I'd like to congratulate everybody for their excellent talks. Dr. Thompson asked me if I would contextualize what they're saying from a big philosophy point of view and then present some cases to the group. So here we go. We have a cancer problem in this country. I don't like the way this started, but let's try that again. We have a cancer problem in this country and by that I mean that we are better at finding these cancers early than we are at fixing these cancers early. This is a very nice graph looking at thyroid cancer, prostate cancer, melanoma and breast cancer. We find them more frequently. We don't fix them over the years, much better. The same is true for kidney cancer. New diagnoses up, deaths from kidney cancer about the same. The reason for this is clear. We have this find it mentality. We're a better with the technology of finding cancer than we are with understanding the biology of fixing the tumor. So we scan people more often. We find it more often, but do we fix it any better? That's the question. So the problem here is that the cost of care for the caring of these cancer cases is increased. This is some data from Neurology Diseases Online, Mark Litwin's data, to look at how much we've changed the cost of caring for these patients over the last four years between 2006. And as you can see, we've almost doubled the cost of care in these patients. So at the same time, while heart disease has decreased in terms of death rates and cerebrovascular disease as well as infectious disease, cancer death rates have really been pretty much the same. So what we now have is a situation where we're costing or paying more to give equal outcomes. So if you define value in healthcare as the best possible outcomes at the lowest necessary cost, if you increase the cost and you have the same outcomes, you decrease the value. And that's the problem that can play out very well with a lot of early cancers, kidney cancer, no exception. So if you think about it, this is a very nice article looking at how you think about these different types of cancers. There's a type of cancer that grows very fast from inception to death is quick. We will call that the hawk. That is the most aggressive type of cancer. That's the one where you're at risk of under-trading that patient. Then we have the slow progressors. We'll call that the tortoise. That's the one where no matter what you do, you're probably going to win. And then somewhere in the middle is the rabbit. So what this article really talks about is the simple concept of risk stratification. Risk stratification with localized kidney cancers.  The doctor's first thought, however, might be, I can cure this with a robot. Because we're managing cancer. We have this find it, fix it mentality. And I propose to you that really what we should have is managing their risk. We shouldn't be managing their cancer. We should be better at managing their risk. Should we find it? And if we do, should we fix it? And the same can be said for early stage prostate cancer or breast cancer. So to start off and contextualize that, let me just sort of talk to you about the different types of risk in a very general sense. There's a voidable risk, right? There are not a lot of avoidable risks in kidney cancer, smoking perhaps, perhaps obesity or hypertension. And there are some undefined genetic and epigenetic risks which may or may not be avoidable. But the first type of risk is avoidable risk. The second is the difference between relative risk and absolute risk. So this guy just jumped out of an airplane. He has a risk of dying from what he just did. Relatively speaking, this gentleman who's about to jump out of an airplane has a risk of dying that is not much different, maybe a little bit lower because he didn't take the leap. But from an absolute standpoint, the guys on the ground that never get in the airplane have an absolute risk of dying from skydiving to be very, very low. So you need to communicate absolute, not relative risks. The third type of risk is calculated risk. And this is a calculated risk. You have to know when to accept those risks. And the fourth type of risk is the unexpected one. How do you predict the unexpected risk? How do you account for it? And how do you manage it? So medical risks are, you have to educate for avoidable risks, communicate absolute risks, accept calculated risks, and study unexpected risks. That's how you manage risk. Well, this is a fundamental human endeavor. Drive home, listen to the radio on any given minute. You'll see that we as humans try to manage risk all the time. Why? Because we try to predict the future. Weathermen try to predict hurricanes. Stockbrokers try to predict the stock market. Real estate or all state agents try to predict crashes. Ben Bernanke or his successor try to predict inflation. And actuaries do a good job of trying to predict the future as well. Well, how do we manage risk? We try to predict the future. That's what this discussion's all about. Well, here's a guy that can predict the future. That's Carl Frederick Gauss. And Carl Frederick Gauss came up with this equation. It's very simple. He said, if you want to predict the future, it's the bell shaped curve. There's probable and there's possible. And we use this all the time. We all flew to this meeting, or most of us did, because we believed the probable outcome was going to be we were going to get here safe. The possible outcomes where we were never going to leave the airport or where the airplane was going to crash. But we predicted the future because we managed what's probable, not what's possible. Well, in this elderly man here with that small renal mass, what's probable? It's possible he can get metastatic disease. It's possible, which we don't really usually admit, that we can cause his demise. But what's probable is he's going to die from something else. And in fact, we know that from lots of studies.  Dr. Lane published data that says 4% of elderly people die from kidney cancer, and 30% from cardiovascular disease. Dr. Kudovkoff and myself, the group at Michigan, again, competing risks appear to be the biggest risk. So we tried to do this study now with Brian Eggleston, one of our PhD statisticians, looking at latent class analysis using perpensity score matching, a very sophisticated modeling. And if you ask me, there's just three or four options. If you've got a long life expectancy and you treat the person, that's a good thing. If you've got a short life expectancy and you don't treat the person, that's probably also a good thing. But if you've got a long life expectancy and that person goes untreated, that's probably bad. And if you've got a short life expectancy and you treat that patient, that's probably bad. Can we estimate each of these blocks? What winds up, we've tried. And we're trying to, we're submitting this publication now, it winds up then in the majority of cases, surgery appears to be helpful, and the outcomes appear to be relatively beneficial. That's what's probable. But what's possible is right here. Surgery can be very highly beneficial in a small, maybe 10 or 11% of patients, where you really affect the natural history, or it could be harmful, where your intervention actually causes the patient harm, causes them to live less, not longer. So that's really risk stratification, right? How do you take this tumor and predict if it's a hawk, if it's a turtle, or if it's a rabbit? Now a lot of times in medicine, what we're doing is we're managing the case, not what's probable, but rather what's possible because that's in fact how we get paid, right? We get paid for fee for service. And so this type of thinking sometimes threatens physicians because how do you make money in risk stratification? I'm gonna submit to you that you can make a lot of money in risk stratification. Here's my example. If nobody knows who this is, that's John Bogle. John Bogle found index funding in Vanguard. He's a billionaire. Why? Because he realized that there's not a lot of Bernie Madoffs and there's not a lot of Warren Buffets that most of us sort of regressed to the mean just invest in the middle, managing what's probable, not what's possible. It's possible to win in those kind of scenarios. So if you have a patient you're trying to do if you should excise, ablate, or observe, we can argue that there are some factors that we could use, but probably the number one factor that makes that decision is the physician. The physician who that person goes to will decide how they interpret the patient's risk for them and therefore how that patient will go have their treatment. And so instead of managing cancer, I say manage risk. And here's my risk model. There's four buckets. You have to understand tumor risk, which is the inherent biology of the tumor. We don't do that very well. You have to understand patient risks, which is comorbidity. We don't do that very well either. You have to understand the physician risk, which means what's my individual skill set. And you know, we've got a lot of dogma and what Stephen Hawking's term's illusion of knowledge, that we don't really do quite as well. We don't like to report on our own outcomes quite as much as we should. And of course there's hospital risk, which is process. And the goal in my risk model is to understand and manage variability. And if the young people in the room don't think that they could make a career out of this, in just one of these boxes, Atul Gawande has made an entire career reporting on our inability to manage hospital risk and process. There's lots of opportunity here, guys. So with that, I've put a little context around, I hope the discussion, I'd like to present the case. I apologize to the panel because they have not seen this case. So anything they say about this is truly honest. So with that, I'm going to start. This is a 73-year-old female with an incidental left renal mass. She's got hypertension, some diabetes, and had a stent in her heart a while ago. She had an extended left colactomy and colostomy with a delayed renalastomosis. She's got a midline score and a GFR of 48. That's her tumor. What you can see better here, it's an afrometer score of 10AH, meaning it's a high complexity tumor. Here's the tumor. You can see it in multiple views. And I'm going to ask Dr. Kudakov first, is a biopsy necessary in a 73-year-old woman with that tumor? And if so, what is it likely to tell you that you don't already know? So I think you can make a good argument for biopsy here. And I think you can make a good argument against biopsy. I think it's a discussion with the patient. I, as I said in my talk, there's basically no downside to a biopsy here. The upside, you biopsy this is an oncocytoma. This woman avoids an operation. And so I would have a very low threshold to biopsy a 75-year-old person because she looks better than her age, but I can make her look her age very quickly if I take it for an operation. All right, well, then let me ask Dr. Lane, would you forego the biopsy because it's not in an exactly great location and what have you gotten a biopsy if it might have been easier? I think there's, can I answer a different question first, which is I'd love to know the natural history on that renal mass. I'm suspicious that she's got multiple prior CTs since she's already had a couple operations for cancer. And I'd like to know if it's grown from undetectable to 3.8 centimeters over three years or whether it's been 3.8 centimeters for three years. So good question. She's had no prior, she's had no prior CTs. Okay, so it was for diverticulitis. So again, I think if this were a stable lesion, I'd feel much more comfortable watching it. At this point, I'm fine with doing a biopsy for that. This is a high risk patient who has, high surgical risk patient who has multiple options that would be affected by biopsy. Well, I'm gonna tell you that I think in most cases, as Dr. Lane described before, you could probably tell more often than not what it is without the biopsy. It's heterogeneous, there's brisk uptake. If you talk to your radiologist, they can tell you about the uptake patterns. If you've got an MRI, you can use ADC mapping to tell that this is probably a clear cell carcinoma. I grant you that, it might be an oncocytoma, but it's certainly not a papillary and unlikely a chromophobe. So I'm not entirely sure that biopsy completely helps there. I would also say that most of these are low grade. We've got very good data. And we've got nomograms that will predict as well in some cases as a biopsy, as Dr. Lane told us, that this is probably unlikely a man eater. So, Dr. Jewett, say you biopsyed the patient and it came back a clear cell. Now you tell the patient that she comes back to you. Can you estimate for her, her biological risk of this metastasizing in the next three, five or 10 years? How would you counsel? I would have biopsied this patient as I said earlier. And if it was a clear cell, I would still manage this initially by active surveillance given those comorbidities and the patient's desire. She's right on the line of age, but she has significant comorbidities. So I wouldn't object to treating her, which would probably be a partial nephrectomy, but I certainly wouldn't rush into it. And if it wasn't growing and she had other issues, we'd be quite happy to watch it for the short term. So you know now it's a low grade clear cell.  Can you give her an answer? So it'd be very low, and we would put that in probably one to 2%. But again, by watching it for three and six months, we probably can refine that. Okay. All right, let me ask Dr. Atwell early. Is this an ablatable lesion? It's anterior, it's difficult perhaps. You gotta go through the spleen or maybe entirely through the kidney. Let's start with Dr. Lee, can you microwave this? Well, I just wanna go back and comment on one question that was put out earlier about the difficulty of certain biopsies. And I would say that if you're looking at just a CT scan, you can get fooled into thinking that something is incredibly easy or incredibly difficult based on location. As someone that does hundreds, I guess, or thousands of these biopsies myself, we use almost exclusively ultrasound for this purpose. And the major advantage of that is, well, besides being real-time, is that you have multi-planar capability. So for example, for this particular tumor, it's likely if you come from below, you'll have a really nice window to pop into this thing easily. So I'd just be careful about estimating the difficulty of a biopsy or procedure based on CT. Now to then follow on with about ablatable, I showed a case almost identical to this in my series just a minute ago. The anterior lesions used to be a problem before we understood how to get some of the intervening structures like the pancreas and the bowel out of the way. I would say, and I'd be interested in Tom's comments on this, I would say that that is almost never a factor anymore, except for patients that have undergone multiple retroperitoneal surgeries or for some reason the bowel is actually stuck on the tumor. So assuming that this bowel was able to be moved with hydro dissection, sure, this is pretty easy tumor, I think. So before Dr. Atwell comments, can you tell us that ablation does a better job than Dr. Jewett would do watching it? No, not necessarily. What I can tell you though, is that our chances of destroying the tumor completely with minimal or no risk is very high. How that translates into a long-term outcome we're not quite sure yet. Dr. Atwell? I think the easy answer is yes, it is ablatable. The risk of bleeding, the central collecting system isn't an issue. So technically the answer is yes, whether it provides a better outcome for the patient. I guess it depends on how you define an outcome. Will she live longer maybe? Will she sleep better maybe? Yeah. Will you sleep better? Things go well, yes. All right, so the biology of the tumor, I'm not gonna go over much of this. Dr. Jewett and our group and others have talked about the biological risk, right? A 2% three to five year metastasis progression rate. There are also very good nomograms to look at what is the success rate, a 98% five year cancer specific success rate in this patient if you excise it. So anytime you win 98% of the time, I think Dr. Jewett and I and many of us would agree that you have to question the fortitude of the competition. Okay, what about comorbidities? Now let's quantitate patient risk. Charleston Comorbidity Index, competing risks of death. There are life expectancy tools. This is a good one from the NCCN. You can put in a 73 year old female in the 50th percentile of health. She's got a 13 year life expectancy. I mean, what resonates here with me is that if I go to buy life insurance, this is what my agent's gonna do and this is how he's gonna price out my policy. Similarly, you can look at competing risks and Dr. Kudakov and I and others have worked on how do you actually measure competing risks? Her competing risks of death, 3% from kidney cancer, but 15% from other causes. So trying to objectify these risks in this patient becomes important. Dr. Stifleman, what do you tell the patient the likelihood is of a major or minor complication? If you do a robotic portion of the front of me, in this case at NYU. So I'll answer that question first, but I think this patient, and you showed this earlier, has a higher risk of having a high grade disease based on that nephrometry score. So you show this, we've looked at this as well, using the nephrometry score to help assess the risk of being a high grade tumor and that is a high grade nephrometry score and I think that's gonna be a high grade tumor and this could be end up being a shark. So Ursula, I would offer her definitive therapy at 75 years old with a 13 year life expectancy. In terms of the likelihood of a minor complication, I would quote her probably a 20% chance of a minor complication for this. And in terms of a major complication, which would be a urine leak or a pseudo aneurysm or a bleed requiring a transfusion, I would quote her less than 5% chance. So my point exactly is that these are the risks the patients need to make an informed decision. Let me ask you to follow up. Would all the surgeons at NYU use fluorescence and does its use and associated cost lead to improved patient-centered outcomes in your estimation? So two of the three of the surgeons would use fluorescence for this. I would absolutely use fluorescence for this. This is a high grade tumor. Though it's a 10AH, if you look at it, you're gonna basically enucleate this out of the sinus. This is not gonna, you're not gonna have to remove a lot of parankula for this. So because of her comorbidities, I would definitely use fluorescence. I would try to do this with selective clamping and I think she's got an excellent chance of being home in two days from the hospital and a week going back and doing her errands. And you believe the cost is justified? Well, I think in this case, the person has diabetes, she's got hypertension, she already has a GFR, CKD of 30. And in our earlier experience, we've shown that the delta change in GFR initially is lower when you can do selective clamping. So yes, the answer would be, I do think it would be worth a $250 cost. Okay. Well, it's $250 for the diet, but more for the more for the hardware, right?  All right, so here is how, this is the physician risk box, right? How do you know, how do you know what your own physician set is, skill set is? If someone's to ask me where my skill set was on this bell shaped curve to fix a bladder extra fee, I'd put it down here. But most physicians believe that their skill set is quite high. I just remind everybody that it is a bell shaped curve and most patients believe their physician skill set is extremely high. So the question is how do you know what your skill set is? Whether it's with the knife, the scope or the robot and that is, you gotta measure it. And we've published ours. You know, we've got relatively robust data to suggest in a patient like this, she's got a 20% major complication rate, mostly leak and a 30% minor complication rate. We could also tell you based upon what system she is likely to have the complication in. So understanding your own data in your own institution with your own processes becomes an important part of counseling this patient. So again, how are the processes in your hospital are you improving value by either decreasing cost or increasing patient centered outcomes? Because most of the costs are buried in variability and it gets back to my concept of risk modeling. How do you use your system to minimize physician variation and avoid unnecessary risk with these patients? It requires a village as they say, of people, physicians to own this and to move it forward locally in their own institution.  I mean, it's a 79% chance for a high nephrometer score like yours, it will be robotic. I will tell her that based on our data, there's a 22% chance of a Klavian 3, 4, or 5 complication and I will give her the other statistics because you can't manage what you don't measure. So in the end, managing risk is what we are supposed to be doing, I believe, and managing that variability is important. So move away from managing kidney cancer to managing risk. And as was said by William Osler, science, medicine is a science of uncertainty and an art of probability. And with that, I have another case, but we only got about two minutes. I could run through the panel very quickly. We want me to stop here, Houston. Okay, very quickly. Okay, 63-year-old male left radical nephrectomy for a chromophobe carcinoma in 2007. He's got high-grade prostate cancer T3A, Gleason 8. He had a prostatectomy and has a PSA recurrence for which he was radiated. That was seven or eight years ago. A smoker with some coroner disease. I will promise to make this short. He's got a solitary kidney. He had chromophobe on the other side. Let's go down the list. Dr. Steifman, would you biopsy this patient? Solitary kidney chromophobe on the other side. Dr. Lane. Yes. Would anybody not biopsy this patient? You got chromophobe on the other side. Dr. Kudakov mentioned something about hybrid tumors. Dr. Kudakov, would you like to sort of elaborate, is this likely to be chromophobe or do you think it's likely to be something else? It's a good question. The concordance rates for, there's not large areas for chromophobe concordance rates, but this, I mean, the biopsy will certainly be able to distinguish if this is, you know, if this is an oncocytoma versus another chromophobe versus a clear cell. I mean, I think biopsy is very informative here and will absolutely change management, especially in this patient with chromorbidities and with solitary kidney. So a young man, solitary kidney. He had kidney cancer on the other side. He's very worried. He was referred for a portion of rectomy. And here I am gonna say you need a biopsy because I don't know what it is even though there was cancer on the other side. But we've all agreed that's what you should do. And in fact, he had a biopsy and in fact it was an oncocytoma and in fact, he's now avoided the morbidity of that operation, managing risk. So again, I'm not gonna go through that again. I've already beat that to death. The risk model, managing variability in tumor, risk, patient risk, physician risk and hospital risk. There's a very good article. I've got 45 seconds left by Fagerland and JNCI about how to communicate risk to patients. I invite you to read it. It is very, very good. I think that if nothing else, if it doesn't change the outcome of your decision, it certainly engages the patient in that decision-making process. We're moving toward accountable care. We've got to quantitate and estimate risk. It forces us to give better care. And I'll give you three quotes. I said it before, medicine is a science of uncertainty but an art of probability. Let's manage what's probable, not what's possible. The second one is it's always difficult to get a man to understand something when his salary depends on his not understanding it. And as we move more towards accountable care, I think we're all gonna have to deal with that one. And finally, in the midst of every challenge, ACA, Obamacare, call it what you want. There's opportunity and the doctors have to lead it. We cannot be put upon, this is ours to own. Thank you very much.


Hello there, my name is Sandy Allnach. I'm an artist and paper crafter here on YouTube And this is the third in the series today on Daniel Smith watercolors I'm going to talk about the Prima Tech paints and some of their properties But before I do let me just give you a disclaimer Which is that out of the paints that you see here the ones on the left are the ones I've invested in so I've Spent quite a bit of money on these and already loved them and then Daniel Smith Came alongside and partnered with me to provide more paints so that I could test some things out for you and share them with You my opinions in these videos are still my own The Prima Tech paints are 37 or 38 of the colors within the Daniel Smith line that are made from these natural Minerals I am so amazed that they could get paint out of these natural minerals a lot of paints are synthetic A lot of colors are but these are all natural from the actual rocks And this is a set of six It's a starter set that you can get and just try out a few of them and see what the properties are That they have a lot of them will have Granulation to them that is unique to these kinds of paints others will have more of a glittery look You can mix these with all the other paints that you use so you can get just whatever colors you want if you like Just the glittery look I'll tell you which ones have some of that glitter in them But I'm going to run through and just do some swatching This is with heavy pigment and less water so you can see what they look like pretty full strength And with just a little bit of blending as it goes down that when I put a little too much So I was struggling with trying to get enough water in there to get it to move But I wanted to see what they looked like and I also wanted to see the glitter content When it's heavy color versus when it's light color So now I'm going in with a lot more water and just really soft washes So you can see you get a really soft look with these things as well You don't have to just use them all heavy and that sort of thing and then after they dried I wanted to be able to compare how much granulation there is when it's light color and heavy color And you know do you get more glitter when it's heavier or when it's lighter and We'll take a look at that in just a second after it dries But this is the whole collection of primatex spars I know and I will have this chart on my blog so you can check it out But I wanted to point out which ones are the glittery ones So let's kind of take a nice close look in here So you can see what the shimmer and shine looks like on just some of them So the red fuchsia genuine has some sparkle in it I had a heck of a time trying to get the sparkle to show the bronzeite is gorgeous and Right next to it is the burnt bronzeite Absolutely beautiful colors with lots of sparkle and as I said you can mix these with other colors So there's a number of uses I can see for a lot of these and here's the amethyst This is the one that's in the starter set. So you'll get glitter on that one There's fuchsia, which is a very pale greenish teal kind of color I'm sure it's called fuchsia instead of greenish teal But this one's kyanite and I want to use that to do some night skies and The suga light or suga light would be great for a cloudy sky I think this is the chart we just painted and the hematite is the heavily granulated one and the amethyst Genuine has sparkle both in the heavily pigmented and the lighter Pigmented types of washes and this is a terribly painted chart. I apologize for that But I was tired But I wanted you to see that when you mix that purple with any of the other colors and you can see in the Previous video how I did this chart. It carries the glitter with it So it will make other colors sparkle if you get one of these and mix it with it I'd like to show you a sample painting It's just going to be a quick speed painting and I'll talk through it a little bit But I wanted you to see the kinds of colors that you would get from the primatex. These are Granulated colors in many cases a lot of them are just much more naturalistic colors But they're a little duller than you might get out of other pigments So other ones might be brighter stronger flatter or that sort of thing But these will give you a really I don't know it feels to me like a gritty look There's just something about them that I I find really appealing So that's one of the reasons why I've invested in a lot of the primatex because I really loved the look that they have here So I've painted a little bit of rhodonite for the undercoat on the grapes a little bit of Mayan blue in the background and then a little jadeite just to start the leaves out a little bit I'm going in now with the amethyst now This is the one that has a little bit of glitter in it and as I'm looking at it from an angle and up close and everything I can't really see the glitter Until it dries and if you get some of these colors Don't worry if it doesn't immediately show up to your eye Once it dries if it's one of the paints that has glitter in it will show up definitely and you'll be able to see it so that's one of the things that I discovered about them and they tend to have a little more of a bold glitter look when there's darker color when it's richer color if it's really soft and pale It's super subtle So I'm going in with a little bit of dry brush and then throwing in a little bit of water to blend a few things to add some definition to the grapes and Keeping it as loose as I can if you know me in my art here on my channel I Struggle with loose so water color has been a real wonderful exercise for me in just loosening up the creative muscles and Letting myself get crazy and paint So I'm mixing in a little more of the pinkish color the rhodonite Because I wanted these to have that that really bright color as well and show you you can get that the rhodonite is the only like Really really bright color within the primatex. The others are much more subtle types of colors And here I decided to add a little bit of brown in there, too because the pia muntite. I think it's called I thought would add a little bit of That grittiness to it if I mix a little bit of that with the green I'm only mixing them really on the paper as you can see I'm not mixing a whole lot on my palette so I Wanted to just give you an idea of what these pure colors can do but you can definitely mix them Come up with all kinds of things and I will be continuing to do more of that as time goes on But just so you know my channel is all different mediums So I will be showing love to lots of mediums here Not just Daniel Smith and I'm not going to be giving up all of my other watercolors as well I want to be able to play with all the toys because all the toys are so much fun I'm taking little breaks in between here that I'm not showing you just for letting some of this air dry because There's some areas where I wanted the sharper detail like this and if I put it over wet paint It would all just mush out and bleed into the wet paint So as I wanted to add more of this detail onto the leaves It was helpful to wait until they were kind of dry but I'm going in with the pia muntite and a little bit more of the jadeite to add more detail on the leaves just give them a little more definition a little more sharpness and Occasionally I'd hit it with my heat gun just to make sure Things were good and dry before I started on my next layer and now I wanted to add much more definition using the amethyst on the grapes and just add some heavier shadows and Just kind of squinting at it as I paint just so I can see which areas are Have some definition and which ones are a little more on the mushy side and where I wanted to loosen it up at There's part of me that wishes I had stopped at the last stage because I liked when it was even softer In terms of the shapes, but I liked the contrast so I guess I'm glad I I kept it going And then I would occasionally stop and throw some Paint spatters on there, but here you can see the actual glitter within the paint It took me a bit to figure out how to film this so I could show you the actual glitter But you can see how well it shows up when you're doing a painting itself not just on swatches So here are the two videos that were earlier in this series if you missed out on those You only landed on this one You'd like to see more about the dot charts or making swatch charts for your watercolors and then another watercolor video That's just for fun and I will see you guys later on be sure to subscribe if you'd like more from me And there's all kinds of information on my blog including stills of all the charts and everything in these videos. Thank you much. Bye. Bye


Thank you. Thank you. Dr. Anso, how are you? Sir, I am doing well. Well. Okay. Your hobbies, extracurricular activities and social issues. Sir. Just, you know, RTI. Sir. RTI Act. Just relate your social issues with the RTI Act and tell me how it has been performing. How RTI Act has been working for the last 16 years or so. So, the Right of Information Act is a big turn in the case of transparency and accountability in the administration and other public fields. Sir, in the working aspect, there are both positives as well as negatives. Sir, when one talks about positives, sir, it has assured transparency and the right of public to seek information and hold their public representatives accountable. And sir, as far as the negatives are concerned, sir, we see that certain public authorities were not under RTI Act initially. And sir, the officers that are assumed to be giving information do not perform their tasks well. So, there are also reports that the information is not collated in a way that they could be given to the public for educational purposes. But, sir, recently the decision of Chief Justice of India to come under the RTI Act and other judgments have paved a good way for the RTI Act. And there have been, against the activities, activists, there has been some problems also. Some have been killed also. Yes, sir. Yes, sir. Some activists have been killed and lives have been jeopardized. Okay. In near your place, some new bridge has been inaugurated. What is that? Sir, it is Sri Krishna Bridge which has been inaugurated on the Ganga River. And sir, it has reduced the distance between north and southern Bihar, especially between Munger and Khagar. Will you benefit it by that? Yes, sir. Okay. Booster Doze. Coming in newspapers, tell me something about that. Sir, the Government of India has announced that all people above 18 years of age who have completed 9 months from their second dose would be eligible to get the booster dose. And sir, as far as the recent guidelines are concerned, sir, the vaccine that already has been taken, only that could be taken as a booster dose. And sir, as of now, the mixed policy has not been followed. Cost. Sir, it would be initially given by the private sector, sir. What is the cost? Sir, I am not aware about it. Okay. It will not be free? Sir, right now it is not free, sir. But I find in the newspapers, 185 crore doses have been given, all free. Is it correct? Sir, not all doses have been free. People who were allowed to go to the private sector could have given the money that way, sir. So, my first dose itself was in a private hospital. Sir, I have also paid for that. So, it means that advertisement is wrong. It is written all free. Sir, initially when the vaccination drive was rolled, private sector could procure and vaccinate people by taking money. So, sir, I think that should be excluded. Sir, after when the government of India came out with a pan-India proposal to give vaccination, then sir, it was free. Okay. Two days back, some word, disease day was celebrated. Parkinson's. Sir, I will have to read on this. April 11. Parkinson's. Okay. Who is the senior most law officer in the country? Sir, it is the attorney general of India. Okay. And second senior most? Sir, solicitor general of India. Thank you. Thank you, sir.  Sir. What are the common viral or bacterial infections which are there in Bihar? Sir, the viral would be sir, smallpox, sir, dengue, and sir, chicken guinea, and sir, in bacterial. So, there are instances of salmonellosis. Sir, acute dial infections due to E. coli. And so, this is what I can recall. Do you feel Bihar has been left out of India's growth story till now? Sir, while there is an instance, a decade when Bihar's growth was not at par with the national growth, but sir, in the recent 10 years, Bihar is on the path of development and becoming a sava in the growth process of India, sir. Okay. All right. And how is Bihar utilizing its demographic dividend? Sir, there have been negatives as well as positive aspects to it. Sir, the unemployment rate has been higher than the national average in Bihar. And sir, outmigration has also led to underutilization of the demographic dividend. But sir, in the recent 4 to 5 years, Bihar has been able to rope up its human resource for its own development by setting up certain mega food parks, food industries, textile industries, like staff, sir. You know, a doctor is already a public service, being a doctor. So, why do you want to join the civil services? Sir, civil services would give me an opportunity to diversify my area, sir. So, later on, I could be associated with policy making. And sir, I can deal with health on a whole. For example, sir, in the field of water, in the field of sanitation and preventive health, sir. And sir, apart from this, there is also a personal anecdote to it.  I also got an opportunity to interact with certain imminent people. And sir, I saw that administration has a huge role to play. Even the delivery of healthcare systems could be concerned. Okay. You also do journaling. Sir. What is the utility of journaling? Sir, journaling helps me to bring out my creative expression. Sir, journaling also helps me to bring out my emotional intelligence when I am able to write down the kind of emotions that I feel. And sir, in that way, I am also able to regulate them in a better way. Sir, apart from that, journaling helps me to plan my life. For example, sir, how do I see myself five years down the line? What I need to do in cases of social issues? That is also one of my hobbies. So sir, journaling has helped me to become a better aware and informed person, I would say. Okay, alright. You also do skits. Sir. What is the definition or meaning of a skit? Sir, skit is the expression or the experimentation of a real-life incident which can be told through a story. So, is it a sweet play kind of a thing or how exactly does it work? Sir, it is not exactly a screenplay-like thing. Sir, it basically hovers around the real-life stories. It cannot be fictitious. And sir, it involves certain characters who portray certain roles so as to convey certain messages to the society. So, what contemporary social issues you have written? Sir, recently I wrote a skit on the impact of social media on children. Okay. And what did you write? What has been the impact? Sir, the impact could be seen in all spheres. Firstly, the children are losing their interest in their own studies. Sir, this motivation came from my own 13-year-old cousin whom we saw that was so much engrossed into social media during the last two years because of which her studies were hampered. So, sir, that I could say as the first impact from my own experience. Sir, secondly, there is a psychological impact of too much being on social media. Sir, thirdly, teenagers could fall into prey of blue whale games and certain stuffs which could jeopardize their mental health. As a fourthly, even the smaller children, so when their screen time increases that has an ill-impact on their eyes which could lead them to be myopic in the near future. Last question. You have done telemedicine during COVID-19. Yes, sir. So, do you think telemedicine is effective? Sir, I believe telemedicine is effective. Sir, telemedicine is a good way to look at diseases for which patients need not visit the doctors. Sir, in this regard, telemedicine can solve some issues regarding the lesser doctor-patient ratio that exists. And, sir, telemedicine could be a harbinger of health changes at the very ground level. However, sir, the issue of digital device and the praise of the doctor to not be able to physically examine the patient is a limit to it. But, sir, I suppose that in the near future it has a bright thing to do in our health system. Is it regulated? Sir, it is regulated by a guideline that was given in 2020 by Niti Ayo and Ministry of Health and Family Welfare. Sir, however, concrete guidelines are yet to be given. Yeah, Anshu, so which silk is this which you are wearing? What do you call this? Ma'am, this is Bhagalpuri silk. Bhagalpuri silk? Yes, ma'am. Okay, and how is this and the print is also what do you call this? Ma'am, this is Madhubani painting. Yeah, all from behind. Okay, and how is the situation? This is what kind of industry it is produced in? It is like small scale or medium scale. What exactly is that? Ma'am, it is small scale. As of now in the areas of Bhagalpur and Munger, ma'am. Okay, and how is the situation of artisans who are working on this at the moment post-COVID now? Ma'am, unfortunately, their condition has not been that bright post-COVID. Ma'am, before COVID, Mithila paintings and Saris with Mithila paintings had huge market share, but ma'am, due to the impact of pandemic and drying up of the capital, this industry has not been doing that well, ma'am. Any products from there which has GI tax? Pardon, ma'am? Any product from Bihar which has a GI tax? Ma'am, there are products like, ma'am, Zardalu mango is one such. And ma'am, apart from that, ma'am, I will have to read. Ma'am, what is so special about Bhagalpur silk? Ma'am, Bhagalpur silk is known for its huge and very good quality of the silk that is being manufactured over there, ma'am. So, when you say good quality silk, what does it mean? Ma'am, the silk is not that prone to environmental damages and weather effects, ma'am. Can you just explain that how? Ma'am, I may not be sure about the mechanism. I will read on that, ma'am. Migration. So, what is this migration stress and why so many people migrate from Bihar? Ma'am, migration stress is the outflow of human resources from Bihar. And ma'am, the reasons could be, ma'am, firstly, lack of industrialization in Bihar due to which unemployment rate remains high. Ma'am, secondly, it is also about the prevailing law and order situation. Ma'am, in which many Biharis who are affluent find other places much more secure. And then, thirdly, it has to do with the aspirations of Biharis. Ma'am, Biharis are always open to experiencing changes in the outer world and states outside. So, ma'am, please. So, the reservation in different states, reservation on employment. Does that impact Bihar's economy or the living of Bihar people? Because in a lot of states, there are a lot of people from Bihar who migrate to different states. For example, in Haryana, there is this reservation now. So, how does that impact Bihar? Ma'am, in Haryana recently, there was reservation announced in the private sector job map. Ma'am, if that is enforced, that could hamper the migration of workers from Bihar to Haryana. And ma'am, the workers of Bihar are well trained. They are available at a very dear rate. And ma'am, they add to the economy of other states like Haryana. So, ma'am, in that regard, there could be certain issues. But how do you view this, that instead of focusing on their states and instead of contributing in their own state, they are contributing in some other state, economy of other states? So, what is your view on that? Ma'am, I think there are both positive and negative sides to it. Ma'am, talking about the negative sides, ma'am, this represents the outflow of human resources and human capital from Bihar, which could be retained in the state for the betterment of the state. But ma'am, talking about the positive aspect, ma'am, I think the workers or the labourers of Bihar are contributing to the GDP of our nation, in whichever states they are, ma'am, and enhancing their economy. But ma'am, we should try to retain them in our own state by industrializing our Bihar so that ma'am Bihar prospers on its own dint. So, how is Bihar contributing in that? Ma'am, Bihar recently, ma'am, the Honorable Prime Minister announced for a mega textile park in Bihar. Ma'am, secondly, there are renewable energy projects, which are under the guidance of NTPC in Bihar. Ma'am, thirdly, Bihar is also going for huge production in agriculture and contributing to the food security of nation through Pradhan Mantri Garib Kalyan Yojana. And ma'am, the artisans that you mentioned in the beginning, ma'am, we also are having certain programs to map the skills of artisans so that ma'am, we can revive the textile sector of Bihar. One last question. Life of a doctor and life of an administrator. How are they similar? Ma'am, both the jobs come with their own challenges and ma'am, in both the jobs, the ultimate aim is to go to the grass root level and look at the problems of people. Ma'am, as a doctor, I mainly look from the aspect of health and curative part, but ma'am, as an administrator, I would look at their health from a very holistic part. For example, ma'am, what is the role of society, the role of economy, the role of quality in causing the health condition? As an administrator, how would you ensure or how would you promote or encourage more doctors to come and work in rural parts of Bihar rather than migrating to other states and other countries for work? I guess ma'am. Ma'am, we need to install infrastructure in the rural areas so that ma'am doctors are able to utilize their own talents. Ma'am, from my own experience, I feel that doctors are quite willing to go to the rural areas provided that their talent is given justice to. So ma'am, that could be one issue. Most of our infrastructure in health is concentrated in the urban areas because of which the avenues in rural areas are almost absent. Ma'am, the second thing that I could do is we could allow these spouses of doctors to remain in the same colleges in rural areas ma'am. That would serve as an incentive for the institution of family. And ma'am, third thing, ma'am, we should encourage more students from rural areas to enroll into MBBS courses because ma'am, rural students who have such kind of background would find it more fruitful to go back to their areas and serve the patients. Thank you. There is another bridge also in news from Bihar in the last 1-2 weeks. Yes, sir. What was that about? Sir, that is in the Rathas district. So it was a defunct bridge not used.  Stole a bridge? Yes, sir, I am aware. What is the experience of prohibition? How do you see prohibition in Bihar in the last 6-7 years? As a woman and as a person living in Bihar, how do you see this? I say prohibition laws was intended in a right direction. And sir, there are certain positives to it. For example, sir, the NFHS data shows that there was a 14% reduction in the domestic violence against women after the prohibition law. Sir, second, there was also an increase in the consumer goods consumption. For example, sir, the consumption of honey is what a report exclusively cites. And sir, there was reduction in the cases of eve teasing. But sir, the implementation of the law has faced certain issues. For example, sir, we were not able to tackle the parallel illegal liquor and illegal market that surfaced in Bihar and the cross-border smuggling of alcohol that takes place. Sir, apart from that, we could also see that the poor people are disproportionately burdened because of this law. And sir, thirdly, as the Honourable Chief Justice of India also pointed out that the Patna High Court has been flooded with certain litigations concerning the prohibition law. So, although sir, the impact was assumed to be very noble and it has also had certain aspects. But sir, we do have certain challenges in front of us. Should we implement this at a pan India level? Sir, I may not say to implement it at a pan India level. Sir, I say this because first of all we need to make people aware about what are the consequences of taking alcohol. Sir, unless people themselves know the kind of harsh effects that this could have on health. So, we may not be able to actually de-addict them. And sir, second thing is without having de-addiction centres sir, without seeing the illegal trade that could flourish this should not be implemented. And sir, Bihar is a case in point that shows that even though the intent of the law is noble we need certain prerequisites for it to be successful. Is Bihar still considered to be a Bimaru state? Or what kind of development has Bihar seen in the last one decade? Sir, Bihar has seen quite a lot of development. So, for example, the annual growth rate of Bihar has been 10% in the last decade which is more than the average of India. Sir, second Bihar has seen almost 10 to 17% rise in the literacy rates. Sir, third is Bihar's agricultural production has also increased a lot. And the fourthly in the domain of gender development and gender equality with Yojana like Karnakarnya, Suraksha Yojana we have tried to achieve the gender equality aspect as well sir. So, sir, I would refrain to call Bihar from a Bimaru state and would say that Bihar is on the path of progress and development. Okay. COVID has taken a lot of attention away from other diseases like TB, HIV, etc. What has been the impact of COVID on TB, HIV? Sir, the recent tuberculosis report says that we had increased incidences of tuberculosis during the COVID pandemic. And sir, similar is the case with HIV diseases. Sir, that basically occurred because our entire health infrastructure was directed towards the management of pandemic which perhaps shifted our attention away from these diseases in general and other diseases as well. What are the new variants with respect to COVID and how well prepared are we to deal with this? Sir, we have recent variants in the form of XE, XD and XF. Sir, XE and XF are the recombinant variants of Delta and Omicron. And sir, XD is the variant of Omicron VA.1 and VA.2, sir. Sir, the WHO guidelines say that these are more infectious, but sir, the clinical outcome has not been ascertained. And sir, as far as the preparation part is concerned, the health ministry has said that we are well prepared to face it. And sir, having seen the pandemic for last three years, I suppose that our medical infrastructure is well equipped to handle any pandemic if it comes in the future. You have written a combined medical service examination. Yes, sir. Result awaited. Yes, sir. Let's assume a scenario where you get a positive result there and you get a rank which does not get you the top three, four services. What would you choose? Sir, I would like to go for civil services. Civil services, even if you get the combined medical services. Yes, sir. Thank you. Thank you, sir. Thank you, sir.


here with theCUBE. We're at Stanford University at the Ariag Alumni Center for the first annual Women in Data Science Conference. We're really excited to be here. We got invited, came over, I think it's about 500 women are here talking data science, some keynotes, some panels, and there is no other poster child for algorithms and recommendation engines than Netflix. We're really excited to have Caitlin Smallwood, the VP Science and Algorithms for Netflix. Welcome. Thank you. It's been a great day so far.  It was fascinating. I think we could sit down and go for like an hour to follow up on all the things, but we won't do that. I'll only hold you for a few minutes. But the first thing that just jumps off the page, I think it was your first slide, was the simple thing as the name of the labels when I look at my Netflix screen, you said there's over 50,000 row names. That's right. One of the biggest pieces of evidence of your personalized recommendations on Netflix are those row labels. And some of them are very intricate, romance dramas with intense female characters or something like that, right? And so these very specific labels, it's interesting to study the distribution of those and how much they're viewed by different members and over 50,000 combinations, which is somewhat a function of how we even do the labeling and the tagging of the titles in the first place, of course. But it's just fascinating to see how tiny the head is and how very, very long and flat the tail is. It is, and that you can extract enough value to really slice and dice it to that degree to have such a long tail, because obviously you wouldn't do it if it didn't pay. So what are some of the things that you measure that say it is worth that 49,827 label for Jeff that we know that it's working for him? Yeah, great. So obviously we can't study every one of our 69 million customers and understand your tastes deeply and see what worked for you and what didn't. Instead, what we'll do is compare different algorithms that might use different labeling techniques or might use different mechanisms for showing those labels to you, right? And then we can kind of compare and see over time who's retaining better than members who saw this set of row labels, maybe, or this set of row labels, or different algorithms that are powering which ones get surfaced to you. So it really comes out of being able to compare whole populations. And the row labels was just the first of many of those attributes that you think is just kind of a basic distribution of metadata around the movies, but there's actually, you guys are optimizing and tweaking on a whole bunch of those things. Yeah, that's right. And in fact, the algorithms really are mostly unsupervised learning, meaning we're really looking at the raw structure of the patterns that are going on in people's consumption and the patterns of that data and what's successful for people and what's not. And it's less about first labeling the rows and then figuring out which label works for you. It's not that so much as finding the clusters of content that are interesting to people and then after the fact kind of putting a label on there to help humans navigate. Now you talk quite a bit in your talk about experimentation and really being active in your experimentation process. Talk a little bit about that versus just kind of, there's this vision of big data where you throw all the data into Hadoop cluster and magically all the answers are going to come out. And would you clearly say no? There's a very active hypothesis driven experimentation that we're doing as well. That's right. And we definitely from top down throughout the company we really very dedicated to the idea of experimentation. It's the one thing that can really help you get at causality instead of correlation. So even the best of statistical models with the best of data as an input, it's still correlation at its core rather than causality, right? And really a controlled experiment is the only more reliable way to get at causality. Causal inference, that set of techniques are really fantastic and you can't always, for practical reasons, run an experiment. And so in those situations, sure, the models and algorithms that are out there are certainly much better than just human judgment alone. But still they don't hold a candle to what you can also learn if you augment the practice of experimentation on top of that. And when you say you're getting to causality because you're using basic scientific method with baselines and fixed positions that you're experimenting against, you're doing AB, you are actually driving kind of classic scientific method to get to causality and not just correlation. Yeah, that's exactly right. Just like those middle school experiments you did in the science fair, it's just like that just on a very, very different scale. Very big scale. So a big part that you talked about too was ethics. And there's a lot of ethics around experimenting. And you talked about it kind of at length, that you've got customers that are paying. You know, I'm paying, Greg is paying, but maybe we happen to be the subject of two different experiments. And really being sensitive to the fact that, A, you want to deliver a better service, you want to get the data to deliver that better service, but at the same time, these are your customers. Yeah, that's right. We feel very strongly about being great stewards of our customers' data and really using it for positive purposes that are for the customer and not for us as internally for curiosity or things that we might learn just for fun, right? And so we take great care to think carefully about our own sort of internal guidelines around what types of experiments we'd run or not run. And also giving customers control to opt out of experimentation. It's an account setting that you can go to to opt out. Probably what most customers don't understand is, if you opt out, you're still gonna get a lot of change in the product because we're always changing the product. So you wouldn't even really notice necessarily, but still we feel it's the appropriate thing to do. And then we take great care to never run an experiment where we're ripping out a core part of the service. Like, no matter who you are and what experiment you might be participating in, you're always gonna have access to all the content on all of our devices at all times, unlimited streaming. We wouldn't run an experiment where some people could only stream on weekends and other people could only stream during the weekdays or something crazy like that, right? So we're very careful to be fair about the kinds and with positive intent about the experiments. So the other part that you spoke about that I would have never guessed, right? Recommendation engine, of course. Give me a movie that I wanna see. But obviously Netflix is much more involved now in your own original content development, right? We're doing that in the old days, the DVD days, I guess there's still some DVDs out there, but you guys are developing your own shows. And I thought the story that you talked about and using your own data to try to figure out kind of the scripts that you're looking at, the shows to produce, and even the names of those shows for uptake was a fascinating story. I wonder if you can share a little about the audience that wasn't in the talk. Yeah, yeah, sure. So that's actually one of my favorite areas of trying to apply data science at Netflix is this area of originals because it's an incredibly hard problem. You don't really have any data to speak of when you get a script from a writer. You might have a little bit of a talent attached to that project, right? But you don't really have much to go on from a big data kind of perspective. So what we try to do is triangulate and leverage really the expertise that our content organization has. They've got all this deep expertise. They can read a script and they know a lot about how successful that script might be. So we try to leverage their knowledge to piece that together with other data that we do have. What are the titles that they think are similar that we have already on Netflix that might be similar to what they envision this script becoming? And then from there, we can kind of get a little deeper into the audience that might be interested in the title. Depending on how it's executed, there are still many, many unknowns, right? But it still really helps us kind of play so which portion of the audience might we be satisfying with this new project and is it worth a big investment for us or not? Because we really aim to satisfy that long, long, long tail of member tastes. And beyond the title, you must do it for cover art too. I mean, I just think back to the old days, right? Before Netflix, before recommendation engines, you would go to the video store and really alls you had was the title. Maybe there was like new releases and you had the picture on the cover. I would imagine doing very similar things with the actual photographs because as you're scanning through, of course, it's a great recommendation engine. They're going to give me something I want to watch but it is really a function of those two then to maybe go to the next step, check the reviews, go to the next step, see who the actors and the actresses are. Yeah, that's totally true. We try to get into the weeds on all that stuff. We have endless dreams of experiments that we would love to run or things we would like to try in the service. Some of, you know, we have to always, of course, be very sensitive to our partners the studio partners and others that we work with the device partners and studio partners who are massive part of our Netflix ecosystem, right? And so often they have particular requirements or preferences around say the images and things like that that we have to be very careful about. But with originals, you know, we have more flexibility there on the kinds of things we can try. It's really exciting to have that, you know, the platform that can be so flexible like that, yeah. Well, I wonder if you could talk a little bit because you guys do a lot of stuff. Some of the business decisions that you make in terms of business trade-off because there's a smorgasbord of things you can do. You've got X number of computing horsepower, which goes up and you have a lot more than you had years ago, but right at the end of the day, you got to make trade-offs. What are some of the factors you guys think about when you're making some of these business trade-off decisions about should we do this or should we do this or maybe that's got value, maybe not, or is there a way you can kind of jump in halfway? How do you make some decisions? Because you don't have ultimate, I mean, you don't have infinite computing horsepower and you don't have infinite budget to do these types of experiments. Yeah, I mean, that's obviously a really tough question. It really depends on the specific decision at hand and what are all the trade-offs at play. I would say generally we're quite a thoughtful organization from the perspective of the people who are hired tend to be very strong experts in their area. And so we have product innovation leads who are focused on different parts of the product, right, who are very, very, very strong at their ability to make strong, good judgments and they'll evaluate all the data through the data sciences or other things as well as competitive information or what have you and make a strong decision. But we have a lot of internal debate, which I think helps because it surfaces all the things that one might wanna consider when making a decision. All right, so last question before I let you go, what are you most excited about that you're working on say in the next three months? Ah, well can I answer in two ways? All right, one thing, the thing I'm most excited about Netflix lately and this is a newer one as we've moved toward going global. We're aiming to be totally global by the end of 2016. And to me this brings me a new sort of personal philosophical satisfaction in the idea that we can actually share storytelling around the world from stories around the world. So the idea that cultures can get more knowledgeable about one another, more comfortable with another, learn in subtle ways through entertainment is really super motivating to me. So I'm deeply excited about that. And then in terms of data science, I'm particularly excited about some of the stuff we're doing in the content space right now where we're really trying to marry, it's a difficult space, because we're really trying to marry that, like I said, that creative expertise with what is the information that we can empower. And so we're doing a lot in this space of originals and trying to really help empower those decisions, but not in any way get in the way of the creative piece, right? And so how can you have tools and things like that that let the creative folks play what if games about their potential content that they're thinking about in a way that really informs them in a trusted way? All right, well, it just begs the question on the recommendation engine. What, you know, you're sending me stuff that you know that I'm gonna like versus maybe I need to see something I've never seen before from South Korea or Japan or India or whatever. That's a whole different type of a challenge because I want to explore, I don't want to see what I'm used to seeing. Yeah, that's definitely true. And that's when we hear, you know, we hear that from customers that people are worried that they're getting, you know, put into a box. We do actively experiment with how much diversity we share and how that diversity unfolds over time for customers. So we generally have discovered that we're really not keeping people from any type of content that they might not otherwise see. I sometimes play around that with that, which anybody can do with Netflix, go in and create a new profile. And then it'll start without personalization and you can kind of start over and see, oh, is there like a vastly different set of stuff that you see that you wish you would have been seeing, you know, and that's kind of an interesting game you can play. You're just gonna say log in and watch a couple of movies that you usually don't watch and see how that scrambles everything. I'm not sure you can do that too. All right, Caitlin, well thanks for spending a few minutes. Great talk. Love to get you on another time. Really enjoyed your talk. Thanks so much. Absolutely. So Jeff Rick, we are at the Women in Data Science at Stanford at the Ariaga Center. You're watching theCUBE. Thanks for watching.


All right, good morning cyber traders happy Friday everybody How's everybody doing? All right. Good to see you John Mark. Good to see you. All right Hilmer Jason Glenn look at all those great names JJ Neil Tom mark. All right. Good Al Rogers Craig good to see you. All right everyone. So let's get started. Happy Friday everybody Today's a very very special day for me. I want to share it with you My oldest son is going to graduate. So Very very happy very and it's also his birthday to 18th birthday and graduating today. I think it's great, you know So while I'm getting into that league with some of us in that are in this room, huh? Thank you very much. That's right Alex. I very congratulate him and I'll let him all know that all of you feel the same You might be seeing him in the cyber group room shortly You want to do a summer program at Cybertrade University and learn and learn and learn how to trade with his friends Wow, he would be happy to receive a car wouldn't he Mark yeah Let's not push it. He did but you know Let me let him teach you how to trade to go by his own. We don't give free stuff around here You got to earn it makes it worth even makes you appreciate even more We do give Benio we do give scholarships, you know and You know it it's on an on a merit system, you know depending on We'll give it. We'll give it. We'll give some bonuses, but he has a little in with the owner So we'll see we'll submit his his letter and see full accept him All right guys, but let's get right into it. Let's talk about what's happening tomorrow what happened yesterday remember today is Friday and When when it is Friday, it is an absolutely gorgeous day I always focus on the weather because remember this is summer It's a and with summer a lot of people want to go away. Enjoy the weekends. So a lot of companies will come up They'll come out with news some of them don't There are a couple of things that are making some big moves I know a lot of us already have traded him early this morning got some really nice pushes specifically with that RE&N and we'll talk a little bit about that one that one had some Unbelievable buy orders out there, but we're gonna check out that one But let's talk about what moved yesterday because there were a couple of good nice moving stocks that did pretty well first of all IQ I don't know what the hell happened to that day.  I don't know what caused it But I know some of you did the short on it. You did pretty well. They're real good steady shorts pretty fast Also, TWTR was also a really nice short Some of you guys did great more from 46 down to 44 not as much as IQ did But it also had nice little bounce everyone did pretty well on that one David G did pretty well He made over $2 on it and he also traded the HU the HU YA You know, he because remember they follow both side-by-side, you know, let's give him a round of applause He did pretty well on that two bucks on it It's good money We go deep go way to go Dave and John B. They pretty well I've got to mention you need a over a buck on the Twitter short get to him And Also, we had the X-Bot that did really well Xbio that one was a real had a nice push early in the morning went from three all the way to seven It's just talking about a short squeeze. That's that was a short squeeze at his best S-Bot was also a great one we traded yesterday That one went from a buck 90 to about 320. That was a great pre-market mover We did really well and then I don't know what the hell happened with the dryers. Holy cow You know, I was talking Real I was in a middle of conversation. So when I'm sitting here watching this thing and all of a sudden the thing goes from 520 to 620 And we killed it yesterday going right into the clothes.  I know Dana's been watching the dryers for a while but Then it started backing off. I'm like, damn, you know, I had so many shares of it too And uh, I still my my p&l just go into thousands and I'm like You know, all of a sudden the things started to reverse on me like, uh, man, come on So, uh, it's still been pretty good. Listen great traders guys always remember They we never buy at the bottom and we never sell at top. You always buy in between so if you remember that All right now with that said guys a couple of things before we go through today's watch list Just don't forget today. Josh is going to be finishing up phase two today Recordings will be up on your dashboard tonight to review them So, uh, you so go out there and make sure you review it. Remember every class is different You need to focus on them. Um, remember you got to learn before you could earn And when you guys come in you do when you come to our free events that we do we host all the time You'll see some of the people that you're competing against a lot of them Want to join and they become a member of ctu But you know, you have to understand that You just can't see some of these stocks that we're trading that up, you know, 200 300 a day 50 a day 20 You got to know why they're going up. You got to know who's buying it. Who's selling it You got to know you do your journals You got to know if they're tradable everything and you could see you got to know how to trade pre-market All these things are very very important factors. So always keep an eye on it All right. Um, now let's go and talk about what's moving this morning. Now, obviously the re nn was unbelievable You guys saw what happened That was a great stock. I mean you saw 100 000 share bids come in Stock only traded 1.9 million shares already But you saw those big orders and the stock just went from a buck 30 all the way to a buck 90 I still like it. I mean it's up 100 already You could see it, you know, if you got in here and early bird got a worm when you're supposed to I'm sorry. I I I dislex that early bird gets the dot it gets the money If you got into re nn you did pretty well on that one But I still like going to the close so and if you feel like you're chasing it We you could always trade one share All right, so we could do that abio is another one that's moving this morning Kind of backed off.  So had a nice little pop early and uh Up 30% you could see it nice little cheap little stock spreads a little big right now But this stock you got to buy in the bid Don't be go buying it at the offer because you're going to lose that spread Remember that was one of the biggest things that we teach you in phase one Doesn't matter what the ticket charge cost you that's the cheapest part of the trade It's the it's the spread you got to worry about sl and oh here's another one I just came up on my radar another little cheapy right here his stock at 250 It's already at 320 nice little push Stock is testing, you know December highs great iceberg orders look here on the matrix You could see some iceberg orders people already trying to Position themselves in it fill the waters for some of their retail clients So that one looks like a good one going to this open TNDM I spelt that wrong TNDM Here we go Here's another one that has been just been flying lately I mean this stock since april was a four dollar stock. It's been a sleeper I guess not too many people have been knowing about it, but it's um I haven't been noticing as being a good day trade, but it's been a great great swing trade So it's it gapped up pretty big this morning. It was as high as it was 27 thumb down to 2390 You know, you got to use yesterday's pre-market to kind of get a good sense of where support levels are Only thing I didn't like the this stock I was trading is the very very small tier sizes Ken said he made 29 cents on the the TNDM. All right, where'd it go? Ken? Looks like you're already on top of that for a while, huh? All right, so we got a couple more here. I want to talk about the gr bk trade Here's another one that is trending down getting crushed lately Listen, we do got shorts. I I personally like shorting bedding going long shorting is so much easier It's it's it's so much more consistent And you know, you always get more pandemonium on a short thing going long So this one I don't know if it's on your shortlist right here. This one looks like it's trending down So that one's going to be on our watch list the t uh, no he's felt the one y t r a Is another one that's not doing too well down 7 300 000 shares traded I don't know if this one's going to be on your short list But check but this one looks like it's breaking lower lows Uh, also breaking 52 week lows Another little cheap little stock some people look at and says well, it's a five dollar stock How much lower could go? I can still go down five more points. So don't uh, don't underestimate it KMX This one's more on the expensive side. Um, it's you know, it's up eight percent It's got a big spread if you're a level five trader Car max, you know, it's got a nice little push been gapping up nice little fossil flags right there you could see So this one you got to be a little bit more of an advanced trader So this one you could you could look at this one and last but not least, you know Which is all over the news is red hat red heart getting crushed right now Uh, you could see after hours I guess earnings must have came out 170 down to 150 down to 144 Level five traders here. This might be your this might be your gig right here If it breaks the support levels right around here back in april Uh, you could see a sting all the way down to about the 130. So a lot of room there Um, just don't trade a lot of shares of this thing because the stock could really it's gonna be Stock's gonna move in dollars not in not in not in pennies But this one if you're an advanced trader to write up your rally So we got some cheap ones for the beginners We've got expensive ones for the advanced traders So we got a little bit a little bit of both worlds and as we see them We'll go out there and share ideas in the room anything. I'm missing guys I did not call out that I found that I did not find that you might have Anybody see anything else All right, so um Yeah, you don't run. I sold the g evo Listen, we made so much money with g evo. Just I personally think we should just stay away from it You know, we we we made money from going from 4 to 24. It's on a downtrend You know, I would just stay away from it Ron now now they got a lot of program trading kicking in you're gonna have a lot of You're gonna have a lot of um Amateurs trading the stock just let's let's let's trade but let's trade the new ones before Listen, it might change if I see something change, I'll I'll share it with you guys right now I personally would just stay away from it. Let's not go back to something that we Uh, that would be a lot of money and by the way, kem was making fun of yesterday about the dryers trade It's like I'm trying to get even with dryers. Listen, I mean that was a good trade yesterday I mean, listen, I got one one foot out the door One in the door. So getting ready, you know, you got always got to be prepared But this one because we already made a lot of money stay away from it Kenya lost I'm always gonna sucker you in, huh Uh, all right. So anyway, uh, listen guys, it is Friday if I don't see you this afternoon Enjoy your weekend. Remember, this is a two hour trader We made a lot of us already made our money for this morning in pre-market But um, but remember there's gonna be a whole new list of stocks that will come out of the out of the woodworks When the market opens up so not every one of these is going to make big moves So I'll put them in a watch list and then like I said, if there's anything out there Always remember see something say something. All right guys. Good luck. Everyone found see you Enjoy class today phase two Make sure you watch your videos do your homework And get ready for monday. Good luck. Everyone happy trading


So today guys we check out a new DLC for legendary shotgun. It's called the blind sage It's a maliwan weapon, so we kind of know what to expect What is this new legendary actually any good? How's it going guys? My name is DPJ and if you enjoy your stay here and would like to show you support You can by hitting that like button or subscribe if you like what you see and want to see more And before we go any further guys for all your gaming needs No matter the platform you play on amazing prices and incredible weekly deals check out G2A linked with in that video description So this blind sage is a shotgun which should be honest I ain't really to show about on a personal level I do feel shotguns are limited and for this reason alone. I don't much use them I mean There's that odd time when they release them with DLCs or events and you get that one That is just stupid overpowered like the anarchy, but overall I probably say they are my least used weapon Now when I saw this drop, which by the way I believe is a world drop and it's dedicated bus drop is a little comorbius That big old dirty train located on sapphire's run But when I first saw it drop seeing it up on the floor Immediately got my attention due to what it offers besides that wild damage stat Damaging an enemy applies a debuff to that enemy Which lasts eight seconds kill the enemy before eight seconds is up and it fires a projectile This got my attention straight away weapons that benefit from buffs and debuffs for some reason grab my attention So I jumped straight into the system of slaughter to see what this thing was capable of and well I'm still not sure about it watching how it works It doesn't actually seem to shoot anything but an energy blast And we've seen this on previous Mali-Wan shotguns a blast which sometimes does great damage and other times Just tickles that enemy now the debuffs enemy and that projectile. I can tell you do some great damage But other than that I wouldn't if I'm honest rate this shotgun that high now I play a particular way using mainly zane and this just doesn't fit what I look for in weapons Especially shotguns, but it might be different for you You may be watching this video seeing something great about this weapon that will fit your build And I actually think this is that kind of weapon I think it's a kind of weapon where you're either gonna love it or hate it now this blind sage I do believe like all Mali-Wans or most Mali-Wan weapons has the option to switch between two elements and any elements at that I do believe so that's a good thing But yeah guys all in all for me Just isn't that great of a weapon for the way I play its damage is slacking Considering it's damaged that value on that item card and using it to be dependent on that debuffs projectiles just isn't worth it in my opinion So yeah, I recommend you at least try this weapon out But for me it just really don't suit my place though and on that note guys We have come to the end of the video if you guys enjoyed it leaving a like really helps out feel new around here I want to see more BR3 be sure to subscribe and if you never want to miss a video about counter notifications on by hitting that Bell button but guys thanks as always for stopping by hopefully enjoyed video and hopefully I will see you on that next one