Hello, welcome to theCUBE's presentation of Women in Tech Global Event, celebrating International Women's Day. I'm John Furrier, host of theCUBE. We've got a great guest here, Isabella Groger Cesarvich, who is the Vice President of Worldwide Public Sector, EMEA sales for AWS Amazon Web Service, Europe, Middle East and Africa. Isabella, thanks for spending the time and coming on this program for International Women's Day. Appreciate it. Thank you very much for having me on that one. It's an exciting topic, John. A lot of things going on, a lot of themes. We'll get into that. But first, tell us about your career and how you got to be working at AWS. Yeah, that's a really interesting story, I would say. I give you, first of all, the headline. I am a dental technician by training. I am business administration economics by study. And I spend my really whole life in tech. So my first message here is that you can have a great career plus in tech having a diverse background. What you need really is to be curious and to be eager to learn. And you see that I have slightly tweaked our leadership principles, saying learn and be curious on that one. But when you agree on that one, saying, I am curious, I want to learn, this is really a great place in technology and in AWS to be in and to progress a career. It's really, really cool. And when I look ahead, I see that because the industry lines are blurring more and more, they are more and more diverse skillsets, diverse roles coming in. And that is really opening an exciting opportunity also for women, but also in a broader sense of diversity to go and have a career in technology. It is quite exciting. Back to my career, I started in a company, I think when I look back at that and reflect it was a startup these days, very, very early in parallel computing, moved on then into management consulting, into international consulting project and managing those ones. And when I look at that piece, I have built out at that point exactly my industry skills. And that was beginning in the oil and gas industry. When I then transitioned in a bigger cooperation into the ERP space, that also continues on a global scale and then eventually I switched over and started to go deeper into another industry segment which was the public sector. And when you come from oil and gas, that is a transition that comes to national oil companies. So that just sort of naturally came but gave me an absolutely different scope. So 16 years in oil and gas and then process into public sector. Now in my last global role, I really get across the whole discussion about cloud. And this is why I got also in touch with AWS. Talking about, wow, this is the future. This is really the way of how computing is gonna be consumed in future and how agile those types of a model is. And that was really super intrigued. Also having a sort of a really startup mentality. And this is, and here I am as the sales responsible for a mayor in public sector. Well, I love the throwback to parallel computing. I remember those days, exciting story. And I love the point about a lot of opportunities with tech. The aperture of technology has really widened the surface area for things you can do and bring a diverse background to is really amazing, great point, great insight. I have to ask you, what first got you interested in working in the tech sector? How did you get attracted to the parallel computing? What was the gravitational pull? Was there a moment of luck, serendipity? What happened? Tell us how you got interested in the tech sector. John, I wish I would tell you now a story that this was the wow moment, right? Where I came across something and that sparked the idea. Can I tell you a secret? So when I started my study, the thing that I said, or the statement I made was it's just I want to work in everything, but not in IT. And maybe that is how the brain process. So the brain process, I want to work in IT. And this is how I got into it. No, but seriously, I think the first part was, I got to my business degree, but I got it from a technical university. This is why I came, first time came across that in a broader sense. Would I say, is it late or is it early? I don't think so. That was for me at the right time that was mechanical, engineering, engineering and IT. I've also built a couple of ceases around that part. That was the first one. And certainly when I get into this company that was on parallel computing at that time and underdog being responsible for optimization models for refineries I sort of transitioned into that one. So coming really from a technical university background being on a daily basis with that and being in this topics all the time and also thinking about how could I progress that way? And also having my first engagement with the company in that space, that got me intrigued and stuck into the startup space not calling it the startup those days but also in the technology side. And I think the farms have been so cool if I look back on that one. You know what's interesting about that story is is that you were in an environment that was technical and nerdy. And we're seeing that now. People are, we had a leader on AWS that I interviewed. She said, we're nerd native. The younger generation is natively nerdy and they got tech and they're touching it everywhere. They're in think zones, they're in think tanks and building things. So this is the new situation. So this is kind of where we're going. So the next question I have for you is how do we encourage young women and girls to get a career in tech? Are there initiatives that you guys have? I know get IT initiative that AWS runs is one. How do we get this word out that it's all in front of us? The environment is rich to bring careers in together. Yeah. And I think to your point, you can't start early enough on that one, right? So I can say it has been a different touch points but I think I also had an inspiration earlier where I really thought about, yeah, I can do everything. So from that perspective, that paves a way into a looking at, I can equally proceed different career passes but you touched on the get IT side and I really, really love that initiative that we as AWS have put together and I've been a judge on that one and it's amazing results that have been driving that. So the initiative has a defined frame. It is encouraging girls in the age of 12, 13 and also then, but potentially also then later going and considering and career in tech. With that one, it brings these challenges that teams are solving for specifically, for example, schools are taking problems on that they're gonna frame and set up into a sort of a mini startup mode thinking about what is the business case?  This is a very, very round off and defined program that we have set up and it really, it sparks very, very great, not very, but great ideas in the sense of it sparks the ideas for really how those problems can be solved in those communities and potentially beyond. What I really love about it is it forces diversity. You think about it, it's not only just for girls or it's not for younger women, but it is diverse teams. So they are from a diversity perspective, it brings different perspectives into it and is solving those problems for communities or challenges for communities. So since we started that one, we have had a very, very strong participation in the UK, for example, from 136 schools and I think over 30,000 students and we are now rolling this initiative also out to other countries in Europe and I had the pleasure to participate in the one in Germany. So I think that was really an outstanding experience and it really brings that top of mind again and again thinking about no matter what's your background is, just go and solve problems for your school, for your community, get people together, get diverse perspective and get things going. I love that example. It's a great story because it also allows people to get their hands on some technology experiment, break stuff, fix it, get building at the young age, but also the theme this year is breaking the bias. So when you get to the younger ages, the bias can be worked on there. This is a great example of that. Does that have an impact there as well? Yeah, I think so very much. You have those teams that are naturally then working around the problem and they are really absolutely focused on the topic. They are absolutely focused on solving a challenge and I think that really brings the diversity of perspective together and in that context, the teams are also looking at what we have in our organization, what makes really that strong culture which are the leadership principles. So this is an invent and simplify. This is a build trust very much, just deal respectfully with other people, but also be able to discuss, have your strong opinion, but then also agree on a direction. So I think it really brings that to the topic and by that broadens the base of the collaboration. Right, organic diversity from day one, as they saying Amazon phrase, but let's take, speaking of Amazon phrases and leadership principles, one of the things that we hear, Andy Jassy talked about this all the time, but now Adam Slavsky talks about it as well. He's the new CEO of AWS is to be the world's best employer, right? So one of the things is the diversity, inclusion and equity part of the equation. And of course they're putting stories out like this is a great, great service and we're happy to be working with them on this. So why is diversity and inclusion and equity such an important part of this leadership principle for Amazon and the world? Can you share your thoughts and share the urgency and imperative of why this is a big deal? Look, I think now, first of all, we need to acknowledge that we are all diverse, right? And we can by default say that. So we are bringing all this diverse views. We are bringing a lot of diverse perspective when we are joining a company, when we are talking to other people in each and every interaction, we are expressing our diversity. And we as AWS believe that when technology is delivered, it should be in a way that it should be built in a way that is first of all diverse, it is equitable and it is inclusive. And we have the responsibility to make that happen. And we also have as an organization, the responsibility to take the way on, to understand what does it takes to get there and to get the commitment out to make sure that we bring more diverse perspective. We bring more diverse perspective. We foster those ones and we build on that we never stop on looking at bringing more and more diversity in, that's one. I think we are as AWS committed to a diverse workforce for one reason and that is our customers are diverse. The challenges are diverse. So delivering the best solution needs a diverse perspective. This is where the best of innovation comes together when you have people that can discuss, but those people also feel safe to express themselves and to have their voice heard. So that's the second part to it is it's the customer focus and we are extremely customer obsessed. But on the other hand, it is also the question about we do it for our people because we want, and that comes then back to your point, John, also on the leadership principle, we want our people to feel the belonging into the organization. This is what they are in their safe point. This is what they deliver at their best, also for our customers and what they feel that they are part of the organization. And when you take diversity, equity and inclusion together, the outcome of all of three is belonging. So we want to really drive that to make sure that we drive more aspects of that diversity into the organization. So we bring a broad basis of our colleagues into the organization and make the work voice heard. That's it. Now, that's one, hang on. And then we want actively recruit women into drive this gender diversity specifically as well. When we look for example at EMEA and we are going to colleges, we are going to events, we are going to conferences. When we want to really offer the benefits for our industry leading, for example, parental leave, mentorships and sponsorship programs, which have women to develop their careers, to really focus on that one. So I think it is striving for being the Earth's best employer by bringing those top industry programs to life to make sure that each and every diverse personality can find a space at AWS and run for the best of our customers. Yeah, that's a great point. The world's diverse, the customers are diverse. And if you put the three words together, they're all equally important. You got to include everyone. Got to be diverse. Everyone has to have equity. That is a community. That's about what community is about. And we're now doing seeing more community focus than ever before in today's world. This is super important. Quick follow-up on that, the role of community. What's your vision on community? Because people want to belong to something. They want to be part of a tribe, this community. Yeah, and that's what I'm saying. I think when you, to your point again, to reinforce that when you bring these three words together, you get this community feeling, you get the belonging. I think it's also the question of a strong culture. You, the ability to offer a cultural framework that people can identify with where they see that the breadth and depth of their skills and all the people around the globe can be folded in. I think this is massive. And this is extremely powerful to bring that to life and to be able to offer this to our colleagues that are working at AWS, but also beyond. That is a universal message that we can spread. Yeah, I got to say, props to Amazon and AWS and we're investing at theCUBE. We're going to do more of these interviews. This is a force multiplier. I think diversity, inclusion, and equity is a force multiplier competitive advantage. The product gets better, the people are happier. It's just a wonderful thing. So I really appreciate the insight and points on that. That's a great, great segment. Lastly though, we're speaking of the number of inspiring women. You're one of them. Thanks for joining us as part of celebration International Women's Day. I'd like to ask you, who inspires you? Look, there are so many. I think we are living in a world where you get the inspiration from very, very many sources. But if I drive that back to what has shaped my career, what has shaped my past, I would say that they are two main data points. The first one is, I'm really going back to my dad when I went back to him and says that, what eventually can I do? He just looked at me and said, do whatever you want. And this is how I really went into life rolling up the sleeves saying, okay, yeah, well, let's go there, right? So it inspired me to look at the positive side and to always take it from an opportunity perspective to go and do whatever I wanted to do, what I thought is interesting for me and where I have been really curious and wanted to learn more about. That is one. And the other one, besides all the frameworks that we, for example, have at AWS, the leadership principles, our culture of diversity, but also our culture of discussion, high debate. And those types are super, super inspirational when it also comes for me to drive in the next level of getting everybody on the same page. I had a discussion with one of my former skip managers, as skip level managers. And the sentence that he has formed that still sticks with me is, I was looking at the next career point and we have been discussing that back and forth. And he was always asking me the same question. So what do you wanna do next? And I gave him an answer. He never answered, he just walked away. And I did that two times and I eventually figured out that it's probably not what he really wanted to hear. And when we started to go into a discussion, he pointed me to a fact or to a direction that he said, do you want to wait for dead men's lippers? And this is a sentence that just, you don't really need to understand that in breadth and depth.  Is that something, this is something where I always think myself back and forth, I'm thinking, which point am I at? And is that eventually also a point where I would say, this is a dead men's lippers transition point. And this is what inspired me of thinking about the next career points, staying agile and also staying always curious and learning. So going to that next level is about pushing yourself and really rethinking and going after things that may be aspirational, but attainable at the same time. Understanding that role sounds like that was a growth opportunity. Yes, it was a growth opportunity. It never comes to the point where you're gonna say, I'm gonna now, that's it, right? I've learned everything. It is a, I'm gonna step out. It's gonna be outside my comfort zone. Am I ready to do that? And is that the right point for me? And I think the answer to that one is always yes. This is how you stay, stay keep up with technology, but you keep up also with all the fantastic opportunities that the life and also the environment like, for example, AWS offer. Isabella, thank you for coming on to sharing this story. One last question I'll ask you is, what's next for you? What do you want to do next? You're worldwide public sector executive leader for Europe, Middle East and Africa for AWS, hot company. The regions are everywhere. There's more regions as local zones. Everything's happening. It's expanding. You're in the middle of it. What's next for you? I want to see cloud being the driver of innovation and business dynamics and business model change. And I want to be part of this business model change that is based on cloud in future for the benefit of public sector and all the other entities. And also very much for the benefit of all citizens around the globe. That's my next. Well, it sounds like it's gonna be very diverse, inclusive and highly equitable. And I want to be part of that. I want to belong to that. Thank you for sharing and looking forward to more conversations. And thank you for spending the time to come on theCUBE's presentation here. Thank you so much. Thank you so much, John. I appreciate it. Okay, theCUBE presentation, Women in Tech, global events celebrating International Women's Day. This is the first episode. There'll be more. We're going to get more and more stories out. But March 8th is a big day. We're celebrating it today. International Women, I'm John Furrier, the host of theCUBE. Thanks for watching.


What's going on guys welcome back to another video and to a brand new video series actually The second edition, I'm not gonna say annual because the first one was back in 2018 And what an experience it was guys. We're here for one reason and one reason only To get back into NFL fantasy. I've got time We have a good week and a half until the start of the 2021 regular season So the time is now it's it's simply now I'm gonna do it through the NFL comm website. I know there's other options, but I did use the NFL League last time So I'm gonna try and log in using my old details. We're gonna get it up We're gonna have a wee look around and we're gonna I'm led to believe join a free league So if you are interested in the NFL if you're interested in NFL fantasy if you are playing NFL fantasy Then stay tuned guys because it's gonna be a hell of a lot of fun There have been a lot of lessons learned since my first attempt But I'm not gonna try and predict anything because last time I came into it feeling relatively confident Unfortunately, that didn't last too long, but I'm feeling Even more confident today. So all right and Here we have it apologies for the the lighting in here I'm feeling like Casper the ghost, but it is because I'm cracking into it relatively early. Well, it's not too early It's actually 9 24 in the morning on the 2nd of September 2021. So guys, let's get into this I've logged in I'm assuming I'm gonna join a free league leaderboards No, not quite yet. Nope. Certainly not on a leaderboard. I Do have trophies from the 2018 season. I managed two teams in 2018 apparently Oh No, oh no, you're joking. Yeah, I might have a trophy or three But they've all got bombs on top, which I'm assuming means they're not for anything good And in fact as I read here, I Got the trophy in week 16 for the team with the highest scoring player left on the bench and My friends that was Russ Wilson. Not sure what I was doing there. Oh another one week 13 Yeah, same thing benched Russell Wilson and left 24.8 points behind Lovely and what do we got here the first ever trophy earned actually week number two once again See, I just couldn't win I could not win Trophy is awarded weekly to the team with the highest scoring player left on the bench and this time it was Blake Bordles And I left 32.58 points Behind I'm not quite sure what happened But if we go week to week, I'm assuming I'm assuming is that I went with Russ early on Week number two. I'm unfortunately for me Blake Bordles must have balled out I must have kept Russ in there for a fair few weeks and then nearing the end of the season I throw caution to the wind and put Blake Bordles back in and unfortunately left 24.8 points behind in that week and and 28.54 points behind in that week. So there you have it My 2018 season summed up in three weeks now as you can probably expect I'm keen to crack into it again. I'm keen to I'm keen to prove myself once more I'd been watching the league. Well, I hadn't even watched a live game ever Okay, got into the league in the offseason round about the time of the 2018 NFL draft So I had two months of watching highlights then I went into my first ever fantasy football season didn't work out Anyways, here we go. We're about to play. We are we are about to play and I'm gonna join a free league NFL managed now, I'm gonna have to check what the time is So we've got the first one starting at 8 30 p.m. Eastern daylight time and the current Eastern daylight time is 529 p.m. So if I'm sitting here at 9 29 so 9 30 would be 5 30 we're talking three hours We're talking 12 30. Do we do that one or do we go one o'clock or do we go to 30? I'm gonna say later in the day is actually better It's gonna give me more time to crack into some reaction videos and for anyone wondering I do have 44 more players in the NFL top 100 series to go and if I can get through 14 today That's a real win, but that's enough of that. I'm gonna go for the the latest time possible 10 30 p.m Which will be 2 30 p.m. For me. So I'll write that down. We have one of 10 openings available That sounds about right team name Max 30 characters no profanity and no special characters. All right.  We'll be doing pretty damn well if they all Actually play the game for the entire season, but we're gonna give it a go rugby player reacts time zone New Zealand Submit. No, what are we? We've got some rules. We do have some rules We've got 10 10 teams a 90 second time per pick and Look if anyone was wondering we've got Charles Sean Daniel Mateo Tim Ellario Sergio can Andy and rugby player reacts So let's do it sweet and There we have it. You have joined NFL managed league 100 22486 so guys for anyone following along at home for anyone who wants to check in on us throughout the season.  We're allowed to pick and Then I might start drafting a few First second third fourth round picks but apart from that. I reckon it's time to head to the league Here we go. Hang on. Where's my logo one QB two running backs two wide receivers one tight end and one either wide receiver or running back One kicker and one defensive team, right? I can do this I Can do this. We've got four hours 55 minutes and 16 seconds until the 2021 fantasy draft begins So that my friends is that for now First week first matchup rugby player reacts versus hands of doom and Bound to be a cracker. Anyways, I'll see you back here in about four and a half hours


This study compared the cognitive impairment between patients with epilepsy and psychogenic non-epileptic seizure disorder. It was found that patients with epilepsy had greater cognitive impairment than those with psychogenic non-epileptic seizure disorder. This difference was statistically significant with an effect size of 0.42. This article was authored by Narina Kauser, Hofsocrabin, and Bushrabibi.


Marines and sailors with 3rd Marine Expeditionary Force departed for Thailand as a Humanitarian Assistance Survey Team to assess the flooded areas and the caliber of assistance needed. The team will identify key areas of support from US forces to include medical, transportation, engineering, and communication needs. We are headed to Thailand to do an assessment and a survey of the damage or the needs there so that we can determine how we can have US forces and Marines from Okinawa render assistance. The HASS deploys to an affected country to assess and gain information essential for planning. Three MEPs regularly trained to respond to disaster relief and humanitarian assistance during exercises held throughout the Asia-Pacific region. I think this event highlights the responsiveness of 3rd Marine Expeditionary Force here in Okinawa in this Pacific Theater. It was less than 12 hours ago that we got the word that we wanted a HASS there in Thailand. The Marine Corps is committed to working with the people and government of Thailand to ensure their relief needs are met during this unfortunate time. Lance Corporal Mathias Hernandez, Marine Corps Air Station Fatima, Okinawa.


Reuse of hemodializers has become the standard of practice in the majority of clinical centers and for the majority of patients on hemodialysis in the United States. Whether one agrees or disagrees with the practice of reuse, all agree that patient safety and well-being are the prime concerns of everyone involved in dialysis. Patient care must not be compromised by reuse or any other procedure used in the clinical setting. Reuse of a hemodializer is defined for our discussion as the use of a hemodializer more than once on the same patient. The reprocessing of dializers has been practiced almost from the very beginning of dialysis and its frequency has varied over time. A recent Centers for Disease Control report showed that approximately 70% of all hemodialysis patients are treated with reprocessed dialysis. All experience and research indicate that the use of appropriate reprocessing procedures results in reprocessed dializers that are safe and effective. To assure patient safety and effective treatment, the medical profession, government agencies, manufacturers and patient organizations recognize the need to establish guidelines that would provide the essential elements of an acceptable practice for reprocessing hemodializers. A consortium of these interested parties came together under the auspices of the Association for the Advancement of Medical Instrumentation, AIME, and in 1986 published the document Recommended Practice, Reuse of Hemodializers. Later that same year, the Healthcare Financing Administration, HICFA, was required by Congress to establish regulations for the reprocessing of hemodializers for those facilities that elect to reuse such devices. As part of the regulations for reuse, HICFA incorporated by reference the guidelines developed by AIME into the Medicare conditions for coverage for dialysis facilities. HICFA will evaluate the facility's reprocessing procedures as part of their health and safety surveys. This videotape is not intended to be a complete compendium of instructions to fulfill all of the mandates in HICFA regulations. Neither is it intended to encourage or discourage dialyzer reuse. Rather, it has been prepared to assist facilities which reuse dialyzers to become aware of their responsibilities under the HICFA regulations. In addition to meeting federal regulatory requirements, an effective dialysis program, whether it includes reuse or not, requires communication and cooperation between all members of the dialysis team with as much involvement of the patient as possible. Each member of the dialysis team should be familiar with the HICFA regulations and the AIME recommended practice. As with the entire dialysis program, the medical director and the facility's governing body have the ultimate responsibility for the development, implementation, and monitoring of the facility's reprocessing policies and procedures. These reprocessing procedures should follow a logical sequence of steps. Before we start talking about all the specific details of reprocessing and training and techniques, we need to really understand two terms that are critical. One is master record file and the other one is process validation. The master record file should be a compendium of all specifications, policies, training materials, manuals, methodologies, and procedures. The file should also contain samples of forms and labels used in the facility. The master file either contains all of these records or indicates where they are kept. We talked about that there can be separate logs in terms of our quality assurance procedures, our health and personal safety records, our occurrence reports in terms of anything that is out of the ordinary on our unit or in the reprocessing procedure. All these records and logs... These files often refer to as operational logs and any other files which the facility may establish may be kept separate from the master record file. It is important that these files be kept current since they provide an ongoing record of the facility's reprocessing operations. As with all dialysis records, analysis of these records can identify problems which could, if not corrected, result in patient injury or ineffective treatment. Now let's talk about the second term, process validation. Let me read to you from the A&E document in terms of what the term process validation means. Validation is defined in the A&E document as the establishment of document and evidence providing a high degree of assurance that a given process will consistently yield a product meeting predetermined specifications and quality characteristics. In other words, it's a process of documenting that a particular reprocessing procedure works in our facility. Before establishing a reuse program, the medical director should initially establish criteria for the performance of the reprocessed dialyzer. Then a written procedure should be developed for each step of the reprocessing program. If followed conscientiously, these procedures will assure that the performance of the reprocessed dialyzer will not deviate from the pre-established criteria. These procedures should be noted in the master file and should be audited periodically. The procedures should be carefully reconsidered after any significant change in the reprocessing steps to assure that the pre-established criteria continue to be met. Finally, quality assurance checks of staff performance should be done periodically to determine that these written procedures are being followed. All of these procedures are included in what we have described as validation. Now let's examine each step of the reprocessing procedure in detail. Many facilities subject new dialyzers to the entire reprocessing protocol prior to their first use. This provides a standardization of procedures for all dialyzers used in the facility and establishes a baseline value of performance for that dialyzer. The dialyzer must be labeled with the patient's name and or identification number. This should be done prior to its first use. After the patient has completed dialysis, the used dialyzer is ready for the first step in the reprocessing procedure, rinsing and cleaning. Initiation of the rinsing and cleaning process should begin as soon as possible after the termination of the dialysis procedure. Each facility should establish time limits and develop written procedures that avoid delays and assure that the dialyzer will always be handled and transported in a clean and sanitary manner. It is very important that water used in all reprocessing steps meet the requirements of the Amy recommended practice for the reuse of HEMO dialyzers. The water should have a bacterial colony count of less than 200 per milliliter and or a bacterial endotoxin concentration of less than one nanogram per milliliter as measured by the Limulus Amoebocyte Lysate LAL assay. In addition to water, there are a variety of chemicals and procedures that can be used to effectively rinse and clean the dialyzer. The safety and effectiveness of the solutions used for rinsing and cleaning and the amount of flushing necessary to reduce the concentration of these solutions to safe residual levels should be established during development of the facility's initial reprocessing procedures. Both the dialysate and blood compartments of the dialyzer should be flushed with a rinsing or cleaning solution until the affluent is clear. A pinkish or brown tint is not acceptable. The facility's acceptance criteria for a properly rinsed and clean dialyzer should be established and noted in the master record file. After the rinsing and cleaning step, each dialyzer must be subjected to appropriate performance tests. To check the performance of the dialyzer after each use, Amy suggests that a test for clearance should be performed. For hollow fiber dialyzers, total cell volume is one test that can be used as an indirect measurement. Total cell volume, also known as fiber bundle volume or total blood volume, has been shown in published scientific articles to correlate closely with clearance. However, it is also important to monitor the clinical and laboratory status of patients during the long-term course of their treatment. Failure of dialysis therapy to provide adequate clearance should be recognized as a complication which can occur even though the performance test of reprocessed dialyzers may be satisfactory. Inadequate clearance can also occur with new dialyzers and may not be related to reprocessing. It is important, therefore, that the cause of inadequate patient dialysis be determined. Although the Amy document does not call for a leak test on each dialyzer, the Centers for Disease Control and the Food and Drug Administration recommend that this test be performed on each dialyzer to assure integrity of the dialyzer membrane. Automatic reprocessing machines perform this test as part of their normal operation. Once the dialyzer has passed the required performance tests, both the blood and dialysate compartments must be subjected to at least high level disinfection. The facility must assure that the germicides that are being used have been shown to be effective against a wide spectrum of microorganisms, including the highly resistant water-adapted forms. For germicides labeled for a dialyzer reuse, manufacturer's instruction should be followed. This data is supplied by the manufacturer of the germicide on the product label or the package insert accompanying the product. These values have been validated by the manufacturer and do not require revalidation if instructions are followed. When formaldehyde is the germicidal agent, the concentration in the blood and dialysate compartment should be 4% with a minimum contact time of 24 hours at a temperature of at least 20 degrees centigrade. Lower concentrations or shorter contact times are appropriate if equivalent results have been demonstrated under other conditions. Rationale or data supporting formaldehyde concentrations other than 4% must be documented in the master record file. To prevent any risk due to combined actions of different germicides during storage, a single dialyzer must not be exposed to more than one germicide. This is not intended to apply to the use of cleaning chemicals which may be employed to rinse and or clean the dialyzer after patient use. If the facility changes germicides, dialyzers which were exposed to the original germicide must be discarded. The facility's procedures must be updated to reflect use of the new germicide. As with rinsing and cleaning, the quality of the water used to prepare the germicide from concentrate is critical. The water quality should be tested frequently and should conform to any recommended practice for re-use of hemodializers. When filling the dialyzer with germicide, an adequate volume of germicide should be purged through the dialyzer to ensure that the germicide will not be diluted by any residual rinsing solution. The final concentration of germicide in the effluent should be within 10 percent of the prescribed concentration. In manual systems, each prepared batch of germicide should be tested prior to its use to verify proper concentration of the germicide. When the germicide is diluted with automated equipment, the germicide concentration in the dialyzer after it has been filled should be tested regularly. All germicides can be tinted to indicate its presence in the dialyzer. The facility should have a method to verify the presence of germicide in each dialyzer, and procedures should be developed to assure that each dialyzer is properly filled with germicide. If the dye method is not used, follow the instructions that accompany the germicide. If the instructions do not require testing each dialyzer, an appropriate test for the presence of germicide must be performed each day on a random sample of reprocessed dialyzers, according to a written procedure established by the facility. Verification of the presence of germicide must be documented whether the dye method is used or not. Written procedures should be developed to provide assurance that the appropriate concentration of germicide is present in each dialyzer. The outside of the ports should also be disinfected. The ports of dialyzers may be capped with new or disinfected caps. If dialyzer blood port caps are reused, they may be disinfected with either the chemical germicide that is used for disinfecting the dialyzer, or any other chemical germicide approved by the EPA as a sterilant sporicide. If the manufacturer of the germicide or reprocessing equipment makes specific recommendations regarding port-captis infection, these instructions should be followed. The use of germicides could pose an environmental hazard to staff and patients. In order to minimize exposure to those who may be involved in reprocessing, HICFA has adopted limits set by the Occupational Safety and Health Administration for a number of ingredients contained in the formulations of chemical germicides used in dialysis facilities. HICFA surveyors may look to see if the facility has taken steps, including providing adequate ventilation and air sampling, to assure that these limits have not been exceeded. In addition, appropriate precautions such as gloves, masks, eye protection, respirators, and protective clothing may be required to minimize staff exposure to hazardous chemicals. After the disinfectant is added, the dialyzer must be thoroughly inspected before it is placed in storage. Some aspects of the inspection include assurance that the dialyzer casing is free of blood or other foreign material. There are no leaks or cracks in the dialyzer casing or the dialysate or blood ports. There are no more than a few dark clotted fibers evident. The headers are free of all but small peripheral clots. Blood and dialysate ports are capped without evidence of leakage. And the label is properly filled out and legible. Reprocess dialysers which have failed any of the acceptance tests or the criteria established for passing inspection can be reprocessed again if written procedures permit. Reprocessed dialysers must be labeled as rejected and quarantined until they are further processed. Dialysers which continue to fail the acceptance tests must be discarded. Reprocess dialysers which have passed all acceptance criteria must be stored for at least the length of time required for the particular germicide. The storage area for reprocessed devices must be separate from storage areas for new devices, rejected devices, and devices awaiting processing unless the condition of the devices is clearly evident. Following storage and before use by the patient, another series of inspections and checks is necessary. These include at least the following. Assurance that the label of the device is intact, affixed to the device, legible, and contains the information required by the facility. Assurance that there is no structural damage or tampering with the device. Assurance that the dialyzer ports have been properly capped and there is no leakage from them or other portions of the dialyzer. Assurance that the storage time and conditions were appropriate for the germicide used. And assurance that the cosmetic appearance of the dialyzer is acceptable. Results should be recorded in the reprocessing records. This inspection report should be signed by the person performing the inspection. To ensure that each patient receives his or her own reprocessed dialyzer, two persons should check the first and last names and any other identifying information contained on the device prior to initiating dialysis. Do you want to check your dialysis? If possible, one of these persons should be the patient. Are you allergic to babies of any kind? No. Any shortness of breath? No. Thank you. This step should be recorded with the signature or other identification of the person or persons performing the verification. Prior to patient use, the dialyzer should be rinsed and primed according to the germicide manufacturer's suggested procedure. If no instructions are provided by the manufacturer, the facility's written procedures must be followed. These procedures have been designed to produce a reduction in the concentration of germicide to an acceptable level and to result in a physiological solution in the blood and dialysate compartments. The level of residual germicide should be measured by a test of appropriate sensitivity to assure the germicide level is below the maximum allowable concentration. If the germicide is formaldehyde, Amy recommends that the residual concentration should be no greater than five parts per million. Some states have set lower limits. Although clinic test is useful for determining the presence of formaldehyde at some concentrations, it must not be used for determining concentrations in the range of one to five parts per million. Also remember, the dye method is used to determine the presence of germicide in the dialyzer. The absence of dye should not be considered an indicator of the absence of germicide. The completion of the test for residuals should be recorded in the appropriate log or patient flow sheet. If the test indicate that the concentration of the germicide has not been reduced to the required level, a repeat of the rinsing procedure and a retest for germicide are necessary. After all reprocessing steps are successfully completed, the dialyzer may be used. It is important that the clinical course of the patient be observed and recorded during each dialysis to identify any possible complications. Any unexplained increase in temperature or chills occurring during treatment should be reported to the physician. Either of these symptoms could result from endotoxin contamination of water used in reprocessing or in preparation of dialysis as well as other possible causes. Other unexplained symptoms at the onset of dialysis such as pain in the blood access arm, flushing, hypotension, nausea or a strange taste may be an indication of a reaction to residual germicide. In this case, extracorporeal circulation should be terminated immediately and the blood should not be returned to the patient until the situation has been evaluated. Any significant events must be recorded on a special incident report which should include the results of any investigation or remedial actions taken. A pattern of new dialyzer failure should be reported to the manufacturer. Similarly, an unexpected pattern of failures of reprocessed devices or other unusual patient symptoms should result in an investigation of the reprocessing procedures. Results of such investigations and if appropriate corrective actions taken should be recorded. With the completion of the dialysis treatment another reprocessing cycle can begin.  They will not only check files to be sure that they are complete but they will be particularly interested in determining if documentation exists that indicates the staff is properly following the procedures described in the file. Being aware of what the surveyors will look for during their visits can help the facility's personnel assure that the files are complete and are in compliance with the regulations. To run an effective reprocessing program it is essential the personnel possess adequate training and experience to understand and perform the procedures outlined by the individual dialysis facility. The facility may employ persons to perform the reprocessing procedures who have no medical background as long as they are fully trained in the essentials of their job by the medical director or his or her designee. Repair of automated equipment however is usually done by the facility's technicians specially trained in the maintenance and repair of that equipment or by a manufacturer's representative. Manufacturer's recommendations for periodic preventive maintenance must be followed as well. The medical director should establish a written training curriculum. It should encompass the full spectrum of the reuse process and safety considerations which are discussed in HICFA regulations and the AEMI recommended practice. Instructions applied by the manufacturer of automatic equipment and germicides should also be included in the curriculum. Each person performing reprocessing procedures must have successfully completed the facility's training course relevant to their task and have demonstrated competence in the area covered by the training. Documentation of the successful completion of the training should be recorded in the employee's personnel file along with the trainee's verification of having received the instruction. Realizing the personnel performance lies at the heart of good reprocessing. The HICFA surveyor may observe the performance of the persons carrying out their tasks to see if they are properly performed. Therefore, it is important that all staff be adequately trained. The welfare of the patient is the primary goal of any dialysis program whether it uses only new devices or reprocesses them. The patient's treatment should not be compromised by the procedures used. The decision to reprocess hemodializers should be made by physician knowledgeable about reprocessing and its medical implications. When patients have special medical conditions such as aids or hepatitis written procedures should stipulate whether and how reprocessing will be done. HICFA also requires that the patient be fully informed regarding the facility's reuse of dialysis supplies. However, in most states the decision on whether to require specific informed consent with respect to reprocessing is up to the medical director in the individual facility. If used, a copy of the consent form should be in the master record file and a signed copy should be placed in the patient's medical file. Patient cooperation in the facility's reuse program is best achieved through an open, honest, non-coercive and trusting physician-patient staff relationship, where the patient feels that his or her participation in the reuse program is in his or her best interest. Physicians and the clinical staff should be sensitive to the patient's physical and psychological dependency on the life-supporting treatment that they provide. The physician and patient may wish to discuss their joint responsibility to maintain the efficiency of the end-stage renal disease program while assuring quality of care. HICFA surveyors may be talking to your patients to determine how the facility informs patients about reuse and whether or not they are comfortable with the information they have received. The recommendations we have presented describe some of the elements of good practice for the reprocessing of hemodializers. But the real foundation of a successful program is made up of people. If the processes described in the Amy document are carried out by trained conscientious people, reuse will be done in a quality manner just like the rest of dialysis. If you do it right, it works. If you do not do it right, it doesn't work. To assure that one does it right, a few basic messages from this program should be remembered. First, water should meet the requirements of the Amy recommended practice. Never expose the dialyzer to untreated tap water. Second, be certain the performance of the reprocessed hemodializer is maintained for each use. Third, be certain that the proper germicide concentration is maintained within the dialyzer for the specified length of time and be sure the germicide has been reduced to required levels. Finally, always follow your facility's written procedures for reprocessing. Reuse can be safe and effective. However, it is up to the entire dialysis team to assure that the facility's standards are being met. It's common sense and knowledge, not mandatory regulation that should dictate good processes and adequate controls in your facility. Providing your patients with a reprocessed hemodializer which maintains its performance characteristics, aesthetic appearance and safety should be your goal.


Hi, this is your something party and welcome to another episode of tear for let's see or demo And today we have with us drew stokes head of engineering at jelly Drew is great to have you on the show. I'm excited to be here Yeah today's discussion is going to be interesting because you folks in yourself had some incidents internally and that's where you ended up using Jelly and a lot of things that we have talked about With the jelly some of those things came back some of the practices that we talked about earlier as well So I want to talk about all those things But before we get it started just remind our viewers What is jelly all about on how you folks are a bit different from when we look at traditional actually traditional is not the right word there But typical incident response companies or solutions happy to talk through that So jelly is it an end-to-end incident management platform? And so what we're trying to do is provide products that help our customers Effectively respond to their incidents and then also learn how to adjust their organizational processes and Teams in order to be more effective in building the products that their customers need and delivering on the The reliability that customers expect for some of those in the previous discussions with jelly One recurring theme was that it's really important to focus also on what happens after an incident you know that plays a big role so talk about this focus and its importance The post-incidence analysis and how was again it's different from other approaches. It's really easy to imagine Incident management as being primarily about Identifying the issue and fixing the issue and then moving on and I think We've come to recognize it jelly that effective incident management It requires going beyond technology and the contributing factors for a specific issue and Looking at how to bridge the gaps in understanding and priorities and context between people in an organizational You know a group is this socio technical aspect of managing software Nora Jones our CEO and founders she started jelly to help organizations recognize those gaps and brought on a bunch of folks onto the team who have experience kind of navigating these complex systems in these complex organization organizations, excuse me And they know how this stuff works So we kind of can bake that knowledge into the product and help fill those gaps on behalf of our customers For us post-incident analysis is one of the most important things organizations can do Because understanding the way that organization operates and the way that these systems are maintained Can help you Make changes that reduce turnover that help your bottom line as a company that that overall help you deliver more reliable products to your customers I mean if you looked at Sometimes some companies I mean there are tools they use like Slack is their email is there Google Docs to that Which did not only used to record but also kind of a lot of post incident analysis happens on those platforms as well talk a bit about What role does jelly play there what additional value you folks bring oh my of course It's not replacing those but in addition in on top of those other you know Platform that folks already use incidents generate a lot of data and and we see with a lot of our customers There's this combination of Discussion in your Slack channel. There's a Google Doc running where you're capturing details on what remediation steps The team has taken what they think is going on Sometimes there's conference bridges where folks are talking in real time and coming up with solutions that maybe don't make it back to the team Longer term and so I think jelly's kind of value proposition for those types of complex data rich Situations is that we save you time and money. I mean at the end of the day That's the thing that we need when we're dealing with these customer impacting incidents and trying to learn how to improve efficiencies and organization So, you know when you're in an incident keeping your stakeholders be they vp's of engineering or customers or whom I'm a bit whomever they are updated on what's going on during the incident so they can kind of set expectations with with folks and then conducting the Investigations once the incident is mitigated all that stuff takes a lot of time, right? You got to make sure you're communicating things to the right people Got to make sure you're pulling in, you know the Google Docs the slacks all of the details from your various systems And so the ways we try to help with that is we've got an incident response bot that standardizes the process of responding to incidents so responders don't have to look at Incident run books or kind of remember the sequence of steps that they need to take to get an incident going And our narrative builder, which we'll look at in a little bit Makes it easier to build those infinite narratives and do that analysis After the incident by doing some of that work for you. It makes it really easy to kind of gather all of that information Finally over time as you're responding to incidents and analyzing them and coming up with themes and takeaways that data Can can be presented back in a way that helps you make decisions about What engineering work needs to be prioritized where there may be gaps and headcount or skill sets on particular teams and Knowing all of those things help leaders make better decisions about organizational growth and and operation Operational efficiency. Will it be wrong to say when we look at you know posts incident analysis or just look at incident management in general It is More about people and processes right processes then tool I mean, of course tools are important, but unlike a lot of other things. I mean, of course Most of things but sometimes right tools and that's done But when I listen to you or you know, when we look at these things Is the engagement of whole team is like a whole organization? They have to look at it from a really different perspective a holistic view has to be there It's not just a problem of one team because when something goes wrong, you don't really know what went wrong We're so whole teams have to come together. Of course Jelly cannot go out and change Cultures, but sometimes tools they do encourage, you know teams coming together So talk a bit about the importance of culture and then I'll talk about how jelly's tools actually kind of help It becomes a catalyst in changing the culture as well That's a really great question So culture is really important and and we found and this will come as no surprise that every organization's culture is different both in terms of the way that they Respond and and kind of think about incidents But also the ways in which they analyze and incorporate what they learn into their organizational process So one thing that we're really proud of and we think is really important about jelly as a product is that it is People-centric so every feature that we develop We're asking ourselves. How does this help responders make better decisions or focus more on the incident rather than you know kind of Pushing information around as things are going on and then on the tail end in the analysis How are we telling the story of the people that were involved? What they knew at the time that they responded what they didn't know and how these specific types of events affect them their teams and the broader organization and You know as I mentioned earlier like this is this is a huge area of opportunity That can be difficult to invest in because of the amount of time, you know, if you're doing this all by hand That that it can it can take up So I think one of the things that we hope is this people-centric focus in the product and the ways in which we are kind of supporting Existing processes and making this process customizable For our customers is that it will help shape some of that cultural, you know Perspective on on incidents and what they mean for an organization and what what can be learned from them And I think one of the best example can also be jelly itself as we were doing before the recording We're talking about that you folks have some incidents a few weeks ago And once again you leverage itself to understand what's going on and which which is you know a very good example not only just About the right tool, but also kind of culture that either jelly had or kind of triggered a hate This is the kind of culture you should have so let's talk about you know The resident the lessons and of course We would love to see a demo as well that how you know jelly help you folks as well If it's okay with you all kind of show you how we run these incidents very quickly and then we'll talk about Some of what my team did to analyze this this big kind of multifaceted incident what we learned from it and how jelly help So let me just show you a little bit of how the incident response process works for us a Fun thing about jelly is that we are all incident response and analysis nerds And we get to build a tool that we use you know every day to kind of respond to our incident So what we're looking at here is a slack demo environment where I'm going to show you some of these features. So You mentioned culture one interesting thing about Incidents is that sometimes it can be difficult for an organizational culture to make space for folks to declare incidents You're worried is this an incident should I declare it? I'm going to pull people out of their work They're doing I'm going to page them, you know, maybe at a time that's inconvenient for them So one thing that was really important for us is when there's an issue We wanted to make it as easy as possible to get an incident started So in slack you can run slash jelly open and you're presented with a modal that allows you to add a bunch of optional data about an incident For example, you can add channels that you want to send status updates to to keep your stakeholders updated on what's going on You can create conference bridges with zoom you can create incident tickets in your ticket management platform You can also specify who is The incident commander or whatever role that you use internally both are all customizable as well as Declaring incidents in private sometimes you have incidents where the information is sensitive and you need to conduct those in a private channel So this is the modal and one button gets you into an incident channel We talked earlier about how jelly saves time And I think one of the things that ends up happening when you're a responder Is there's a series of steps that you need to take to get the incident going you got to create a new channel you got to set up your Broadcast you've got to start a zoom call you've got to do all these things And so what we try to do is take care of that with the press of a button So we now have an incident channel. We've got a zoom bridge in there Freddie Mercury. I'm Freddie Mercury in this demo is the incident commander and I can start responding In whatever way makes sense given the incident, right? Maybe maybe searches down Right So we can kind of coordinate the response there I can bring in other folks into the channel and assign them their specific roles and we can kind of Figure out how to resolve the incident drop and drop in the bridge and start talking about it once everything is is kind of cleared and we've closed the incident out or We understand what was going on and we fixed the issue There's a lot of different options of things we can do along the way, but at the end we can close that incident This will mark The incident is closed as well as indicate that the incident has been mitigated and in the jelly platform We can control who can view the resulting investigations. Sometimes we want these investigations to be Private until we've kind of gone through all the details We can set an optional severity during or at the end of the incident and then we can provide a summary to our stakeholders I'll just give a really brief one here And then we'll close it and what happens is when this incident is done Jelly takes care of all of the work of gathering that data for you So we don't have a lot of data in here But the entire slack transcript as well as all the on-call rotations for folks involved and all of the communication That's pulled into jelly. We'll go ahead and archive this channel because we won't need it later And that's that's how we respond to incidents almost every day We declare them we run through and then jelly takes care of all the heavy listing of setting up what we need to respond And getting all that data into a place where we can analyze During the incident, I'll just show you an example. Here's our incident view This is like live updating view that folks who are not a part of the incident response can kind of look at to keep Up-to-date on what's going on. This is an incident that's closed obviously, but lasted 25 minutes There were a couple folks in the channel Responding along with their Specific roles and what group they're in so this is really cool for you know keeping everybody on the same page about what's happening And how we're resolving it you that's the front end of the incident management process as you mentioned we recently did a Pretty comprehensive cross incident investigation So jelly had four incidents over the course of about two days, which is kind of an unusual situation for us so we a Colleague of mine and I came together to do what we called the galaxy brain investigation This was the one that was gonna help us see you know everything there was about the organization because we were looking at a Couple different incidents and what we're looking at here is the result of that investigation We've got this overview where we provided some summary on each of these specific incidents that were involved And we got a lot of details on who is involved in each What sorts of terms or tags came up in each of those these little sparkles are automatically tagged technologies from the transcript as well as some things that are related and In the process of working through this we spent about a day or two working asynchronously Looking at the incident conversation all the detail around it and coming up with a narrative of what actually happened and what it meant for our organization They can see here There's a timeline that shows Everything that happened over the course of those four incidents including when we detected them how we figured out what was going on and then What we did to repair and for each of these you can look at the specific what we call narrative marker and you can see details about What was happening from the actual transcripts the conversation inside of the the incident channel? So this is really cool for telling a story and in our learning review We walked through each of these narrative markers and talked about you know, how we got there what the implications were This is not exactly helpful for us But we can also see where folks were located at that time and what their time zone was and how the situation might have impacted them But the real like value of these types of exercises are the themes and takeaways So we had a couple things here that came out of this investigation that we found Helpful one is in this specific week. We were doing a lot of changes very quickly Balancing quality and speed is challenging. This is no surprise to anyone And so it gave us a chance to reevaluate ways that we could kind of manage that Those competing priorities Tuning monitoring is another one that that lots of folks deal with pretty often We found that there was some opportunity to tune our monitoring so we could get better insights about what was going on in the system And then we noticed some other things like there were a couple folks that were involved in all four incidents And we talked a little bit about why that is and how those folks know what's going on and kind of keep up to date all of this stuff was really helpful for us and Something that we learned as we were going through this investigation is We could not have done it without jelly I mentioned saving time and money Not only did jelly help us coordinate the response for each of those incidents But it made it easy to gather the incident data from a ton of different channels If we look at the event log here, which we used to kind of tag and annotate data There's a lot of channels in here and slack that we were using to coordinate response across all these four and Copy pasting data from slack into a Google doc and then working in comments to try and Constructed narratives can be really difficult, especially for these large Issues with with jelly. It's one command to start and then just the incident and we can pull in additional channels via import And so it makes it all really easy Furthermore doing this feeds into our broader understanding of what's going on in our organization So this is jelly's learning center and we can start to see patterns and when our incidents are happening and who's involved in what technologies Are implicated in those so it was it was a really interesting experience to do such a kind of all-encompassing Investigation and like I said, it would have taken a lot more time. I think then The two days we were we were working on it asynchronously if we didn't have something like jelly to kind of collate and give The ability to tell a story about all of that data Can you talk about when we look at, you know, the actual value of the post, you know Incident analysis is if you look at some of those practices that are there chaos injuring a data force if you look at sorry Is you know, how how does you know a jelly kind of helps with those kind of practices also? Because when we look at the themes and all those things that can help a lot with some of those strategies Some of those practices as well. Do you do you see that I think there's there's kind of two primary ways that It helps and we actually talk with our customers a lot about this and I could go on and on but let's focus on on the two primary ways so the first way is It can be very difficult to communicate effectively during an incident and if I'm a site reliability engineer on the team Which I have been in the past my primary goal is to reduce the impact of an incident as much as possible and kind of understand what's going on and and get us to a point where the incident is mitigated and Some of the features I showed around incident response and and also looking back at past incident data can really help Not only with coordination of incidents, but with helping SREs expand their understanding of complex systems over time So education is a really important part of what we're building here Skills and expertise and specific technologies do not just spread on their own you've got to kind of work at that And so we think it helps There and the second area that that I think this helps with with site reliability engineers and folks who are kind of in In the the incident space is that telling stories about what's happening in an organization can be really challenging and it requires data and it requires finesse and Requires kind of a shared understanding of what's going on we talk a lot in in jelly about a recent specific case where We had a customer who had a piece of technology that had been causing them problems for months on end And we had a senior member of the org come in and say you know what we're going to deprecate this technology we're going to get rid of it and replace it with something else and the the folks who responded to that incident were able to tell a an alternative story about the Team like the current implementation of that technology not using best practices or standards The problem wasn't the technology itself It was the organization's ability to invest in getting that piece of technology to a good state The cost of moving off of that technology in this organization would have been extremely expensive But investing a little bit of time to get that technology configured in the proper way saves a bunch of time and kind of avoids some of that Roadmap thrash that would have been introduced by that change So I think the second way that it helps is by giving those folks a storytelling tool so that they can bring the things that they know To groups that don't have the same context You've got these folks who are working with the tech technology who are experts and understand it very deeply And you've got a lot of a lot of other folks in the organization who need to understand that but not at the same depth And that's really the the the gap we're trying to bridge with this tool Is to make it easy for them to do their job and to give them tools to tell better stories about how to make the organization more Successful dude. Thank you so much for of course talking about Jelly incident response, but I really love you know the way you talk about how you folks internally use it And I also love the whole process where you showed a step-by-step How I mean because this is not just still as I was saying earlier that sometime Tools like or companies like jelly can become a catalyst in changing the whole culture or enables a lot of team who have those practices But sometimes we talk about practices a lot, but we see a disconnect between the tool and the practice But here we see that it's like a very good, you know kind of Relationship between these two so thanks for sharing all those and I would love to chat with you folks again. Thank you Thanks for having me. It was great talking with you


Biden warns Prigoshin, keep your eye on your menu. US President Joe Biden has advised the leader of the Wagner group Yevgeny Prigoshin to beware of poisoning. The American leader has been asked about Yevgeny Prigoshin's possible actions after the failed coup. God only knows what he is likely to do. We are not even sure where he is and what relationship he has. If I were him, I'd be careful what I eat and I'd keep my eye on my menu. Biden said, at present it is not known where Yevgeny Prigoshin is. But now it is believed to have met an uncertain fate following his failed mutiny in Russia according to radar online sources. Speculation suggests that the boss of the Wagner mercenary group may have been either jailed or possibly even killed and his whereabouts remain unknown. The latest reports indicate that the world may never witness Prigoshin publicly again. The events surrounding Prigoshin's disappearance and subsequent developments have been unfolding over an extended period with tensions mounting for months leading up to the failed coup. Retired US General Robert Abrams expressed doubts about Prigoshin's fate, stating that he may have even been forced into hiding, imprisoned or dealt with in some other undisclosed manner. General Abrams also questioned the authenticity of a recent secret meeting between Putin and Prigoshin, suggesting that it might have been staged to give the impression that Prigoshin was still at large. The publication reported.