Hi guys, you are watching OxyVlogs and if this is the first time here and you would like to know more information about life in Dubai Don't forget to hit subscribe button and the bell icon, so you won't miss anything Today I'm gonna provide you with the main information about the public transportation in Dubai There are several transportation options that include Dubai Metro, Dubai tram bus and water bus Let's start with Dubai Metro. It is fully automated driverless railway system The metro rides above ground Providing the great view overlooking the city when you travel, so it's quite an interesting Experience especially for the tourists. You can purchase the tickets at any metro station And one-way ticket will cost you around 5 dirhams or you can buy a day pass for 20 dirhams The tickets is in the form of a null card which can also be used to pay for a tram and bus Dubai's transportation system is divided into seven zones The price paid for a journey depends on the number of the zones crossed during the trip Another option is to use Dubai tram, especially if you are planning to stay in Dubai Marina It runs from Alsapra to Jumeirah beach residences in 42 minutes As I mentioned you can use the same null card as for the metro The tram provides access to destinations such as Palm Jumeirah, Dubai Marina and Jumeirah lake towers If you want to visit Palm Jumeirah, you should try the Palm Monorail You can buy tickets at the stations You cannot use your null card and you can buy tickets only with cash It's a little expensive but it gives you the aerial view of the Palm And it takes you to the top from the Palm and back So it runs from the trunk of the Palm to the iconic Atlantis the Palm hotel The single trip will cost you 20 dirhams and the round trip 30 Another way to travel around Dubai is to take the city bus It's a great budget option and you can use a null card to pay for your ride And the bus stops are air conditioned to keep you cool when it's hot outside And the last option which is more for tourists is to use the Dubai ferry It currently runs from five terminals, seven days a week And the trip runs for approximately one hour It's a comfortable and quite affordable way to see the city from the water I will leave the link with the schedule and prices in the description below And one more transportation option which is not a part of the public transportation But you should consider it as to rent a car The business of renting a car in Dubai has become a big industry in recent years So you can rent a car in Dubai easily But before renting a car in Dubai it is very important to know That general UAE driving rules and regulations If you are a tourist you need an international driver's license passport Credit card and third party insurance And the age limit for drivers is minimum 25 years But if you live in Dubai you need to have a UAE driving license Unless you have a driving license from reputed countries Just to give you an idea of prices One of the cheapest options is to rent Chevrolet Spark 2015 It will cost you 1200 dirhams per month Or if you want to rent a more luxurious car You can rent for example Ford Mustang convertible 2014 It will cost you 6000 dirhams per month Or 400 dirhams per day So guys I tried to give you an overview of the public transportation system in Dubai If you find this information useful Please don't forget to hit the like under this video And leave your feedback in the comments below And if you have any questions let me know Thank you for watching and I will see you very soon Bye-bye


Hello, everyone. My name is Lydia Khalil. I'm a research fellow here at the Lowy Institute. Welcome to this edition of Need to Know. Today, we're really pleased to have with us Ed Davis to give us his expert thoughts on some very timely issues that have exploded in the United States and is capturing global attention, policing, and the Black Lives Matter movement. He's here to talk us through what's really an extraordinary moment in America right now, where we have protests calling for systematic police reform and there's been a huge shift in mainstream support, particularly among white Americans for the Black Lives Matter movement. Now, Ed has a particular perspective for us because he's worked in law enforcement for 35 years. He spent most of his career in U.S. policing. He started out as a patrol officer at the Lowe Police Department and rose up to became superintendent. He also served as head of the Boston Police Department as its commissioner from 2006 to 2013. He was also commissioner during the Boston Marathon bombings and led its response. But Mr. Davis' policing experience is also international. He's worked on policing issues in Singapore, London, Northern Ireland, Jordan, and Israel, and has been a board member of the police executive research forum, the International Association of the Chiefs of Police, and Major City Chiefs Association. And currently, he heads his own business strategy and security services firm. So Mr. Davis, Ed, thank you so much for joining us today. Thank you, Lydia. So great to see you again. So the first thing I want to ask you is your views on systemic racism within U.S. police departments. So it seems like now, particularly since the killing of George Floyd, there seems to be this widely held view that's not only reinforced by his killing, but subsequently by recent compilations of acts of police on video showing police using excessive force in the subsequent protests, that the police are systematically racist in the United States. You've been in policing for a long time. Do you hold this view? Where is this view coming from? Can you give us some context on why so many people are thinking this way of U.S. police forces? Sure. I welcome the opportunity, Lydia. So I reject the view that police are racist. I will say that we still recruit from the human race, and systemic racism is a problem in every institution. We're seeing it in the health field. We're seeing it in schools. We're seeing it in the boardrooms. So we're no better or no worse than any other group in the United States. As a matter of fact, our hiring policies over the last 20 years, usually driven by court decisions, but they've resulted in a significantly more diverse force than what it was when I went on the job in the late 1970s. So we've made a lot of progress. So on the issue of racism, sure there are problems. Sure, we have to work on this every day, but so does everybody in this country. So I guess what you're saying is that policing in police departments in and of itself is not systematically racist, but rather it's a reflection of American society. Absolutely. Police officers go out there to keep the peace. That's the primary job that they have. I've been a big advocate of community policing. And a lot of people think of police as one sort of monolithic group that we all think the same way we all do the same things. And that couldn't be further from the truth. I've been part of a real large number of progressive police chiefs in the country that have been pushing for community policing model and pushing away from the militaristic model that some police departments still employ. And so I'm sorry, we've made a lot of progress in that. And I don't think people understand that there's been a lot of change in police departments over the last 20 years. Well, I was going to say this is a good moment, I think, to step back and perhaps explain to our audience, which is a bit more globally focused rather than US focused, how policing works in America. Because in so many other countries, as I'm sure you've known, there's only a handful of police departments. They're often either state based or federal. Whereas the system in the United States is incredibly diverse and complex. I'm wondering if you could give us a bit of a background on that how policing works in the US. I'd be happy to. So there are 18,000 separate police agencies in the United States. Almost everyone is controlled locally, some with just one or two police officers in it. So the concept of policing in the United States was transferred here from London in the middle to late 1800s. And we followed the Peel philosophy, which was about maintaining the peace and the public of the police and the police of the public. And it worked like that for many years. For a lot of different reasons. The model began to change in the 20th century. And with the advent of police cars and the idea of law enforcement as being the main responsibility of police. Before that, police did any number of social services. They ran food kitchens. They housed people who were new immigrants to the country. I mean, it really was a wide range of responsibilities. They started to move away from that. Corruption drove that sometimes political corruption. But the bottom line is there was this whole mentality. Sort of simply is this an arrest or is this not an arrest? If I can make an arrest here, then this is a police matter.  It's a civil matter. And when I first came into policing, that's the way I was trained. But in the early 1900s, it started to change. So you pointed to something really interesting about how policing had served a whole lot of other social service functions, rather than just you know, criminal investigations in long order. And you know, there's I've been having a lot of conversations lately with some, you know, police colleague friends of mine about the protests that have been going on and it's really interesting to me because they themselves have complained that to police departments over the years have been asked to take on more and more functions that are not a part of the core functions. So police have been called out to handle issues that they're not necessarily equipped to handle issues that might be better left to social workers, counselors. And now a lot of the police officers that I know saying, well, they're asking more of us and we're being responsible for the failures of society because we're the ones who are at the pointy end of the sphere. And it seems to me that that's actually what a lot of the defund the police movement people are also saying. So I'm wondering what your thoughts are about the defund the police calls or what reforms need to be made. And what do you think about this idea that policing is just taken on not only is militarized in some instances, not all departments, but some departments, but are taking on too many functions that are better left to other other agencies? There's no doubt that's a problem. And it was best mentioned by a colleague and friend of mine, David Brown, who was the police chief in Dallas when five police officers were murdered there by an active shooter. And David said, you're asking too much of us. And he's absolutely right. When I was brand new on the job. We had a very robust mental health system. It had its problems.  That center no longer exists. Those hospitals would have been defunded. And, and nothing else has been put in their place. So there was a conscious effort to fix a problem that the mental health system had problems in it. But instead of fixing it, they disbanded it. And the the outcome of that is that police and emergency rooms now are doing that job. And just that issue, dealing with mentally ill individuals, results in violence, and there's got to be a way to fix that. Yeah.  It seems like major city departments or other departments who have done the community policing model have been far better at at not only community relations, but also in law and order and law enforcement. But I'm interested in your views on what might be standing in the way of reform. And here I particularly remember an op ed that you recently wrote in the Boston Globe about how police unions can sometimes stand in the way of reform. So I wonder if you could elaborate on that and in other ways that you think that reforms have have been blocked. Sure. You know, I come from a police family, my father was a union official when I was a kid. And I was a I was a steward stop shop steward is when I first came on the job. So I'm very sympathetic to unions. Years ago, police were very badly mistreated in pay and hours and things like that. They needed to that needed to be fixed. But as time has progressed, the unions have eaten more and more into management rights. And you know, they call it quality of life for the officers. But it's got to the point now where offices are picking their own cars, they're picking their own shifts. There's no, there's no concept of putting diverse offices in diverse neighborhoods. There's just some real serious issues that have been gobbled up by the union. They're also the biggest impediment we have to effectively disciplining an officer that quite frankly doesn't deserve to be on the police department. Those there's not a lot of them. But boy, when you get one, and it sounds like this guy Chauvin was one. These are the kind of things that can happen. We've got to be very aware of that and we got to fix that. Yeah. So I guess my last question that that we can end on I want to bring it back to the Black Lives Matter movement. You know, the world is kind of waking up to this movement in this moment after the recent killing of George Floyd. But this is a movement that was started in 2013 in the United States. So this is not the first time that we've seen Black Lives Matter protests we had it after Ferguson, you know, Eric Gardner, Philando Castile, and other black men that have been killed protests. And the movement led by the Black Lives Matter movement has has shown itself calling for accountability and calling for reform. But I don't know about you. But to me, this moment feels very different. Not just because the protests are larger, but there just seems to be really a widespread embracing of what that movement is calling for. What do you think makes it different this time? And do you think that this could be a moment for change, serious changes in policing in the US? Well, I think there's a few things that make this different. And I'm actually happy that we are moving towards solution to some of these problems. The brutality in the inhumane act that occurred that set this off. It was just incomprehensible that someone would treat another human being like that. So I think that that that being caught on videotape and showed to everyone in the country and throughout the world. Really really did trigger something about the inequity that is occurring in the treatment that some people receive. And so if we can boil down some of these injustices that have happened for centuries into this one moment into crystallizing this and making people act on it, then some good comes out of this horrible tragedy. And that's really what I'm seeing here. Lawmakers who for years have supported unions and not been involved in solutions are starting to think about the decisions that they've made and change those decisions. Police officers who suffer with these, you know, people that are on the job and make life difficult for them and actually intimidate some of them in their actions. They're going to feel relieved about this if we can start to remove them. So there's a lot of very positive things coming from this. I hope we end up with a better society. Me too. And Davis, thank you so much for your time. We really appreciate your perspective. Thank you,


Hello fans of Sight42, I'm going to go ahead and finish off this list of things Bright is not allowed to do at the Foundation. Nobody ever refers to Dr. Bright as Tim, and he is no longer allowed to introduce new personnel to SCP-524. The platypus is not an SCP, no, not even an explained one. Dr. Bright is not allowed to test internet creepyposterites using D-class personnel. SCP-963 is not a millennium item. Dr. Bright should refrain from trying to convince SCP-237 to become a brony, not even to improve his disposition. For that matter, trying to make SCP-042 a brony will just make things worse. Putting an equine, no matter how small, through SCP-914 on very fine is strictly forbidden. And no, you cannot keep it. The answer to a containment breach is never to recruit a team of teenagers with attitude, or send 5 rings to 5 special young people, or to ask junior staffers if they are bad enough dudes to contain the breach. Dr. Bright is not allowed to claim he has been trained to conquer galaxies. Dr. Bright may not attempt to neutralize SCP-682 using the power of friendship, the power of love, or any other sort of power which has not been proven to actually exist. Dr. Bright does not remind anyone of the babe with the power of Voodoo, and is not allowed to tell anyone else that they remind him of the same. The cast and urgency has no interest in summoning demons to the material universe to serve the ruinous power of chaos, and therefore Dr. Bright is not allowed to inform new researchers otherwise. Dr. Bright is not allowed to use SCP-582 in order to deal with junior staff members who get on his nerves. Dr. Bright is not allowed to stick refrigerator magnets to any objects under Foundation control. SCP-1916 only works if administered orally. We know this, there is no reason to test further Dr. Bright. The real doll Dr. Bright purchased does not have a security clearance, not even if it writes reports better than Dr. Condraki. Why not is not considered authorization for SCP cross-testing. The Foundation has no mobile task force dedicated to capturing containment of forum trolls. Dr. Bright is not allowed to found a new mobile task force dedicated to capture and containment of forum trolls. The serpent's hand is not a synonym for masturbation. Yo mama is not so ugly, 096 didn't look at her. SCP-173 is not a babysitter.  Dr. Bright is no longer invited to the annual Foundation holiday party. Dr. Bright is no longer allowed to host his own Foundation holiday party, in fact, the Foundation holiday party is cancelled indefinitely. SCP-682 does not have a wondertainment logo stamped on its upper palette, nor on its posterior. Playing this long thriller in the presence of SCP-008 victims is expressly forbidden. Letting out SCP-008 victims and punching them to simulate Minecraft is also forbidden. Pushing several agents in front of SCP-008 victims to simulate Resident Evil is not a valid excuse either. Actually, let's just make a rule that Dr. Bright is no longer allowed near victims of SCP-008. SCP-682 will not be satiated by the ritual sacrifice of a virgin. Filming, directing, or performing in celebrity sex tapes are not appropriate work assignments for Mr. Deeds. Dr. Bright is not allowed to do anything involving the words elephant sauce. Site-19 is still recovering from the last incident. I like a little junk in the trunk is not valid authorization to feed SCP-1575-1 to an elephant. Dr. Bright is under no circumstances to attempt possession of SCP-682. A touched SCP-1453 a little while ago is not a valid excuse for any containment breach. No shirt, no shoes, no service does not imply that pants and undergarments are not required parts of the dress code. And doubly so, since no shirt, no shoes, no service is not actually a part of any official Foundation dress code. Dr. Bright is not allowed to use this list as a resume. Dr. Bright may not begin his sentences with thou shalt not in the presence of SCP-343. Dr. Bright is not allowed to recreate any experiments seen on the television program mythbusters using any SCP, especially not if he can do it better. Regardless of whether or not it exists, Dr. Bright certainly does not enjoy diplomatic immunity as the local console of the Islamic Republic of Eastern Samothrace. Dr. Bright is not allowed to put SCP-278 into SCP-914 on course, so I can learn to make more of them. Dr. Bright is not allowed to transfer, copy, upgrade, or relocate SCP-079 on any form of high-capacity data storage device. SCP-1156 is not Dr. Bright's royal steed. Dr. Bright is not allowed to use SCP-1543-J to launch SCP-727-J into itself again. Even if Dr. Bright is wearing an eyepatch, he is not allowed to killhaul anyone, not even on Talk Like a Pirate Day. Talk Like a Pirate Day is no longer allowed to be celebrated at Site-19, any personnel violating this rule will be severely disciplined. Also, there's no such thing as Talk Like a Ninja Day and Dr. Bright is not allowed to create it. Introducing SCP-682 to SCP-002 just to see what happens is not recommended. Don't even think about it. Dr. Bright is not allowed to interview new personnel, even if they ask for him. Dr. Bright is not Kenny. We will also ask new researchers and Dr. Bright to stop referring to himself as such. Dr. Bright is not allowed to play SCP roulette with SCP-173, a light switch, and any combination of D-Class or new personnel. Dr. Bright is not allowed to ask SCP-738, what would you want in exchange for not making a deal with me? Dr. Bright works for the SCP Foundation, not the Terminus Foundation. He does not possess a degree in psycho-history, and no group of interest is the Second Foundation. The fact that SCP-682 regenerates all lost tissue does not make it an infinite hamburgers machine, mostly because they tasted horrible. Dr. Bright is not allowed to use SCP-127 to place projectiles under his pillow for the Tooth Fairy to give him money. Dr. Bright is not allowed to use SCP-252-ARC on any person or organization affiliated with the Westboro Baptist Church, and Dr. Bright is not allowed to attempt to sift the Horizon Initiative on the above religious organization. Dr. Bright may not request a pool of D-Class recruited solely from the members of the above religious organization. The Managed Charitable Foundation does not host an annual Labor Day telethon, and Dr. Bright is not allowed to offer the services of Foundation employees as performers or phone bank operators for such. Dr. Bright is not allowed to access to popular science magazine now that they've shown him how to create cyborg cockroaches. Dr. Bright is not allowed to go on a crusade, or a jihad. Dr. Bright is not permitted to use fatwas against anyone or anything. Dr. Bright is no longer allowed to declare, after 10,000 years I am free. It's time to conquer Earth, after assuming a new host. All Foundation personnel are required to attend a seminar on the difference between an original idea and a good idea before being allowed new or continuing contact with Dr. Bright, Dr. Clef, or Dr. Kontraki. Dr. Bright does not have 10 tons of gold hidden somewhere at Site-19. SCP-963 is not to be given away as a good luck charm. Dr. Bright is not a wizard, no matter what he might tell you. He's not an alchemist either, and is not to be consulted regarding alchemical issues. He's also not a witch. Dr. Bright is not magic and cannot perform magic and must give sufficient explanation for any actions he undertakes. Dr. Bright is not, nor has he ever been, the undisputed SCP intercontinental champion. Dr. Bright is no longer allowed to run through Site-19 while screaming, The Keeter is loose, unless it's an actual emergency. Also claiming it's for research on the effects of social engineering is not an emergency. Nor is using it to clear out the areas Dr. Bright has otherwise restricted from entering due to reasons given on this list. And Dr. Bright may not start referring to any persons or SCPs as The Keeter in order to circumvent these rules unless they are actually classified as Keeter. Dr. Bright is not allowed to perform any tests or experiments utilizing the reproductive organs of any dead or living being, including himself. Dr. Bright may not tell anyone that SCP-920 will show them to their quarters, at least not again. Dr. Bright may never attempt to ingest SCP-1842 when a pie eating contest, nor any other kind of eating or drinking contest. After what happened last month, Dr. Bright is not allowed to watch Firefly ever again. I think most of the people involved, that are still alive, are still in the psychiatric ward. Dr. Bright is not a reaver and may not handle any form of sharp tool unless under protection of at least two L3 guards armed with stun guns. Dr. Bright is not allowed to come within five meters of any explosive device, not even if Dr. Eisberg asks nicely. Trying to blow up 682 is not a valid excuse. Attempting to make shadow puppets with SCP-017 is forbidden, and trying to entertain SCP-053 is not a valid excuse. Dr. Bright is no longer allowed to stand in a corner and twiddle his thumbs. Dr. Bright is no longer allowed to use the words swag, swag it, swaginator, swagify, or superswag to define himself or any other persons. YOLO is not an excuse for anything, most especially because it doesn't apply to him. And neither is why not. And Dr. Bright is not allowed to ask anybody ever to play a game of patty cake with SCP-049. Dr. Bright is not allowed to ask Mr. Deeds to do any of the things on this list. Dr. Bright is not allowed to bring food into a restroom. Dr. Bright is not allowed to speak in a voice resembling a movie character. Dr. Bright is not allowed to reenact any movie, even G-rated ones. Dr. Bright is not allowed to do anything relating to the sport of cheerleading. SCP-957 is not a prerequisite to becoming possessed by Dr. Bright. Dr. Bright is no longer allowed to say, everything the Bright touches is our kingdom. Dr. Bright is not allowed to digitally enhance any of the original Star Wars movies. Dr. Bright is not allowed to advertise himself on online dating services. Dr. Bright is not allowed to use this list as a to-do list. Dr. Bright is not L. Ron Hubbard Incarnan and is not allowed to tell personnel otherwise. Dr. Bright is not Sherlock Holmes and is not allowed to say what he thinks a person's appearance means about them to any reality-bending SCP. Dr. Bright is not allowed to cause a containment breach of any kind just so he can have a case. Neither is he allowed to convince anyone to be his Watson. Dr. Bright may not urge bereaved staff members to look at the Bright side. Nor is he allowed to refer to any of his ideas as his Bright ideas. Dr. Bright is not allowed to use SCP-1994-J with Dr. Kane. Hours of actual productive research are now unrecoverable. Dr. Bright is not allowed to play chicken with any members of any department. Dr. Bright is not allowed to order the works from the cafeteria. Dr. Bright is not allowed to put anything on his tab. Dr. Bright is no longer allowed to commit sepacoo even if he has an audience and especially a captive one. Dr. Bright is not in possession of any of the following.  Dr. Bright is not allowed to yell to the bright cave. Dr. Bright is no longer allowed to sing Silent Night following the Always Bright Incident. Dr. Bright is no longer allowed to commission, produce, advertise, or display animated videos to anyone with this subject.  And no, it's not educational Bright, not the way you show it. Dr. Bright is not allowed funding to replicate the experiments of Dr. Krieger from Archer. Dr. Bright is not allowed to convince people to replicate his famous high dive into SCP-120. Actually, you know what? He's not allowed to talk about his famous high dive into SCP-120. Dr. Bright is not allowed to be referred to as Rainbow Bright. Dr. Bright is not allowed access to infants for the purposes of becoming the baby new year. Dr. Bright is not allowed to create a Things Dr. Bright is allowed to do at the Foundation List by listing everything that isn't on this list. Just because it isn't on this list doesn't mean you should do it. He may, however, request for one to be created. He may not, however, suggest what should be on said list. Dr. Bright is not to attempt to neutralize SCP-1013 just because he can do Fluttershy's Stair. Dr. Bright may not create an infinite logical loop. Dr. Bright is not trollegous no matter how much candy corn he steals. There is no such department as the Bright Ideas Department and if one did exist, Dr. Bright would not be in charge of it. Dr. Bright is not allowed to throw himself through a window to prove that glass is unbreakable. Dr. Bright is not allowed to convince anybody to cough in front of SCP-049. Dr. Bright is not allowed to use any green dyes for the purposes of being creative because reasons will no longer be accepted as a viable excuse for removing any SCP from containment. Dr. Bright may not refer to anyone as a peasant. Dr. Bright is not allowed to convince anyone that shouting bing bong bring it on while ringing SCP-513 will negate its effect. Dr. Bright is not allowed to arrange gladiatorial arena combat between D-Class, especially with SCPs as weapons. SCP-173 does not just want to hug and Dr. Bright should not attempt to convince anyone otherwise. Because there's an alternate universe, me who wouldn't do it, is no longer a valid reason for violating containment procedures. Dr. Bright is not allowed to attack instances of SCP-217 claiming the Borg have attacked. Dr. Bright is no longer allowed to recreate the Harlem Shake video. Dr. Bright is not allowed to start any drag races between D-Classes in cars and SCP-096. Dr. Bright is not allowed to reenact any scene from Pulp Fiction. Dr. Bright is not allowed to convince anyone to have a friendly staring contest with SCP-096. Dr. Bright is not allowed to open SCP-1025 to random pages in front of anyone. Dr. Bright is not allowed to dare anyone to finish SCP-1997. Dr. Bright is not allowed to send a slinky down SCP-087. Dr. Bright is not allowed to use SCP-884 for shaving purposes, nor for any other personal care purposes, nor for any non-approved purposes whatsoever. Especially not for the purpose of making people doubt that he's not allowed to use it. Dr. Bright is not allowed to tell New Foundation recruits fictional horror stories involving his family, nor is he allowed to tell New Foundation recruits factual horror stories involving his family. He is definitely not allowed to edit this list just to mess with people in Tumblr. Dr. Bright is not allowed to talk about Bottle Dick. Especially not over the site Intercom, Loudspeaker, Megaphone, Group Chat, Email, or any other device intended to speak to a large number of people at the same time. For the love of God, man, stop wrapping bows around aquafina bottles and sending them gift wrapped with loving sonnets on it. It was funny. Once. Stop. Also, you really aren't allowed to edit the list to mess with people on Tumblr. And that is the list of things Dr. Bright is not allowed to do at the Foundation. If you look on the screen right now, you can see a video from Site 42, or another video from my own channel. You can click that and you can follow through and subscribe to me and make sure you subscribe to Site 42 as well. Thank you very much for watching.


Hello everyone and welcome to our next enterprise data world session case study and data quality and information analysis which will be presented by Michael Schofield and a Soma Linda University. All audience members are muted during these sessions so please submit your questions in the Q&A on the right of the screen and our speaker will respond to as many questions as possible at the end of the talk. Please note that there is a link form at the bottom of the page titled EDW Conference Session Survey. This is where you can submit session feedback and we encourage you to do so. So let's begin our presentation now. Thank you and welcome Michael. Good morning to people in California and good afternoon to people in Boston. I hope you can see my second slide. This is a little bit about my background and that's my official photograph with the School of Nursing where I co-teach and my bachelor's was in physics and my MBA was from UCLA a long time ago. I've been on the speaking circuit in data management for about 23 years and very fortunate to have the opportunity to speak all over the country and twice in Australia and seven times in London. I get to go to museums and somebody else pays the airfare. I've been using this model the data to understanding supply chain that starts with reality and then facts and data describing reality which we convert into information. That information can be expressed as John Ladley pointed out and he wouldn't use these words not all expression effectively communicates and that communication isn't really complete until there is understanding of the meaning in the mind of the audience or the intended listener or reader or something like that. So facts and data are observations of reality and the kinds of observations that we have in public health include the human senses and devices like clinical thermometers in the lab and blood that gives us blood contents and things like that and that's the subject of raw data quality which I will not go into today. That's a whole hour topic. Actually it's a three-hour workshop. In the pandemic the discrete events that we observe are tests and hospital admissions and things things like that. There's also patients lingering symptoms which we are going to talk about later. All data to information requires regulations, aggregates, ratios, rate of change and things like that and one of the things in COVID-19 is when you're looking at a state total for any particular day you've got to ask did all the counties report this morning or are we under stating what's really going on in the state and so this is information quality which is different than raw data quality another one-hour topic. I eat lunch in the hospital across the street from the school and nursing with my friends and I saw this t-shirt come through the checkout line that says without a clinical lab you're only guessing. I like that. They're basically a message to some of the physicians who diagnose more intuitively. Now a couple disclaimers. I have no formal certification in epidemiology or virology. I'm not a physician and I'm kind of a neophyte in mathematical statistics but for a while I worked at the US Army Medical Research Institute for Infectious Diseases and learned a lot about viruses there. I've been in the data management space for 30 years and particularly in data quality assessment for 25 years and this topic is a moving target. It changes over time but good science is that way. Always discovering something new to improve our understanding and a lot of people in America don't understand that science is going to get smarter and so the message may change and I reserve the right to be smarter and better informed tomorrow than I am today. Now we have had some experience with 1918 flu. It came in multiple waves. We're seeing that today. It mutated over time. It killed selected age groups. Children under 10. Very different from today. 3% of all factory workers in the US died. 6% of all coal miners were killed but it barely touched the elderly. Very different characteristics than what we're dealing with today. But one characteristic in common is the more people are infected, the more opportunities the virus has to mutate into something more deadly. Now to put this all into context, the Spanish flu in America killed about 679,000. World War II, all the American deaths only amounted to 419,000 but with COVID-19 we're up to 569,000. It was what I saw this morning. So we're already 130,000 more dead in America due to COVID-19 than were killed in World War II. To put this in an international context, the United States has 4.2% of the world population. Back in February, we had 20% of the world's deaths. It's about the same today because Mexico and Brazil and India are seeing a large growth in deaths. Now I know people who think that this is a hoax. The whole pandemic is just a hoax. The New York City Department of Public Health conducted a study for a 52-day period where they counted 32,000 deaths. Now they know their territory and they know their seasonally expected number of deaths, their baseline, for that same 52-day period was only 7,900 which meant that they had 24,000 deaths over baseline. And 57% of those were laboratory-confirmed COVID-19. Others, by basis of the symptoms, were probable COVID-19 and another 22% needed further study. So this kind of puts a lie to the propaganda that it's all a hoax. They had to bring in extra trailers, refrigerated trailers to hold all the bodies. Now a couple weeks ago, we got this chart from the CDC giving us the total situation in the United States during the calendar year 2020. And so the baseline for all causes of deaths is relatively flat. It goes down a little bit when you get into the spring and summer. And so the number of deaths in excess of the baseline is very visible in this chart. The COVID-19 first spike, particularly in New York State, was there in April and then it started to go up after Thanksgiving. So COVID-19 is now considered the third largest cause of death at least in 2020. Right in January and February, it was the largest or the most frequent cause of death in the United States. Now these charts of the number of cases and the number of deaths here in the United States total, the solid line is the 7-day moving average. I find that much more useful than to see the volatility of the weekly and reporting and the non-reporting over weekends. In California, as of March 31, this is what the shape was. So we were really hammered with deaths after the holiday season. And as you can see, there's a bit of a lag between the peak of the deaths and the peak of the cases of infections. So that's important to know. The deaths will not appear immediately as a metric. Looking again at this internationally, South Korea had 2.8 deaths per 100,000 people while the United States death rate per capita is 51 times that of South Korea. So at that rate, if the US had responded, if the government and the authorities had responded as effectively as the South Korean government did, there would be today maybe 12 or 13,000 Americans who would be dead, not 550,000. But the South Korea culture is different than the American political landscape. A more useful metric than just the number of cases is the morbidity. If infected, what are the odds of death? And currently, as of this morning, it's 1.78% of all people who are infected die. If the infections are undercounted, and this is one of the vicissitudes of the statistics here, if the infections are undercounted, then the denominator is larger and the death rate would go down. But as of this morning, using this morning's numbers, this is where we get to the 1.78% infection. It was 1.81 a month ago, and it's 2.11 worldwide. And the reason for that is that much of the world does not have as good a acute care health hospital system as does the United States. But that figure is really too simplistic, because the actual death rate may differ for subsections of the population. So morbidity varies by subgroup, it varies by gender, ethnicity, age brackets, and if the person has any latent health issues like diabetes, obesity, hypertension. So if we were to publish statistics, we would have to expand that 1.81 that was last month. We would have to be more specific by gender and by ethnicity or by gender and preexisting condition, diabetes, cancer, obesity, or something like that. Now, there were some who said that COVID-19 was no more deadly than the seasonal flu. Well, the statistics don't bear that out. It's actually about 20 times more deadly than the seasonal flu. Now, the World Health Organization estimated 3% to 4%, but that's over the entire world with many countries having a lesser quality response in terms of health care. This Lancet publication from the UK said if infected seniors have a 5.6% odds of dying, where 20 to 49 have a very low chance of death. It's still there. Minnesota Public Health gave us a histogram of the total number of cases. Now, this is cases, not deaths, and by age bracket, five-year age bracket. And so the highest infection rate, not death, but infection rate, is with 20 to 30-year-old people. Well, are they reckless and responsible? The ones I see surely are, but they're also more active in the economy, particularly in interfacing with customers. Now, this very gratuitous photograph is of me donating blood. And I do this every 56 days. They love to see me coming because my blood type is O-negative, CMV-negative. And what does CMV-negative mean? I have no antibodies to the cytomegalovirus. I have not been exposed and my immune system did not develop antibodies, and they don't want those antibodies in blood that they give to low-weight newborns. So I have to fill out a questionnaire about my behavior and my health history before I can go in and they stick the needle in. And it hurts. It's a big needle. But before they use my blood, they test for all these conditions and diseases before they can put it into the pool to use on real-life patients. Now, what is a virus? It's a protein shell surrounding some genetic material, DNA or RNA, but it is not alive. And our language sometimes belies this. It cannot reproduce or divide. It requires a living cell to replicate itself, and then it kills the cell. So the virus would enter the membrane of the cell into the cytoplasm. The protein shell around the virus dissolves. It releases the genetic material, which combines with the genetic material in both the cytoplasm and the nucleus, and it expels one or more, shall we say, daughter virons. And then the cell dies. So this is how the virus replicates. Gotta talk about antibodies. Antibodies are created by the amazing human that detects this invasive pathogen of bacteria or virus and creates some proteins that attack it. So for every specific kind of virus, the immune system develops an antibody to attack and eliminate that virus. And sometimes we see the antibodies in a blood test and the virus is gone. So that tells us that the person had been infected with a particular virus, and the antibodies basically eliminated it from the bloodstream, but the antibodies are still there. And so that's, that's an important way to measure.  And like I said, that's 1.8% of infections. Or they may not show any symptoms at all. And this occurs in some younger people and it actually deludes them into thinking they're invulnerable. Now in the period of time before they show symptoms, they're pre-symptomatic, but still contagious. We have a test that that's where we put the swab up the nose. The victim doesn't know they have the virus unless they get tested, and so they're contagious and can spread. That's why we want the face mask. So up until the time that symptoms are visible, we use the antigen test. After symptoms are visible, we use the antibody tests. We use blood tests to detect the antibodies. Once they have the antibodies, are they immune from further infection? That's still being studied. The Imperial College of London study said perhaps 90%, but otherwise these people could get reinfected. And so a secondary infection, it has happened. We don't know why the antibodies didn't attack the secondary infection, or had they just faded away. And so this is a major unknown and it undermines our achieving the goal of herd immunity. Did the virus mutate? We don't know without doing genetic sequencing. And that test is a little bit more expensive. Now there's another life cycle. A friend of mine works in the ICU, ICU nurse and boy is she stressed out. She had a patient that came in, was in the ICU on the ventilator for a while, somehow recovered, went home, and three months later died from organ failure. And this is being seen more and more often. So even if you walk out of the hospital after a severe infection, you may not be out of the woods. Now the original tests, putting the swab up your nose, had a quality issue. In a perfect world, if it's present, the test should be positive. If the virus is absent, the test should be negative. But there are false positives, depending on the kind of tests. But what's more worrisome is there are false negatives. These people think they are okay, but they're not.  I love this photograph. We would not see this today. But I saw an excellent video on the JAMA website where Michael Osterholm, and he's one of the experts in this, said that the rapid detection test used at the White House back six months ago, nine months ago, gives quick results but a high rate of false negatives. So it's not very reliable in telling us what's going on. Now, when infected, the Vyron count has a curve something like this. And the antibody count kicks in a little bit when there are enough Vyrons to trigger the human immune system. And so these antibodies eventually kill off the Vyrons and that count will eventually go to zero. The test sensitivity is an issue. For example, with that Vyron count curve looking like that, a low sensitivity test with quick results has a very high threshold. It needs a lot of Vyrons to trigger and give it a positive test. So in the period of time before the Vyron count is high enough, it's going to have false negatives. Whereas a high sensitivity test has a lower threshold, but still for the first two days, it's going to give false negatives. So no test is absolutely perfect. I hear a lot from the start of the pandemic, we heard about cases. And these are infections. And I found myself yelling at the TV screen, what was the denominator? How many cases, how many tests did you do to yield that number of cases? And so to illustrate that problem, let's just say we had three different groups that we ran tests on. And we got 15 positive with patients with symptoms. And then we got 40 positive with a group of at-risk hospital workers. And if you remember back in April and May, those were the people we were doing the testing. And then we had voluntary drive-through testing. Let's just say we got 20. So in the county, we have a total of 75 cases that are reported up the data chain to the state health department and the CDC. Well, I want to know what the sample size is. And in the patients with symptoms, the sample size yielded a positivity rate of 75%. In the at-risk hospital workers, we had 8%. And in the drive-through testing of self-selected people, it was only 2.5%. So in reality, the actually it's a 2.5% rate that I would consider more significant. The ideal situation is for public health officials to conduct a random sample of the community. And let's say we did 2000 tests and we got 25 positives. That's a 1.25 rate of positivity. If we multiply that times the half million people in the county, we would estimate that there are 6,250 people in the county with infections countywide. Unfortunately, we don't know who the other 6,000 people are. And they don't know who they are. They don't know they're infected and contagious. And then there's the delay of data gathering and aggregation. So the funeral homes and the hospitals report to the county health department. There are 3,000 counties doing that in the U.S. That may be reported to the state health department, but it also may be reported to the CDC. The CDC passes its numbers to Johns Hopkins. And that's for many months, the media, the news media went to the Johns Hopkins website to get their statistics. So this is what I call the data to information supply chain. On the left, we have raw data. On the right end, we have meaningful information. Gotta talk about co-morbidity, a medical condition existing simultaneously, but independently with another condition in a patient. And so for you data modelers, cause of death is a multivariate valued attribute. And so if we look at a certificate of death, and this comes from the state of Utah, and there is provision for three different causes of death. They can be chained together or they can be simultaneous. And so when somebody dies and they are declared death either by a ambulance driver or a physician, there may or may not be an autopsy on the body, which results in blood tests and tissue examination. And eventually a medical examiner, coroner, will finish the test and fill out a death certificate. But there could be some delay in that death certificate. So that's why we have some delay in reporting the number of deaths to the CDC. So if we had a situation where COVID-19 was clearly one of the cause of death for a patient that had these pre-existing conditions, then an argument ensues, and here's where it gets political. Should this be included in the COVID-19 death count? Some would argue, no, they would have died anyway. Others would argue, yes, but they could have lived longer without COVID-19. And so that no argument is used as an excuse by some politicians for under reporting or underestimating the death total. So basically you cannot manage a public health situation without metrics. And so we test for two reasons. On the macro scale to get the big picture and to conduct public health management. On the micro scale to alert the individual who may be contagious and advise quarantine and contact tracing. Both reasons save lives. Early on we heard about flattening the curve, and this was one of the reasons why we wanted to shut down the economy. The flattening the curve doesn't necessarily reduce the total number of deaths. Getting everybody vaccinated does, but flattening the curve, the area under the curves, the two curves are the same, it just spreads out the workload for the hospital and regulates the number of cases so they don't overwhelm the emergency room or the ICU. What would reduce the total number of deaths, high volume of random testing, frequently and of course subsidized. I think we're pretty much on top of that. Rigorous and aggressive contact tracing. I haven't heard much chatter about that. Not sure why. Selective quarantine. You can tell someone they're infected, but will they quarantine? People who deny the existence of the virus will probably not quarantine and go ahead and infect and possibly kill other people. Encouraging protective behavior. Here is a man who would have difficulty social distancing. When I spoke at the DAMA conference in Austin, Texas, I took an afternoon to go to the LBJ library and I saw this photo up on the third floor. I like this is typical of a very assertive politician. The stages of patient status and events. It can go something like this. A person can be tested. If they test negative, great. If they test positive, then they may or may not have symptoms. If they do show symptoms, even some people never tested show symptoms. They may recover or they have to go into the hospital. Some who are hospitalized may just get a mild case and walk out. Others have to go to the ICU. Some in the ICU recover and some in the ICU dead die. We also discovered that there were a lot of folk, elderly folk in New York, who never left their apartment and just died in their apartment, but they had been infected. This raises all kinds of questions about public health management. How soon afterwards should we test a person who tested negative? If they test positive, how do we monitor their symptoms? If they recover, the big question is, are they still infectious? Could they develop symptoms later or could they become a long hauler? It's the long haulers that become a new problem. But first, when we use the word risks or odds, there's risk of being infected. There's risk of getting sick. There's risk of infecting others. There's risk of being hospitalized. Even smaller risk of going on a ventilator. You do not want to do that. There's a risk of death. Each of these has a distinct percentage along with long haul symptoms. Before the vaccine, there was a certain percentage of risk on each of these. After the vaccine, hopefully on all of these, the percentage of risk should go lower. But when you enter or experience a new mutation, like the B117 coming out of the UK, all these odds change. We have to express the risk in context of the whole situation. Now, the metrics reported in the press were just the number of cases and the number of deaths. And I've already said that cases without knowing the denominator is not as helpful as it should be. My ideal situation is to have metrics on every stage. And some states are doing this in their public health department. Many of these metrics have a daily and cumulative nature. And they could be used to calculate the trends and ratios and the odds of moving on to the next step. In other words, the risk. But the problem is that capturing these additional metrics is work. Costs money for the health agencies, hospitals, and data integrators. And what motivates them to do this correctly? And here is a classical data quality issue. When humans are involved in capturing data points and facts, what motivates them to do it correctly? That's a whole hour long topic. The trade-off between burden and benefit is something that gets argued over quite a bit. And then we have the long haulers. And approximately 2.2% of the people who were hospitalized are experienced long haul symptoms. And they're mostly young. They're mostly female, which introduces another cultural challenge for healthcare. Over 100 kinds of lingering symptoms. And I'm not going to read all these. 40 to 60% of hospitalized victims experience neurological symptoms. And 74% had persistent symptoms, fatigue, shortness of breath, up to 12 weeks after discharge. So how do we gather and post data on this phenomenon? So, and of course it's more complicated than this. And here I'll go into very briefly, very quickly, some of the elements of the data model for a hospital, a clinical system for a hospital. And we have kernel stable entities. We have episodes. And we have events. And we should understand the difference between these. And beyond this level of detail, proprietary EMR architectures differ. Illnesses are not mutually exclusive time wise, so the patient can have multiple episodes of the same disease or multiple diseases at the same time. They can be hospitalized in multiple episodes, but generally a hospitalization and hospitalizations are mutually exclusive. So a patient can have two hospitalizations. There are distinct events of when they're diagnosed, admitted, sent home, readmitted. And so within the hospitalization experience, there could be different unit assignments as they get worse. They're moved up to the ICU. So we would see that that episode as a distinct kind of episode. And there are events marking the change from condition to condition. So the unit assignment is a sub episode. And then the treatment is a part of a regimen. So there are treatment events that occur at a particular point in time. There are medical tests. They are generally events that occur in a particular point of time as our diagnoses. So those are some of the essential subject entities in an EMR database. Which of the patient's medical events should be reported externally? And again, there's a trade off between the value to the physicians and the public health management versus the cost of reporting. So for many diseases, the typical trajectory was you get well, the symptoms abate over time. And so generally, most health professionals don't track that. Once you're discharged, they don't call you up a week later. At least my doctor doesn't call me up and say, how are you? Doesn't happen in this environment. But with long-haul lingering symptoms, a big question is how do you digitize this curve or express it as a metric? And part of the problem with particularly the cognitive fade in long-haul is that there aren't many objective metrics for it. Yet the patient may be so sick that they can't go to work and they lose their job. And that's happening an awful lot. So can an EMR database contain patient conditions not observed or confirmed by a medical professional? That's kind of like crowdsourcing data. Are we willing to do that? There's no formalized name for the wrong-haul, no ICD-10 code for it. Hence, it's not recognized. This is a frustration. These people can't get state disability because there's no confirmed code for the long-haul symptoms. So the medical community must recognize it. And the shape of these symptoms can change. There's all kinds of shapes. How do we capture those shapes in a consistent way in the EMR database so that we can aggregate the characteristics for predictive purposes? So this creates some new database design implications. Are the characteristics of COVID? I'm going to skip over this because I'm watching the clock. These are some of the... If we were in the same room, I'd throw these out and we could have a discussion. But I want to talk a little bit about the vaccine. There are issues of effectiveness. Does it prevent infections? Does it trigger antibodies to the threat? And do those antibodies stick around for a while? And is it safe? Are there minimum immediate side effects and no long-term consequences? A typical development life cycle for a vaccine takes a number of years. I want you particularly to look at phase two, where they do trials for safety and immunity. Typically, that takes two to three years. We are dealing with vaccines that were warp speed developed. There are over 178 distinct vaccines under development in five categories. I'm not going to go through that. But at the current time of all the big pharma companies, these four have developed vaccines that have gotten emergency approval. There are all kinds of potential side effects, which is why you want a large sample in your trial to catch these side effects that may have a very low frequency. You want the sample size large enough. And then there's the issue of safety. Now, for example, when I was a kid, I got the polio vaccine. That's been around for 60 years. We have pretty much absolute confidence in of the polio vaccine. There's been no sustainable discussion to the contrary. Now, the efficacy of a vaccine for COVID-19 will rise a few days after the injection. So you still have to be careful and wear your mask and do all the distancing. And then the efficacy becomes flat and may decline after a period of time. But we don't know because it's too soon to tell. We have not had enough experience over time with these vaccines. So one way I would graph it is a range of uncertainty that looks something like that. But we could have two different vaccines with two different characteristics of efficacy and lasting power. And when this occurs and when we have this kind of data and we don't have it yet, then would we allow the patient or the consumer to choose between the two vaccines? Well, time will tell, but we can't wait. So the future, the vaccine efficacy may fade. We may have to have booster shots. The virus may mutate and then all bets are off because we're going to have to develop new vaccines. But fortunately, the manufacturing and technology and resources are in place. So a vaccine efficacy, what we do know about the Wuhan strain is that Pfizer is 95% and Moderna is 94%. At least those were the original statistics. But we don't know the efficacy against some of these other strains. Now, this is the campus of Loma Linda University. We have this very large hospital. We have 17,000 employees. We see a million patients a year. And for some of the employees, particularly the nurses of childbearing years, it has been tough to persuade them to get the shot. I had no hesitation once all my friends walked back and seemed to be alive to me. And of course, being a health sciences university, the employees had a priority. There are new risks. The original antibody can destroy the original version of COVID-19. But with a second version, a mutation, new cases are causing a surge in the UK. Will the antibodies developed attack the mutation? Or a third mutation, will the antibodies attack that? That's why we have to continue to gather data. And the matrix gets to be a little bit more complex. With each mutation, we have new statistics on symptom severity, reinfection, and the long haul characteristics. Are we ready for the next pandemic? I don't think so. The public health infrastructure in America has been severely underfunded for the past few years. And so that's a major question. And what else could come down the pike? And I see we're at 42 minutes. We know about a lot of diseases, but there are cultural biases undermining data quality. And I've worked in a number of organizations where if the data doesn't confirm the executive's expectation, he may say, don't capture that metric, or don't report that metric, or they may cook the numbers. Now, here's an excellent example of politicians cooking the numbers. These are daily clusters of the five colored bars or the five counties in the Atlanta metropolitan area. And they published this on the Georgia Department of Public Health website. And you'd have to look carefully to notice that they sequenced the days, not in chronological order, but in order to convey the impression that the number of cases was going down. This was a deliberate misrepresentation of reality, implying a downward trend. So the situation, the challenges we have highly distributed data gathering and reporting, inconsistent timing of aggregations leads to highly volatile metrics. We saw that. There are occasional ambiguities in the cause of death. We discussed that. And retroactive collection of statistics, some stats are retroactively restated by some reporting mechanisms and the mutation of the virus complicates testing. And so the key takeaways, we have to consider statistics carefully. The face value of what a reporter is saying may not be accurate. When cases are cited, we need to ask what's the denominator? How big was the sample? And how representative is the sample? In any aggregate of cases or deaths, we need to ask are all the constituent parts reporting? In a state total, did a third of the counties not report this morning? We have to properly normalize statistics such as showing the rate of deaths per 100,000 population. That allows us to compare large countries with small countries. And so that's basically the end. And I see we have six minutes for discussion. And I got to figure out how to unshare my screen, unless you... Oh, you're okay, Michael. You got it. Thank you. Yep, we're good. Okay. So yeah, we do have a couple of questions that have come in. Thank you for that great presentation, by the way. The first question is, are there any current organized efforts out there to improve the quality of COVID-19 data, such as definitions, data models, timeliness, et cetera? Yeah, there are... The previous hour in this conference, one speaker told about what they're doing for the state of California Public Health Department and creating a dashboard to report the cases or to report all the metrics. And there are increasing number of metrics, hospital admissions, ICU admissions. Our hospital across the street of... What was it? Five weeks ago, we had 230 COVID-19 patients. Right now, we're down to 20. That is an amazing volatility. But there are efforts. I think a lot of people... And I think the CDC is being taken more seriously now than it was three months ago. And they're being given the resources to improve the statistic reporting. I hope that answered that question. Yeah, that's great. Thank you. Let's see. What do we have? What percentage of the people I think have the health literacy to understand many of the ideas you describe? And how can we improve the health literacy of the general public? Do you see why I used pictures? A lot of people don't understand this. And I think it's part of the dumbing America. But health literacy is a big issue. And that's worth talking about. But I don't have a neat solution to it. Great. Then we've got... Let me see. Do you think this pandemic will trigger a digital transformation in this pandemic management sector? I think it will now, yeah. I think once the death rate sinks in, and there's still a lot of denial about it, or just ignoring the fact that you have bodies dropping all over, once that sinks in, I think politicians are going to be interested in better funding public health. And the broad public health includes record keeping, tracking, and surveillance. So we should have had people on the ground in China to give an early warning that something was coming. And that's a whole other topic of surveillance. We did have some people, but not as many as we needed. Great. Thank you. And we've got about one minute left, so we'll give you one more question. What do you think was the biggest lesson learned from this past year that we can prepare for before the next pandemic in terms of gathering and defining data and some of the stuff you've talked about? Yeah. I don't think... Well, first of all, testing. We know when people die, but until we had a high volume of testing, we didn't know when they were infectious. So that's an important data gathering. But there's got to be more respect for science and respect for expertise and to take this kind of thing seriously. And that respect has to grow in the politicians as well as the general public. I'm getting a little political there, but that's what I feel. Great. Thank you, Michael. So that's it for today. Thank you, Michael, for this great presentation, and thanks to all of our attendees for tuning in. We were up to, I think, over 30 or so at one point. It kind of goes up and down. Yeah, it kind of goes up and down. But I think we had a lot of good questions today. To everyone, please complete your conference session survey at the bottom of this page for this session. And the next session, and actually the last session for the day, we'll start in about 10 minutes. And Michael, thank you very much, and you have a good rest of your day. Take care.


Like there's people out there that can go and dive straight into the deep end and go full-on keto straightaway But usually dependent on background where they've been what they've previously been doing potentially what their goals are as well and what their lifestyle has looked like in the past but With years of experience of coaching people you and I have this sort of common belief that it's a great area It's just to start by cutting carbs. So tell us why you think that's the best approach Well, first thing is there's actually two what one thing is is it's funny because I'm gonna say this in the nicest way But you know most RDA the recommended daily allowance. I'm not on board with like there's a lot of there's a lot of Wow, but I don't know most people know that the RDA is recommended daily allowance for carbohydrates. It's only 150 grams a day So it's not very high, right? But people consume that in one meal or they'll consume 10 times out in a day So the most important reason when people think of keto and if you start looking at the ketogenic diet or even a low-carb diet They might they also might be hearing you can eat high fat Well, one thing we know for sure is fat and carbs don't mix well together So if you have a lot of carbs, you don't want to have a lot of fat But if you eat a lot of fat, you don't want to have a lot of carbs And so what happens with people is that they get started in this journey and maybe they don't quite understand what low-carb is Maybe they slip up here and there or they're not low enough carbs and they started increasing their fat intake And they're fine like I'm not getting the results that somebody else got and So for me the most important thing you do when you starting this low carb life or a keto life Is to really understand and learn how to go low carb and remember everybody's low carb is gonna be different Some people can get into ketosis and burn fat very efficiently with under 50 grams of carbs If you're athletic you might even get under a hundred grams of carbs a day and still get the response that it might take somebody that is That needs to get under 20 grams of carbs a day so what I always start people out with is like I'd rather start you low and get you a result and Then work you back up to find the place that you can live your life in and and I have a simple rule is If you need to lose more than 20 pounds for more than two years You're probably gonna want to be below 20 or well 20 total carbs 20 We don't that's net carbs. I guess Are under 30 total carbs a day? So that's usually my starting point for people But I always say hey fake the first two to three weeks get low carb and then once we do that We can talk more about how to increase the fat intake and I know a lot of people just start with this well They're like well What does that mean like what does it mean is it net carbs is a total car right right and and that in itself can just really Confuse people so without going to super scientific eekie and all that sort of stuff Can you talk about the difference between total carbs net carbs and and why one might focus on one rather than the other?  Okay, just ignore them. It may matter But relatively for most of you it's not gonna matter.  You're focused on high-quality proteins like that might be the starting point But what's gonna happen is you're gonna see me on tiktok doing a recipe and it's gonna show you this crazy Dessert that says it's low carb has a lot of fiber in it and now you have to do the mathematical problem So it really comes down to psychology and then once you go from the total carbs to 100 I might go total carbs are under 50 and then see how you're doing. So you can choose either method It comes down to really you being committed to the journey to learn how it works for you And where you need to fall in line with with what the food choices that you choose. Yeah, I love that like, you know my background more so is Sort of the fitness realm of things and I love that approach because you get there, you know, the super geeky engineers or the not that I ever had it but like I Space rocket. What do you call it? I know a few rocket scientists That's what I'm looking for and they want to know every single piece of information and for those people Sure go if that's what floats your boat go for it But I think you know my basic approach and everything that I do is dumb it down so a child could understand it If a child can understand it most of the time an adult can understand it, right? So I think some of the best things I've had with experience with coaching people as well as not so much Focusing on numbers, but like you said, let's coach people and teach people what is good food? What is good? Substitutes for those carbohydrates that they're so used to in the past because if I attach a number to it And you're either too high or too low then people automatically feel like they're losing. Oh my god I didn't hit that exact number Exact number. Are you kidding me? The calculator is out there That's why if you haven't got a chance to grab our cookbook because we actually have this really just a simple guide Like it's a simple trade-off an easy way to make some adjustments But I'm not a big fan of calculators and the reason why is that if you were to work with me one-on-one Which I don't do anymore But if you were to do that you have to do a ten thousand dollar decks of scan to scan your whole body We have to analyze your basal metabolic rate We have to we have to break everything down to make it so it's perfect and then guess what in two months. It's gonna change So it's it's not a done. It's it's gonna change. It's gonna evolve I mean, and that's the process of what we're talking about here is that is that We want to keep it as simple as possible And so I think if most people would start their journey to stay under a hundred grams of carbs a day for two Three weeks and know that it's a journey now I'm saying like you might be competitive and you want to go a little lower and then move to 50 And not even do the net carbs and not try not to do the math and add it up You're gonna start seeing results Especially if we could do some strategies like intermittent fasting and maybe some other tools that we have to help you with the ketogenic effect So that can help you get the benefits of ketones without actually, you know being crazy on that on the keto diet And once again very very specific to the goals that someone's trying to achieve right like sports versus general population versus someone that's you know, trying to conquer an autoimmune disease, right? Yeah, very specific, but I like that general sort of General rule of under a hundred grams to start with because we're setting them up for success. So Share with us your three top alternatives because I know I know so many people like well, this is my favorite What do I do right my favorite? What do I do? So give us your three top favorite alternatives?  So I grew up Minnesota.  So it's a big deal to me my spaghetti and I've tried nearly every spaghetti noodle out there in the planet I mean you name it. I've probably tried 20 years of doing this My favorite is cauliflower rice with spaghetti. It just is right, but you got miracle noodles. You have Palomini noodles do I also don't eat wheat So there is some low carb wheat with wheat in them noodles that actually probably taste better But I do cauliflower. That's my favorite thing. So in our household Just so you guys know our kids aren't full-blown keto. They may have a rice noodle with spaghetti sauce, right? So that's my one little trade-off. You can use obviously cauliflower rice rice, which works really really really well My other favorite thing is I this is a secret. This is one of my favorite recipes is I do a chili I made it this weekend and it's a huge hit like people love it You never feel bloated or gassy from it and what I use is I use turnip root For the for the beans. So I replace the beans because you get the same texture It's taste exactly the same but no heavy bean gas and no very still relatively low carb Now depending on how many bowls you eat if you're full-blown keto You might go a little above because there is tomatoes in that and there's tomatoes in both of them by the way So those are my two biggest alternatives. I would say my third alternative would be I don't eat bread So I'm just not gonna go there. I've been away from that for a long time So if you're a bread person, that's just too bad for it from my coaching side of things I would say my alternative Huh, that's a good third. I don't know like I just eat vegetables a lot of vegetables I do a lot of vegetables and protein. What's your favorite alternative? That's funny because I actually I eat the same stuff So I'm pretty I'm pretty boring. So I'm a pizza guy. You are a pizza as well and Just so most people are listening know that I am more Animal-based than I am plant-based and I'm not against the plant-based. I'd have just done lots of Testing on myself and I find that vegetables are just not a high priority for me And I'm not saying that's for everybody guys, but it's what works for me So I love the chicken base pizza and then I basically just chuck on some cheese and some more meat And that's about it with I think I've been wanting to make that so it's chicken grounds like it's We can talk but can you post that recipe and get it to me because I want to make that I've been I've played with a Lot of pizza I have but it's like you don't make I don't make pizza very often And so sometimes I just go to Costco and I eat only the cheese and meat off the top and just throw it away the cross Haven't done that for a long time and then one the other day was like, you know, like just nacho chips or chips in general I saw it on this group. Actually, it was just melted cheese with a jalapeno dropped in the top Cook it melt it sit it to the side. Let it dry and you've got these beautiful cheese crisps That's good. Awesome. Awesome. Awesome. So I believe guys, we're gonna chuck in a little document that explains