When we look at CME Group doing the equivalent of 55,000 Bitcoins per day in the month of September, that certainly puts Bitcoin as one of the leading centers of price discovery in the US and globally. This is Tim McCourt. He is the global head of equity products at the Chicago Mercantile Exchange. That means he is directly responsible for the development of Bitcoin futures and options products listed by CME. In this video, we discuss the importance of open interest, the cause and effect of CME price gaps, and how CME competes with crypto-native exchanges. My name is Jackson, and welcome to another exclusive Cointelegraph Intermediate. Changely is a suite of products and services that enables customers to have a one-stop shop experience when engaging with crypto. Changely acts as an intermediary between exchanges and retail users, offering over 160 cryptocurrencies that can be effortlessly swapped within 10 minutes on mobile or desktop. In 2020, Changely branched out to accommodate the needs of traders with Changely Pro. Pro is an easy-to-use platform that enables retail buying and selling of digital tokens and coins. Piggybacking the great support system found in Changely, Changely Pro will provide simplicity, effective pricing, fast execution, and 24-7 live support. How are you doing today, Tim? Great. Thanks for having me. Looking forward to catching up today. Could you just describe what open interest is and why it's important for people to pay attention to? Open interest is the total number of futures contracts held by market participants at the end of each trading day. It's often used as an indicator to determine market sentiment and the strength behind price trends. So that's something that we watched at the exchange because it does show a sign of growth of the contract, but also it's interesting to notice what is the relationship between something like trading volume and open interest growth. So if you have an uptick in trading volume but no change in open interests, that's really a function of people that may be just intraday trading or taking advantage of price movements intraday, but there's no net gain of open interest. But when you see an increase in volume that is followed or met with a corresponding increase in open interest, then you know people are trading and deploying strategies with longer term time horizon. They may be buying the future as an investment. They may be selling the future as a hedge to maybe mining operations. So it's really when looking at the two of how many contracts are held at the end of every day overnight that also when looking at volume provides a little bit more, I think, perspective about what may be going on in the market. You also then look at something like the CFTC website where they monitor large open interest holders and large traders. You can also see the Commitment of Traders reports which show you by type of client, what are the trends of those that are holding long positions or short positions. So open interest is really an informative piece of information in the market with respect to trends and how the growth of the contract is coming along. Yeah. And speaking of things to pay attention to for traders, one of the things that a lot of people pay attention to is the CME futures gaps, the gaps in the charts on the CME futures chart. Why do people pay attention to this? And as a follow up to that also, why do most of these gaps eventually get filled? Do you have any thoughts on that? Yeah. So I think it's interesting when we look at the CME gap, which personally I kind of love that that is a trend, it's a topic on Twitter. People love to talk about it and it's really a technical aspect of the market. When we look at CME Group futures, we offer nearly 24-hour trading, but from Sunday night through Friday afternoon from a US East Coast perspective. We have maintenance windows and maintenance that needs to be performed over the weekend. So that's where we do product launches for all of our asset classes and our thousands of futures and options products. That's where we deploy technological changes or as we deploy enhancements around our match engine. So we have weekend downtime as a function exchange. What's different about crypto, when we look at something, let's say like the equity index market, which is the other thing my team looks after, futures are open when the primary markets are closed. Futures are providing price discovery in overnight trading hours from a US perspective. And we're open when the underlying market is closed. Crypto in Bitcoin is a market where the opposite is true. Crypto is traded 24-7. The underlying market never closes with the exception of the occasional platform downtime for up-to-age releases, et cetera. So because of that, you just have price discovery happening over the weekends on crypto spot exchanges or some of the crypto native exchange when CME is not open. As a result, that just will, as a day factor, present gaps in price information being presented to the marketplace. So I think that's just kind of what it is. When the markets are closed, the underlying is open. So this is going to be divergent in price. So I think just watching the basis, watch how these things perform. And if people are so inclined to devise trading signals from them, then so be it. But to me, it's just more interesting from a technical perspective. It's largely explained because of operational aspects of each of the markets. But it's certainly a lot of fun to read about on Twitter for sure. Do you have any personal theories about why they get filled? I don't, I mean, to be honest. I think like going back to some of our other conversations, when you look at the markets, it's really a function of supply and demand. So not every gap is filled, right? I mean, I think that people like to talk about filling the gap. I feel like the gaps that don't get filled don't maybe get quite the attention. Or sometimes it's a function of time and Bitcoin itself is a pretty volatile underlying. So at some point, at some point, just gas will be filled months later because of natural supply and demand. So I think it's just interesting. But I do think what I personally find fascinating is when we look at the Bitcoin, how the Bitcoin futures market has grown over time, the open interest, the ADV. When we look at CME Group doing the equivalent of 55,000 Bitcoins per day in the month of September, that certainly puts Bitcoin as one of the leading centers of price discovery in the US and globally. So I'm curious to hear your opinion on the narrative of institutional smart money moving into Bitcoin, but not crypto. What are your thoughts on that? You know, when we look at that, I mean, it's certainly something that you've seen in the marketplace. But from our perspective, it's CME Group. We offer futures and options on futures on Bitcoin. So that's certainly what we're seeing. But you also need to consider that I think the definition of institutional accounts or institutional money has also evolved during the crypto era. And what I mean by that is when we say institutions, it's not necessarily the standard or the traditional definition of institutions that you would have seen more than 10 years ago. You know, you now have the advent of crypto-only hedge funds, crypto-focused trading shops, crypto-focused CTAs that are offering services and products to their own customers. But then it's also something that people need to be mindful of is when labeling things or attempting to label things as institutional smart money or institutional accounts, everyone really just needs to understand, like, what does that mean from your vantage point in the ecosystem? So certainly CME Group, we've seen that institutional onboarding and that institutional adoption happen. But in terms of some of that narrative, I can't really comment outside of Bitcoin because we don't have products really around that from a tradable or an investment perspective. So we don't have transparency into that. But what I can certainly confirm is that the institutional adoption of Bitcoin has been happening at CME Group for a long time now. And it's going to be interesting to see where it goes from here. So in addition to the options product that you brought to us in 2020, we've also just kind of seen an explosion of derivatives products across crypto-native exchanges.  Just everyone's doubling down on the derivatives market. So what do you think about the growth of this derivatives market on crypto-native exchanges? So personally, from a philosophical standpoint, I believe in the interrelatedness of the underlying spot, or in this case, digital market with derivatives market, I believe in the convergence between spot and futures in terms of discovering price and making sure that these markets are interrelated in the fact that they keep each other aligned from arbitrage or basis opportunities. So it's really important for the ecosystem in general to develop with respect to the ability to transfer risks, access markets. It's been interesting to watch some of the innovations and product development in the crypto-native space. But what's interesting is we need to remind ourselves and keep focused on what makes CME Group different. And I think one of the largest things is that we are a regulated venue operating here in the US, but we do have global distribution. And there are a few things that make our contract a little bit differently. One, unlike things like perpetual swaps or some of the other leverage type products out there that may use the colloquial term future more as a marketing angle or just a description that the marketplace is using. At CME Group, these are regulated futures by the CFTC, we're a regulated venue, which just increases the burden that we have in operating with respect to the marketplace of providing to our market participants the trusted, tried, transparent, regulated experience that they have on all other products at CME Group. We have to approach cryptocurrency and Bitcoin the same way. And that's something that I think has been great for the marketplace. We think regulation is a feature and not a bug with respect to cryptocurrency trading, especially when we look at some of the institutional accounts and adoption because the fact that we've been able to bring this in a regulated fashion to the marketplace and meet those expectations placed on us by both the regulator as well as the marketplace. That is what is bringing institutions to the marketplace at CME because they know how the contract works. They know what the rules of the road are. And we have a near 180 year history of operating a marketplace and in exchange venue for futures. And that all is something that differentiates CME. So we're certainly intrigued and we're always watching in support of competition and the interrelated aspects between the crypto native market and regulated venues like CME in the U.S. There are clear differences that just participants need to be aware of that CME can provide that some of those crypto natives, despite the interesting and innovative work they're doing, it's not necessarily the same experience trading there as it is at CME. So do you see yourself as a direct competitor to these crypto native exchanges or do you do see yourself as just more of like a separate entity? I think we're separate. Just I think that's my opinion is something that we also hear from feedback because we operate slightly differently. We have different rules. Our product is different rights. We have the five Bitcoin multiplier. We settle to the Bitcoin reference rate, which is a index based on five constituent exchanges. No, it fits them. It bit coin based Gemini and Kraken. We are representing a large swath of the underlying spot market. We're not tied to the potential idiosyncratic performance or trading on any one exchange. We have a diversified robust reference rate that is a regulated benchmark, the first regulated benchmark in the crypto space under the BMR rules in Europe. So I think that is something that differentiates us from others. So I don't necessarily think we're competitors. I don't necessarily think it's an either or choice. A lot of customers are trading on both. It's just different. You know, the regulated venues, particularly here in the US, we have different rules and standards that we must adhere to. So I think it's different. So you've already begun to elaborate on the differences in your futures product versus some of the products on crypto native exchanges. I'm curious, what are the factors that really affect the CME futures price? So when we look at futures contracts in general, I think it's important to remember that CME Group as the exchange operator, we are agnostic to price. We are the venue that facilitates where buyers and sellers can meet and exchange risk and trade with each other. And as a result of that, it's really like other futures contracts, whether it be equity indices or something like Kulman or soybeans. These are all functions of supply and demand. The market will have one clearing price that's equivalent to where the last trade was. Where did the last buyer want to pay a certain price, such that the last seller agreed to sell it to them? So I don't necessarily think Bitcoin is different in that regard in terms of fundamental drivers. What is different are the nuances of those fundamentals when you look at the underlying asset itself. Certainly Bitcoin has its own supply curve, its own demand function. But it's really just where is the market going to clear at CME Group? And that's, you know, that's a function of who wants to buy and who wants to sell at what price and what their personal or kind of corporate motivations are at that time. Would you be able to describe some of those nuances differently, nuance differences a bit more deeply? I think when we look at something like Bitcoin, you know, when we certainly, I wouldn't necessarily say it's different, but it is a little bit more nuanced when we look at something like the supply side and the mining aspect of Bitcoin. There's just different risk parameters in the underlying market that are not necessarily unique at the, you know, it's called the 10,000 foot most futures contracts on underlying assets that can be transferred have cost of good soul, they have cost of raw materials, they have input cost, they have output cost, they have term structure. So even though some of those nuances, whether it's the demand for hedging purposes, because it might be a slightly more volatile asset, or if you're a miner, which may be akin to a commercial grower, you need to know where can you offlay or sell or liquidate that inventory that you're looking to mine at a future date in time, so that you can manage the cost expense of what it's going to take to extract that asset for, you know, in this case, mining the Bitcoin. So these are all things that I think are common in futures, but that's where Bitcoin is a little bit differently, is one is it's a fixed supply, right? There's varying and often increasing degree of difficulty around accessing that or mining that finite supply. And a very evolving demand profile is more and more folks and institutions get into this space. People have different risk management needs, different hedging needs, and it's evolving very quickly. You know, to think back, you know, Bitcoin itself is only a little over 10 years old, so we're still early days in the grand scheme of things of this asset class and figuring out what those institutional as well as individual needs are and how they'll manifest, but at the end of the day, it's really a supply and demand function of where people need to manage or transfer that risk. Great. Thank you so much for joining me today, Tim. My pleasure. Thanks for having me.


Thank you, Mr. Chairman, the audience. It's a pleasure to be here. My presentation is about forestry and foreign aid. I'm a specialist in forestry and a little bit an outsider of foreign aid. I've been struggling with this question since April this year, as Dr. Jung-Fu Hoang of Wider Institute contacted me with these questions. What has worked in forestry and foreign aid, and what is sort of feasible? The questions looked very interesting, so I took the challenge and have been struggling since. I'd like to have your help and your comments. I'd very much appreciate your comment to this first presentation of these ideas. Tentatively, I'd suggest three solutions to these questions that have been given, and that's the idea, and I'd like you to comment on them. But first, before we go into the theme, I'd like to refer... My background is on climate research and forestry research. I worked with the IPCC precisely on mitigating climate change with land use measures. Some news are not so good. We have CO2 in the atmosphere keeps rising at a faster rate this past decade than in the 1990s, so we do not see an improvement there. Even worse, the global CO2 emissions have hit new records, both in 2010 and 2011, growth rate last year, the latest one, 3% plus, despite all the effort with the Kyoto Protocol and so forth. So this is not good. You've all seen these latest news about the Arctic ice. The picture on the right-hand side is from the day before yesterday. It's freezing again, of course. You feel it outside there, but we had the lowest Arctic ice ever recorded about three weeks ago. Just a picture of Finn, who first went through this ice, so this is a big issue for us in the North, whether the Arctic will become ice-free. Some good news, though. Carbon sinks are doing fine, and we have new paper, this is last month in Nature, an interesting paper showing that over the past 40 years, we have emitted about 350 billion tons of carbon into the atmosphere, and about 160 billion tons of carbon have remained in the atmosphere. So the sinks have taken up about 190 billion tons, more than what's now left in the atmosphere. And the rate of sequestration into the sinks has improved, and there's no sign of any saturation, and this is certainly something very positive. We published a paper last year with a football team of scientists showing where in forestry we can see these sinks. And this is technical, you can look at the details if you wish in the paper, so the main message is that the tropical area is in balance regarding their CO2 budget, so what's lost in deforestation is gained in other areas of the tropical region, and the northern forests are gaining carbon, so that's a good part of that sink, which is developing positively, as we show. So then, with this background coming to the questions, what would be feasible regarding aid? An excellent book has been published by C4 in 2003 on what forest assistance has been done. This is available over the next, so if you're interested, I'd recommend. So one of Persons' concerns is that we really often do not know what do we want from forests, and if the goal is unclear, then the aid obviously has trouble. How do you promote something that you don't know what you should promote? I mean, of course, we have the same debate, like in Finland, we have a debate of conservation and utilization of the natural resource that's everywhere, but nevertheless, one would think that at least the government has a policy in balancing these different needs that we have on forest, so this is what is interesting. Another one observation of Persons is that we have shifted the paradigm of aid and forestry every 10 years. So first there was the industrial period in the 60s, and then there were the local community development, and finally we've come up to this red plus debate. Now then, what could we do, perhaps, which can be feasible first in the short term, then in the midterm, then in the long term, short term being five years from now, midterm like 15 years, and then a permanent, more sustainable solution. First, an idea of simply an effective stove to burn wood in the areas, which is freely available and could be implemented more or less immediately. Referring to the front page of, you see the whole picture there, a woman carrying about 20 kilos of wood, roughly, probably needs five kilos per every meal that she cooks for the family. So if she could cook this meal with two kilos of wood, she would save time and we would save the wood. And these are available. This is my camping equipment with a stove that I can cook a meal with two kilos of wood, and these are affordable and could be distributed in large quantities fast. Midterm solution, measure the forests better. We have an excellent project in Tanzania in measuring the forest resources of Tanzania. Finland's government and Finnish expertise has been involved. And now, quite soon, we will know how many trees there are in Tanzania. Do you know how many trees there are in Finland? 65 billion. So we have 10 trees for every person in the world. And that can be done. And then a more sustainable... So measuring forest is important, whether for many purposes, including assessing the carbon issues. But the sustainable solution, really, I come from the university, so this may be obvious. I think universities are really very important. So in the long term, we need education and how to do education. You need teachers. How do you get teachers? You get the university. So summary, there are bad news and good news about climate, mostly bad, unfortunately, mixed experiences of what has been achieved in forestry. Some lack of agreement of objectives, paradigm shifts. And then we have, in this field, we would have low-hanging fruits and we have sustainable solutions that then take more durations. With this picture of our university headbuilding, I'd like to thank you.


All righty, good morning everybody. See our attendees are trickling in here. Good morning, good morning. And I see some names I recognize from all around the world. So it's good to see some folks here from everywhere. All righty, wonderful. Well, we're gonna give it just a few more seconds for people to trickle in here before we get started. But thank you so much for joining us here today. My name is Olivia Lowensbury. I'm the Quality and Safety Program Manager for the Patient Safety Movement Foundation. So I'm really excited to see all these names on the screen and get to learn from some of our panelists today. So let's go ahead and get started. We are focusing on we can't do this alone. So the role that patients, family members and the general public play in advancing patient safety. So our objectives here today are to understand the current policy work happening around the world, to recognize the importance of regulation and legislation and advancing patient safety, to discuss the importance of regulatory oversight and to examine actionable recommendations for patients, family members and members of the general public in policy work. So we've got quite a lot in store for you here today and definitely a few actionable recommendations you can take home with you towards the end. I do wanna emphasize that we are offering BCPA CE credit. So these are for our board certified patient advocates. We're offering one BCPA CE credit and participants will receive a certificate from the Patient Safety Movement Foundation within about five to seven days of this webinar. So I do just wanna do a few housekeeping reminders here. You have both a chat and a Q&A function. Go ahead and use the chat to reflect on any of the insights from panelists to add any of your remarks in there. And if you want your question to be answered live during the last 15 minutes of this webinar, go ahead and put it in the Q&A and somebody from our team will be monitoring that so that we get hopefully to all of the great questions that are in the Q&A. Alrighty, and I'm very excited to introduce our moderator, Yvonne Gardner. Yvonne has been very involved in patient safety efforts at the Patient Safety Movement Foundation, particularly from a patient advocate and a family member perspective here. So Yvonne, I'm gonna pass it over to you to just introduce a little bit more about your background and what brought you into this work. Well, thank you very much, Olivia. I lost my son after a tonsillectomy and we found out the cause of death was respiratory depression brought on by the opioid that he was prescribed. And we were able to take, we found a lot of information about others in our area that had died in the same manner and compiled that information was able to take it to the legislature and pass a bill that brought on more education for the doctors in our area and the hospitals for this problem. And we've been able to raise some awareness that this is a big problem. And the best part of it, I've been able to hear of a lot of people that have been saved because of some of the information that they have received through this legislation. And Olivia, I don't know if you want me to go ahead and I'll introduce our panelists today. We've got Dr. Aether Tajik joining us from Norway. And if you'd like to go ahead and introduce yourself, you're in a minute. And then we've got Beth Bailey Olem and Mr. Tai Moss, who's the CEO and co-founder of Niles Project. Thanks for the introduction, Yvonne. Just very briefly about myself. My name is Aether Tajik. By training, I'm a cardiologist and specialist in both internal medicine and cardiology. I have worked in setting up the Norwegian Health Care Investigation Board for the last three years. And formally, I was the medical director in that organization, a national oversight organization that investigates serious adverse events with the aim to improve patient safety and quality of healthcare. Currently, I'm working as associate director in MSD, pharmaceutical company, working in vaccines and infectious diseases. I have many years of interest in and working in various projects and in quality and safety improvement and have also worked in health technology and innovation for delight previously. Thank you so much. Beth, would you like to go ahead and give us some information about your background? Sure. Hi, everyone. Great to be with you today. My name's Beth, and like Yvonne, I lost my son to medical error and kind of brought me in this journey into healthcare that I never thought I would be in. I was formerly in business, worked at McKinsey and in banking, and I pivoted to try to create some of the change to prevent future harm that happened to my son. That sort of led me down a path of really thinking about which are the areas that I felt I could have the most impact and needed to be changed. And I've worked really extensively on engaging governance in oversight of quality and safety, wrote the seminal white paper for IHI with the governance role, board role is in governing health systems on quality and safety. And I'm super proud to be involved with a fabulous group of patient advocates trying to change the US direction of patient safety by forming a WHO chapter in the US called Patients for Patient Safety US and really trying to elevate the drift that's happened in patient safety in the US and reprioritize and create greater accountability around that. I've also been deeply involved in the candor work and advocating and advancing the apology and disclosure and transparency efforts in the US. So great to be with all of you, thanks. Thank you very much, Beth. And it's kind of as Beth points out, one person can make a huge difference. And thank you so much, Beth, for all that you've been doing. Hi, would you go ahead and introduce yourself and let us know the things that you've been working on? Sure, thank you for having me on the panel today. I really appreciate that. I'm the CEO and co-founder of Niles Project. And our Niles Project Foundation is a Public Health Patient Safety and Nonprofit Awareness Foundation we started in 2007, my wife and I. And it's basically to provide education and bring awareness to eliminate the preventable harm that we've all experienced. We lost our 15-year-old son Nile in 2006 to MRSA, Hospital Acquired Infection. And we've been on a journey since then to bring education and awareness. We're not doctors, but on the scale of learning things, we feel like we're almost a PhD in some of the things that we've been able to do. So we continue to work with other advocates and organizations to bring awareness. We've had some success here in California with some legislation. And we want to share that information with you today as we go through this. Great, thank you so much, Ty. And something that I'm aware of is just as a patient advocate, I see that in Ty and Beth. We want to share the love that we had for our children with everyone else and help them prevent this happening in their families. All right, we're going to move on to Beth. What is the Global Patient Safety Act plan and how does legislation align here? That is a big question of on. So I think the question is for each of us, the Global Patient Safety Action Plan is something that was adopted by the World Health Organization in May of 2021 and really is a framework for looking at patient safety within your country through a lens that allows you to identify deficits or opportunities to improve patient safety. And also to be able to have a global network to talk with other countries about some of the innovation ideas that you might adopt in your country or might advocate in your country to improve patient safety and sharing of those ideas across borders because there's some really good things happening in other places like Norway or England. And we can bring those to the US and the US might have a nugget that we could share with somewhere else in the world. And so it's really this framework to really commit and advance patient safety and look at your own country's progress or in the case of the US, I would say lack of progress towards patient safety on many fronts. So it's just a great tool. For us as patient advocates in the US, we use this as a lens to look at the state of patient safety and where we wanted to prioritize some of our advocacy efforts. And so what we've really observed even though many of us have spent 15, 20 years working in patient safety and we've had some nuggets of great success, the overall drift and leadership commitment and the drift in progress in patient safety is frankly palpable and painful in the US. And so this was just a good framework for us to try to identify how do we move forward from here in patient safety. All right, how does legislation influence the quality and safety efforts? Sure, I can start on that and then I would love to have others jump in because certainly legislation is different based on how your country's rules are structured and your health system is structured. If you have a universal health system, your centralized approach to feedback on safety issues is gonna be coordinated very differently than if you have a pretty disaggregated and fragmented system like in the US. So in the US, our system is incredibly fragmented. The payers are fragmented, the tracking of errors and harm is fragmented and frankly, the incentives to be transparent do not supersede the incentives to be non-transparent in the US. The penalties are not great enough and the incentives aren't good enough. So that fragmentation is one of our big barriers to progress. So one of the things that we're using that WHO Global Patient Safety Action Plan is to come together as a group of patient advocates to create greater legislative and government accountability pressure because unlike other big patient movements, whether it's an issue related like heart disease or cancer or Crohn's and colitis, those are not seen as I think culturally as threatening to the healthcare system, whereas I think patient safety kind of gets at the everybody's deep vulnerability in healthcare. And so in a way, I think culturally, there's just a bigger resistance to seeing the problem, owning the problem similar in a way that racial bias in healthcare is avoided. It's a very vulnerable and painful topic. So one of the things that our group is doing is trying to overcome the fragmentation of the patient advocate world because so many people advocate for their particular niche issues, but we at some point all have to come together to put greater legislative pressure. There's just not enough commitment at least in the US to the accountability that needs to happen for both for the budget and for governmental oversight of payments related to safety as well as oversight for reporting and things that are structured to happen that don't actually happen. So the WHO gives us a platform to come together and have those conversations and frankly a little bit of authority to come together to get meetings that we maybe one off couldn't as easily congregate but together as a WHO group, we have been much more able to pull that together. Kind of that. Yes, thank you very much Beth. And Arthur on the international scene, what do you see as far as legislation and how that is helping? Sure, I'll pick up on that. And I just want to pick up on some of the points that Beth made first addressing a little bit about the issue of fragmentation. And of course we have to understand it's a really, we have to understand the scope and the size of the issue. And patient safety is really a large question. We see consistently one in 10 hospitalizations across high income countries leading in serious adverse events leading to huge costs and huge scale of suffering in human terms. And we see that when we're talking about patient safety we're talking about the broad issue, broad set of issues. We're talking about cultures. We're talking about processes. We're talking about procedures, behavior, use of technology, use of innovation. And when addressing the barriers to actually introducing legislation it is actually because this is such a big topic. It is such a big issue. It touches upon every aspect of medicine. And from a clinician's perspective it touches upon the daily clinical day to day how do you actually improve on the processes you are doing? How do you actually learn from adverse events? How do you actually learn from serious unexpected events? And we see that serious adverse events there is a culture of shame among clinicians. We see that there is a lot of resistance against talking openly and addressing these serious adverse events from a systemic perspective. So we see that there is a limit limitations regarding the understanding of the scope and the fragmentation of the issue. So that's one important barrier. Secondly, of course, every country is unique. As Beth pointed out, the US has a larger part of its more private healthcare from our experiences here in Europe. We have a more of, let's say, single-payer system in many of the countries from experience in Norway. But interestingly, you might expect that there is much less fragmentation in, let's say, a single-payer system. And of course, there is probably a little less than in, let's say, in a system where you have a large private sector. But still you see also in countries like Norway and the UK and Europe, you see that there is a lot of fragmentation. There you have clinician professional bodies, you have patient interest groups, you have government agencies, you have NGOs, you have healthcare providers and everybody's speaking different from a different perspective. And finally, I would also add the point that I think there is also a lack of understanding, perhaps on the political side, because you do have patient safety efforts that are local, but you also need something on a national level. Because of course you have, let's say, you see that there are serious adverse events in, for example, one hospital, some patient is administrated, given the wrong medication. And then you see the same kind of error happening again in just the hospital across the street. And again, sometimes even in the same hospital in just the department across the ward, something like that. So there is this lack of coordination, there's this lack of a national oversight. And there's that understanding is necessary. So those are some important barriers as I see it. Thank you for sharing that with us. Ty, do you have any insights that you'd like to share with the panel and our guests as well? Sure, I'm happy to jump in. I agree with Arthur and Beth as well. Legislation drives regulation that requires a certain action. And in patient safety, it moves the process from being an option to a requirement. So that's very important, trying to get things in place that people will have to adhere to. So I think that's key. And also it provides clarity for those that are writing regulation and for those that provide services. So we are very strong advocates in terms of getting regulation in place. Yes, Ty, were you able to see with your work through Niles project that some of the procedures were able to be changed in your local hospitals there? Yes, we have noticed a lot of changes to be honest, especially here in California. For example, one of the things that we worked on in 2008 was our SB 1058, which was Niles law but in place where hospitals must provide their infection rates and to the public annually. And that's a very important point. Very hard to get through a lot of the pushback that we got from hospitals and things like that. But overall, we as advocates continue to work on these, it seemed like it's never ending, but we continue to work hard at what we care about. And hopefully through that effort, we find we do get things done. So it just takes a lot of push. We need a lot more people doing what we're doing. Yvonne, one thought I had, like Niles, the law that you guys created took a long time and it's so much work to push these laws through. And it's always a trade-off of do you introduce new legislation where you have to introduce new legislation versus is there existing legislation and government oversight that just isn't being implemented or executed? So just an example would be one of the things that our group did is we literally mapped the patient safety ecosystem on a national government oversight level in the US. So from the CDC to the Centers for Disease Control to the Center for Medicare and Medicaid Services to the FDA to, so all the different organizations that have their hand in the pot of managing patient safety. And then we went down in each of those organizations and we mapped out what are their specific levers, what actually do they oversee? And then we actually said, okay, how do we actually get them to turn up that lever? What could we change? Could we add questions to the hospital surveys around safety? Could we ask them to produce a congressional report on accountability of the budget towards safety? So there's always this trade-off of do we, where is new legislation needed and where is there existing oversight that's just gotten lax and any more need to turn up the pressure? Yeah, so Beth on that, how are we able to track the legislation and keep that in front of our hospitals and administrators, those that are making the policies? Is there a way to do that? Yeah, so there's, I mean, there's state legislation and then there's national legislation, right? And one of the challenges as patient advocates, most of us are people in our own homes, just doing this out of passion. We don't have a giant lobbying firm that tracks legislation. We don't have the dollars of big pharma and medical device and so on and so forth that can track legislation that relates to them or in the case of the US, the big lobbying of the American hospital. So it's really hard, you know, one to track legislation and to propose legislation. So we've kind of taken, and so I think if you have a very targeted issue, like you did for Niles's law, I think it's really effective to do legislation. If you're trying to, I think move a lot of different pieces, we've worked more through the relationships that we've built, like really getting to know the people at these different organizations and work with them to know what the oversight is and trying to ideate or innovate with them on how to elevate the pressure. And, you know, it's our fault also as advocates in the US not having aggregated to create greater pressure.  But if we had thousands of people calling or thousands of people writing, we would get heard. So as patient advocates, we have not done what other patient movements have done, which is aggregate our voice to create deeper, you know, noticeable pressure. And I do think that's a fault for us, at least in the US. I don't know how it is elsewhere in the world, but I think that, you know, really being strategic about what you wanna change and aggregating the voice to elevate that change is effective. And as opposed to just going in and generically, I've seen so many patient talks where people are like, we need better safety. But like, we have to actually, you know, roll up our sleeves and say, what does that mean? Okay, does that mean we need, you know, different questions on the hospital questionnaires? Does that mean we need different penalties for safety events? Does that mean we need different incentives for hospitals doing high reliability? You know, I think too often it's just patient advocates have not taken the time to, you know, to really figure out what that means when we say we want better safety. I would like to pick up on some of those ideas. And of course, coming from Norway and from a European context, it's not easy to fully understand the US context, but I think it's worth making some reflections on the differences. For one thing, as I, of course, the US is a very large country. It's geographically diverse, it's huge area and a huge population and very, very diverse, both state and federal kind of legislation. So I can imagine that it's a much bigger challenge to, as you say, have a unified voice in the US for patient advocacy groups. But what I can say is that what has been successful in European countries is the alliance or the trifecta, you might say, of the patient advocacy combined with clinicians, clinicians strong support from clinicians. And this has been kind of a recent development because if you go back just a few decades, clinicians, they didn't really understand patient safety because they said, okay, but we are just trying to do our clinical work according to the best medical practice that is patient safety. So they had a very simplistic understanding. They didn't understand the systems level. They didn't understand that there's a culture, their mechanisms, there's all these things around it. So this change in mentality among a larger and larger portion among the clinicians. So you have the alliance between the patient advocacy groups and the clinicians. And in addition, you have the politicians on the side, on the same side. So you need some champions in the political sphere that really understand the systemic approach. And the systemic approach, it means of course you can't summarize it in one sentence, but it's not about somebody gives the wrong medication or some serious mis-procedure, some procedures performed in the wrong way and just focusing on that narrow issue. It's looking at what caused that, going a step back, looking at education, looking at financial incentives, looking at evaluation, looking at all these things that are surrounding it and having politicians that understand that. So kind of having that alliance is absolutely necessary to kind of push legislation. But again, I can imagine in a country as large as the US that has compounded these challenges. But I think in Europe, you've done a better job of institutionalizing the patient role in the feedback and oversight process that we have in the US. In the US, there are some hospitals that have really integrated the patient role. And then I work with a lot of hospital boards. There are other hospitals whose board would never talk to a patient and who don't have patient and family engagement processes and panels. So it's just hugely variant in the US, whereas I think in Europe it's institutionalized and a deeper cultural commitment to it. So for us, we really do need the government push in a way to say no, everybody has to do this. And then the accreditation process for hospitals will look at that, or the condition of participation process for government payments will consider that. So you're ahead of us. Okay. But yeah. I would agree as well. Patient efforts is fragmented here in the United States for sure. And there's no true collective voice in it. It's very complex. Patient safety efforts are very complex. And as you mentioned, things that happen federally and things that happens in the States are going to be totally different. There's different efforts underway. So the thing that we found at work or helped us initially was reaching out to other organizations and found out what they're doing and how we could join and be a part of what they were all about as well and support those efforts. As long as we were all finding our passion and working together. So I think that's important. It's a life long effort to be honest for us, something that you continue to do when you take those little wins as you go. But bottom line is you have to have a passion for this type of work that we do. And it's not easy for everybody. So we've had success, but we again would like to see a lot more federally. We'd like to see a lot more people involved. And that's why I think we're talking about this where we can't do this alone. We have to work together. And we're happy to do whatever we can do, share our stories and provide any kind of background that we've had success at. So really it's an ongoing process. So I'm really glad to be a part of the conversation here. Hi, did you see that a lot of your success came with educating the people when you're working on your project? Absolutely. It was a matter of educating your family, friends. That's where we started. And also joining other organizations to find out what they were doing and seeing how we can support each other. That's really the key. It's a grassroots kind of a thing for us anyway. And then as Beth mentioned, there's a lot of other work going on domestically and internationally as well. Like what Arthur's doing is sharing stores, sharing information. And over time, you see progress. We've all seen progress and that's why we do what we do. So that's really the key to it all. And we've had our challenges, but we feel it's worth every effort, every time we get a chance to talk to people, to be a part of these types of programs, panels, whatever it might be. We jump at that. Yvonne, I would love to add, like I think my patient advocacy journey really changed. Like, first after I lost my son, it was much like my ecosystem was small. It was about preventing that harm in that hospital where that harm happened, right? And making sure that there was learning and in a way that his death wasn't in vain, right? And then it kind of evolved to, I had this greater understanding of the barriers to learning after harm. So my passion really became, how do I help other hospital systems have shared learning systems? And I think there's somewhat of an organic evolution because as I then started to understand the quality infrastructure, the risk management infrastructure, which was also often separate from quality. And then the state and governmental oversight, my vision of what I wanted to change went from changing within one hospital system to changing within many hospital systems to what's the role of legislation and governmental oversight. And independent body oversight to create incentives for that kind of learning and improvement. So wherever you are in your advocate journey, you might be at the point where you just want your hospital to make change, to learn from that event. And that's a really good place to honor and try to make that change on a one hospital level. And that change can help tons of people. And you might be at the point where you say, my hospital's not interested in learning, but I wanna work with other health systems or my hospital already made changes. And I wanna make sure other hospitals make these kind of changes or everyone in my state makes that kind of change. So I think it's important to kind of think about your own journey and really reflect what's important to me, what change is important to me to make. And then as you understand that ecosystem better, figuring out what you wanna change might evolve. And that's okay. And I do wanna emphasize one thing that's helped in my patient advocate journey has been the power of really rolling up my sleeves and getting in the weeds of how payment works, how legislation works, how accountability in all these different ways works. And then the power of conversation and collaboration with other advocates, with other quality leaders, people who care about safety want to help other people who care about safety make change. So really committing to some of that collaboration and conversation. So roll up your sleeves and get in the weeds so that when you come to those conversations, you understand the payments, you understand the ecosystem, you understand that quality is often separate from risk in the US and what that means that you're game on. And be willing to learn and collaborate and join panels or join working groups to learn more. Yeah, I agree. And the other thing I would mention too is important change happens when there's true transparency. And that's really something that we have worked on. Just trying to make sure that we all are understanding what Beth just mentioned, that we're all doing what we can do to make sure that organizations are providing, especially government agencies are providing true transparency so people can share and understand better. I would like to also address the importance of advocacy, both patient and family advocacy. And from experiences in many European countries, many of the most important legislative efforts have been championed by patients and their families and actually led to real change. So that's one important lesson to bring with us that this is actually an important tool because the power of the individual story has the effect of kind of lifting these, can have the effect of lifting these things up to a national level. And both in those cases that I'm most familiar with in Norway and in the UK, for example, the Norwegian Healthcare Investigation Board was set up shortly after the health minister had direct conversations with the individual patients that had been advocating for such a national oversight organization for many years. Another thing I want to point out to the importance of advocacy is what we have seen is within the medical field, perhaps over years, you have let's say a narrow way of thinking and a limited set of tools that you're using. And what we have seen is that some of the families and the patients that are advocating for change, they're bringing in completely new tools. Some of them they are engineers, they're worked in quality control, let's say in the airline industry, maybe they have worked in the military, maybe they have some experience from the global telecom industry, something completely different. And they're bringing ideas and tools that kind of address systemic improvement, data-driven improvement, monitoring that's completely different from what we have seen previously from people working in quality improvement in healthcare. And also we have seen, which I think is very, very important because we see now that tech and innovation is becoming more and more important. It's actually a tool of empowerment for patients. It gives them the ability to both to monitor their own data, but there also gives them a tool to control their own kind of, their own medical history and so on. And we see that there is inpatient advocacy and patients that push that aspect as well has been very important in the patient's safety aspect. So it's an absolutely important, it's important to get involved and it's important to kind of get your sleeves rolled up and get involved if you are interested in bringing your competence and your viewpoints to the table. Matthew, you made such a good point. In my situation with my son, the ENT that operated on him and did his tonsillectomy was our biggest advocate as far as pushing through the legislation. Once we gathered data, we lived in a small town about 20 to 30,000 people and we were able to go back a few years and find five different cases of patients that had died the same way as my son. And a few of those were his patients if you weren't, but with some other information that we had gathered, he could see the need for more tools, just like you said, that would help the healthcare system do a better job and make it easier on them. So he did go to some engineers, to some large companies and say this is exactly what we need and that company was able to work on that for a few years and engineer products that would keep patients from dying. In my case, my son's case from respiratory depression at home once they were sent home. So I appreciate you bringing that point out that there are tools out there. There's people, ones listening that work in the medical profession and others that maybe have seen a need and work in different fields that could help solve some of the issues that we face every day in the medical communities. All right, we've got just a few more minutes. Ty or Beth or Arthur, is there something else you'd like to add? You know, I would just add that if you're not at the point where you are ready to do state or national legislative change, you can do change within your health system of just making sure that the patient committee reports to the board and asking what percentage of your, this is more in the US for boards of health systems, what percentage of their board time is spent on quality and safety because frankly, if it's not a priority in the boardroom it's just not a priority for the leadership team. So that is something that we encourage all patient advocates to push. Just on a very local level is our leadership team spending time on this. And does the board walk around, do a safety round, look at the safety dashboard, look at the total dollars spent on medical malpractice and the total number of claims. There's a lot of basic safety metrics that the board should be looking at, never events and your infection rates and all that sort of stuff that we all know about. And if they're not looking at it, the patients within a small ecosystem of a hospital or a health system can create pressure, aggregate pressure to at a minimum get that board to look at it and have that be part of the CEO and leadership team compensation. Just another idea like if, for some people legislative change feels like huge but there's different ways to create change and create pressure. And everybody has to kind of figure out what's right for them at their point in their advocacy journey. One of the things that we've been working on with the safety movement is the National Patient Safety Board. We think that's, as you mentioned Beth, very, very important that we have something like that and implemented. It's just like the NTSB, it's important. It's can help implement and regulate health care policy and to make for better patient outcomes. So I think that's something we all need support on and we surely want to promote that to the folks that are listening. And it's gonna help us all domestically. Just a brief point on, just a very brief point on that and I really do agree with what Ty is saying and what Sarah pointed out. We need efforts on all levels. So quality improvement happens on the local level but at the same time you need that national oversight and that is because of the large volume of reports of adverse events, the large volume of underreporting there are large areas we don't know anything about. You need somebody thinking about it strategically. Where should we put our efforts in to get the most, to get the most improvement for most people. All right, we're gonna be moving on to some Q&A and so feel free, anyone on the panel here that would like to answer these questions. The first question is, what are the examples of levers in organizations? Some like to comment on that. Sure, I think in different countries your structures are gonna be different. You have, I think of levers as carrots and sticks, right? Some of the levers are things like accreditation. Like are you allowed to be open as a hospital? Some of the levers are payment. Like how much you get paid or how much you don't get paid if an event, a harm event happens. Some of the levers can be reputational like the star system in the US or leap frog recognition. So you have levers that are dollars, you have levers that are reputation and you have levers that can deeply affect your ability to exist, right? And all of those are levers that patient safety leaders and advocates should be looking at of, you can't push for all of those levers to change at one time. So which of those levers is gonna be most important or most effective at changing the particular issue that you're working to change? So that's one of the things that we went through with our group, our WHO group is looking and really mapping out each organization and the levers within that organization that they control whether it's reporting or payment or incentives like reputational incentives. So I'm happy to share that in the US with anyone. Join us and I'll put in my thing in the chat if you wanna join us and we'll share that all with you. I would like to jump in on the first two questions as well, the question on the levers and what's in it for them, for the clinicians. So absolutely I agree, carrots and sticks both are important but I do believe that the carrots are more important than the sticks, of course we do need sanctions. Of course there is gross malpractice, there are doctors who completely kind of their conduct is completely not acceptable and that those are some cases but that's really not what we are talking about. Those doctors, they should be sanctioned and so on, they should perhaps even have their license revoked but for the majority of clinicians, doctors, nurses, healthcare personnel, they go to work and they really, really want to do a good job. They want to help people, they are completely running themselves to exhaustion to use their best efforts to help people but still these same doctors and these same nurses, they still they are involved in serious adverse events and they are related to human factors, they're related to how their shifts are set up, how the payment and structures are set up, how they are incentivized perhaps to do unnecessary procedures or unnecessary diagnostics where there is no need for that and so on. So the most powerful levers are those that facilitate because really what we want to do is that we want the majority, this is the majority, the majority want to do a good job and they know how to do a good job but they need the help and the most powerful lever is to facilitate and go into conversation with them and ask, how can we use our story, how can we use our voices to together kind of help you address these issues that you need to do to address to do a good job and that has to do with all kinds of things that's on the systemic level. And so we need both but the carrot part is more powerful. And I think the other thing encouraging shared learning, collaboration between shared learning organizations like I'm involved with Solutions for Patient Safety which is a pediatric shared learning organization committed to advancing safety that's had a huge success in the US and we have about 140 pediatric hospitals where there's shared, all teach, all learn committed advancement of everybody has to identify their issues and then come up with collective solutions and then whoever's doing really well on certain of the metrics has a responsibility to teach everybody else. So as patient advocates, you can push to say are you involved in a shared learning network and how can you help your organizations be involved in one of those shared learning efforts? And like you guys said, my experience with legislation was a lot easier and to answer the third question we had on here about how people can use social media to be heard for legislation, when my son passed away, of course it got out on Facebook, what had happened and everything and instantly, I mean, I didn't see those responses for a few weeks later but instantly I got lots of replies of this same thing happening to this person's child or niece or nephew or brother and sister and how and so I was able to gather a lot of information that way and then after my son's autopsy came back, I reached out to those parents or those people that had contacted me through Facebook to gather some more information. And like when Ty was talking about earlier, mostly when we went to the legislature, it was just presenting the information and educating them. We didn't get one negative vote and they were so shocked that this was happening to people that were just taking their prescription as they were prescribed and that it could kill them and that they didn't know that that was such a deadly alternative to reducing their pain. So for us, as far as we just wanted to get the information out there, so no one else had to die like this for no reason when it's totally preventable. And as far as using social media, I think it's a good thing just to let people know what is happening because sometimes a lot of these incidences get swept under the rug and that's what had happened in our community. And so when people had contacted me and said, well, did you know, this happened to a little three-year-old just a year ago, when I was told that this was just kind of a freak storm of events that my healthy 21-year-old son, the dying is asleep, and then that was just a freak storm of events, I knew that that was not right, especially when I started getting other people that would collaborate and say, no, my three-year-old died the same way. My 32-year-old child died the same way. So I think like Arthur says, it's getting information out there and trying to collaborate and correct these issues. Anyone like to? Yeah, I would add to that. And when Nile passed away in 2006, there was not much for us to gather information from. It was Google, that type of thing, but today we have so many other tools that provide a lot of transparency and a lot of input. So I think it's helped us a lot. It's a good way for people to get involved, to learn initially, especially if they don't have any background in healthcare and they want to help to do some investigating and through social media. And I think it's such a great tool, so many different organizations out there today that can provide information. And we even had a time where we were doing a lot of drive-time radio on particular subjects with organizations and radio stations around the nation wanted to have us on to talk about our story and our journey. And we found that to be very, very helpful, very enlightening, a lot of good questions came to us from that. I also mentioned that I'm a musician, so it's been a lot of time with other musicians and people that provide music. And we've used music as a tool for our advocacy, that's helped us get the word out about what happened in our particular situation. And it's allowed us to learn from others, their stories as well. And that's really the key, it's just the grassroots piece of it, it's getting out, talking to other people, providing any way that you can get the word out to bring people in that wanna help. There's a lot of people that wanna help, but they just don't know how. And these are some things that we are able to share, happy to share. But I would just add that, I think the biggest benefit that social media and has provided to me was a community because I think losing a child from medical error or losing anyone is a very isolating thing. It's not the same, it's a bizarre injustice. And so I think that, I remember finding like Carol Hemmelgarten and Sue Sheridan and it was like this bond that like, oh, we see each other's pain and that was very consoling to me, but also this empowerment that like being with other people who kind of understood this crazy stuff that we were trying to do and helping each other figure that out. And the collaboration that it connects you to people that are hard to connect with without that. So it helps break through those barriers and helps you get mentored because I think a lot of the knowledge that I've developed since 2003 has just, it's hard to gather that structural knowledge, the legislation of knowledge. And I'm the first to say there's so much that I just don't know. So I'm just grateful for that I have now this community of people that I can call to say, help me understand, how do HCAPs actually work? Or help me understand, how does the joint commission process actually work? I mean, now I know those things, but I didn't before and to have the mentors through social media to ask the questions of how do I make the change that I'm trying to make? Or someone to guide you to help you figure out what change you might wanna make? I just want to also very briefly address a little bit the question of transparency and the importance of transparency. Of course, when you're hit by such a tragic incident, somebody has this kind of incident in their family or it hits them, it's an isolating experience. So just having the option, the possibility to connect with others and share your information that's from a human perspective from an emotional perspective, it's absolutely important, but also from just from an information sharing because it's really, it's interesting, the story we have mentioned here, many of these stories, similar stories with opioid overdosing in hospital has happened many times also in Norway and also in the UK. So it's interesting that something can feel so isolating and that this just happened with me, but in reality, it turns out that this is something that happens over and over again, both in the US, even in the same department as you mentioned, and in other countries. So that points to underlying issues and that again points to having access to systemized data. So health registries, transparency of registries, transparency of hospital data, transparency of operational data, clinical data, of course taking personal data safety into consideration is also an important area of advocacy. Yeah, I would say one other thing too. Over the years working on patient safety issues, we felt kind of isolated in a way because it was kind of our focus, Merza, CEDA for those types of things, Sepsis, but now that we've had this pandemic hit, it really is, I think, open opportunities for especially advocates because this affects everybody. The pandemic has created the awareness of people having family problems and issues that they have to deal with. And I think it's opened a lot of people's eyes that may not have paid it much attention to what we've been working on for lots of years. Alrighty, everybody. Well, it's very hard to follow a discussion with the expertise, the emotion, the engagement and the historical experience that our panelists have had. And I do wanna thank each and every one of you. Yvonne for being our wonderful moderator, Beth, Ty and Ather for teaching me things that in a lifetime, I never would have been able to acquire myself. So I really, really appreciate your time today. I do just wanna kind of close out here with a few housekeeping items. There were some wonderful questions that we didn't get to answer today live. You can expect us to develop an FAQ informed by our panelists and our moderator. And that'll be posted on YouTube with this recording in about three days or so. So you can see that FAQ on YouTube if we didn't get around to answering your Q and A. And I'll also look at the folks who we didn't get to answer. I'll send that FAQ to you directly. Some other things here is that, again, we are offering board certified patient advocate credit. You're gonna get one hour of CE if you registered as such. You can expect to receive a certificate from the Patient Safety Movement Foundation in about five to seven days here. And of course, if you have any questions about that, please go ahead and reach out to us. The last thing here is we are doing our best to keep these efforts free and to provide free CE for our patient advocates and for some of our webinars, our physicians, our nurses, our pharmacists, et cetera. If you are able to donate, please do. You can go to patientsafetymovement.org and you'll see a donate button right at the top of the screen there. Again, I do wanna thank all of our panelists for your wonderful expertise and the time that you put into developing this content here today. And to our panelists, please don't hesitate to reach out with any questions or ideas for us. And again, until next time, we'll see you soon.


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Uh, eight of 150 blue mookie bets Dodgers on the color match Okay I'm sure I'll be able to find that later though Roger Bob Brady and Morgan Freeman Canvas red socks bogarts A quad relic brewers Corbin burns Mr. Burns Uh, I look on the number the back for the number it's on the front 84 of 99 and purple for the braves chippa jones 64 of 99 Where's chipper rank all-time third baseman? Third baseman's a weird one like a not a lot of like huge names come to mind immediately Who'd be the best all time? Yeah, you could put cabrera up there too Yeah, what about like old-timers jersey card astros kyle tucker 11 to 50 Yeah, I would say chipper is top 10 not knowing like everything else, but I think that that's pretty safe Beltray is probably right around there too As far as like A full career a beltray you can you can talk about for sure Our knot will be up there when it's all said and done. I think yeah But even in like machado as well Like he'll be up there when it's all said and done because he was really good really young So he his career counting numbers are going to be great and he's like a gold-loved defender. So Yeah, Scott rolling. That's a good one Hey, what's up sin got bobby wedge junior rookie Uh upside down beaver Rodra's dual relic auto eric osmer Number 228 of 300 And copper bobby wit and like 15 years devers will be number one all time No bias here not at all No bias there. Oh, yeah, george brett george brett. He might be he's probably better than most of the guys we just named I'm trying to think like Because specific third basements. I don't think of a whole lot of names before like, you know, 30 years ago or so Definitely not a rod. I mean a rod. He's gotta be up there. Well So he played short and third so it's kind of It's kind of strange people don't want to admit it. But a rod. Yeah, you got he's gotta be in the convo at least Andrew jones 27 to 299 auto for the braves and a j-rod copper Joe creedy Yeah, that's red socks, man. I don't I don't want to talk about it. But yeah a rod for sure. There's a Royce Lewis rookie Brooks Robinson, absolutely, man Underrated Sean's a red strap Nice, look at this Number 81 of 99. Oh, I thought this was gold for a second, but it's just the Padres colors tauti's quad relic To 99 I thought that was gonna be lower numbered the Padres copper pooholes Yeah, Mike Schmidt was a beast like do like can you put Miguel Cabrera there or did he switch to like first in dh2? Too recently, but I mean If he counts then yeah, he's way up there if he counts then he's way up there Yeah, bow Jackson canvas for the Royals Patch card nice patch braves here one at 25 Ozzy Alby's copper lindore Yeah, machado when it's all sundown will for sure be up there. He's gonna have some big counting numbers Torkelson hunter green. He's on track for I think I think 3k hits Um, I imagine he'll probably approach 500 home runs as well. So Uh purple freddy freeman 73 99 but combined with his defense. He's yeah, but he also played short for a while didn't he? When he was younger, so We got redemption What we got here Duel autograph jumbo lumber Bat relic emerald parallel Of bernie williams and paul o'neill yankies Emerald should be one of one congrats yankees on that one That'll be freaking awesome. So that should be I'm guessing autos on the bat barrels That's nasty. Yep emerald one of one congrats yankees on the redemption bernie williams paul o'neill we had the rice and the um Wade and wade bogs and they were both autographed on the bat barrels on the on the book We pulled last case to five. So Yep, that'll be a one of one right there.  Sean said wade bogs really all the wade bogs absolutely What is the position of tori win play? Short second no first first. Yeah I think he's in the other You watch on youtube and tiktok. Yeah, I mean that's what I do at home. I'll watch on youtube and tiktok What's up, kevin? Yeah, man a Oh, that's nice max kepler auto twin six of 25 Come yeah, congrats kevin, man. That's that'll be so nasty once you get it copper rapidevers Hella cruise verlander. We got canvas mets alonzo, right? Yep. Alonzo and whit marifield royals triple relic auto to 200 Whit marifield 129 to 200 copper miguel cabrera tigers Yeah, it's it's kind of it's kind of crazy roger I'm so tired of the PED hull of fame thing Jersey card Yankees louis zebrino 31 to 50 Blue honest wagner 110 to 150 You're just saying that like the most recent type of cheating isn't acceptable But all the all the cheating that took place in the past that's known about is is acceptable Not all of it, but some of it you're like picking and choosing. It's very strange Good old baseball hall of fame though. They don't they don't know anything I got quad relic ramuto filly is one of 25 395 per box got copper and auto so you get four mini boxes. You get one on-card auto an auto relic Quad relic or relic as well. So you get like a relic card So you have one on-card auto an auto relic quad relic or relic per mini You should be guaranteed the on-card and then the auto relic. That's what you should be guaranteed It has on the on the checklist All right, here we go After this pack i'm gonna check something real quick coal louis robert canvas. That's soda. Yep soda for the gnats God's archival auto braves john smolt 39 of 125 And copper chris brian. That's what i'm saying, man Let's let's not put the guys that saved baseball in the hall of fame They cared more about baseball than than the current commissioner. Okay. They took steroids because they wanted to be the best Right or wrong They helped the game That that cannot be argued. That's that's undeniable Six to go guys on the next one. Let's get it filled up Let's not put those guys in the hall of fame. God forbid Thomas yas wander rookie. We've got a Too old jersey auto. We brought this guy to existence mani machado nice hit for the padres That is a copper parallel 47 of 50 nice mani copper akunya 395 per box Which would be four miniboxes We've got brujan. We've got a jersey card kershaw 29 of 50 dodgers copper rizzo Got quad relic Posi malina remuto and pares some great catchers there three of 99 giants cardinals filly's royals I'm going to check for majority need three quarter majority on this eat over 50 percent Have the card outright Let's see giants. He got christopher g Cardinals is michael d filly's Isaac w. That's three already. So that's a random at the end A great example Remember that purple Suzuki rookie three and 99 cubs What year was that Yeah, exactly Yeah, they were they were for sure on a on amphetamines back in the day That's what i'm saying, dude. We have so many guys in the hall of fame that have done probably worse And we're just like, oh, yeah, this is cool, but no, not you guys Not you guys Thanks for making us a bunch of money, but no That's pretty much what they're saying. You got a tim salmon auto 170 at 299 for the angels and copper bay bruth There was a bernie. Williams pull o'neil in this case. Shane last case to five was jim rice and wade boggs Great stuff so far today ashtos dual jersey auto alex bregman Number 147 100 Got copper hobby bias clayton kershaw Stott Chapman ricky henderson patch card and mets francisco lindore 5 at 35 Got red trout 2050 angels We did go fishing we got tim salmon not mike I Sorry angels i'm trying There's a base there's a there's a there's a trout numbered in the same box uh canvas Nolan ryan as astros there chris sail red sox quad jersey 1799 and blue for the oriole sprake robinson 26 of 150 They should just disband the hall of fame now Just end it Like if clements doesn't get in then what are we doing and bonds to get in and whatever what are we actually doing here? Picking who we like which is exactly what they do Now what about all the guys that had all those home runs during the juice baseball years from like two three years ago? What about that players weren't enhanced for the baseballs were Got a dust of a droil auto red sox 11 to 50 Don't drink coffee. It wakes you up too much. Can't play baseball in that copper george brett for the royals Yeah, p roe should be in too But hey, you know what whatever We all know We all know bonds is one of the goats grom tatis pudge got quad jersey stand for the Yankees 34 of 99 Copper rookie calerality mariners big dumper mariners What in the world is that? Dude, that is some serious thickness Hostile to pay copper Um, what do we got coming up here? Oh boy Aaron and griffy. We got a cardinals natto on the canvas. What am I holding in my hand right now? austin haze mlb silhouetted batter logo patch relic card one of one for the orioles That is awesome. Congrats. Oh Who's got baltimore?  We were pulling one-on-ones Every few boxes here.  Like his bat has been quietly pretty good good stuff Kirby and marsh duran dual relic auto zander bogarts red sox Nice bowler. He is red hot right now 32 of 100 red sox Got blue podre's manning machado 44 150 All right guys five to go on the next case Two teams for spot here random team style The heck is this not cut? Yeah, it's true jessie Oz harper and andrew jones auto for atlanta 30 of 50 copper tony gwin res maddox canvass garreg for the yankees blue garreg dual jersey auto white sox dylan cease That one's 183 of 399 and purple blake snell podre is 599 Let's fix these Usium collection is 394.99 for box alex thomas Dot patch card giants brandon crawford 24 or 25 Hunter green rookie copper for the for the reds Yeah, let's see like a big miguel kebara for you chris quad relic uh astros michael brantley two of 99 Got a torkelson rookie copper. Yeah, exactly blake Boz got brewers christian yellich auto 83 of 125 And copper buster posie quad relic angel shohai otani might trout anthony redone jared walsh we go angels 98 of 99 and copper joey vato thomas we got canvass dale murphy braves jersey card a's denis eckersley 23 of 50 And blue max shares are 53 of 150 Everyone players perspective you don't want those guys in but i mean Fans perspective is definitely definitely different I would say largely Which is totally fine everyone's allowed to have an opinion We're not going to get in like this. That's that's what it is dual relic auto hosier amir as cleveland number 28 of 50 nice j ran for cleveland and copper max scherzer But there's also already a lot of players in every hall of fame But that have anything that you know I've bent the rules or straight up broke the rules And it'll always be that way So spider Yeah, I mean with the able with the added playoffs we got our framed card now nice Got our framed auto coming up Soto yellich straws prayer. We've got bronze Wade bogs auto eight of ten bronze frame nice hit red sox on the wade bogs Heck yeah framed hall of fame auto Hall of frame And copper petal anzo Nice hit red sox Yeah, we've got a lot of bogs today great player Sean's favorite favorite Got canvas henderson jackson henderson for the a's You can tell squinty Quadruple like bogarts 499 red sox Num, uh, yeah 499 red sox quadruple like bogey and copper rookie rois louis twins I don't believe tatsi's um excuses At all, but I don't think he should be ruled out of the hall of fame like I don't know It's it's a weird gray area for me on that one Matt relic lord escurdy l 25 of 50 blue jays blue avon rodriguez 44 of 150 marlins I don't believe tatsi's excuses at all It honestly made it worse if he would have just been like i'm sorry It made it worse in my opinion Abramsnell reveri got auto rookie for the tigers matt manning 43 of 299 It makes it worse His excuses were pretty bogus. It wasn't like uh, it was so bad.  It's like dude. That's like a topical steroid. That's so different than what he took So bad. It's pretty bad. It's pretty bad Yeah, so they should let everybody safely use some sort of peds if they want to Like rory said at a level to playing field George curbie triple patch auto beautiful patches orials here ryan mount castle Five of five. That's awesome. You can bag this one five of five congrats orials triple patch auto mount castle Local kid copper bogey for the red sox Aaron griffey canvas ichiro mariners and mark molder auto 163 299 a is mark molder There's a hudson zito and molder triple auto in this That'd be a really cool card hit copper ernie banks cubs. All right last few here Quad relic nice one here judge trout bets and harper one at 25 beautiful patches on this one Well, let's see you would need three out of four for an outright majority has to be over 50% Yankees kevin m angels chris d Dodgers kevin m And fillies isaac w that is a random at the end Random at the end nice card And kevin m has 50% but we need over 50 for outright ownership But obviously we'll have two spots on the random marsh duran a patch card med spray and a memo 30 of 35 Got gier 44 of 50 yankees nice one there and say a Suzuki rookie copper nice Good last box there. Let's do this random And if you guys watching on tiktok link is in the bio. We got more breaks coming up right after this Yankees angels Dodgers Fields great outfielders there Uh, so there it is again judge trout bets harper Yankees angels Dodgers fillies feel luck on this one a three two and one Three time whoever's up top one two Three going to the fillies fillies get the card So fillies got the quad patch there. All right got a Mets branded nemo to 35 Blue jays dirty yelled a 50 bow guards quad relic red sox to 99 Eckersley a's to 50 quad relic angels. Oh tani trout rendone walsh 98 of 99 Brantley for the astros to 99 Giants brandon crawford to 25 Stanton yankees to 99 quad relic quad relic sale red sox to 99 Lindor Mets to 35 Quad relic here Oh, that's gotta be random too, right? Cozy yacht. Yeah, okay, so glad to have one as well Dodgers jersey Clayton kershaw ramuto fillies to 25 Yankees Severino to 50 albies patch to 25 braves Quad tauti's Padres to 99 jersey card astros Kyle Tucker corbin burns brewers to 99 Got patch card fillies zack wheeler to 35 Fillies quad relic to 75 gene sagora buxton to 75 twins and colin glaver for the Yankees to 10 Autos a's mark molder to 299 Uh tigers manning the 299 as well jram cleveland to 50. Yep White Sox cease to 399 astros bregman to 100 Padres machado to 50 We've got john smoltz braves to 125 merafield royals to 200 twins kepler to 25 Braves andrew jones to 299 Osmer with a Padres number to 300 Brewer's kesson here at a 399 White Sox Gavin sheets to 299 andrew von white Sox triple jersey auto to 200 Um cardinals ted simmons 24 50 angels tim salmon 178 299 red Sox pejoy at a 50 bow guards for the red Sox to 100 Andrew jones 30 of 50 braves Got christian y'all at 83 125 brewers wade bogs bronze frame 8 to 10 red Sox A triple patch autos of five ryan malcastle So or else five five And i'll be logoman one of one austin haze orials orials had a very good break for a second tier team And one of one emerald parallel dual jumbo a lumber bat relic autocard bernie williams paul o'neill Good stuff. Let's do this next random Had one that we forgot about let's see make sure there's no Giants christopher g i think i already checked this one cardinals michael d Philly's isaac w and royals. Yeah, okay Giants Cardinals Philly's and royals Giants cardinals philly's royals on this one to 99 posiyati remuto pares 11 times whoever's up top after 11 gets the card one two three four five six seven eight nine 10 11 Let's go into the cardinals cardinals up top. That'll do it. Thanks again everybody. We've got more museum collection up next


clean energy. What's up? I'm going to give you some survey here. Welcome to another video guys. So in this video, I want us to talk about tickets and ball WPRT Westport fuel systems. So this is a company that is actually involved in our, um, engineering, manufacture, and supply of advanced clean fuel systems and components. So they actually, you know, produces these components to a variety of vehicles from like, you know, cars to trucks to semi trucks and to delivery events. And to my surprise, this is, this is a company that's been around for a while. Again, with the new energy push from the Biden administration, we're seeing more and more of these companies start to get some, some shine, start to get your spotlight. So, um, that's why I wanted to talk about this one, uh, into this video. But before we get started guys, if you're new to the channel, we talk about how to earn money, how to save money, how to invest and build wealth. So if that's something that interests you, go ahead and hit that subscribe button and the notification bell so you don't miss out on new content. So this company, um, I actually got my attention because they started gapping after hours, um, on Friday. So I'm like, Hey, what's going on here? So I kind of jumped in there, took a look at the company, said researching, um, just to find out that they had this huge catalyst come out. So let me bring this up here. You guys can see they have this huge catalyst, which is Amazon ordered more than 1000 truck engines and that run on compressed natural gas. So this is, this is good for them. So they are doing that in, in collaboration with, uh, Cummins, take a symbol CMI, uh, because Cummins build, um, engines, um, especially heavy engines and diesel engines. So now Cummins is actually now moving into building engines that work that run on natural gas, which is good renewable. Um, you know, energy. So this is really good news for these guys. I mean, the fact that Amazon is getting at least a thousand trucks. And if this order goes through in Amazon likes what they get, chances are they're probably going to order even more. And if so, even Amazon started ordering from then and other companies see that it's working out for Amazon, guess what they're going to do? They're going to put their own orders and try to get, you know, I mean, that's just competition. It's monkey see monkey do in, in, in business. So most companies are going to see it. I want to get on board. So let's kind of take a look here and see what happened after hours. As you can see throughout the day, the stock actually just stayed pretty mellow. Nothing around that $8.50 point. And then after hours, when the news came out, this is where happened to the stock, it went from that $8.50 and actually got to a high of about 13 60 before pulling back and sitting at a 12 30, uh, for the close. So again, what I anticipate with this one is since this news happened after hours on Friday, a lot of investors were done for the day. And then so when they come in Monday morning, this is going to be the news. They're going to jump on this one and be like, whoa, what happened? New order. So I'm thinking that on Monday, when we come in, uh, since we're sitting at $12.30 here, Monday morning, this thing is breaking the gap. So we already, we already had a high of about 13 60, uh, anticipate this thing to break at least $15 on Monday morning before pulling back. That is my personal speculation again. So do your own due diligence. Again, I'm just looking at the momentum because it happens on Friday after hours, when most traders are done for the day, the news is going to carry into Monday morning. And don't be surprised that it might even push as high as testing 20 before pulling back. Uh, what I see here is if you want to trade this particular stock, guys, um, if you have a platform that does pre-market, get up early and put in your order for this one, because by time you wait for the market to open, uh, it's going to be gone or you can wait and then just wait and buy regularly at the open, but then you have to be a very, very, uh, quick executors can get in and out. But for me, I plan on trading this one as well as, uh, picking up some shares and holding longterm because I like what I see with the company. I like the fact that they are, uh, working with other companies. I mean, I've seen that work with, with, with Ford and then some big companies, Volvo. So that tells me that the company is actually heading in the right direction now with Amazon. So yeah, that resume is really getting stronger and stronger. So I definitely going to pick up some shares here, um, and hold it. But here's what I plan on doing. I don't plan on picking up shares when the stock spike. I'm going to wait for a pullback right now. It is sat here at $8.50 for a while before these news drove it up like that. So again, I'm going to wait in my, if it comes down to me around maybe $10, $9 price point, I might start looking at picking up a position. But so again, I'm anticipating that if it pulls back to, let's say that $9 price point, that would be a good entry points with a long term position, but for, for just day, for day treating or intra day trading, guys, you can just look at the charts and just look at the momentum and trade it accordingly. So that is my speculation. Again, I really like the company. Uh, when I go through and see, uh, some of the solutions that I, they provide out there, I think it's really good, um, ties, um, you know, with what the Biden administration is really working on. And again, if you can see here, they actually mentioned it. So, um, that WPRT shares already had more than what triple since November presidential election. So just this point alone right here, it tells you that the momentum of the current administration is driving these, uh, companies shares to go up. So that's something that you want to keep in mind. Again, they are pushing for renewable and clean energy, uh, in the administration. So that's something that we all want to take advantage of. So you can see again, here's a list of some of the, uh, companies that they work with. And if you, if we go even further down, you can see, uh, some of the solutions that they provide, um, just go do some research again, do your due diligence by going to the website and just reading through it and see, uh, what these companies actually doing. I think they're doing some amazing things. It's, it's really amazing that some of these companies are doing wonderful things, I guess, and are still, um, hiding. And we cannot find all of them. I bet you can't, you can't find or win all of these stocks. So that is what I wanted to bring to you guys. Again, uh, let me know the comment section, what you think about is, um, these, these two things that I want us to do here for display, um, for Monday morning, we can day trade this one and then wait for that pullback and grab some and hold long term. Again, that's my strategy. So see what works for you. If you really have a ton of plays in the EV space, you might just day trade this one and let it go. But if you don't have a ton of plays and then those would be one that you can definitely actually, um, buy and hold long term and here's why I want you to be involved in this or at least give this a stock, some consideration because we are talking about batteries, um, with the EV space, a lot of EV cars and lithium batteries. It looks like that's the focus that everybody is, is on. And I've mentioned this to you guys over and over, like few cells are going to come into play. We really want to make that transition and go to clean energy. It cannot, our focus cannot just be on batteries. It has to be a combination of batteries and fuel cells and hydrogen cells and all these other things that can definitely benefit us. So, um, that's why I, when I see plays like this, I know for sure that we have to, you have to have them in your portfolio. And the other thing too is again, this is my personal, my personal take here, uh, a lot of vehicles that are running today on fossil fuel, when you retrofit them with technologies like this, and they can actually reduce about 70% of their carbon emission to me, that's a win.  We, do you know how much, um, a CO2, uh, would be taken out of the atmosphere if we do that for every fossil fuel vehicle that there is out there? So that's my take. So I don't think that every people are just going to stop driving fossil fuel. It's going to be a slow transition. So we go from like, hey, converting what we have today into at least, um, a point where they don't emit a ton of fossil fuel or a ton of CO2, and then slowly transitioning to those, um, chargeable or EV vehicles. So that is the plan that I see for this one. So let me know in the comment section, what you think, uh, about this one. And again, if you're new to the channel, guys, we talk about how to earn money, how to save money, how to invest and build wealth, and if that's something that interests you, go ahead and hit that subscribe button and the notification bell too. Don't miss out on your content. Also, if you're looking to get started with investing, we both has a promotion where if you sign up, you get some free stocks, links in the description below.