think really puts pressure on some of these organizations to free up data that is that is the right of the person to access and share for research. So just real quick on sync for science and I'll take a moment here to give Dan this is a shout out for for I think pointing this term perhaps and and this is really important. We got really excited about this project because this is truly participant mediated EHR sharing and so both relies on a HIPAA right of access and also technology to get the right data and the right form of formatting to our system. So the way that's for science works is that our any of our participants who joined directly not through a health care provider organization that we're funding but directly from their couch can go into their their patient portal and say yes I want to donate my go through all the agreements and then say yes I want to donate my data to all this research program and that data will then come into the data and research center in the form and format that we would want it to come in and so that it can be added to our data set. We are partnering with four major vendors to to build the technology epic a clinical work center and all scripts have all contributed greatly to this and they will be deploying the technology at 14 pilot provider sites starting in the next month or two so we'll get a real test of how well this is working with the patient controlling the data flow. The another challenge we have that I'm sure Emerge has had to I'd love to hear more about this that the day and other large cohorts is engagement and retention. So we are because we're trying to reach so many people we're really thinking about both getting folks in the door but then how do we retain them and this might be it's a different scenario when we have folks coming in through a relationship with a provider and there's a real strong relationship between that provider and their patient base and it's very different when we have digital digital participants and we understand that falloff could be quite traumatic. So trying to think about you know how to engage people digitally I listed some some things here that we're doing we are we're really interested in participant feedback we have a lot of surveys usability testing that we're deploying all the time and we're trying to get in the frame of mind where we can get participant feedback and make changes to the program pretty rapidly. But we also are working with federally qualified health centers we're going to learn a lot about how to work with their populations. We have a new community engagement partners that are helping us to be sort of trusted intermediaries between a certain population in our program and hoping to build engagement and trust that way. But one of the things I wanted to talk about here with this group because I think it might be of interest is also deploying some digital engagement tools the different ways that we can use our digital platform to keep people interested in the program and sharing data with us as well. Some of the things that we've been thinking about and our team here at Vibrant I think PJ is here somewhere in the room has been helping us along with the Scripps team to think a lot about what different types of things we could deploy through our app that would both give the data the scientific community data and also keep people engaged in the program and give them something back for participating. So here's just a couple examples we'll continue to refine this over time interested in any thoughts from folks in the room here. And then and then finally speaking of returning things back and giving back to our program we have made a promise from the beginning of the of the build of the precision medicine initiative which is now still a thriving initiative but this one piece of it which is now called all of us about returning information and promising to our participants that we will both return information and even specific results raw data to participants. So this is a big task as you all know you've been doing this for a decade. We we imagine there will be areas where this will be pretty simple and really just requires building up the technologies you can see over here on the right. We will be ultimately giving people the survey data back and showing how they compare within the broader demographic and just a nice interface. We'll be giving individual access to their EHR data so they can see what actually we have on them what came from their EHR and what data we have claims data any other data that comes in that they share with us individual research results which I'll talk about in a second of course ongoing study updates aggregated results scientific findings all of the things that come out of the study will want to share back with our participants and then opportunities for them to be contacted for other research opportunities especially as we learn more over them on them over time and if you consider what what other studies they might be interested in so genetic results we had a workshop in March which many of you stuff I think you're losing your mic am I you maybe oh it's probably too far down have people who nailed to hear me yeah I wish I saw it was just the last minute or two thanks Sharon thanks Mike I had another slide in this so return of results you know for us we have so we have just begun thinking about how we're going to return results to participants for us we you know this is going to be quite the challenge and you guys have done a lot of work here I think we at this March and at this workshop in March we agreed that we should start with the ACMG 59 pharmacogenomics that it sounds like Emerge has done a lot of work here and we certainly will benefit from the clinical decision support and some of the patient resources that you have already developed we would love to you know start this journey with you and learn and share and share lessons learned across both of the consortia because I think this will be one of our greatest challenges and could be quite resource-heavy and then finally electronic phenotyping and Rex talked a ton about this I mean we have you know we have none of this we really are going to be able to take advantage of the well-validated and public phenotypes that Emerge has developed right off the get go and that's a huge running start for us and for the researchers who access the data and then integration of genomic findings into EHR for clinical research and care we are not anywhere near this point but really look forward to learning from you all on how to sort of complete the cycle from research back into care and then finally this is my last point I just wanted to expand upon my point earlier about how we intend to add data types over time we are really interested we set up the core data set based on the ACB working group report that helped with sort of the blueprint for our study and also what we think people might want to have on hand but we want to work with the scientific community to understand across all of the different domains what are the types of data that would have the most impact on as data set of the size and scale that would be common across many different research questions so that we can maximize the impact of the different data types we add to this large piece participant base over time and so we'll be holding a workshop in March to start to talk through some of those use cases and understand what's most beneficial and hope to include researchers and participants in that as well this just shows how we're breaking up the workshop to talk about all of the different all of the different scientific topics that we think this program is right to help understand and so then just briefly where we are we've enrolled I'm sure this number has gone up Josh could probably give us the latest numbers as of today but at least 4,600 participants have gone through the full protocol at about 60 sites we're going to continue to ramp up between now and winter we're in beta phase you can only join with a code that's invite only at this point we're going to be ramping up to over a hundred sites that will be enrolling participants and hopefully around 10 to 15,000 participants with the guests so that we can launch this spring and open up the doors believe that's it thank you Stephanie question microphone oh yeah so good question his question was why will we have any restrictions on data access when we open the doors so we we the data resource actually will not be available to researchers when we open the doors it's really just for just for participants to join we expect to have the researcher portal open sometime later in the year well we have did okay fair enough you want the substance so we when we do open the doors I imagine we'll want to do some sort of beta testing phase but once we have opened the doors to researchers broadly the access process will be the same for pretty much anyone we'll ask them to go through a code of conduct to validate who they are and then and then go through approval and that should really be the same process for everyone we are running into a little trouble because we're hoping to enter to integrate citizen scientists and that's trickier because at the controlled data level where we have some more of the high-risk data types we want to have an institutional backing and it's it's hard to uh that's that's a challenge we're working on is there a way that we can get institutional organizations to validate citizen scientists so that they can get access to some of the deeper data but we haven't figured that piece out yet but so not no no real no major restrictions unless josh join sorry I'm fine okay well I think she's first thank you um two questions one was I heard you in talking about the access is going to be researcher based as opposed to project base but also emphasize the transparency of the description so I like the researcher based because it can be a pain in the butt to go back and sort of do everything but at the same time there's the transparency so how are you gonna combine those things that if a reader comes up with another project that they have to make sure to report it or how does that work yeah and then a separate question is the sync for science is awesome and if it works yeah um and in theory if people can sync to your model then someone with cerner data could sync out for your model and then sync back to epic and is anyone looking at that as sort of a solution to interoperability I don't know if you um yeah I'm probably not the right person to answer that question although I think I I love how you're thinking um but on the first question um which was data uh transparency and access so we uh yeah so it's all uh researcher based when a researcher starts to opens up a new workstation just where sort of where they'll pull the data that they want to use to answer a specific question we'll ask them to get pretty clear about what they're trying to do um and we both we need to post that publicly uh and we want to and then we're relying on the panopticum which is a new word I've used and love using now I just learned this um to uh to help look across these different data uses and uh flag stuff if they think some researcher is acting outside of the code of conduct so because we're not doing a study by study review we're really losing that opportunity to look at some of the research questions and we don't want uh we want to be sure that there's uh there aren't a whole bunch of studies going on that either violate our code of conduct or which will also be public or uh you know get into some sort of stigmatizing uh area that could cause problems for some of our communities that we're hoping to be able to trust with so uh at that point if somebody flags something we will have our board uh be able to review those studies so which is why we're leaning so deeply on transparency sorry oh sorry um two quick things I think it's certainly right did you want to respond to that that was okay okay um each workspace can be attached to a bunch of people and so the descriptions in a workspace a computational you know place where data and analysis will happen um uh you know it can have many people attached to it and that has labels so anyone that works on a common project will be in that same place with the same descriptions of what the project is um and that's sort of the mediation and any group of projects uh any individual can be on a whole bunch of different projects with a whole bunch of different clusters of people so it's all driven by the workspace connection that's clear and yes we are thinking about inter EHR and intra sites and all that kind of stuff collaboration with science um it's it's based on smart on fire and sort of the growing fire descriptions and so so you know you could imagine that and it was always envisioned because i'm sure dan would would say as well as you know a 350 million plus you know experiment not just a 1 million you know or 10 million or whatever you know all of us in the team in the year is there anyone else yeah you're okay so um you know another thought the you know the literature would suggest the um decision support directed to the patient can be very effective actually effective in activating the patient to subsequently activate their their doctor so i wonder if the sync for science resource might allow a patient citizen patient if you will to suggest their data set or their assets be linked up to decision support services from both public and private sources blackford that wouldn't have anything to do with the PCORI uh patient facing cds the thing that you lead would an interesting idea thank you for that we we haven't thought that far but i appreciate that my question was sort of a follow-on to that uh in in the return of results activities i didn't hear anything about returning the results to physicians how our physicians out of this loop or we hope that they're not and uh you know these are some policies that we're going to be developing with the healthcare organizations that we're so closely linked to that are the help those in this program with us but we haven't fully defined that whole process so this is something that we're working on you know we certainly want to have all of that defined by the time we start running genomics at least because that's really going to be the first or individual level results that will be returning to people i i think i'm out of time dan's gonna maybe grab me at a break i'm at zero minute yeah so if you could ask your questions if if stefanie's going to be around for a little while you could ask questions directly


All right welcome everybody to what is our final session for our 39th annual conference sea change life worlds and ecological upheaval special thanks to everyone who's attended and participated to our planning team. Anna and Tom as part of our help desk have been absolutely amazing mark flanigan for helping bring this entire thing together Nicole Torres, our journals managing editor and every single participant attendee and presenter and including all our folks on the twitch stream. We've had an amazing transformative time here, and it wouldn't have been as special and as important and as relevant as it is without all of your help and participation. One of the great things about sat conferences is that we are an interdisciplinary organization that likes to explore consciousness from an anthropological lens but from a lot of different perspectives and our conferences, sometimes the most memorable aspects of them are the experientials are the things that aren't necessarily a bunch of academics and PhD sitting down to read papers that they've written although those have been fantastic over the past few days. But sometimes it's these events that spark our curiosity we've had more questions. Since this started what's the same property thing about what's going on who's this right and so the generation of that buzz and that curiosity and that mystery is part of what makes these conferences so exciting and so I'm happy to be in this event and I'm happy you're all here with us. So to begin I'm Andy Gervich, the president of the organization I probably should have said that sooner. I'd like to start with a quick land acknowledgement I'm speaking to you today from Portland, Oregon. This is called, which rests on traditional village sites of the Multnomah, the Kathlamet, the Clackamas, Chinook, the Tualatin Kalapua, the Malala and many others tribes and bands. As the original caretakers of this land I want to begin by acknowledging their presence their dignity their continued struggle for respect for restoration for reparation. I wouldn't be here today if they hadn't been here first I wouldn't be here able to speak to you from this space in this very building on this land, if they hadn't been displaced from it first and so we want to acknowledge that we want to use our organization to be a small part of the conversation to help create a restoration and reparation for that. And this panel like this presentation like the others is is a small part of that. Just a couple of quick announcements, and then we'll turn it over to Mark to introduce carry our guests. Please, for the sake of bandwidth, keep yourself muted, and for now at least keep your cameras off. And there might be a time later when we can open it up for a time of back and forth and sharing but for now, just for the sake of continuity and bandwidth if you could keep your cameras and your microphones off, but turn your chat window on the chat window already is filled with information about it's not really any upcoming sessions other than our anthropology of consciousness business meeting which will be the final event for the night which we hope many of you attend, but will not be as exciting as this. I'm giving you loads of information in there about the organization about the session links to things. And this will be where you will primarily be interacting with one another and with our speaker and so put your questions in there and put your comments in there. And we'll do our best to gather them, and then ask them at the end if you also the other thing you can do is just jot your questions down as you think of them and then post them in the chat box at the end. Last thing, and then we're on to our session, you have a live transcript button across the bottom of your page if you roll your name across the bottom of the page, you'll see almost to the third, second or third everyone might might look a little different from the far right you have this thing says live transcript. This is zooms AI captioning service it does a pretty good job if captioning is something that will be of service to you by all means enable that for yourself. It's only about 90% accurate. So some folks find it confusing. And if that's the case you don't need to engage it. Since we are in a zoom meeting. You do have access to your name as well. And so if you click on the participants button, which is there across the bottom or on the middle just next to the chat function. You'll see all the participants in the meeting and then if you would like to. You can change your name we'd like you to keep your name as close to or exact to the name you registered with. So we know who's in the room to keep it safe. But if you'd like to you can see some folks have already done it you can add your preferred pronouns as well you absolutely don't have to do this, but it helps keep the space more welcoming more inclusive more and we're happy to have you do that if you choose. So, okay, with that I want to hand things over to our program coordinator Dr Mark Flanagan to introduce the mysterious and elusive happy new hoppity. Thank you so much, Andy. And I just I want to make a clarification so not a doctor, but I do have many bastards degrees. So I'm certainly been in my fair share of classes but anyways, your doctor love. So I just wanted to also echo my love and acknowledgement for everyone that has helped create this conference near and far. So this was really a team event. And that includes all the participants as well thank you so much for dedicating your energy to making the space possible. And I wanted to make a land acknowledgement here behind me is one of my favorite spaces is in Savannah severely colonized and oppressed indigenous communities, as well as enslaved peoples who are brought here and form their own beautiful communities. The Gala Gichi and others in these areas. So I just say that in deep humble respect. And I also wanted to encourage everyone to just thank yourself and for participating and providing the space where I know that I found myself kind of in a work and kind of producing environment but it's also good to reflect and embody. So I, I think that's what this will be getting at, but we are all very excited to hear from our presenter Kerry Miller from John of Kennedy University. And she will be sharing a short story and poem and providing her personal connection to the story, followed by meditation and grounding. But I'll hand this over to you Kerry thank you so much for participating and take it away. Thank you that was so nice and warming from both of you, especially since we're online. I'm assuming everybody can hear me okay still. Yes, you sound good. Yes. Cool. Well, I just want to kind of first acknowledge all of those things. I'm here in Oakland, California on own property. And so yeah I want to be grateful for that. Give respect to that. A lot of displaced people currently definitely seeing gentrification happening in my neighborhood trying to be aware of my place in that. So much happening in the world right now, definitely lots of shifting. And so this is just kind of a poem I wrote when I was going through my own sort of shifting or awakening. And how that process happened for me, moving into embodiment. So yeah, I guess I'll read that and then I'll talk about it a little bit more of how that kind of came about. Yeah, I just I do I do want to connect the current events to the to the way that this poem came out for me of just, you know, awakening into a greater consciousness beyond just our minds and our conceptual interpretation of the world. So this is hippity hoppity amongst the trees and the bees over the hills and within the tills atop the peaks to anywhere I might seek. I wandered and often pondered, sometimes day, sometimes night in the black and through the white, walking and often talking with what may appear here and trying to take it there. But all seemed clear, holding everything so near. After all, it was so dear. When I came upon a ridge. I was unsure of how to bridge where I seem to be to a place far in front of me, scheming up a plan with thoughts and retro band, my brain quite in a twist. The only thing left was to fist, but suddenly spewed a mist, no time to think, all in such a blink. I was no longer walking, nor frolicking, nor trying or denying aware faded my despair, completely set free.  I fell apart of me could tell without thought, not being fought, let alone to be my legs knew what to do with me. With no end in sight. I gave up all spite and quietly fading into the white night. Yeah, so I just kind of like everybody to maybe we can try just just before I give an explanation. Just see how that lands with you. You know, the major points for me were like seeing really beautiful things and wanting to take them along with us. And feeling kind of lost and trying to understand and calculate with our mind, getting into a twist, and sort of being stuck. And my experience, which was like falling. So suffering. And in that falling came surrender, because there was nothing else I could do. And suddenly, my body knew what to do. And I found a greater sense of knowledge and consciousness and wisdom. So yeah, this was all in 2016 when I wrote this. And it was at the culmination of my college degree. And I was really suffering, you know, I had the job and the money and my degree. And I just felt unhappy and then that was like a process of yoga and I went to Costa Rica and sort of this, this process of healing through embodiment which within nature. You know, I think we're all we're all I don't know where everybody's from or what your understanding of things are what you study but I think a lot of us can see, however time we've become separated from the land from the earth. You know we cut down big trees all the time without thinking we clear lots before we build things. And to me that represents not only a disconnection from the earth which supplies us with what we need, but a disconnection from ourselves from our own body. So the earth body, our soul body or physical body, and then our soul body or cosmic body. And this sort of like relationship of all bodies within the universe. So what I found through this process was by giving up my need to understand within my mind, I could live in a way that was a wisdom through my body. Now that's a process it's a continuous process it's like a excavation, I think of anthropology and what is what is Ross, what is Ross on friends paleontology and digging up bones. That's what I feel like is happening within me right as we like, as we work on embodiment. So you know let's let's let's check in right now before we do the meditation so notice how you're how you're sitting. Notice how you feel are you comfortable. Do you feel your feet on the ground or on your bed or whatever you're sitting on. Can you hear my voice. Can you feel your stomach going in and out your chest rising and falling. Can you let go of needing to understand. And just be here, feeling like the many verses the universe the multiverse of your cells and your organs. And how that touches your skin and then suddenly you're outside your body but yet there's still a relationship to that. So, I wanted to do a meditation, but I was wondering if maybe we could try to have the cameras on for a little bit for people who feel comfortable with that. I wanted to maybe maybe talk a little more do a meditation but I was curious. If anybody wanted to share what their experience with embodiment has been like where you are now versus where you were before. Before could be whatever, you know, yesterday or a year ago or if you started yoga or like what is what has been a shift you've noticed or something about your story maybe just just a little snippet. So I'd like to share my story. So, for me, I'd always been where I've learned that school was a good thing, and I really appreciated school. It's got me a lot of things. I found myself relying on my mind a lot, and that got me into a lot of issues, mental health issues, relationship issues and other items to that. And it was really through an experience in college where I was brought back into my body from kind of some reckoning with some truths that about myself about my dedication to school, perhaps too much. And I, it was really like something broke apart in me for a bit. And it was only by coming back to my body, my experience in my body that I was able to reintegrate in a different way, and, and understand the world in a different way. And in a large way led me to anthropology, and to what I am currently invested in right now which is body psychotherapy and embodiment as a healing tool through horticultural therapy and other practices. And I resonate a lot with this story and kind of your, your personal story as well so I just wanted to recognize that. The fact that iterations, I, one piece that stuck out to me was the fact that there are iterations of this and that it comes in waves and different epics, if you will. Yeah, so I just wanted to share that thank you for your, your story and thank you for providing this. Thanks, Mark. Yeah, like, I feel that too. So something you're touching on that connects with my story and was, was a, it was a predominant thing for like this poem as well is just that like shifting back into our body kind of and how it, it balances us right. And like, when you talk about mental illness, and I will relate that to physical illness as well, in that, like, the way that our mind dominates so much of our experience is really just a, it's beautiful in a sense it's part of our evolution. But now it's realizing that it, it needs to be rebalanced again or it has learned, we don't, we're not, we're not, I mean, we're, to say we're not messing up is to, to take away responsibility but I don't mean that I mean, it's all like a discovery right, we like became so intelligent and we've seen what we can build and that's so beautiful but we've also seen that destruction. So it's like, how can we integrate this and rebalance this so that there's a more holistic view so we can have our earth and we can still survive here. And that's how I look at like embodiment or allowing, allowing our personal process of evolution that is like more scary so like a picture someone gave me once was a lot of us are living with a pyramid upside down pyramid right so we have the so much of our experience is up here, but a lot of our body is down here. So if you want to have more balanced life, then it's about like kind of switching that pyramid upside down, and not being afraid of losing the beauty of thinking, but just realizing that it's like a tool and so using it and a more effective and intentional way so we choose when to use it. So what embodiment has done for me is allowed me to move my attention, rather than telling myself to stop thinking, because thinking. Probably most of us have noticed how thinking a lot of problems. I don't know about you, I can make a lot of assumptions really fast and go off on somebody and then they're like, wow, none of that was true. And you just did a whole thing and we just got in this three hour argument. And all that really had to happen was just checking in, right. And that's hard to control when we don't have other tools so that's what embodiment is for me. So now maybe we could all practice it a little bit if you'd like to. So I was just going to lead a little bit more of a body meditation that helps me just can. I think it's important to have techniques or things or ways of being that you can easily incorporate in your day, so that, yeah, it's good to have that space of like, you know, maybe your sacred time or your intentional, you know, healing ritual but then also allowing that to spread over into daily life helps with like integration and then it has helped me learn how to live differently rather than like, you know, rather than like dieting and trying to control or meditating over here. I can also like do it in my daily life. So yeah, just, we're just going to take a few minutes to kind of practice like giving yourself some tools or connections to to focus your to focus your attention. So to allow it to move to other places. So, if you want to just, it needs your camera for whatever makes you feel comfortable. No problem there. So, I'm just going to do a few minutes and remember that, you know, this is about allowing yourself to be to be comfortable and to trust yourself so for me another part of embodiment is a process of inviting and being honest about our history of violation and exploitation and abuse of the body. So just as much as we want to heal and become embodied is respecting our own relationship with our body and its history of being pushed. So our body knows it knows what's safe and it knows what's not. So sometimes when there's resistance, that's because it's not safe yet it's not time. And that's okay we are going to approach things when we're ready, because there's no reason to uncover something that we're not ready to handle. So, this is my invitation to you to follow along but it's also an invitation to invite yourself and to honor your boundaries. So if that means stopping in the middle of it and like you know looking around or feeling your hands or walking away or eating something you know whatever makes you feel comfortable if you get into a place that feels like it's kind of an edge. So, yeah that's sort of my, my invitation and lay out there. So if you feel okay. Allow on yourself to get comfortable where you are. So we're just going to do a few minutes we're just going to kind of work on starting at the top and bringing the energy down to our feet and to our connection with the actual earth or the earth body. It's also important to use terms that you feel comfortable with so if someone says universe and you prefer your higher power or God or you know planets or science. That that's your relationship. So yeah just finding a comfortable place. And just for now not trying to do anything. I'm just here in my voice. Maybe noticing if there's any noises in your environment. We're just going to start out with like some acceptance. Just feeling like acceptance of the current state of how things are. Maybe within us or around us. So just kind of like that acceptance can be accepting all parts of myself. So I'm sort of inviting all of Carrie to be here. I'm accepting her. Everything she's done everything she's been she's just trying to figure it out. So I'm kind of inviting all of me and breathing with that. Bringing our attention to like the head and maybe noticing like if we've been thinking a lot if our head sort of hurts or if there's areas that are pulling. Maybe our foreheads wrinkled just feeling our like brain forehead. If it's difficult to feel it you can just you can use your hands. You know you can put your hands there.  That helps to develop that relationship. Then moving down. From the head. And just feeling that all that energy that was there about thinking and figuring out and just allowing it to come down. Into the chin and neck. Just feeling like burping a little bit. Maybe your throat itches a little or you want to swallow. Your throat is how we how we speak how we communicate. So just acknowledging that expression of ourselves. Then like feeling the tongue a little. Maybe you feel it on the top of your mouth or you use your teeth. Just kind of move it around a little and like feeling that go down into your throat. And then a deep breath in and just let it go. And relax and just notice like where your mind is and if you're thinking. Let's notice it. It's okay we're just practicing you know generally you know bringing that attention back to the shoulders. Maybe your shoulders are tight. So noticing it first and then and then giving it permission to relax. And then moving into the chest and feeling our lungs and heart. And maybe feeling like some gratitude for just just the ability to experience. And you can relax this is really just an opportunity to kind of move some energy down. No pressure or no hurry. Plenty of time coming down into the chest. And feeling like the arms the weight of your arms I feel the weight of my arms on my legs. And feeling the diaphragm the way it like moves the lungs up and the intestines down. Moving your chest. And you know anytime we get a little distracted just just noticing that and gently bringing our attention back. It's okay. There there feeling our intestines. Your livers on your right side of your rib cage and your stomachs on the left.  General massage. Feeling like that power and our emotional feeling center the knowledge and wisdom that it holds another nervous system there. So intelligent processing all our food and turning it into energy telling us when things aren't safe. So awesome.   Give yourself a little back massage love. And then then just letting that go. Just relaxing noticing like maybe how you feel if everything feels okay. You know there's like some things coming up just kind of kind of noticing how you're experiencing things here. And now we're going to do the second half of the body just a few more minutes of the legs. Not too long you know. Take a deep breath. Let it go. You can always readjust you know there's no right way to do this this is just a practice to feel your body you know and develop that focus. And when you're ready. Just noticing your hips. How do your hips feel do they feel comfortable do they feel like aligned. If you're sitting is one feel above the other tight. And you know anytime it's hard to feel it just you can use your hands. Or you can picture the image you know just bringing that down through the legs into the thighs. Feeling that the muscle tingling little maybe rubbing your legs if you need to.  If that's if that feels okay you know the shin ankle maybe you move your ankles if that helps or just kind of imagine all the joints and ligaments and feel the feel the. The inner workings there. And then lastly maybe feeling your feet on the floor. The soles of your feet. They're kind of like hands they have that connection. Just breathing.  And noticing if it has any urges or desires or pole. Maybe it's pulling your attention in a certain way. Or there's a predominant thought or feeling that's showing up. Maybe just notice that for a second. Don't do anything with it just notice it. I feel that we are fortunate to be able to create this space with people from all over in in a time that is so unpredictable. And that we still get to make these connections. Even if it's just for a brief second. So yeah, as you're ready you can just kind of like, you know open your eyes and find your way back maybe fell asleep. But yeah, that just helps me like get grounded in my body, usually feel pretty relaxed after that. Sometimes tired. Sometimes I try to do it in the morning when I wake up and then I almost fall asleep again. But actually it's, it's a way that I've done some deep healing to but um, yeah I was just curious if anybody had anything that they wanted to say or if like what you noticed by doing the meditation. There's no right answers maybe. I, for me this meditation is something that I discovered naturally and it was part of my healing process. And when I discovered it later, I learned that it was called the body scan meditation, but for me it was like, Oh, these are these parts of my body. Wow, like, and acknowledgement and answers came from this area. And for me, I, this part of my body is very strong. And for me the heart centers, I can tell if I'm in a bad state if I can't feel here. And it took me a long time to learn that because you're not taught that right you're not taught to check in with your body. I, I, a comment was made yesterday I think if we taught meditation in our elementary schools, just as a non spiritual is like a psychophysioregulation or just getting in touch with yourself. Instead we're taught different systems of economics and political science and that sort of thing which are valuable, but the body is left out of it and that's so much, you know, so much can be learned and discovered and it's yeah so that this meditation kind of brought that out for me and those different. So I lead a meditation myself for cancer patients who are affected, going through the various stages. So that awareness of kind of these different areas and in viscera kind of inside I think can really help relieve pain there's a lot of people who are in chronic pain that hold areas that are really sensitive and pain medications don't get at that. Neuropathy is a particular one that one one patient in particular that comes back again and again she has neuropathy and we're teaching her meditation to try to deal with that and afterwards she's like I don't do a guided meditation she's like this I felt some relief. But it's just about particularly sensitive areas when they might come up as I say which I learned from john kevins in. Do you want to dip your toes into it you don't want to go fully into it just around the edges where can you get a shape of it. Can you try to learn what that body language is about. And each person's experience is a little unique. As you say, so getting in touch with that is going to be that communication is ongoing and yeah so I really appreciate that that meditation. Yeah, like, when you say that about like having done this before you even knew as a thing. That's another thing that I think we miss out on when we're disconnected to our bodies is that there's so much wisdom in there like I was doing these like healing techniques that I had never even read about or heard about but have been around for like thousands of years and it's not because I'm special but it's because it's like written into us you know it's it's it's it's in there to like, you know, heal healing is in there totally right. And I, you know I've had moments where like I was having a lot of like spleen some pain in my spleen, and I went to like a therapist and it was about like rumination of a particular thing that's been like kind of passed down in my family. And the spleen is in Chinese medicine is kind of connected to like rumination right. And so by like being able to speak to that and connect with that that aspect and it like came up in like a sentence, you know it was like, I feel sad that my dad was never able to express himself. It was like something about that. And it like came from my spleen into my throat and you know your throat is like your expression. So, that's just like the whole embodiment piece and like this self healing is how it. So it just like happens through you and you know and I used to have so many problems with digestion and all these physical issues that doctors were giving me like laxatives and antibiotics and Pryla second, you know wanted to take out my tonsils and all these things that were just destroying me and I felt so hopeless and then, and then to come to discover that like I mean and it's no no simple task it's and it's not necessarily easy and it, you know, I becoming embodied as painful and it's suffering because you feel things and it's, you're connected now you know and you don't get to just turn away anymore because it's squeezing your heart. You know, so there are like, you know, like the small print, right, like, I do think that this is a reality that it does come with the full package, you know, so that can be that can be overwhelming and frustrating but ultimately, I'm grateful to feel the power to identify what's happening and have it shift, and it's like air in my intestines and the doctor would have given me a pill, you know, like, so it's amazing so Yeah, did anybody else have any experience during the meditation or feel, feel sort of maybe disconnected from their body, or, you know, have have done this before or anything.  I know like my child's teacher had yoga and like kindergarten and first grade, they did some exercise which was great. I know in some parts of, like the south, I don't know, Georgia at least like I know that there's teachers who've got trouble in trouble for even teaching just meditation and yoga is seen as like religion teaching religion which you know it is related to religion but like, you know, as opposed to something that can help them learn and so there's some resistance to that I guess still some part of the country but I also agree that it's really useful for kids. It's interesting because I was actually a board member for an organization that teaches meditation to schools all over the place. And there's apparently quite a number of them and growing. You know the usual on the East Coast and the West Coast and slow to fill in the middle but yeah they're doing exactly that teaching it in a non sectarian on religious format and focusing on the massive benefits to emotional equilibrium, brain health, etc, etc. And the kids love it. Yeah, it's great way to start the day for them. Yeah. Where are you anyway Sandra. I'm in DeKalb County, Georgia. Do you make this like near Atlanta so we're kind of somewhat of a progressive bubble where we are but you should go a little bit more. Yeah, not far. Yeah. Chris, do you practice this too. Do I practice. Do you practice like the body meditations or the meditations. Yeah, there's a really great book people should look up called focusing. And that's where they talked about they were studying why certain people succeed in therapy and others don't. And they found like the good reasons. And one of it was a focused awareness of body sensations. And in fact I had a gentleman here for living with me for about three or four months that I met at a near death experience lecture. There were four of them. And he became a long time student of what is the Gwenka method of Buddhism, and it is a totally somatic awareness meditation. They seek out any tiny little feeling in the body and unpack it to release it. And that is, according to their understanding directly from the Buddha, from the longest time you can think of, of the primary principle most successful way to get to the point of enlightenment. Yeah, I was, I was fascinated and, and, and I had forgotten about that focusing book I'd read it like in the early 90s, and an old girlfriend gave it to me one day, like a few months ago. And I put her lines in and everything and I was like, well look at that. No wonder I was doing this. Do you type that. Can you type the name of that Buddhism. Yeah, Gwenka. I'll look it up here and see if I can find how to spell it. So, give me a minute. I was kind of rediscovered focusing about the same time a few weeks ago, because it's been sitting up on my bookshelf for a little while. I was wondering why you were laughing over there, something that I discovered in high school as well. And I kind of, I read it over it was like this makes sense. And it makes sense from a visceral level and that's why I was talking about these iterations like I rediscover my body at different times in my life. And it that generally helps me get through life transitions it's this correlative effect that's happened where there's like, oh there's like this greater increase in body awareness, body awareness, and that book focusing and some other really great references the body keeps the score for trauma and healing. And other other other works that that compile that that body awareness it's very critical in psychotherapy, it just isn't named a lot. And I think the way to do this psychotherapist job is to try and create will not try but to show authentically to create a safe space where that that sharing can happen that focusing or that ability to go into oneself, while also talking about perhaps difficult experiences that helps move to a different level of understanding. One thing I was going to bring up so Daniel lendy who was on here yesterday. He would often say in his classes that a mentor told him while he was like stuck on a problem like trying to theorize it. He's, she said you can't think your way out of this problem, you have to, you have to get out there right you have to go understand the people or really get into a different space you can't just analyze it. So with me and it's like it's coming full circle here. So thank you for bringing up that focusing book that's been a recent readmission of mine and a lot of my professional. Well, I'll go real vulnerable here and share a quick thing. I went to a, you know one of those four day long weekend personal growth sessions in Marin back in 2000 and another one in 2002. And they did an interesting exercise that we had to basically tell somebody, everything terrible that our parents or any authority figure ever said to us that made us feel absolutely miserable. Take a week and to relive that. And the first part of the exercise was just to feel all the grief sorrow you could. I tried three times couldn't do it just sat there with a smirk on my face.  I did that about a millisecond scared to be Jesus out of everybody, including myself. Clearly the facilitator was smart enough to go okay you're going back to the first part of the exercise. Finally, after 20 minutes of resting and getting back into it I was able to do it. And I ended up on the floor in the fetal position pretty much just kind of having a shamanic journey, observing myself falling down an endless abyss of despair and anguish and sadness, thinking nobody wants to go here. The third part of the exercise was to hear that voice tell you all the bad things about you whatever, and just say thank you for the message and the role you played in my life. I am complete, you're no longer necessary and be at peace with it. The really fascinating thing happened. A few days later my father came over to take me to lunch. We're hopping in his car we're driving to downtown to go to a restaurant, he starts getting irate at a driver in front of us it's going slow, and I could not handle it for the life of me. I was like, dad, could you please calm down. Okay. I had the unbelievable discovery that my emotional armor that I had built up to survive my childhood had been dismantled. Giving me a capacity to feel that nobody could have described to me, or thought I was missing. You know, I never had any problems of major sort in life at all ever. No big psychological problems of any kind. It was a stunning revelation, but it gave me a capacity to reintroduce myself to feeling and it's taken me a good 15 years to finally get to an understanding that I have to just accept that I'm one of those highly sensitive almost empathic people. That has been more, you know, in the news or talked about in the last 10 years. But a difficult journey and very, very valuable understanding of the importance of feeling in the body. So you said that you had a moment of sort of realizing that your armor had come down. Did that take, was there like a period of sort of maybe feeling like you didn't have any other resources of how to confront situations like did it feel like it was too fast or did it feel like it was an appropriate speed.  Yeah, I was going to say like that's a full like that's a full psychotherapy just thrown into it. All right, let's do it. You just like split apart. I probably would not do that with my clients, but you know that's another way to approach that I'm also very open and wanting to explore those kinds of avenues of healing for people who do want to experience something like that with some caveats what was that you said that was a workshop or Yeah, a woman named Katie Darling in Marin and it was called Mother Wave they then changed it to Soul Wave, and they had like four separate weekends. And it was brilliant. I mean she had everything but the kitchen sink in there I mean Gestalt therapy hypnosis re birthing chaos theory, Buddhism, everything you could think of she'd been like a student of everything for her whole life and she had managed to integrate it all as in an amazing way that was just for me in my intellectual, you know, fast learning brain it was very entertaining and engaging. And obviously highly useful. In a previous session a year before, or two years before, we had to do a re birthing session and getting in a hypnotic state before that. And I actually in one of those sessions stopped breathing, and they as turning blue. I later discovered Oh my egoic structure was so wanting to block feeling anymore back then that it chose dying over feeling. You know I had that realization after another re birthing hypnotic session that I got the big aha my whole body felt like it turned into light. It was just like an amazing stunning experience and I was like grinning from ear to ear and kind of freaking everybody out and they're like who are you. But that was my first introduction to a real personal embodied understanding of the egoic structure resistance. And kind of what I call the ground fault interrupt switch of our nervous system to protect ourselves from kind of getting overwhelmed and short circuiting from, you know really traumatic emotional experiences. Yeah, I think that's like something I had to go through and see that destruction and then realize that it's okay to have that resistance. Because I think, you know, before it was like, Oh, I want to destroy all this stuff at once and be done with it. But that's still just a sort of like kind of colonizing, trying to do everything fast. You know, not always sometimes the fast, quick things are good too. But I have had to also develop the practice of being accepting of the slow process of evolution and allowing, you know, the crutches.  And I wanted to quickly add that, you know, this this aspect of this conversation talking about the, the struggle, the danger of entering into the spaces. We've been talking we started this day with meditation and we're ending it with meditation and I'm so thankful for that. And for the sharing that's occurred here and for the discussion of the difficulty of entering in these spaces with this sort of radical confrontation with self I'm a mythologist and a professor of religion and, you know, throughout history in the religions, whether it's Moses and the burning bush or Mohammed in the cave. This, this, this radical confrontation with the self leads one through a kind of heroes journey to use the Campbell metaphor and it starts with an embodiment but we become embodied, immediately into a radical notion and the word radical is associated with with rootedness right in our embodied radicalness is that we become aware. Right, but what we become aware of first and foremost is our own impending death.  They just don't know it yet. Right and so to become embodied and to become rooted and to become aware is to become aware of one's own finite sense of the private self in space and that can create a kind of terror and a disruption that becomes very difficult to return from and some of us would rather not live than to have that awareness some of us will go bury ourselves in work, or in our minds or in sex or in drugs or in all these other things. But if we can keep walking into that space we can then maybe come to an awareness of our awareness. And then when we get there. Right, then we become introduced to a connectivity to this living conscious matrix that we cannot deny exists because we can experience it directly. We can only get out of the way and realize that it's right there the whole time that's what you said before. And these things we need training for decades. And at the same time they're written into the very coding of your DNA. And you can sense them right and both things are true. Right at the same time and that's part of the mystery what young and others called the mysterium tremendous which is that which we emerged from and returned to and so I just want to say thank you for this great presentation and to everyone for their contributions here I also before we left. Mark will be officially closing us but I saw john and Daniel up I didn't know if they had anything they wanted to add as well. I mean, I mean for me, these kinds of things are just really important to do in a group and having these discussions because you don't know where it's going to go and everybody's bringing their stuff to it. And I always say that.  It just depends on what you do with it right and so, you know, so to me that's, that's kind of how I always shut it down is There's a cartoon I sometimes use and I some I didn't show it in my last session. But it's a little cartoon of people sitting around the table and and they're talking to the speaker and they say we want you to take us on a journey of transformation without requiring any real change. And I sometimes will start workshops with that cartoon because you know I want to make sure that you're in the right place because you know we're going to require people to actually have some change here. You know, and I think for a lot of people. Because they're not embodied, and they haven't really thought through why they're doing something they're disconnected from who they are, then then it's entertainment and it's not transferred to transformation. So, thank you Kerry for your for your offering. It was a hippity hoppity. So, I just wanted to add and then I'll let Kerry kind of have closing remarks here. But to also have compassion for ourselves and for all these different practices. And even if we are just unit for informational or not embodied experience that perhaps information can come around different iterations. And how to describe me. One time is like a spiral staircase right so we're coming around these different topics or ideas Monday that might click or something might percolate. And so that's something I've had to work with personally, but I find it's helpful to remind just everyone in these spaces that we're all working. We're all starting where we are right and so to have compassion for that as well and to give honor for ourselves where we are for just showing up just being here. But I just wanted to thank you so much Kerry for this, this presentation in this, and this space and holding the space for all of us.  Really, really wonderful people and experiences I'm sure we'll be communicating this for a little while and talking about our next one when that'll be coming up but we're really grateful for for all the participation energy and work. That's gone into this, and that includes all of you. Just wanted to say anything before we kind of round this out and if anyone else wanted to say any kind of final remarks. Just quickly before you toss it to Kerry john thanks for bringing those dogs into the frame to find the it's great to hear them in the last session and now to see them even better this is just so great. Yes. I was just kind of following up with what you were saying mark about the compassion compassion for ourselves compassion for others and, you know, I think when I when I first got into this I really dogmatized it because humans are so good at creating dog. And, you know, it was so healing for me and I just wanted everyone to know, and that that this just connects to what I said before we even started the meditation is just respecting ourselves respecting other people and not thinking that this is the way to go. It would be kind of like you were saying about, you know, certain people choosing to choosing death and I think I respect that I respect that because I know it's so painful.  I don't want to do it anymore. But I keep going so. Yeah, just like all the different consciousness is all the ways that we're going about it and then just like feeling because I get into despair a lot. And what helps me when I'm in despair is knowing that this is all a process of coming home. And we're not messing up.  Yeah, that helps me to just like, just like our own process of disconnection and then reconnection and the cycles in our life that we go through of like, fucking dating terrible people and then realizing it and then getting you know getting better eating and then all of a sudden eating, not well and all our cycles that compassion we have for our own cycles, having that for the greater humanity because to some extent that's what we're doing. So, yeah, I hope we, you know, we make it till tomorrow and the floods don't come yet and the ice age, you know, it might be upon us. But thanks for sharing this conscious space. And in your comments, so that's, that's nice. So, thank you. I would say thanks, especially if those things are upon this. Totally right. You said, you said we're all we all have to be in touch with our imminent death and I'm like, I'm okay with that. Yeah, thank you. Thanks for your, your vibe and the you have such a nice, nice energy so thanks for doing all of this and and communicating mark and everything so a team effort and Tom and Anna and our tech team and Mark doing such a great job and just the energy of the container that the rest of these folks in this room some long time SAC members and Jeff McDonald and David and Julie and Mark you're going to see Sharon Mahars these folks that have been with us for decades and then some names I've never seen before right and coming into the space and holding this collective intention. It's it's beautiful. And it's difficult and it's tiring, but it's also extremely rewarding so actually thank you to all of you guys. Absolutely honored to be here. You're so grateful and we will hopefully see some of you over the business meeting. If not, please check us out and we'll be in, we'll be in touch. Well, this isn't a goodbye. It's just see you later. So, I'm sorry I interrupted you. Okay, go ahead, go ahead. Can I share a screen quickly. Yes, go for Okay, so for folks that aren't going to join us at the business meeting. The next time that you can engage with us is actually coming up. Please do check out our Facebook page, check out our website anthropology of consciousness. There's a lot of ways to get involved with the org. If you're not going to come to the business meeting we'll be talking about all this. But our next public event was actually an event in conjunction with the new school for analytical psychology in the Seattle area and it's Lewis Milmadrona and Barbara main guy, talking about to I'd seen which is a concept that it absolutely is to everything we've been talking about. And that's on Saturday March 27. So, just check out just Google the new school for analytical psychology and check out their upcoming programs and you'll see it right there but this is a program. If you click into more information you'll see that we're doing it in conjunction with them. And that'll be our next event we intend to move away from just doing these once a year kinds of things and start doing what like Mark and others in March are going and others about which is to start generating these local regional opportunities and we can do them in other parts of the country as well for folks to gather and have smaller, you know one day or even a single afternoon or a single morning opportunities to have these dialogues and so hopefully we'll see some of you there. Okay. Back to you Mark. Thank you so much, everyone, and we'll we'll see you around.


It's difficult. It's difficult for me to try and understand what she's actually thinking right now. Yesterday Angelica came into the villa. Hello! Hi! How are you doing? I'm buzzing. I obviously love the girl. Like, we always get along. We always have done since Ibiza. Good to see you. Good to see you. Good to see you. Obviously, things didn't work out for us because we had to break it off. Ibiza is Ibiza. So, we spent two months in Ibiza together. And then, obviously, the season came to an end as did our relationship. It was nice to see Josiah. We haven't seen each other for a while now. Our relationship finished as the season in Ibiza finished. But as soon as I see him again, I know that there is maybe something still there. Obviously, I'm here to see if there is something still there and how I feel about him. I always enjoy his company and I do really care about this guy. But I don't know if it's actually like a real feeling or just like a holiday romance. Seeing her does bring back a few emotions. And I just want to get to know how she's feeling. I kind of want to find out what she's holding back about so then we can try and move forward. I do want to give you a kiss. Give her a kiss. Lovely. We had a little chat and we had to sort out our situation a little bit and see where we were. But it was good to see his reaction when I first came in because it was playing the cool part but I could tell that he was quite shocked. There are still feelings there. It hasn't really changed for me and I can't really see it changing for you either. I'm just trying to figure out if being with you would be like the best option for me. I just don't want to have a good option. I want to have the best option possible. I had a chat with Josiah and I don't really want to hurt his feeling but I'm feeling like what we had was just like a beautiful summer romance. So I'm not sure if we can keep going with this relationship or if we're just going to be friends. Like I would always be the one to say that I'd rather give it a go than not give it a go. In the villa I think we should just take things slow, see how things go. I do find that she is holding back. I don't know why. I do need to find out but it's difficult. It's difficult for me to try and understand what she's actually thinking right now.


Well, good morning everyone. My name is Brian Kirk. I'm a fourth-year medical student here at the University of Utah And I'm here to talk about a study that I've been helping with recently here at the Moran With the Dr. Craig Chia Derek Zikata Bob Langston many others and several of whom are in this room were Participated in this study so There's a question as to the patient experience with sequential cataract surgery and specifically the question we looked at is the Pain comparison between the first eye and the second eye and there's a lot of anecdotal stories and several studies Which I kind of selected a few to put up here that suggests that patient actually experiences more pain with the second eye Surgery is compared to the first eye surgery And as you can see this they the percentage ranges that were from 40 to almost 50 percent Although not all studies agree with that as some studies have found no difference in the pain score And if you think about it Why is this important beyond just wanting to do the best for our patient and decrease their pain during cataract surgery and one of the Important things especially for topical or cataract surgery done purely under topical anesthetic is patient cooperation during the surgery As you can see by this study and it's intuitive that patient has more pain during the surgery They're going to be less cooperative with the surgery which is important for Surgery surgical outcomes as well as pain and anxiety are important determinants for patient satisfaction scores Which have been more important in medicine recently? As to the theories of why someone may feel more pain or discomfort during their second surgery There's several of them out there some of them are listed here One of the leading ones is that someone just has more has more awareness increased awareness They've already been through the process once they're able to notice different things They didn't notice the first time and that makes them remember the experience more and therefore Remember more pain another reason could be That just memory distortion as time passes we kind of forget the bad experiences We might have had a little bit further in the past and the second surgery being the most recent Maybe easier for them to remember the pain There's also theories in terms of increased tolerances to the anesthetic that they're given as well as others But those are some of the main ones So the study design that we for a study here was a prospective observational study and the unique aspect of our study was trying to combine the subjective questionnaire information and patient feedback data with an objective interoperative data and So the objective interoperative data Which was I mentioned the unique part of the study was gathered using this device here a picture of a handheld device This was designed by dr. Derek Zikata and shad roundy from the mechanical engineering department on lower campus As you can see this is a device designed to be held in the patient's hand And it records several parameters So you can see there's a button on top and this is for patients to press if they have any discomfort as the procedure is ongoing It also records squeezing like a grip force Many has acceleration sensors to detect any movement. There's also sensors that can take can that can detect skin conductance Which can detect sweating which is a physiological response to stress This device is paired wirelessly through Bluetooth to a tablet that can record and store the information and Okay, so that's about the device so back to the study the study subject are recruited from the patients of these Cataract surgeons here at the Moran ice center These people were identified as being scheduled for bilateral Sequential cataract Extraction they were contacted with the letter and then pre-consented prior to surgery Via phone call met on the day of surgery and consented prior to their operation It's to be included in the studies the patient need to be more than 18 years old be scheduled for sequential cataract surgery And be receiving only topical anesthesia Some of the exclusion criteria was a resident surgery for either the first or the second eye And this was done mainly to decrease the variation in surgeon experience For the patient There's any complications or also as we define surgery lasting greater than 30 minutes for either the first or second eye that would they're also Excluded surgery happy more than six months after their second eye surgery happy more than six months after their first eye surgery Or any pre-existing conditions that could confound the analysis of pain like any inflammatory conditions uncontrolled glaucoma, etc All right, so The study is set up to examine the patient experience in three stages The pre-operative interoperative and post-operative stage so in the pre-operative stage once a patient was on their day of surgery, but prior to Being operated on we assess both their anxiety and pain anticipation for the surgery This was done using a questionnaire the anxiety was assessed using a simplified six-question state trait anxiety index and the pain anticipation was done using a visual analog scale So basically a 10 centimeter line Asking patients how much pain they expected to experience during their surgery They'd make a mark somewhere along that line with the left side being no pain and the right side being extreme pain Right. This is prior to surgery So interoperatively the data was gathered by the handheld device that we discussed earlier as well as a research Assistant would go back with the patient to the operating room to record that device data and also make time notes on the time During the different steps of the cataract surgeries Hopefully in the end correlate maybe increase button clicking or pain or movement with specific steps during cataract surgery Post-operatively a very similar survey to the pre-operative survey was given again to assess the anxiety and pain recall Through the same tools and this was done for both the first eye and the second eye surgery With them only real difference with the second eye surgery immediately after their Surgery was done. They were asked to think back to their first surgery and compared the pain They had just recently experienced with the pain the experience or they remembered experiencing with their first surgery and the final step of the study is a one-month post-operative follow-up questionnaire and this Questionary kind of assessed a broad experience perception of their surgery, you know experience with cataract surgery as well as Had a similar question as that they were asked Immediately post-operatively after their second surgery asking them to think back and compare their pain from the first surgery and the second surgery And this was done to kind of maybe eliminate that recency bias with the second surgery and the question being asked right afterwards So as far as results today, we're actually still in the process of gathering some data there's several patients roughly 10 patients who will soon get their follow-up questionnaire and The device data we have a wonderful statistician Molly McFadden who's still kind of crunching the data on that it generates an enormous amount of data Hundreds of data points every second for all the surgery. So she's trying to be able to present that in a meaningful and useful way But we do have a most of the survey results today so kind of a broad perspective we enrolled 101 patients and Unfortunately, 23 patients were excluded with the most common reason being resident Surgery other reasons would be surgical complications Surgery as was mentioned before surgery going or occurring more than six months after their first die Etc. But 78 patients were included in this analysis So here are the results or the averages of patients anxiety scores for their first surgery and This was done as I mentioned with that anxiety index and the max score is 24 So the higher the score the more anxiety someone feels so as would be expected someone people going through their first surgery They have a decrease in anxiety After their surgery when compared to the beginning So looking at the anxiety scores from the second surgery again You see the same thing where they start off a little more anxious than they end up after the surgery and An interesting thing to note here is that both the post surgery pre-surgery and post-surgery Anxiety scores were decreased for them were significantly decreased for the second surgery Which lends credence to the theory that people are maybe a little less anxious for their second surgery and therefore more aware of what's going on And able to better remember their experience Now looking at the pain assessment scores for the first surgery we can see again There's a decrease Well, they seem to overestimate their pain that that top number the pre-surgery is what they anticipated feeling on a scale of 1 to 10 and that post-surgery is what they reported Experiencing the average difference going down about 1.3 on that scale Now looking at the second surgery pain scales So pre-surgery it appears they slightly underestimated their pain But unfortunately that difference between the pre-surgery and post-surgery is not statistically significant But there you do see that they're When comparing the first side with the second eye patients pre-surgery Have a statistically significant lower anticipated pain prior to their second surgery And post-surgical evaluation of pain again is slightly higher for the second eye surgery But again that was not shown to be significant So as was mentioned immediately after their second eye surgery They were asked to think back and compare their pain with the first surgery versus the second surgery And you can see that the majority of people reported feeling the exact same or roughly the same amount of pain for both surgeries But among the people that reported a difference in pain the majority of them reported that more pain occurring in the second eye And this trend held true for the one month follow-up survey again. We're still collecting this data but Again, the majority of people reported the same pain among those reported different pains. The second eye was more painful So just in conclusion For what we've learned so far is that anxiety has decreased Overall both pre and post-surgery from the first surgery to the second surgery And the also the anticipated pain prior to you the first surgery compared to the second surgery was also decreased There was no difference in immediate post-operative post-op scoring for the two surgeries And the subjective comparison of pain In the follow-up and immediately post-operatively among those who thought the pain was different the second eye seemed to be more painful So there's still quite a bit more to do. Of course, we have all the device data Which is probably the most interesting aspect of this study Which we hope to be able to share soon And we have the follow-up surveys that we're still collecting and we're also hoping to include Some measure of the anesthetic that the patients received and Correlating that to their pain and anxiety scores as well All right, I just want to thank dr. Chai dr. Sikata bob all the surgeons and OR staff to Let us do this study and thank you if there's any questions. I'll take them