Thank you so much for joining us today. This is our second webinar in the transgender health series, and today our focus is on gender identity and inclusivity. The series kicked off last week, March 31, and it just happened to be on International Day of Transgender Visibility. We heard from Dr. Cheryl Holder and Daria Lester and they spoke about the intersectionality in health disparities, specifically for black transgender women. So today is April 5, 2021, and we are joined by Dr. Lee Pham and Dr. Allison Tao, and they're going to share their experiences with gender identity, inclusivity, and how they make up and how they are affected by the social determinants of health. So this session is being recorded. We will email that to the email addresses that you provided when you registered. We are using Zoom's transcription feature, and for those that are interested, you will receive one hour of CE credit from the Medical Library Association today. So Rebecca is, oh, she just posted in the chat. So she's going to post the link at the end of the session. You can fill out the evaluation and receive that code. I'm going to share my screen. So I'm Nora, Nora Franco. I'm the Consumer Health Librarian. She, her AI, and I am here at the NNLM Pacific Southwest Region at the UCLA Biomedical Library. Hi, my name is April Wright, and I am the, within an LM also, and I'm at the University of Maryland Baltimore. And I'm she, her. Thank you. And you can see my screen right with the slides. Yep. All right. Okay. So before we begin, I wanted to start us out with our land acknowledgement. We are all working from home again, but the NNLM PSR at the UCLA Biomedical Library acknowledges our presence on the traditional ancestral and unseated territory of the Gabrielino Tongva communities. So, well, I'm going to have April, you're going to monitor the chat for me. So just let me know if there's anything. So, we do love our acronyms. I wanted to break these down for those that may not be as familiar with the NNLM. At the top we have the National Institutes of Health, which is the US leading medical research agency. It's made up of 27 different institutes and centers. And the National Library of Medicine, which is the world's largest biomedical library is one of those 27 different institutes and centers. So the NNLM or the network of the National Library of Medicine is where I work and where April works as well. And we are the outreach extension of the NLM. So we're made up of eight different regions and here in the Pacific Southwest. We serve these different states and territories. April in Baltimore, they serve that end of the East Coast part of the East Coast. Here's our mission. I'll go ahead and read that. The mission of the network of the National Library of Medicine is to advance the progress of medicine and improve the public health by providing all US health professionals with equal access to biomedical information and improving the public's access to information to enable them to make informed decisions about their health. The program is coordinated by the National Library of Medicine and carried out through a nationwide network of academic health sciences libraries, hospital pharmaceutical and other special biomedical libraries, public libraries, information centers and community based organizations. You can sign up as individual members as well. You navigate to the page in NLM dot gov slash user slash join and hit the create an account button, and you'll be signed up for our email list you'll we won't spam you we're only going to send you emails about different courses different webinars such as the one that you're on today. All right, I'm going to introduce our first speaker Dr. Lee them. Dr. Lee fam MD is non binary and their pronouns are they them theirs. Dr. Fam received an undergraduate degree in healthcare administration at Washington University in St. Louis, and a master's degree in medical sciences at Boston University before attending medical school at the University of Texas in San Antonio. They were a chief resident of the internal medicine, medicine residency at Louisiana State University in Shreveport before moving to LA. Their main interests include global health and reducing health disparities, especially in the LGBTQ plus community. Along with general internal medicine, Dr. Fam specific areas of focus are in LGBTQ plus health care, gender affirming care which includes hormone therapy and HIV care and prevention. They are a credentialed HIV specialist from the American Academy of HIV medicine. And Dr. Ali the Allison town. She her serves as the regional lead for nuclear medicine in Kaiser Permanente South California and as a faculty member for the KP Bernard J Tyson School of Medicine. She graduated from University of Michigan Medical School and completed her nuclear medicine residency at Stanford University School of Medicine. In addition to her clinical and administrative duties. Dr. Tao devotes her time to training education and advocacy for equitable transgender health care, both within and outside of KP. She helped found the multidisciplinary pediatric gender care clinic at KP San Bernardino County. Dr. Tao also helps facilitate a trans team support group and is active in her local P flag chapter. She lives with her wife of now 23 years and three sons in Newport Beach and enjoys playing double bass and feasting on exquisite sushi. So I'm going to go back and, and have Dr. Fam introduce yourself and if you can share your experiences working and coming out as transgender and gender non binary. I can explain. So I know that before you move to LA you were you were working with COVID patients, and you were living in an area that was actually not protected with anti discrimination laws, and which, which creates a huge potential economic stability with having a social supportive community. So I think that's, that's a really important piece of your story for our audience to hear just that that dichotomy right of one on one hand you're literally risking your life caring for COVID patients. And in another sense you're putting your livelihood at risk because you're not included in those same protections, the same protections that your colleagues had. Yeah. Thank you Nora for the introduction yeah I wanted to I guess we can start from there. I was a resident. When COVID first came out so I was practicing in like the south. And one of the things that people aren't really familiar with is that most of the southern states don't have protections or non discrimination ordinance for LGBT plus population. You know I could have gotten essentially fired or kicked out of my living places because you know only certain areas of Louisiana had protections and I was teaching and working in a very, in the COVID, basically a COVID floor. That's what they used to call it because it was just full of COVID patients, patients who were, this was in the beginning of the pandemic when we really didn't have any, any information about what COVID was besides that it's a virus that had very high possible mortality rates. So I came out. When I was a residence. And, you know, I, and I've been thinking about it for a long time because you know I was never really, I didn't really fit into the boxes right I wasn't just like a woman or man I was like, I didn't want to transition to become male, and I didn't really fit into what I thought was female so whenever I learned more about non binary or gender non conforming that really resonated with me and I felt like that was who I was who I am. And it was a moment where I had clarity in felt more comfortable within myself, you know that that's like the main thing about being is authentic within myself and then because I'm authentic with my myself I feel more comfortable being out. And so one of the things that I did kind of, you know, there's a, and using they them pronouns. So one of the things that I ran into was, you know, it's a learning curve for everyone, and especially for patients but during this time, you know, in the south. There, there's an ingrained belief that you should say, yes sir, yes, ma'am, as a sign of respect. And so, when patients come in, they are I get misgendered all the time serves ma'ams. And part of me understands that it's a sign of respect. But the other part, you know, I use they them pronouns, and it's not really a time to educate when patients are being admitted to the hospital they're in crisis they need help. I'm there to help them, you know, it's not a time where I'm like to say, actually, I use they them pronouns and here's the reasons why you know. It's time to kind of make sure that they are being taken care of in the hospital because you know they're acutely ill, especially even more so during during a pandemic. And you know that felt like I had to ignore part of myself in order to take care, take care of patients and after a while, these things tend to add up or like be very detrimental to I just read like yay for utesca. Yes, utesca add up and you know at during that time everyone's stress already you know the hospitals have stressful place to work at and then you add being a pandemic, and then you add and being gender not conforming. And it's, it's a place where I know it's, it's very hard, you know. And when you add in living in an area that didn't have if if you were living in an area didn't have protections then you have this fear of like oh if I'm out you know what if I don't have a job or what if I can't have a safe living environment, then that all of that combines into a place where how are you how am I supposed to take care of patients to the fullest degree to the best when I'm also dealing with all that other things so and you know using people will say I guess you know it's a small change like using the pronouns but whenever people use my the right pronouns it gives me a sense of it shows them that you know it's affirming you know they see me for who I am and so it's an inclusive environment it's it's a way to show that you are aware of a broader I guess rainbow of people and that are human and that you know it's the same as knowing people's names are asking you know what's your name you know what's your pronoun and then just using it you know I think it's really good to know that you know as long as you don't have to the pressure is like oh what if I mess up and you're like it's okay you just correct and move on and I think that's the the biggest thing yeah yeah definitely and being open right and being open and realizing that that there is that there is more than one gender that people identify differently so I see we do have a question in the chat about the pronouns and we're going to go ahead and let both of our presenters speak and then we'll get to the questions but you know we probably won't have time for everything we only have an hour but you are going to speak on the pronouns more in a little bit Dr. Pham so we'll get to that piece and then you know I I want to also you know pass this to Dr. Ali Tao and you know let her share share her story as well yeah thank you thank you so much for sharing yours Dr. Tao everyone alright thank you thank you thank you Dr. Pham thank you Nora hi everyone I'm Ali Tao thanks for the wonderful introduction Nora and here to share my story with you and I'll just let and also know that the transgender community is not a monolith we all have a story and every story is different just like everybody else just like a fingerprint everybody's is different and you know I always think about like what's the best I can describe gender dysphoria for people especially for those like you know the 99% of the population who doesn't experience it I'd say is like this you know gender dysphoria is like chronic pain and chronic pain is one of those things that doesn't get better on its own it actually just gets worse until you do something about it but something else about chronic pain is also that at some point you don't you lose hope you feel like you can never be free of it so that discouragement that honestly you just give up and that's kind of what it's what it's like to live with gender dysphoria and that's not my story too and one more thing about say gender dysphoria is this is like I know all of you woke up this morning and probably taking you've all taken like thousands of breaths and I'm not going to ask you is how many of you really aware of any single one of them probably not you're not aware of it unless there was a problem and like and for me and but I've been asking you about gender how do you know your how do you know your gender how do you know how you identify but it's not like you woke up you just know it's one of them you woke it's not like you it's not like you woke up one day look down the inventory of body parts and I guess I'm I'm this or that you know I'm it just is kind of like you don't think about it but like for me and like gender it's been like that I've always been aware of it it's like I've always been aware of my breathing it's like ring where breathing there was because there was something wrong and even from my earliest memories from like I was three years old I remember gender was always part of it and always wondering why you know I guess I was a relatively happy kid for just for know when I was young from like three you know just because boys and girls just play together and of course my preference is always just hanging out with other girls and so that was alright and what happened was I remember my family we moved a few years ago and just my parents yes I'm the product of two tiger parents so of course like the good tiger parents they saved everything saved every report card every certificate everything but I remember looking at it and I was looks like I was a kindergarten first grade I remember I was actually they said I was like I was a happy kid we kind of a little silly a little daydreaming but something happened in second grade where all of a sudden I was very became very withdrawn where yeah I didn't smile much anymore and I was thinking back what happened that year because that was the year when and when all of a sudden they started enforcing sort of gender lines kind of gender stereotypes that gave the boys lined up here girls lined up here and and this is what boys do this is what girls do and this is what and this is not what you know and and but of course they say that and anything else is deviant and now I was wondering why how come I couldn't be over there with the rest of the girls those are like oh they're my best friends and them I couldn't really understand why that was the you know that's the way the world was without really good understanding about why I felt the way I felt and why things were harder things felt hard and things also discouraging and of course is growing up in the 70s I know a lot of you all information sciences it's amazing kind of being in a kind of managing a world back in the 70s pre Internet where there was no access there was no way to know there's no way to know anyone felt the way I felt gender dysphoria was still like almost 20 years away from becoming a term and you didn't see anybody there was no again power visibility manners because I I didn't ever saw anyone I didn't I didn't know anybody else felt the way I felt all I knew was that's the way I felt and somehow I wasn't allowed to be doing everything with the girls anymore at the kind of just kind of just hang out on on the other line and and also too was but also new to that couldn't talk about it because you know we know what to say but my parents they're both immigrants from Taiwan they came for their they both came for their PhDs and engineering you know in this good country and so for them they're both engineers and so the world is very they're engineers the world's very discreet and so the world is binary much like a like a like computer like an operating system at the core it's all binary and and also you know the constant the Chinese culture is conservative but also made it harder to I was the first born male and for a lot of cultures you know understand what that all means that means that you have to carry on the name you basically all the entire burden falls on you to kind of to carry the name forward and out of younger brother and so for me so I was the air and he was the spare and so I got all the pressure he didn't I think he also presented the fact that nobody cared what he did you know even you know grades when they got a or C parents didn't it didn't matter as long as I brought as long as I was doing okay then everything was going to be okay and so so I even knew at an early age though that my life didn't belong to me and as much as I wanted to go to sleep and wake up as a girl as my much as I dreamed that I knew that wasn't going to happen and I knew those things as magic so that couldn't happen so what choice did I have and so by even by like age 10 and I'm having the thought that I would never ever be happy because I couldn't really understand why but I knew I couldn't be me I didn't I knew this wasn't what I wanted and and so I learned to not just you know I didn't have to know self esteem I had negative self esteem I learned to hate myself and even by height by you know because what choice that have and the only thing I could do to you know keep my keep me from thinking about this you know myself situation and everything was just to be distracted like you know you heard about some sharks that because they don't have their gills don't move they had to stay in motion to get oxygen through it. I call obligate Ram ventilators, I'm a big nerd, you can tell and and so like a shark had to stay in motion so of course the one way that the two ways I could stay in motion and so is throw myself into academics and music, which of course made my tiger parents very very happy so they thought everything was perfect, I was doing great, even though inside I was dying and by the high by high school, I was suicidal, and I know there's not a week that went by. I didn't think about killing myself, but the only relief I ever had was this in those few moments I could steal away. And I a lot of time find myself for my mom's closet when no one was around. I know I tried something on me a piece of clothing it's really just for a moment where I could just be myself. I remember from those moments where I could just exhale. I just take a deep breath. And I felt like I know I can actually kind of felt like it was really getting oxygen into my body, just like, and everything was okay for there's a brief of some moments but I also knew that I couldn't stay there for long. And so what do you like all you can do is kind of just kind of put yourself together and get back out there, and keep it keep being the person everybody wants you to be. And so, so it was so in those, those few brief know those moments that like, you know, where I could be myself just those, you know, just like, it was like a pressure relief out but that literally was a place where I can get it like to breathe from my tank of oxygen I felt like it was underwater the rest of the time so all the from like before five years old from elementary school junior high high school, even undergrad even into medical school. And that's the, that's the only place I could be be okay. And even the whole time. I was just exceedingly lonely and I was just keep moving forward and I was just hurting. And of course, you know, like I could talk to him about it, I knew that, and I knew about shame that's something no. And they know no, no kid should have to bear that burden of but I knew that it's not something that I could ever tell anyone so it's just suffered in silence, I suffered alone. And so, but everybody thought I was doing okay because some paper, I kind of was bringing home the grades of the awards the accolades so we thought was fine and so all ended into got it, you know, it gets distractions, kept swimming, eventually made it to medical school. And there's actually where I met the kind of hero the story, my future wife, Joyce, and we know, we were med school med school classmates. And for her, it's like, she just, she, her best friend had just graduated and so, and I don't know, some, you know, we became fast friends, we came, you know, became her best friend very quickly and a lot of I think what made that friendship special was this. She never expected something from me like everybody else expected me by a certain way. She just let me be. And we were just when we hang out. I never gender wasn't a thing and just kind of hung out with gal pals we've just. And that was, that was really the one of the only other spaces besides those private moments where I felt like I didn't think about. I could just be, I could breathe.  And before you know it, you're engaged and, and you're about to get married until. I think 34th year that's where when we get married, but about two months before that. And something we also learned in medical schools about informed consent. And I felt like, boy, I need to know to which she's getting herself into and so I felt like hey, so I remember like two months before we got married I get my telling when I was at our apartment said hey, Joyce, I need to tell you something. And it felt like I just felt like I don't know how long it was probably about 10 seconds but it was just hard because I never had shared a Sunday before, but the only language I had back then was in 1997 was, you know, gender dysphoria still wasn't even a term yet I just said, the best right explain it as a pay, you know, since I was little. I was stressed on occasion. I come all the way from elementary school, even all the way through into medical school. And I remember she just paused.  That wasn't that's different, but it's not a deal breaker. We go we know, we can do we can work through that we can work with that. Okay. And so we got married. And so we got married two months later. And guess what, back to the distractions than the busyness of starting a starting a marriage business of finishing fourth year medical school, then the busyness of getting through internship business of residency, then the busyness of starting a career business of starting a family. And, of course, kept moving kept moving couldn't stop, you know, because I of course I felt like if I ever did stop. I would, I'd have to deal with myself. And I knew I would just spiral down, and I didn't think I'd ever recover so I kept moving kept moving. And so I'm also so fast forward to 2009 and that was the year our third third of three boys were born and I think oh and you know I'm it was finally it was at a time where everything was going well. I had the career I was wanting not the family I always wanted, you know, friendships I've always wanted. And unfortunately, you know, guess what, there wasn't no more distractions. There was nothing left to chase. And of course that by that time it didn't have a name, and I gendered like just for like chronic pain only gets worse over time doesn't get better. Even though I was running away from it. It was there and, and there it was in the smoke cleared. And so I did. I did the one thing I did what this is what I decided to do. I remember that, like, I remember into that summer 2019 2009. I remember going to taking a surf lesson, and you know, let me down here in Orange County, and I remember, like, like, I really enjoyed it, but I kept but the thought came to me is this. Maybe if I became an accomplished surfer. Maybe then I have an identity that could live with, and then I could push this all out of the way. And I think it's like, and also for surfing, it would be by far it was the most macho thing I've ever attempted. And so I started started surfing. I started surfing like, for someone one one morning a week, two more than two and three assert like my life dependent on it. I surfed, like, I get up at like 430 in the morning, I'd be, I'd be leaving the house by five. A lot of times I get end up at the beach and I'd be paddling out at 530 even before the lights, even before the sun came up. I'd surfed a moonlight, and I surfed and surfed like my life depended on it, because I thought it literally did. But also surfing was one of those things most demanding activity I've ever done so surf and so it was after three months. I had lost 30 pounds. And by six months, I hadn't, I lost more. I actually, I didn't lose, I didn't just have a six pack I had an eight pack. Of course, it's kind of hard to imagine now because this is a middle aged Asian mom mod. Thank you hormones.   And for me, my, my whole life's been, it's been relatively androgynous because I was, I was at war with it. I hated it. He'd looking in the mirror, he'd looking at myself.  And she was showing me how to make a muscle kind of muscles to use to me how to flex and pose. I never had anything to flex or pose before. So, so did that. And I kept thinking, maybe I should be, I thought, you know, hey, I got, I'm here now, but I thought I should be better. But I wasn't actually I was worse than ever. And the dysphoria had flared so badly that I had started cross resting again going out like staying after work actually telling her that telling family telling Joyce I was staying late to do research or something.  I go to the mall, just have a meal, just like kind of like being back in my mom's closet again as a kid. And I did that, of course. In the meantime, what I did, I surfed even harder thinking I could get rid of it. But then, of course, making the transfer, the making the, the spore even worse.  And then looking back, of course, you know, of course, I was never going to work. But at the time, I was just desperate.  So by Christmas 2012 Christmas Day 2012, you know, I think something else about the holidays, I think there's a lot of times where this is an emotional time, but I think a lot of things come to a head. And I think I then I haven't been doing great. I think I'd really kind of withdrawn from the family. And I think, you know, Joyce even knew something was wrong. So but I remember telling her Christmas days and hey, Joyce, said those same words again, we need to talk. Of course, there's no words, no spouse ever wants to hear. So remember, we're, you know, when we're downstairs, I had the lights off, I couldn't even look her in the, I couldn't even look her in her face.  And you know, I've been telling him and tell her that I've been, you know, doing it kind of in secret. And I think for her. Of course, it was a mixture of sort of like a, it was, it was confusing because I think for part of it, she was of course, when you know when because she knows with withdrawn, I wasn't, you know, and she of course the first thought was that I was having an affair. And so the first although there's relief that I wasn't that, but also though that the thought was that maybe I was transgender, and she, you know, she's an internist, and, and she's taking care of a lot of trans patients, but she also knows that how devastating can be especially because for me enjoys our marriage is the most important thing we have. And so, and that's the most things most precious to us and she knows that that may most marriages don't survive transition. But at that time, she made a, she remember telling me later on but she had in our mind she had to make a decision. She could either decide that she could either be a speed bump, or she said, or she could be sure she could be helpful. And despite how she felt her misgiving she said, I'm going to choose to be helpful so at that point we decided we're going to go through this together. And, and none of us pulling or pushing. And I told her this as like hey, if you say slow down we slow down we say stop we stop, but we do something we do together. And I think the fact was I wanted her to know that I'm not, she's not being dragged along with the ride that that she's, you know, she's got a foot on the brake pedal. She's not, she's not a victim. She's in control here. And so what's it we did. And so it wasn't much longer before. The physician for the first visit you know we have found a Kaiser we started having that goes the year, the early 2004 and 2013 where we had a registry of physicians who were, you know we're competent and transgender care. So I made a call the member of services guide connected to a family medicine physician who's become actually now one of my close friends but she, I remember talking to her is only a second person ever talked to for 30 minutes yet she didn't say a word but I'll just tell you my story by saying that she was, I was in tears but I think we both knew what that all meant. And I remember she just kind of looked at me with a kind of the with all and with all kindness and empathy and said, Well, are you ready to start hormones, and they know the scares it was. I think Joyce and we've talked about it. We said yes, and it's literally things a point of like a point of no return but we realized that there's only a way, there's only a way forward so we did. So actually we move forward, but then what happened was, like our, we had date nights and our date and I think my grandma would come over to the boys, we'd go out there and like, and we'd sneak it and we go out there we sneak a bag of clothes and stuff and supplies, you know like with makeup and stuff. And so my wife always jokes like if any of you ever need make over by the dim interior light of a Toyota Sienna minivan she's your girl. So we do we go we go someplace she'd help me get ready, you know do hair around clothes and we just go out there we just go to like a someplace we just go to a restaurant and go to mall, and she could just see there while I was just just being able to be she could just see my shoulders relax that all sudden. I can actually I can manage a smile. But of course, even before we got home she could see me tensing up again, and just knowing that this was this only but like like feel like Cinderella like the clock strikes midnight to go back and and do it all over again just kind of be what everybody wants it to be expected to be. And so we just, you know we kept, you know, we did that. And as the year went on one date night became two date nights a week. And the difference between how well I was doing when I was presenting as myself, and then, and versus when I was presenting male drug going to work and if everyone else, the difference became worse and bigger and bigger until Christmas day 2013. And we're up a mammoth for a ski trip and she Joyce woke up that morning. And she noticed I was in there she I wasn't in there in bed. She found me lying on the floor in the middle of our hotel room when I was curled up on the floor in a fetal position. I don't even know how long I've been there for I don't know how I got there. I remember that morning was, I couldn't move on. I was like, I couldn't. I was hurting so badly I just want the pain to stop. I was thinking I can kill myself because I couldn't do that to Joyce or boys, and then our boys, but also couldn't transition fully transition because I couldn't do that to Joyce and the boys. I was just hoping I could just something would happen I could just die and the pain would stop right there on the spot and I just couldn't go on anymore, but she came down. She sat me and she got on the floor sat me up kind of help me by my arms and said, you're going to be okay. We're going to help you transition, you're going to be okay actually you're going to be better than okay, you're going to be the best you've ever been and we as a family, we're going to be the best we've ever been. I don't know why I believe her but I couldn't move but this is Christmas Day within 48 hours. She wrote, you know, she wrote every email made every phone call the devil the research. She had found everything. Like even found a surgical day for me. My biggest source source of dysphoria is looking in the mirror looking at them face that just wasn't mine, which it was just. And, and so for me it was facial feminization surgery that's my gender affirmation surgery that's what I needed needed to move forward. So she found one wasn't a covered benefit that at the time so we actually had the tickets with the flight to Chicago. And so she said Ali hang in there just hang until March 1.  But there was hope.  You know, I think there were people there who knew my stores going on, and they went out of the way to make it a safe space for me like a soft like a safe landing spot. They're like even our medical director kind of went in there and said hey, we're going to make it okay. I'll show you a quick story remember which I'll share with them before because he could tell you me before I went off had surgery just you know I was talking to him he said, you know, he said Ali hurts to see hurts me to see you hurting so badly, and said, and he, and he said that the way I look at it, you know, there's only one option because of the alternatives untenable because even that past year, it was, we actually had lost to pay two of our physicians to suicide. And it was a horrible year and he said, he said, we're not losing a third. So we got this so he said he was telling a story about how this one teenager came out, like in the news reading newspaper and the air is very conservative said, when he came out there but nobody mess with them because the full football team had his back he said, he said, and he said Ali. He don't really just have the whole football team, you have the principle behind you, it's going to be alright we're going to make it okay, you just take care of yourself we're going to take care of the rest. So that's what they did, you know, they made, they made, they went department to department.  And so the, and how do you love, and then what do you do, but more importantly, what don't you do, and why do, and then they of course share this, then they read out a letter that I wrote a transition letter, and they said, then the kind of like, then by that point everybody was, it was, they were invested, then it became personal said no, and everybody was like, No, we're going to do this we're going to make it okay, we're going to make it for me, they're making it for me. And that's what it was when I got back to work. And, and I've never experienced so much kindness, they showed me more love than I could ever hoped or ever felt like I deserved.  And so, and that's, and guess what, seven years later, here we are now, and you know, Joyce was right. I am the best I've ever been, our family is the best, if we've ever been.  And so, and I keep thinking, because I had those resources and the privilege that I have as a trans person, I had Joyce I had my family, I had my work family who went out of the market, okay. And also the fact was, you know, to physician income, I could afford gender affirming surgery, it was $40,000 out of pocket. That's a, that's a significant, significant barrier. That is one of those social determinants or sES. And that's, I realized that I was never more reckoned, I never wear my privilege. And so, I know that because of my privilege, I had the chance to live my best life. But I know, but I will say no, that's, everybody has a right to live their best life. And so that's what the fight was for, to make sure that take away those barriers so they can be so though all those things that I need, all the resources that I had available to me. So you wouldn't need any of that to be able to move forward to, to, to, to thrive. And so, so back then, so my, so now, all the everything that I needed to do all that $40,000. I was back in 2014. Now it's a part of the fight was actually having its first, as a first person in Southern California Kaiser transition, the first openly transgender physician. And, and so of course being the first means that you have to, you know, they experienced even for the medical group they never had.  And so for them, they, they, for them, it was genitals equals gender so that all they offered were bottom surgery and I kept telling them, no, you don't understand, trans people are so every every transition is different. Everybody needs something different. So that was it, you need trans people to inform transgender care. And so happy to say now it's 2021. And, and all that, all that $40,000 that's been out of pocket, anybody who's a, who's a member can have all that, all those services for $200 co pay.   And that's the fervent hope and that's why it's important to have trans people in spaces so they can advocate to navigate for themselves or community. And also, and so that's what we can do. And that's what inclusion is all about. That's at the core. And so is, it's like, do you want to do right by trans people, get trans people in the space.  And so do that, bring people and have those conversations. I know one more thing that I know I'm sharing with nor, you know, we were talking earlier before this, we're talking about even one of those experiences I had back in 2014, it was only like six months after our transition. And, and I don't know, somehow, I found myself because of a little casting call just to the trans community. This is the last year of Glee. This is 2014. And they were for the last season, they wanted to do something for the trans community. And so they had one of the storylines was Coach Beast was transitioning. You know, and, you know, and as part of that, though, as one of them, for those episodes, I think it was season six, episode seven. I think that the name of the title transitions what they wanted was a 200 person all transgender choir. And so they send a call to the community at that time actually, you know, I just kind of like my wife Joyce saying do it. I said, okay, why on the lark so I send an email out do that out there and before I knew it I got a call from my casting director. Before I knew it I was on set. And I just said, Oh my God, I thought I traveled for I live in Orange County driving to there. I wasn't quickly found out that people came from New York, people came from New Orleans, people came from Ohio, people came from all over around the country. And while I was there before that I had only known. And so that was my experience. But while I was there is person after person and kept coming until I met 199 other trans people. And what I saw was realizing that the trans community is just as diverse as the entire world as any other human at the human race, like you know we are all different shapes of colors different ages, and you know, all different sc s different levels of privilege and I was always there very aware became very aware of privilege I have because there are people there who are at the do sex work. And people there who are homeless. There's something special about just being with everyone there and realizing though that remember thinking to myself said, Wow, this is remarkable. It's breathtaking the kaleidoscope, but also the fact that everybody here belongs, everybody here as a place in this world. And, and I realize that one is the different as we all are we're all moving the same direction where each of us are here to help each other move forward.   And so, that's what it is. This is what I'm passionate about. This is what I'm so glad I haven't as a physician that that privilege that platform that amplified voice. And so, I could, I could amplify these stories to make sure that everybody here has a chance and that their stories are amplified and they have a seat at the table. And one thing to do about privilege to is this, realizing that it doesn't have a seat at the main table but you don't realize how much privilege you have until it's gone, like even a medicine being an Asian cisgender male, heterosexual male. There's a lot of privilege that comes with that. You don't realize how much you have until it's gone. And so, but once you don't even one thing though about once once you're the main when you're at the main table, you don't see everybody else who doesn't have a seat. All you're aware, you're not aware of it but when you're actually not there, then you can see it look around the room and see everybody who doesn't have a seat. You realize that then you know who you're fighting for you find everybody who doesn't have a seat. And also to is one thing I always want to share is this, what I learned is this that I may not I will never fully understand their journeys their stories, what it means to be because they're what it means to be black, what it means to be Latinx, what it means to even all these other marginalized groups on they understand, but that doesn't that's not, you know, doesn't stop me from loving. That won't stop me from loving them, advocating for them, and just having compassion, because one thing I didn't I just want to leave you know I want to be able to leave with you all today is that, you know, understanding is not a prerequisite to compassion, or love. So, thank you all. I appreciate you even the giving this time and space, making a safe space to so freeing for me and Dr family bill share stories, and I know you all have questions as well. I want to hand this back to Nora. Thank you all again. Wow. Thank you. Thank you so so much. We've got. I don't know if you can see yeah lots lots of thank yous in the chat for sharing and and being so vulnerable with us. Yeah, we really appreciate it and, and we're really glad that we have both of you. And we have both of you as healthcare providers as MDs at a time when it's so critical, not only during COVID, but just it's incredible. It's critical to have transgender non binary physicians. We have we have seven minutes I'm going to go ahead and share my screen. Again, these were questions that that we selected from the registrations we had that field for people to send in questions so I'm going to let April read these off and have our panelists answer. Thank you, Nora. Thank you so much, Dr towel and Dr fan. I just wanted to just say one thing that the I'm trying to find it is in the chat. Arkansas governor vetoed the anti trans bill. So, you know, that, you know, that's good news. So for question. First one what services organizations programs mentors, etc. Do you wish you had. Do you wish had been available to you in med school and read as residency. Oh, I can answer part of that. You know, Dr towel Ali mentioned like the privilege that we have as physicians and getting to this point you know one of the things that I am really thankful for is that in med school at utesca, you know, this is when you're a student you're learning you, you everyone is your role model. And so I was able to have like a classmates who supported me in my queerness. I was an outstanding physician who supported the pride group and there was a pride group there and I think a lot of med students and med schools don't have a have a safe space and so one of the things that the program did was advocate for having safe spaces advocate for teaching these young soon to be physicians, how to create a safe space and how to support each other. You know, like medicine is hard. And so having the services, a safe space. Mental health, mental health, having organizations like a student run pride faculty group that, you know, mentors and programs to help help facilitate growth and acceptance and compassion. And then that's, that's in med school and residency I was the only out resident gender not conforming in my program so that was one of the things I wanted to do to for future future residents future staff future attendings to be in that program I wanted there to be a place where they can go to to feel acceptance and not start from the beginning again, you know, I want. So that's kind of one of the things that I wish that I that there was available throughout my training. Dr. Todd, did you want to add anything. Okay, well, outing myself in terms of my age, but I started medical school back in 1994. And back then, there was nothing zero. And so, all of that. All of that. But I wish I got even a fraction, I wish I had some, I wish I had what Dr fan had, but also to as, you know, honestly, I couldn't really use some visibility, I would I could use the men, I could be, I could use visibility and a mentor. There was nobody I could even identify with not even though it was possible to that you could, you know, you could talk about this, that you could come out. And so a lot of it is you just sort of. All you do is kind of just, you know, suffer in silence, that's good it was. So maybe that's exactly that's a hope is to build safe spaces now. And that's why Dr. Famer, I are here for the sake of my visibility, but also to help gather allies like yourselves to to, you know, to create these safe spaces. And so, yeah, I wish, wish I had all of that, maybe that would have been 41 years before I transitioned if there was actually knew what was possible. So how can, how can one be inclusive and be an ally.  Bring in trans people, you want to be inclusive and be an ally bring in trans people into all these spaces, bring especially bring non binary folks, because that's, there's so many misunderstandings there's so much for it's not it's so much for the rest of you know, to be self or does not identify the gender and conforming that for us to learn that the pronouns right to be respectful to be affirming to you know, to be able to celebrate. And so, so you know, it's an even the next question is like what it was the most effective forms of advocacy is actually just bringing trans people into all the spaces where decisions are made. Okay, great. Just one more. What is being done to instruct member services staff and reception about proper pronouns. Um, I mean, even within. So before I started at Kaiser you know one of the things that's, I guess my chief did was you know, tell everyone like hey this is going to be a new physician coming in. What are their pronouns are they them. And then, you know, inform everyone that I work with one of the things that we're currently working with is to, and this is part of advocacy and within the health system is having a having our electronic medical record be used you know, gender not conforming and transgender people can't, you know, it flags on their, their medical record when the chart pulls up so that you know, it's very tiring, you know, to always have to correct or be on the lookout for like oh did you miss me. So it's, it takes it away off takes away from the one risk or the responsibility of the person. And so it makes it everyone so that you know that it's not the person's responsibility it's everyone's there. Um, another one is we're working on a module to teach to have people. So just educate on what is pronouns you know something as simple as that. Thank you both very much, Nora, I will turn it over to you. All right, yes, yes we are at time, but again, thank you so so much. We are all really grateful. I'm really happy that that we were able to connect and that you that you agreed to to come on and share your experiences with us. So Rebecca has posted in the chat the link to our evaluation and the instructions for those of you that are interested to receive CE credit from the Medical Library Association. Lots of thank yous lots of thank yous. Thank you all for just for your hearts to want your desire to be here. And thank you for making this a safe space. We deeply appreciate it. Thank you. And I think, you know, people are asking about what they can do what they can do to make things better so I think something as simple as sharing this recording and, and, you know, in whatever space you're working in whether it's healthcare in a library, a CBO sharing people's stories and experiences is one step toward creating change at at an institutional level. All right, well I am going to end our recording now, but thank you all for coming and be sure to tune in next week. Next Monday, April 12 2021 we have our, our last webinar, and this one is going to focus on mental health and resiliency. So I will send out the link for that to register as well. Thank you, Dr. Tell, Dr. Fail.


Hey guys, Shaber 1000 here. I know it's a little dark But I want to show you something we've been working on the house and getting some lights put up out here Now mind you, I'm not done yet. I'm supposed to be done, but I'm not done yet. I got more ideas But we'll show you what we did this year There's the house Got the mailbox That little thing down there is cool. I forget what it's called But in the daytime it looks like it looks like a Christmas bulb and Over there on that side We've got a kaleidoscope right there and Over here on this side on the garage those little red and green twinkly lights They are Some kind of firefly thing. I think they called it. I don't know if the camera will pick it up but There's the tree It's about 60 feet tall and I know that because I know for sure that the palm tree over here is 60 feet tall And I know that because I had the drone up And you can even I don't know if camera picks it up with the trees in the backyard there They got twinkling lights in them And out in the backyard looks really pretty So it's very windy, but I wanted to share this with you and That's what we've been doing today, so I'm going to get the boat ready this week. We've got some stuff for the boat and I'm trying to get closer to the mic because the wind I forgot to put my lapel mic on So I'm gonna get it decorated and after the parade when we park the boat back here again We're just going to leave it all lit up at night monkey Idea was we're going to be elves Cool, right? So anyway, I just want to show you guys that it's very pretty. I think I think it turned out good We got them in the yard because right down here that thing so I Think it it turned out nice. I didn't outline the house. We left the icicle lights off this year because a Plugged one sat in they didn't work at all. It's missing bulbs. They fall out and stuff and the next set They worked fine until I got halfway done with the set and then they Half of them was going out and stuff like that. So she said the heck with us So we'll get some more and I'll put them up because she really likes them She's like no just put the color lights up around there I said, okay So we did that and we're glad we did because then my sickle lights would have had too much light You wouldn't have been able really to see anything on the house So I think that was a good idea So I'm glad I agreed with her on it and those over there I'll zoom in here a little bit for you or her little snowman. We didn't have last year Each one's dressed different So Those are her little snowman I thought they look cool there. There's five of them there Of course, you know cameras never do justice. So what I'm going to do Is I'm going to I've got it on my on my panhead and I'm going to let this thing pan back and forth For a few minutes And I'll put some Christmas music on with it and And Hopefully you enjoy it. So anyway guys, thanks for watching.  She just did her video. So I let her do her video first That Sony action cam is awesome. I can't believe it was picking up the stuff It was picking up. We've got a full moon tonight. I'll show you the full moon real quick Now the other night if I remember I'll throw it in here, but the other night The way the clouds were it looked like a rainbow around the moon. It was awesome If I remember I'll throw that clip in here. Oh Yeah, it's showing it. Oh, that's pretty. Oh, it is. Wow. I can screenshot you Some of these photos, but there's the full moon. Let's zoom in a little bit here. There we go Pretty cool, huh guys So anyway guys again, thanks so much for watching. I appreciate it hope everyone had a had a good Thanksgiving and See nobody else has lit up on this street at all Nobody I don't know if there's any down on the internet, but I know none of them are like this So we're kind of like the the neighborhood griswolds. Alright guys, thanks for watching I appreciate it. She bear the myth man alleged. I'm gone for now Don't forget check out monkey 1000 channel and we'll see you guys soon. Bye. Bye. Thanks for watching and enjoy the next clip Okay, guys real quick. I'll show you what we did On the inside of house There's our beautiful tree She got her little lights up there check that out fireplace on Good nice and cozy Not cool. I got this sitting up here I'm gonna move it tomorrow. I don't know if I'll put it on the microwave or bound it up under here, but From the stove But isn't that nice and cozy and the tree? Very nice. All right guys enjoy the That was weird my camera zoom just came on for some reason. Okay. Enjoy the the pan Well, paying it left and right for you a few times with some Christmas music and Hopefully enjoy it. Thanks again guys


Γεια σας! Είμαι Vicky και καλύτερα για να φτιάξετε 8. Σήμερα είμαι ευκολογημένη να σας δείξω τα 8 καρδιά που έχω φτιάξει με τα τελευταία εργασία από τα μου ευκολογημένοι.  Τα λίγη ευκολογημένοι που χρησιμοποιήσω είναι από τα μου ευκολογημένοι και μπορείς να δεις τα χρώματα που χρησιμοποιήσω στον σου σχέδιο right now αλλά όμως θα βρείτε την πλησία των όλων των πλαίτης που χρησιμοποιήσω今日 εγώ στον κομμάτι της τεκάψης. Τώρα θα θα χρησιμοποιήσω τα τεκάψης, για να φτιάξω μια καλή εμπραγή και θα χρησιμοποιήσω την πλαίτη μου για να κάνω. Ξεκίνω ότι εδώ έχω χρησιμοποιήσει κάποιους εμπραγές αλλά έχω κοητέρ Harold permissions but there is a stamp for a layering stamp for the banana that i am going to place exactly on top of it and then i am going to stamp again and this is going to add the shadows for the banana top and the bottom which makes it look more realistic. Τώρα είναι ψ απο τεχνικά να κάνω Reid cutting and as you can see there is a tie that cuts out self and i am going to use this couch ότι will be red to assemble my card. So first of all I'm going to work on a white card stock that is slightly smaller than a standard card and as I need a little bit of something at the background but at the same time to be very subtle.  So you can see here I have already placed everything all the little dies on top of the images για να είμαι very subtle. Είμαι καλύτερη με κάποια δυστρασία, με αυτή τη στενσία. Αυτή η στενσία που έγινε was released by my favorite things last month. So now I'm happy with how my background is looking and all I have to do is to stick all the images on top and create my kitchen wall. I'm going to use some gloopen at the back of all those images and start sticking everything down and this card really came out very quickly and what I love is that most of the stamps in the stamp set are actually solid stamps so they don't have wide open areas that you need to color with your favorite coloring method. Instead you just stamp and you get that color inside. Really quick and easy to create cards like that. So as you can see I have used my craft knife to create some slits in those cups so that I can put one inside of the other and since they are so bulky I am adding some strong adhesive at the back and I'm going to stick them just next to the pot and continue sticking everything down. After sticking everything down it's time to add the sentiment so you can see that I am chopping the sentiment in half. This says happiness is handmade and it comes from the stamp set that is called You Bake Me Happy. I have stamped the sentiment with black ink and now my panel is ready to stick on top of my card base. My card base is a top folding card that's a standard card that's 4.25 x 5.5 and I'm going to stick my panel on top with some foam tape at the back. At this point the card is ready but you can go ahead and unbelly fit as much as you like. You can add glossy accents on the plates, on the teapot and the cups but I decided to go just with a clear wink of Stella to add a touch of shine. Now let's move on to the second card and for this card I'm going to use these adorable otters. I'm really in love with this set and I'm really happy with how this card came out. First of all I'm going to choose some of those adorable images and I'm going to stamp them with black ink and from the stamp with the owls I have chosen the little heart to stamp as well. I have a fish, a heart and two little otters. Now this is going to be a birthday card and since I'm going to use my alcohol markers to color everything I used my Memento Tuxedo black ink to stamp my images. So I'm now going to do my coloring and then use the dies to cut out everything. I will end up having two hearts at the end, two fish and two otters. Now I have cut out everything and I'm going to use this parchment paper to be my sea. This is actually a leftover from my kit that I had by Simon's stamp.  You see how I place it making sure that it is a continuous line.  So this way I have the sea on top of my card but at the same time the sea is transparent so if I place something at the back you will still be able to see it. Now in the dies there is this tiny little wave die that you can use to cut a slit inside your sea so that I can put inside that otter and I think this is looking adorable and at the same time you are not losing the detail on all that coloring in the otters. If that was just blue paper you wouldn't be able to see what's underneath. So I'm really happy with that idea and I'm going to place two of them in the sea and I have already cut out another slit where I'm going to place the fish. I have two fish, one is orange and the other one is green I believe. Now if you stick that directly on top of your card base by placing your tape all over you will be able to see the tape and it's not going to look good. So I'm covering up the tape only behind the otters. This is enough tape to stick the parchment paper and the otters on the card. I'm going to place the last fish on my little scene and now the hearts. Now again the hearts are not from the same stamp set with the otters they came from the owls set. I'm going to stick one with foam tape at the back and the other one is going to go flat directly on my card base. This is going to add a little bit of dimension and those hearts are actually going to be balloons. So this is going to be a birthday card with that little otter sticking his hand out of the water and holding the balloons. Now I am going to decide which sentiment I'm going to stamp and I'm going with the one that says Otterly Great Birthday which I am going to cut in three parts so that I have Heve in the first row, Otterly in the second row and Great Birthday in the third row and as you can see I am going to do some coloring in the sentiment. So for the word Otterly I used Tropical Teal this is a color by my favorite things and I think it matches perfectly the parchment paper of the sea and it completes the card. Now all I have to do is to draw the strings for my balloon so first of all I'm going to do that with my pencil just to make sure that I'm happy with how those lines look and then I'm going to go over them with my thin black marker. Now of course you can go ahead and embellish your card even more like add glossy accents on the balloons I decided to go just with my clear Wink of Stella glitter pen but I couldn't leave those noses of the Otters alone so I just had to add some gloss on top of them Aren't they super cute? I think this is a must-have stamp set. Now for this card I'm going to use this stitched hard grid and you can see that it consists of two parts for the first part I'm going to place it at the center of this white panel I'm going to make sure that it's nice and straight and then I'm going to pass it through my scissor machine but this is not going to cut out anything instead it's just going to place the grid the stitched lines on my panel and with the second die I'm just going to place it on top of this red cardstock which is going to cut out this grid that you can use if you wish to or you can use the hearts in this case I'm going to use the hearts but for the grid it's going to I'm not going to throw it away I'm going to use it as a template for exactly where to stick my hearts so I'm placing it on top of the grid and this way all those stitched lines are exactly at the center of those lines of hearts so I'm going to stick one heart after the other and while I'm sticking them I just add glue at the center of those hearts so this way I can add a curve to the hearts so they stick out a little bit and this way it's going to add a little bit of dimension once I stick everything down I'm going to remove that template at the top and this is going to leave me with all those hearts looking dimensional and they are exactly lined up with the stitched grid on the white cardstock now I want to add the message at the bottom of this panel and for that I'm going to use the well connected alphabet and I'm going to write sending love but to show you how I'll do that just to make sure that everything is nicely placed so the letter D is at the center of the word sending so I'm just going to start stamping the word sending by stamping first the letter D so I am having a baby wipe ready to go and I'm going to stamp D at the center and then I'm going to slowly go and stamp all the other letters as I'm stamping everything I make sure that I connect those little tails at the end of each letter and this way I have a nice script letter as if it was hand written so notice how I use one letter I stamp and then wipe it out on my baby wipe place it back at its place and then move on to the next letter and I'm going to do the same thing for spelling out the word love underneath and now I have my pattern ready to go I am going to add some tape adhesive at the back and stick it directly on top of this card base this is a red cardstock that I have folded to be a top folded card that's four and a quarter by five and a half you can add some shine on the cards if you like so but I decided to leave it as it is clean and simple for this card I'm working just with dynamics to create my little card these are the mailbox dies I have also used those clouds from the cloud nine and also one of the slopes from the stitched scallop basic edges I have worked to cut them out just by using plain cardstock so white for the clouds green for the grass I decided to have my mailbox red so I just went ahead and cut out all the pieces with my scissors machine and all I have to do now is to assemble my card adding some tape adhesive at the back and I am sticking one on top of the other now for the mailbox just because I want to have the letters coming from the inside I am going to stick the basic part at the top of my card but for the top part I am going to use some foam tip at the back this is going to create some dimension which is going to have the actual box a little bit raised you will see what I mean at the moment so I am going to cut out just thin strips of foam tape to go all around it I am then going to peel it off and stick it on top of my box so I have an opening at the front to stick the letters inside now although you cannot see it at the moment the white little pieces that I have there are the letters and they actually have some embossing on top of them so they are not just white rectangles you can tell that in real life but it's so hard with all the lights that I have in my studio so I am sticking down the clouds and to make my letters cuter I have punched out tiny little hearts from the same cardstock that I have used for the mailbox and I am sticking them on top to close my letters I am just fighting with those tiny little pieces and my glue pen and then I am going to place them inside that box now again remember that this is slightly raised which allows me to place the letters inside now for my sentiment I went ahead and cut out a banner to cut it out I used white cardstock with the stitch sentiment strips and I am also going to use the lavish in the mail stamp set and stamp happy mail I added some foam tape I am going to cut out what sticks out place some tape at the back and I am going to place that directly on top of my card base and this is going to complete my card and for this card I only stamped the sentiment everything else is just cut out by using the dynamics dies now let's make a fun card this die is called flop card heart you have to take it apart it's so much fun now I am going to make sure that this is going to be placed at the center add just some post it to hold it in place I am going to open it up don't forget to open this up otherwise you are going to cut out the back of your card base and I am going to run it through my Cessics machine now notice how this is not going to cut all the way through it's only going to cut around the heart but it is going to give you those score lines and your flip card is almost ready so all you have to do now is to embellish it so I am going to use the other part of this die the heart and I am going to cut out hearts out of this cardstock and once I have my hearts ready they give you a beautiful stitching all around those hearts I am going to stick them directly on top of that shape or my flip card and I am going to do the same thing at the back and it's looking beautiful already now for the sentiment I am going to go with the one that says guess who's missing you and this comes from the owl's set I am going to stamp it directly on top of this banner that I have cut out again I used the dynamics dies for cutting out this banner and I guess that this is one of the dies that I use all the time I think it's very handy to have one of these to stamp your sentiments so anyway I am going to stick that directly on top of my heart I am going to add some foam tape at the back and now on the inside of my card I want to have this heart again but I want it to be placed at the exact same position as the other hearts so I am going to place it on top of the other one close the flap and my card is at the exactly same position so now all I have to do is to stick there one little owl I am deciding to use this one because I just love her eyelashes I am going to stamp it with memento ink and I am going to color it with my alcohol markers I used my spectrum noir markers to do so so my owl is already cut out and I have also used the arrow and one more of those banners that I use all the time to stamp my sentiments so the whole sentiment from that stamp set says guess who's missing you but I didn't stamp the word me on the outside and I am going to stamp it on this tiny little banner that my owl is going to hold now if you see here a little hand let's say it's a hand is sticking out so I am going to give her that arrow to hold and this arrow is going to be a little flag actually with that banner sticking out now as I am going to stick everything down I am going to make sure that nothing is going to show from the front when you close the card you won't be able to see anything so it's a nice little surprise I think this card also came out really adorable and I just cannot stop playing with it now anyway I just couldn't leave it as it is I wanted to add some glitter on the owl so I am using my Nuvo glitter drops this is going to dry clear but it adds glitter on top and my card is ready for this card I am going to use this beautiful background and I am going to do some embossing now of course you can stamp the beautiful background and if you love coloring just use your favorite method and you will see that you get a beautiful design so now I am going to place my white cardstock on top I am going to press it with my fingers I am making sure that I am not moving the paper at all I am going to peel it off and now I have a nice impression but you cannot see it it's actually there and then I am going to apply some gold embossing powder and you will see the beautiful design that you get I am going to hit set everything and I hope you can see the beautiful clothes that I get so this is going to be the background for my card and I am going to use the big haxa dynamics die to cut out those letters and of course I am going for a shaker card you know already that I always go for at least one shaker card when I am making more than one cards in a video so I am adding my tape all around those windows I am making sure that everything is going to stick nicely and then I am going to add on top a piece of acetate I used foam tape to go all around the window and now I am adding some sequins and this is a sequin mix in gold so I am going to cover up the window and I have covered it up with gold paper and I am going to add some tape at the back of this window and stick it directly on top of my card base for my card base I have chosen this gold cardstock which is going to go beautifully with the sequins as well as the gold embossed background and my card is ready now this is going to be a fun card and it is perfect for those little boys in your life and I am going to use these dynamics dies this is called castle and of course I am going to build my own castle so I have cut out the wall I am going to cut out the towers and bits and pieces from the dynamic set and now I am marking where this window is going to fall and from the tower and I am going to use my craft knife and I am going to cut out the top of my card front and the idea is to be able to see on the inside of the card from the top as if it is a continuous scene you will see what I mean later on so I am just chopping off the top of my card front you can see how it is looking at the moment now I have all the bits and pieces ready to go for my castle and since this is a castle I wanted to add some texture on it so I decided to use the wall stencil by Tim Holtz which I am going to apply on top and with my finger dabber I am just going to add a little bit of ink I am not going very heavily over it I just want to have a little bit of texture I am going to do that on the wall as well as on all the towers so I have stenciled everything and you can see how my castle parts are looking at the moment I am going to stick the top of the towers where they belong so as you can see I have cut out parts of my castle using a lighter and a darker shade of gray and now it is time to assemble my card and as I am placing everything on top of my card notice how I am going to do the exact same thing at the back so whatever is in the front and you won't be able to see all those ugly pieces sticking out and this is going to cover up the part that I have chopped off so now I am going to stick down the doors one at the front and one at the back and at the bottom of my castle I am going to stick some green pattern paper so that I have the grass and this is going to complete the scene at the front and at the back now for the inside of the card I am going to add some broken china to create the sky I am applying it with my blending tool and I am also going to stick the grass there notice how I am going to align the grass on the other side as if it is a continuous line so I have cut out this hill side by using the stitched edges I am going to cut out the excess with my scissors and stick some clouds to my sky these again are cutouts by using the cloud 9 dies and I like how you can see the sky from the front and not only on the inside now I am going to add the focal point which is going to be a night so I am going to stamp this night on his horse I am going to color him the spectrum noir markers and then I am going to cut him out but first I am going to stamp the sentiment and for that I am going with one sentiment that was included in the stamp set I used black ink to stamp the sentiment and it says you are my knight in shining armor so after using my spectrum noir markers I have my knight ready to go I am going to stick him down on the inside of the card and just because the sentiment says shining armor I am going to add some shine on this and for that I am using my silver gel pen now I am not going to put anything else on the front but you can go ahead if you like and add even more elements like the dragon for example at the front and we are all ready to card 8 for today so for that I am going for a princess card I am going to stamp the princess her castle little bits and pieces from this stamp set and I am going to color everything with my spectrum noir markers I am going to use the dynamic set that matches perfectly these dies to cut them out and again I have cut out my hillside just like I did for the previous card as well as the clouds from cloud 9 stamp set and now it's time to assemble my card I am going to stick the grass on top of a pale blue cardstock I am going to stick the castle at the background and I am tucking it in underneath the grass as if it is far away at the background and for the princess I am adding a little bit of foam tape at the back of her so this is going to pop here at the front and add a little bit of dimension to my card I am adding a tiny little foam square as well on her tiny friend that little bird as well as on the butterfly I have chosen one of the sentiments that says happy birthday I hope it's magical which I am going to stamp directly on top of my sky with blocking and now I am going to surround that sentiment to complete my scene with some of those clouds and I am going to stick this panel on top of my card base which is a standard card that's 4.25x5.5 in white and you simply can't have a princess card without some glitter so just head to add some the castle, the princess their crowns and this is going to complete the card and now let's take a quick look on all the cards that I made today and these were the cards for today I hope you had fun and good inspired and if you did don't forget to leave me a comment as well as give me thumbs up on my youtube channel Create8 is going to come back on February featuring the next release by my favorite things Thank you all for watching


Hello my name is Oriel Adpo and I'm Shaila Wilson. Today we're going to be discussing a methodology for using dynamic simulations in the military with particular applications for the Marine Corps. Our simulation is going to focus on the targeting process and artillery. We're well aware that a lot of people don't know what artillery is so this picture is a demonstration. This is a cannon, the base unit of artillery which provides indirect fire against enemy combatants. The purpose of this exercise to show that dynamic simulation is a relevant tool for operational leaders on the battlefield. We will go over in the future how simulation is currently used in the military. However it is not used in the operational level. Specifically the people making the decisions do not have access to manipulate these simulations. We want to show a simple and reasonable tool that these operational leaders with no simulation experience can make a model to help them make better decisions. The decisions they might make include the unit capacity, how much work can they do, how fast can they respond so they can make better decisions when they're talking about support, and in an operation how much more support can they provide for other operational leaders. So first of all a background simulation. Simulations have been used in the military for a really long time and simulations in general in the military are divided into two categories. Man-man simulations and man-machine simulations. Man-man simulations run through operations on the ground mainly through training and practice exercises. While man-machine simulations include the marine tactical warfighting simulation, these occur mainly through dynamic simulations run on large computers. The military has been doing this for a really long time. An example of this would be USA Come which is a joint training analysis and simulation center run by DARPA. Another example of this is the STO 97 which is the synthetic death of war operation that was run in 1997. Our model is going to focus on the targeting process but to make that make sense we need to define some terms. In artillery the base unit similar to if you're if you're familiar with an infantry company is an artillery battery which consists of six firing guns. There are three batteries which compose up in artillery battalion. The battalion's responsibility is command and control the batteries. There are three battalions which form an artillery regiment and the regiment similarly commands and controls the battalions. Generally a target is going to either go to the regiment or the battalion and then they will delegate to subordinate units until it eventually reaches a gun that will fire upon it. So some of the assumptions that we made for our model include the target generation. For this we estimated a random target generation process following an exponential distribution of targets entering the system at about every 15 seconds on average. We also tried to simulate the delays for each step of the process. So from when an infantry unit gives the battalion the target all the way down to when the target arrives at the battery and is fired upon. We got the data that we used for our delays from the marine training in redness. From the marine training in redness manual. In our model the battery makes the firing decision and then accepts and sends the targets to guns to reject or dispose of the target. This is how we use the disposal. So when the gun shoots the target the gun is the last process it's disposed. We then modeled everything from a battalion down. So in this case the battalion is either receiving a target from the regiment or they're receiving it from an infantry unit. It doesn't make a difference in our simulation. So to give you an idea of what our general simulation looks like this showcases what the what the simulation would look like all the way from target generation from target generation from the infantry unit all the way down to when the target is fired on by a gun under the battery unit. But then this is a sub model showing what occurs within each battery unit from when it's accepted or rejected to the guns that receive the target and when it's fired upon. But first let's actually show you what the entire model looks like and then open it up in an arena so we can run through a simulation process. This is our target operating where targets are currently entering the system. As you can see decisions are being made in which unit to test them to. In this case it's just a preferred order system. In that way it's going to rotate through the batteries and evenly disposed. Okay now let's get to the results. In this case we modeled for only one hour and the reason we did that was deliver it. In combat generally there's a lot of downtime followed by small periods of highly kinetic activity. We're simulating that period of highly kinetic activity and seeing how well we respond to targets generating that fast. So one of the things we could get is how long the target remains within the system from when it's generated by the infantry unit to when it's fired upon. We can also figure out what batteries are more likely to be used, what the utilization rates are and how quickly our responses are compared to what the ideal standard is by a set by the Marine Train Mental. This is drastically important because target information decays fairly rapidly depending on the situation. In some cases saying when you're going against a fixed enemy, you do have time to fire. Seven minutes might be good. In other cases say in Afghanistan, you might need to figure out a way to get that fire rate in under seven minutes and you can't make someone work faster. You can't make it less safe so you have to figure out ways to manipulate the process so that the target gets fired in less than seven minutes. And that's what this highlights and this lets them make decisions. Additionally they can change the amount of guns per battery. They say increase guns or decrease guns or they can decide to split batteries up and see how that affects the targeting. Okay, so some of the challenges we face while building our model include the following. For me, O-Ray, one major challenge was domain knowledge, common to terms of some of the factors and some of the specific terminology used within military operations and figuring out what was the right term to use within a particular field as well as not knowing how the Marines run through a targeting process. So for this particular field, I defer to Shiloh who has on the ground knowledge of this particular area. For me, a big challenge was data sources. There's no statistical test or statistical studies conducted on specifically targeting. The data is just not collected. It's not available. We know what we're supposed to do. We know how fast that they're supposed to respond. We don't know how they actually respond. And that's a huge limitation in the accuracy. That's why our scope is a method that can be used, obviously with appropriate data. There's also technological limitations in arena's capabilities. We can only have 150 entities. That's why we're doing the study at the battalion level. Additionally, arena is not facilitated for a military process in terms of there are some things that we could not model with arena. So how exactly do we predict our model could be used? We think our model might be useful in determining the force organization, figuring out what battalion level choices to be made and whether or not a battalion can exist as either direct for providing direct or general support for infantry elements or for other battalions and other regiments on the ground. To lay person, the choice of director general support is it seems transparent. You want to be able to tell however as huge implications in a general support model, all targets go to the regiment first where they're delegated. That extra step adds information to the regimental commander to help him make choices, but it slows down the targeting process. Whereas in a direct support model, individual infantry units send their targets directly to an artillery unit. Now this allows them to get rapid response, but that artillery unit is no longer flexible to support other battles. Another issue will be figuring out the resource requirements of each operations. As an operational lead for battalions, you need to know how many guns you require for each battery and how many guns you require as a whole for an operation. This would also help you in preparing for instance, for seen circumstances. If there are instances of gun failures or maintenance activities going on during the operation, how exactly, how prepared is your operational unit to respond to such targets? In this case, the way it's currently conducted is if a gun goes down, there's kind of a guess of what our current capabilities are. And a lot of times that's an over prediction that puts a lot of strain on the Marines and it creates mistakes. In a model like this, we can directly look at it and say, okay, we're missing two guns. And this is a quantified measure of how we expect our performance to be deteriorated. So based on this model, we'll be able to provide advice and knowledge to commanders to better support the operational activities in varying fire conditions. These are some citations we rely on to build our model and to build our report. Thank you very much. Thank you.