Welcome to NTN Nightly. I'm Hermedi Mark. This edition, Stop Stories. The Saint-Duchess Consulate in Montenegro to host an investment forum for French investors. The Blaschak Combined School benefits from the Goodwill Ambassador Programme. And Health Minister, Senator Hon. Mary Isaac Lodz, the public for sustained low COVID-19 cases. The Saint-Duchess Consulate in Montenegro is preparing to host an investment forum for French investors. This first-ever virtual investment forum will focus on presenters from Saint-Duchess who will speak on various and potential sectors of investment on the island. How to do business in Saint-Duchess, potential partnerships with export-ready companies, as well as discussions on their existing options for merchandise and free transportation between the two islands. Consul-General Joanna Sultan says this is all in an effort to stimulate economic growth and development between Montenegro and Saint-Duchess. The forum is scheduled for Wednesday, 28 April 2021. We are doing it in conjunction with the Chamber of Commerce, Harry Montenegro. They are partnering with us. As a matter of fact, they are hosting a one-month-long trade show on the Caribbean, America, Africa. And of course, I jumped in and I decided, okay, let us speak a little bit about investment opportunities in Saint-Duchess, especially now as we are looking for ways to re-stimulate the economy because we all know what COVID has done. And so this investment forum really is a way of presenting investment opportunities to those out there, not only in the French territories, but I think the wider region because being the fact that it's virtual, it means that it is open to any and everybody. The forum is a part of a month-long trade show hosted by the Chamber of Commerce in Montenegro from the 6th to the 29th of April 2021 and will focus on the Caribbean, Europe, North America and Africa, where entrepreneurs as well as investors and business persons can discover promising markets. Benefit from expert advice, expand their business network and identify support mechanisms to develop their international presence at a lower risk. We have Miss Alana Lansico from Invest Saint-Duchess, who would be speaking about the various investment opportunities that are possible in Saint-Duchess. We also have a representative from the Ministry of Infrastructure, Ports, Energy and Labor. And of course, they are going to be focusing on renewable energy. We in Montenegro have gotten quite a few. We have quite a bit of interest in renewable energy. People wanting to set up companies in Saint-Duchess. The event is 100% digital and numerous conferences and workshops have been planned with simultaneous translation in English and French. Saint-Duchess Goodwill Ambassador Programme continues the yield benefits on several levels. As school resumed this week, students of the Blusher Combined School were greeted by an eye-catching mural of the solar system thanks to a project spearheaded by the charity organization of Goodwill Ambassador Her Excellency Claudia Edward Ladner. Jesse Leos spoke to her and filed this report. Outdoor learning is increasingly becoming a preferred solution for many schools that have reopened their compounds during the pandemic. Charity organization Edward for Education responded favorably to a request of the Blusher Combined School principal who wanted to achieve just that. Her vision included appealing murals and other paintings on outside spaces of the school that would cater to the educational needs of the students while adhering to COVID-19 protocols. Edward for Education's decade-long streak of auspicious interventions at schools island-wide would continue now during the pandemic. National Goodwill Ambassador and founder of the charity is Her Excellency Claudia Edward Ladner. Well, we had a lot of proposals for school projects and we were thinking with COVID-19 and the social distancing. Some of these projects did not make sense for us to approach them at this time. When we got the call from the Blusher Combined School, the principal, she said to us, we have a proposal that will enable our kids to learn on the outside of the classroom which works perfectly with the social distancing and all of that. Getting this project together was, by far, one of the easiest projects I've put together and in a timely fashion as well. Most prominent among the artwork created at the Blusher Combined School is the Solar System mural for science lessons. Naja's Simeon of Saki Productions, most noted for the St. Lucia mural at Point Serafin, painted this Solar System mural free of charge. I selected this huge wall. You walk up the stairs, you get this wall, so it's like you're walking into space. The Earth is right there in the middle and when you see the image, you'll see the Sun is in the center and it's actually painted on top of a light fixture. So when the light comes on, the Sun goes. Everything lights up. So it's just a beautiful concept but I wanted the children to walk into the Solar System and now they can look at, you know, not just the Earth but the entire universe and beyond. After weeks of planning with Edward for Education, sponsors Saki Productions and Harris Paints, principal, Mural Emmanuel was most satisfied with the final product, completed in time to welcome her students back to school for the third term. Quickly. Everyone loves it. We are very excited. The students are very excited. They came in on Monday morning and saw the mural of the wall for the first time and we're very, very excited. Parents are very pleased to see those kinds of things happening at school. So on behalf of the Bloor-Shackle Mansion family, I wanted to thank Edward for Education, Saki Productions and Harris Paints for helping us see this project. Other projects of the Edward for Education charity over the years include construction of a sick bay for the Corinth Secondary School, Theatre Arts Room for the Cicero Secondary School and Learning Center for the Ave Maria Girls Primary School. For the Government Information Service, I am Jesse Leance reporting. The Government of St. Lucia is promoting the development of affordable and clean renewable energy alternatives, an action which will aid in meeting sustainable development goal number seven. During the budget presentation, Prime Minister Hon. Alan Chastney announced the number of measures to be implemented as part of the national strategy aimed at reducing fossil fuel dependence and improving St. Lucia's overall competitiveness in the energy sector. In this regard, I am pleased to inform Hon. Members that Looslick has secured the resources from Abu Dhabi Fund for Development to allow the installation of a 10 megawatt solar farm with sick megawatt battery storage in the Trumassee Meekwood area. Also during this financial year, Mr. Speaker, an allocation has been made for the installation of at least 100 kilowatt or solar PV systems and 10 schools across the island. As part of efforts to promote energy efficiency, the Prime Minister says audits will be conducted at 40 schools and lighting retrofits of over 6,700 fluorescent lights will be changed to LED in selected schools. A similar exercise will be undertaken with respect to our street lights, most of which will be placed with LED lights, thereby resulting in further energy savings. Mr. Speaker, to assist with the maintenance of our PV systems, the government has embarked on a program to train and certify a number of PV installers and inspectors so as to support and encourage the use of this form of renewable energy. Hon. Alan Chastney says consultation will also begin on a proposal for the introduction of energy efficiency legislation, which will provide guidelines and promote efficient energy utilization. Minister for Health and Wellness, Senator Hon. Mary Isaac says the recent drop in the number of COVID-19 cases is attributable to an increase in resources provided by government. The dedication of healthcare workers and, importantly, the collective response to the protocols by the public. Over the last few weeks, we have seen a steady decline in our number of new COVID-19 cases since the upsurge we saw in January and February. This is due to your support to the efforts of the Ministry of Health and Wellness and the Government of St. Lucia by observing the protocols, washing our hands, wearing our mask and social distancing. The road to get here has not been an easy one. The Command Center, the Ministry of Health and the Government of St. Lucia had to make some tough decisions in putting strict protocols in place, especially a stricter curfew over the recent Easter weekend. We know that by our very nature we are a sociable people and that sacrifice over Easter was not an easy one. It has now been just over 14 days since the Easter period and based on the observed declining trend in the number of new COVID-19 cases, the actions we took at that time to limit the spread of COVID-19 is paying off for our country. Honorable Mary Isaac is urging the public to continue to adhere to the protocols and keep the nation safe. Our goal is to get our nation's active COVID-19 cases to under 50 and we know we can decrease it even further with your help. This will allow us to reopen more sectors that have been affected by the implementation of the needed public health measures. As a government, we continue to monitor the COVID-19 situation and look forward to the steady drop in the number of new and active COVID-19 cases. We must thank the public for their great sacrifice that contributes to the success in the management of this pandemic. Thank you for practicing the protocols and helping to keep all of us safe. A book highlighting the history of dance in St. Lucia has been launched. Performer, choreographer, fashion designer Christine Samuels has added to her list of achievements by capturing the endeavors of the local dance fraternity. Details in this report. The book is made up of bios and photographs in color, black and white, so it will give you the whole story from where the dancer started and the group started and will give you the photographs to show who these people are and what they have done in the development of dance in St. Lucia. There have been a lot of people who have helped in the development of dance in St. Lucia. The generation today do not know these people and I felt it was necessary for all the generation of people now and the dancers that are going to be bringing dance forward to the next generation needed to know who these people were. Samuels' own career as a dancer spans over 40 years and she established and managed her own dance institution, the Crystallites Dance Academy, as a premier institution for arts education in St. Lucia. During this period she says she hoarded dance paraphernalia which later allowed her to spearhead an exhibition commissioned by the Cultural Development Foundation. The book she says evolved from this event. What really brought it out was when Auntie Virginie Alexander passed away and CDF did the Icon Series on Dance in St. Lucia and they asked me to put an exhibition together for her and just to document dance and for me that was the right opportunity. So what I did, I did the exhibition at the Blue Coral Mall in bios and photographs. So basically when the exhibition was done I transformed the exhibition into the book. The cover features a poignant image of the author in Dancer's Pose with cultural and dance icon Virginia Albert shortly before her passing in 2008. The few months of when Virginie was very ill, we had decided to go to a studio to do that photograph and we put a collection of photographs together. And I mean last time I was writing my speech and I'm saying wow, this is really a magnificent photo because it captured everything that Virginie has put together for dance in St. Lucia. And I felt it was very fitting since the book is in memory of her and she's the mother of dance in St. Lucia. So hence the reason that this book, the cover of the book puts Virginie and I on dance footprints. The virtual launch for dance footprints 40 years of dance in St. Lucia was held on Saturday 10th April 2021. For the Government Information Service, I am Jesse Leance reporting. This is NTN Nightly. Up next, Primus Hutchinson with the NTN novella Guillaume. And she told me that mouth rinsing with water gets rid of food in between your teeth which can protect you from getting cavity. No way! So after I eat Audrey, Eddie figured it's a good idea to rinse out my mouth with water. Yes! Make sure to spit out the water after rinsing because swallowing will only bring the germs into your body. Remember, water is an easy and cost-effective way to instantly boost your health and a healthy body to fight any diseases. Welcome back. We now join Primus Hutchinson for the NTN novella Guillaume. Thank you very much. Thank you, Madam Department of Universities for the information on Government Settlesy. This is GIS. This is the National Television of the NTN. This is the new cover of Guillaume. This is Primus Hutchinson. The report of the examination could determine if the development of the carpet in its place next to the cemetery of Primus Hutchinson. I have worked on it continuously. The construction of the carpet in its place next to Mount Hardy. This is a situation that could be done at the cemetery next to the cemetery of Primus Hutchinson. This is something that I pay special attention to on the media. In particular, the National Trust officers, such as those who are involved in the development of the carpet in its place next to the cemetery. The National Trust officers, such as those who are involved in the development of the carpet in its place next to the cemetery of Primus Hutchinson. According to Dr. Mothi, the situation is that the discovery of the carpet in its place next to the cemetery of Primus Hutchinson. This is a situation that could be done at the cemetery next to the cemetery of Primus Hutchinson. The archaeological research and history of this place could be done at the cemetery next to the cemetery next to the cemetery next to the cemetery of Primus Hutchinson. The President of this company, Dr. Winston Folgens, claimed that this place could not be found in a fort and that it was damaged in a way. The question for Dr. Mothi is whether he had any opinion on the Greek information that affected the continuation of the work of the carpet development? According to Dr. Mothi, this place was damaged in a way that affected the work of the carpet. Welcome to your continued work and Greek for the development of the carpet. This is Christine Thompson, who said that the most important recommendation is for Dr. Desafé Archaeologique to be brought up by the work he has done, and that the officers of this company should cooperate with the company to make it easier to establish a big role in helping the workers of this work to grow. The head of education department is here, Dr. Fiona Phillip-Mayer. an address for the school who will begin operation in 2021. The school who will open the school will open the school who will open the school I told him that I was going to join the school because it was an opportunity for the students to find their first way to study. So we want to say thank you to all the teachers who supported this teacher who made all the arrangements to make sure that she came. She came out of the situation. We want to say thank you to all the teachers who supported this teacher. We also want to say thank you to all the teachers who supported this teacher. We want to say thank you to all the teachers who supported this teacher. We want to say thank you to all the teachers who supported this teacher. We want to say thank you to all the teachers who supported this teacher. We want to say thank you to all the teachers who supported this teacher. We want to say thank you to all the teachers who supported this teacher. We want to say thank you to all the teachers who supported this teacher. We want to say thank you to all the teachers who supported this teacher.


You need a financial advisor with the freedom to focus on your specific needs. Whatever your goals, Reid Potter can create a game plan tailored to you. Call Reid at 432-0777 at Pikeville, Kentucky to learn more. September is National Suicide Prevention Month, which works to raise awareness around the issue. We spoke to Big Sandy Healthcare provider Cheryl Combs Walker on the importance of discussing suicide prevention and when to seek help. Knowledge is power and, you know, as a community, we, without discussion of important topics and concerns, we don't have the tools and information necessary to be able to prevent those things. And so, you know, suicidality because we tend to avoid mental health related topics and because there's still a lot of shame and stigma connected to it. Very often, people aren't talking about it, or they might not even seek the help or support that they need when these signs arise. And unfortunately, we can't go backwards. If we recognize these signs and symptoms in a loved one and then something happens, we might wish that we had taken action and didn't. So talking about it as a community helps to remove that stigma. It empowers people to know what to do, what signs to look for, and can hopefully help save themselves or someone else. Signs that someone is considering suicide include sudden changes in mood, giving away significant items, talking about death, impulsive or reckless behavior, and increased alcohol and drug use. I think that, you know, recognizing that suicidal ideations are a symptom of another concern in the mental health realm. We definitely want to take some kind of action and recognize them as a higher-level symptom. And so what that means is that it's something that we definitely want to take some kind of action and reach out for support with. And that can be, again, through a friend or family member, through if we haven't already accessed some kind of mental health support through a therapist or a psychiatric provider medication of some kind, then we definitely want to initiate that on some level. If you or someone you know is experiencing a mental health crisis, call or text 988 to reach the suicide and crisis lifeline. Reporting for Mountain Top News, I'm Brianna Robinson.


Good afternoon. My mom had a total radical nephrectomy in 2007, stage two. What are the chances of reoccurrence or is there any time period where there's this many years after a total nephrectomy that you're labeled cancer-free? So you said surgery was 2007. So a new diagnosis of stage two, I usually quote my patients the risk of occurrence of around 30% or so lifetime risk. Certainly as you move through time and the cancer hasn't come back, that risk is getting smaller and smaller. But data tables are always calculated or drawn out based on time zero at the time of diagnosis. So it's hard to give somebody a numerical estimate of relative risk at year two or three or five. So at this point seven years removed, you'd like to think the risk of occurrence is very small. There was a very interesting paper that came out a few months ago. The Mayo Clinic looked backwards at their entire experience of kidney cancer going back to something like 1976, 3,000-some total patients. And apparently their internal algorithm was to follow patients. It appears to be indefinitely with body scans. The current guidelines would say five-year period of observation with imaging surveillance and beyond five years you should stop. So they were able to say, okay, how many recurrences did we find within the five years that are our guideline-based interval for recurrence? But we watched everybody forever so we can say when did they recur was after five years. And only about two-thirds of recurrences were identified within that five years. So fully a third recurred between year five and up to year 11 or 12 post nephrectomy, which I thought was interesting. I don't know of another data set that really gives you that flavor of what's the true timeline of disease recurrence. The lower the stage, the stage one in two patients had a longer scatter of late recurrences at years 10, 11, 12, 14. So that hasn't changed guideline standard practice. I would still say any body like the American Neurological Association or the NCCN guidelines would say a five-year window. So I wouldn't strongly advocate ongoing observation. The risk is small, but that Mayo data proves that the risk really isn't zero. There's this tiny chance of a late recurrence, but really hard to give you a hard number on that. Question is about proton radiation therapy. I know that recently there is a proton facility open up, I believe, out in Redmond or Woodinville. With Evergreen Hospital. Where does that fit in with like pain management or with brain metastasis treatments? Any comments on that? Well, so SCCA has a proton therapy suite up at Northwest Hospital. And I don't directly intercede in making decisions about the style of radiation therapy. But in broad strokes my understanding is proton therapy is more expensive. Third-party payers will deny it unless you can prove there's a study that says it's better than standard external beam radiation therapy. And there's no data for kidney cancer and most other cancers. The one disease where it's done a lot is prostate cancer where there is data arguing that it's better, at least by toxicity. So that would be in the domain of your radiation oncology provider if they had a mechanism to recommend protons and gain your insurance approval. But it's not being commonly done. Thank you. One is just a term ejection fraction someone removed mentioned that and I don't know what that means. So that's just a measure of how well your heart is pumping or squeezing. And with synitinib there can be a slight decrease in how well the heart functions. So it's the muscle function of the heart. Okay, thank you. And the other question was for the last speaker. There were two questions. The nivolum on whatever study. Was it studied on papillary cancer at all or was it just clear cell? So good question. The study I showed you was strictly clear cell. The MPDL 3280A antibody in its first clinical study allowed papillary renal tumors and my recollection is they treated I think six tumors and had I think one response. That's as far as I know the entire world experience with these drugs and non clear cell tumors. The phase four trial that's supposed to be coming for nivolumab is not going to restrict by the tumor histology. So it would allow any kidney cancer diagnosis to receive the drug. Chromophobes, papillaries, you'd come into it not really knowing what the likelihood of responses, but you would be eligible to participate. Great, thank you. My last question was when you had that one slide up that talked about the complete response with these different ones were like one percent or two percent or whatever. How does that compare with just a spontaneous response in the general untreated population? It's really hard to put a number on the likelihood of spontaneous remission. In my entire practice, I can really only think of one patient that had true spontaneous regression was incomplete. It didn't go to complete response, but had fairly large lung findings that shrunk down dramatically over a couple years time. Sadly, then develop brain lesions. So the brain lesion is able to grow larger despite the body lesions getting smaller. I would guess something in the range of one in 10,000 to one in a thousand patients at most. It's a rare phenomenon, rare enough that if you ever see it, you write a little paper and describe it in the medical literature because you're like holy smoke. This is unbelievable, but it's not really a therapeutic maneuver. You wouldn't say tell somebody to wait, hoping that your tumor is going to shrink down on its own. That almost never happens. Okay, general question. As a kidney cancer doctor, other than in a trial, do you guys keep records of your patient's history and what works and what doesn't? And does it go to a national database somewhere? So that's a really interesting question. And the bottom line is really no. We obviously can go back to a patient's own medical chart. It's available to us. Our center and Dr. Kamal could talk about Virginia Mason does not have good bioinformatics tools built in to our medical chart that you could in some capacity say, well, let's see what happens to the last 100 kidney cancer patients. Let's see what happened to kidney cancer patients in our center from 2000 to 2014. That just isn't possible. This idea of national registries has gained a lot of attention because this is a real dilemma in the field. Investigators would like to know what happens not to 50 or 100 patients, but 2000 and 5,000 and 10,000. You'll see statistical findings that you just can't tease out with smaller numbers. So there has been a drive to try and collect patients into larger registries. There is an interest in doing it for targeted therapies. I know Dana-Farber Group is really big on building a large national registry. There's an investigator at Duke that's tried to launch a similar effort. We're actually participating in that IL-2 data registry, but we're not a participant in the other targeted therapy registries. So there could be the possibility down the road of more patients having their data compiled into that kind of catchment mechanism. But for most practices, I don't think that's happening. Okay. And then another question is how often can a kidney cancer patient ask for a scan? Actually, I'd like to go back to the first one, the registry. I think the limitations are manpower, woman power and money. So like the HENG criteria that I showed you that was really driven by the fact that there was money available to develop a consortium and collect all the data. And a single institution, you know, when you have a medical student or a student come by and they're interested in something, that's what the impetus is to look at something specifically. But other than that, we don't keep the data. How often can somebody ask for scans? I mean, I guess they're guidelines as to how often one should do scans. So it kind of depends on what the situation is. Is it somebody who's six years out and we're just doing a follow-up? Should we be doing a scan, not a scan? So the guidelines would say no. I guess personally, if somebody came to me and was adamant, I'd probably do it once. I'm interested in that, like whenever my husband gets on a new pill, I want to see in three or four months if it's working. Yeah, so that's actually reasonable, right? So anytime you change treatment, prior to that, you'd image and then after reasonable interval, I think three months is reasonable, you know, you would see what happens. Okay, thank you. Oh, so I guess if you talk about kidney cancer, you know, it could be chest, abdomen, pelvis, the BSET scan. My question is on the oral medications. Did I understand your presentation in the arrangement, you know, the mixtures and all that? There's none of those that if you start one regimen of that that it doesn't work, that precludes another one. So let me understand. Your question is if I'm taking one oral medication, that doesn't work. Does that mean I, because I've taken that, I cannot take, you know, oral medication X, Y and Z. So I guess that's partly true, but not completely true. So let's say if you were on an anti-veget, and that stops working or the disease progresses while, you know, someone's on sunitinib. And if one's never been on an mTOR, which would be a vrolomus, you know, that would be approved and that would be the next logical thing to do. At least so we thought till very recently, but then there was another one, anti-veget, which is actually used in second line now. So I think if you've tried a couple in one class and another one in another class, I think beyond that approval does become a little tricky. So combinations, there are no combinations that are approved because they've not been shown to work. In fact, you get more side effects, you know, without any benefit. So that is very clear, but you can definitely switch around from one class to the other. I think there is a limit to how many times you can do that because A, it's not going to work and B, one also runs into insurance approval. So yeah, there's no safety reason that you couldn't use any drug after any other drug. So there's no sort of absolute barriers. Scientifically, the two mTOR inhibitors are thought to hit the same target. So I don't think I've ever treated somebody with Temsir Limus and then at some later point Everlimus, thinking that you're giving them the same drug that didn't work previously. But the tyrosine kinase inhibitors are all thought to be subtly different from each other and every time you look at applying one after another, there's always a subset of patients that have some degree of tumor response. So a lot of patients wind up getting two, three, four tyrosine kinase inhibitors over the course of their therapy. And that's not irrational. I had a follow-up question on the scan thing because with the CAT scans, if you haven't too often, they say that you have an increased risk of leukemia and things like that. And with the MRIs, if they do the contrast and you have kidney function problems, then you risk NFS. And so I was wondering if you were trying to avoid too many CAT scans and you couldn't have contrast with your MRI. Is a non-contrast MRI or a sonogram ultrasound, are those effective at all if all you're trying to do is see if the drug is working? So you know that's a good question and I'm not sure I have a straight answer for you. So it kind of depends on the situation. So a lot of the patients already have impaired kidney function because one kidney is out. And so I think I very often will use a non-contrast CT. It just depends on what information you're trying to get. And if we do do the contrast, then I may actually go down the road of an MRI because a CT with contrast is more harmful to the kidney than an MRI with contrast. And then again, within contrast, you can do things to be able to get the scans. You can hydrate patients. So it just depends on what one is looking for. But let's take somebody who has one kidney out. They have mildly impaired kidney function. So I will very often use a non-contrast unless you're specifically trying to look for something which would be... I mean, I think you can get enough information from a non-contrast CT in most of the times. Right. So as far as the radiation goes, now the only data I'm familiar with is because actually long time ago, I used to be with the VA as well. You know, when we did protocols, you had to quantify the risk of a CT scan. And I think if you do one every three to four to six months, it's probably okay. The last time I looked at the data from what I remember is, you know, if you do a CT of the chest, the amount of radiation you're going to get is probably the same as 10 roundtrip. So that's one of the two flights between Seattle and New York. So at least that's one way of quantifying risk. My brother has stage four translocation, Reno South, and not having the full picture because I'm not right there with him. I want to try to help find a study which is incredibly hard so far. What information... Could you recommend to me what information would I need to have at the moment? You know, if I'm trying to get him into something, something that I don't understand a lot of the information. Like you can't do this, you have to do this, you know. Is it... You need the whole medical record, just a snapshot? What's the best bit of information I can have handy all the time? I think if you were just calling institutions, they're going to want to know the diagnosis, the stage, maybe some pertinent past medical history. To formally enroll, they would have to have your brother come out, do an evaluation, get the complete chart to make sure there weren't any issues for past medical problems or they'd need to see up-to-date lab data. So to enroll would be more complicated but just to find out if a study makes sense and if it's a good fit, you should be able to do that with a phone call. The translocation renal cell carcinoma for the rest of the audience, it's a rare kidney cancer subtype, has a very discreet chromosomal rearrangement that can be tested for. That's the hallmark of that disease. I can guarantee, I bet there's not a single study nationwide that is a study specific to translocation renal cell carcinoma. There aren't enough patients, you'd never complete a study. So it really boxes you in to kidney cancer studies that don't care about the histologic type, which are uncommon. They almost always say it needs to be clear cell. Something like the phase four nevolumab study that would be open to any histologic type would be lovely. Or there's a lot of studies, early clinical trials, often phase one studies that are open to any advanced cancer, doesn't care, wouldn't even be kidney, it would just be any cancer process. So those are going to be available hit or miss at different cancer centers. But then the question is, well, what's the new drug? And is there any reason to think it's a clever, smart choice for kidney cancer? And that's where I think you really need your physician to guide you. Is it something that doesn't seem like it likely would work at all, or is it something that might be quite interesting to look at? I think we'll take one more question here. And then I know Dr. Taikoti is staying around for the afternoon. I don't know about Dr. Chattis, but I am going to volunteer you gentlemen to just come ask your questions. And if you're not comfortable asking in front of the group, that'll be a nice time for you to do that. So we'll take maybe two more questions. We have time for a lunch break until about 12.15 when we are due to start again. So we'll work on these last two questions and then try to come back here at about quarter after 12. I'd like to focus on spontaneous regression. In order to know that that's occurred, you have to be following the patient, presumably, without any other treatment. Today, with the treatments available, how often does that happen? And can you distinguish between spontaneous regression and a response to therapy? So if you look for these case reports in the literature on spontaneous regression, most of it is written in the 1950s, 60s, 70s. And that was a time when there were no established therapies for kidney cancer. So many patients, the doctor would say there's no treatment for this. But if you're pretty healthy and you felt well, maybe they come back and they do a scan in six months or something just to see how things were going. So it's data collected in an era where patients very often were not in any kind of active cancer therapy, but were pretty physically fit and doing okay. And they thought, well, a scan might help us to give you a sense of where you're at, how fast things are progressing. So that's where most of the literature comes from. It's pretty old. I just happened to know a patient that did a couple of months of SU-10, didn't like it. And I actually wasn't seeing the patient, but a colleague saw him over the next couple of years off of therapy. He was quite adamant. He was just going to focus on quality of life. And I believe it was for neurological symptoms. They did full assessment and unfortunately found brain lesions. But when they look back at his body where they knew he had pretty substantial disease in the lungs, it was almost completely gone. So it was fascinating that that tumor had shrunk down with no, you know, for two years, no any kind of active cancer therapy. But unfortunately it was discordant with other parts of his body. Okay, last question. Is it real drugs or fake drugs? So if a study was done with a placebo, they would tell you you're not blinded to the fact that there could be placebo. For stage four metastatic disease, that would never happen. It would be considered unethical to withhold active therapy from patients. It does happen for stage three disease. So patients without any findings of cancer, there have been several large trials where they applied one of the targeted drugs versus a placebo. So everyone got a pill bottle and they didn't know if it was a true drug or if it was a fake. Where patients didn't have active cancer by their scans and you want to find out does applying a drug help or not, the comparison is no drug at all. But the thought is you get a truer sense of everyone's behaving in the same way, believing they're taking a pill. Then if you just tell half the people take the pill, the other half you're not doing anything, you're the control group. But that's considered to be an ethically appropriate approach where the people getting placebo aren't suffering any kind of harm. Okay, thanks everyone for your attention. There is a light lunch over here in this area. Why don't we all try to come back here about quarter after and feel free to bring your lunch in here with you.


Dear students, in this module I am going to elaborate on the storage of biological sequence information. You know that the biological sequence information may be of three different types. The first one can be the DNA. At the DNA level, the sequence information primarily consists of A, T, C and G. While for the RNA, the information is changed a little bit and you have A, U, G and Cs. For the proteins, you can have 20 different amino acids which are listed here for you. So these amino acids can be represented by their one letter symbol. For instance, alanine has A to represent it, arginine has R. So a protein can be simply narrated by combinations of these alphabets. Dear students, the DNAs, the RNAs and the proteins can be sequenced in the laboratory. When I say RNA specifically, please note that there are multiple types of RNAs. For instance, mRNA, tRNA, ribosomal RNAs and others. So I am just summarizing all of the RNAs when I say RNA here. So once you obtain the DNA, RNA and protein sequences from the experiments in the wet labs, you can store them in simple alphabetic strings. Note that a DNA sequence may contain multiple genes and therefore it can have a very big sequence in hundreds of thousands of nucleotide bases or kilobases as we call them. In the case of RNA, the sequence can be of a much larger variety because you have a lot more variety in the RNAs. Although their sequence is small, but their variety may be large. In case of proteins, the protein sequences can be very long as well because multiple genes can come together and the axons can code a protein. So the protein sequence itself can run in hundreds of thousands of nucleotides. So you can represent the protein sequence, the DNA sequence and the RNA sequence as simple strings. How do we store this information? So the solution to this problem lies in the publicly available databases that are there already. For instance, in case of DNA and RNA, you have the gene bank by NIH and in case of proteins you have Uniprot and SwissProt and others by the EMBL Uniprot Consortium. Let's take a look at each one of them quickly. So here is the gene bank website. So you can just go to the URL provided here. That is ncbi.nlm.nih.gov slash gene bank and you can specify the nucleotide sequence here as well as you can select some options by this dropdown list box to insert, search by accession IDs amongst others. This is the Uniprot web page so this is also a publicly available database. Uniprot stores the protein sequences, the post-translational modifications and other related information and you can simply search it by providing the accession number here for the protein or the sequence and other credentials. So in conclusion, the nucleotide sequences which include the DNA and RNAs, they are publicly available for several species and the database is the gene bank while for the proteins, several proteins have been sequenced and these hundreds of thousands of protein sequences are available in Uniprot.


Okay, we're live, this is Dave Vellante at wikibond.org, and we're back at the Dell Storage Forum. I'm here with Stu Miniman, who's also with Wikibon. This is theCUBE, SiliconANGLE's continuous production of Dell Storage Forum 12. We're here with Brett Roscoe, who's the general manager and executive director of Dell Power Vault, and owns the data management solutions at Dell. Brett, welcome to theCUBE. Oh, thanks for having me, good to be here. So we just had Travis Vigilon, he was talking about sort of the positioning. Let's start with this fluid data architecture. Earlier, we had Carter George on, and I asked him, why is it more than just great marketing through a data architecture? Same question to you. Yeah, no, it's a great question. The fluid data architecture started with kind of a strategy around how do we solve customer problems, right? What are the issues that customers are facing, and how do we bring value and unique capabilities? And the fluid data architecture started that way, and then we developed the tenants around the architecture. And as we've done that, it's really evolved into a kind of a path, or if you will, a way for our developers to really center around kind of the idea of unique capabilities, right? So if you look at the tenants like self-protecting storage, well, the whole idea of that is to develop a portfolio that makes data protection and data recovery very automated and very easy to use. So as our engineers work on those kinds of programs, they can look at those tenants as guideposts to kind of know, okay, I'm working on a program that benefits a customer in this way and provides a solution for these problems. So it's really been a great, and not just an outside thing that we use with customers in terms of explaining the unique capabilities or the ease of use capabilities within our products. It's also a way for us internally to develop products and make sure we're focusing on the right things and the right uniqueness and the right capabilities for our customers. Okay, and then talk about App-A-Sure, where that fits and what the direction is. Yeah, so like I mentioned, we have a tenant called the self-protecting storage. And the idea of self-protecting storage is that more and more customers are moving to a place where they're not just using the traditional backup tools. In other words, I'm not using traditional tape backup every night or I'm not using a media server to do all my backups. I'm using more and more of my primary storage tools to do data protection and data recovery like snapshot replication, right? Because that allows me to have a backup within seconds. That allows me to do recoveries within seconds to minutes. And that's kind of the trend that we've seen that's happened very quickly. And the nice thing about App-A-Sure is that is the DNA of App-A-Sure. App-A-Sure is really based on a snapshot replication-based solution and allows us to go take advantage of deeper tools around scheduling, deeper tools around single mailbox or single email recovery and databases. All those kinds of tools are now can be applied to the snapshot replication technology that we have at Dell. So there's two things we're doing at App-A-Sure. Number one, we're going to make it the best and breed software backup recovery solution in the market. That's goal number one, but also we're going to continue to complement our portfolio. In other words, provide unique solutions, additional rich capabilities within our compelling ecological and power vault lines where you're going to see the App-A-Sure capabilities in those products. So I wonder if we could talk a little bit more about backup specifically, data protection generally. So when you think about the market, it's really evolved from one that was dominated by tape and then data deduplication lowered the, improved the economics of disk-based backup and then you sort of had VTL evolving into these purpose-built backup appliances, which are now a multi-billion dollar market, even bigger than the tape market ever was. So that sort of tells you that there's some additional utility perhaps than tape was able to provide. If I understand it, Brett, you're putting forth a somewhat evolved, actually substantially different vision, which is utilize local snapshots and a continuous data protection strategy and then presumably mirror stuff offsite, replicated offsite, and deal with the backup window problem that way and address shrinking RPO and RTO requirements that way. That is a different vision than just sort of sticking in a large target dedupe device. That's right, that's right. In fact, talk about that a little bit. Well, it's interesting, you bring up a couple of good points. Number one is the market originally evolved to replacing a big tape library and putting in a big disk library and then using the additional performance you had from disk or additional reliability you had from disk as an augmentation to the current environment. Well, the problem is you're not taking advantage of all the disk-based random access and speeds and capabilities of disk. So what you've seen is- You're emulating tape. You're emulating tape. So there's really, yeah.  So at some point, we all woke up and said, let's start treating disks like disk and getting more capabilities out of them. The second big trend that we've seen is customers traditionally use snapshot and replication for DR and then used disk-based backup or tape backup for backup. In other words, that was more of a long-term, even used as an archive or if I had a complete site disaster, I could use tape to recover or disk-based backup to recover. We're seeing those worlds come together, right? So the nice thing about Apochure is you can take snapshots up to every five minutes and move those off-site and you're only moving change blocks so it's very network efficient. But the other great thing is if I have a failure on my primary data site, I can stand up a virtual machine or even a physical machine either off-site or even in the cloud in seconds to minutes, right? So think about your data center going down and now the workload, the application you're running can be stood up and running in another location or in a cloud in a very short period of time. Or while you're restoring the data, you can actually stand the workload up and be running it while the restore is happening. So Brett, you mentioned cloud and that seems to be really the wild card in storage especially if you go down market to the SMBs and backup specifically. Where does Dell really see cloud replacing local storage for backup or kind of integrating into the portfolio? Yeah, I always talk about cloud. Cloud is one of the biggest overused terms in the industry right now, but at the same time it's a very important trend that's happening and you brought up SMB, what we're seeing is more and more customers want a way to augment their current IT infrastructure, right? It's not about replacing. Nobody wants to go, okay, I'm going to kill all my IT and move everything to the cloud. But if the cloud can provide an off-site data protection target for me, if the cloud can provide a replication or a site where I can keep an extra copy or fail over to a cloud, those are really good value propositions because I don't have to go rent additional data center space or I don't have to go look for a remote site and do brick and mortar on building another location. Those are value propositions I think are very important to customers and where cloud can actually get some stickiness, right? Yeah, so I'm interested in this whole backup transformation and what Delft strategy is there because backup has been for decades a one-size-fits-all and what I mean by that is everybody does daily incremental and weekly fulls and then if you got a lot of dough you could maybe do an expensive sort of very high end like an SRDF type of thing, but that's really it. Right. And so, but different applications have different RPO and RTO requirements. So are you suggesting that your strategy is to enable customers to align their data protection strategy with their application value? Is that- Yeah, absolutely. Can you guys actually do that today? Yeah, absolutely. I mean, the name Aperture is not an accident. It's app aware, right? It's the product that's designed around application awareness and being able to understand the inner workings of an application because it's one thing to take a snapshot of an application, right? It's another thing to take a snapshot of an application that you can actually, you know, an image that can actually be stood up and run, right? Because anybody can take a snapshot, but it's very hard to understand, you know, if you've got an active database or an active semi-structured database that's got a lot of transactions going on, you need to know when to cohese that, how to get, how to flush cash and make sure that snapshot is crash consistent or app consistent as we call. And so the goal is really about the application administrator, right? The ability of him being able to say, okay, my exchange application or my SQL application is down, what's my fastest point of recovery? How do I get up and running very quickly? Because, you know, a one-day, you know, recovery time objective is unacceptable, right? I need to be, I need to have recovery capabilities that are seconds to minutes. And to your point, historically, you've had to buy very, very high-end application, have very, very big pipes to make sure that that replication data can flow over that pipe and have a second site that can recover that. But the new kind of generation is about, you know, it's about doing very efficient RPOs where you can do, you can track the application, be able to quiz the application and take snapshots every five minutes. It's about being able to de-dupe and compress that data before it's ever sent over the wire. It's about only sending the changed, you know, data over the wire rather than sending the whole, you know, every single read and write operation over the wire. So all those things allow us to get LAN optimization, LAN optimization and application efficiencies that allow a true application administrator to be running up and running very quickly. So what about the notion of these purpose-built backup appliances? Do you not directly participate in that market, or do you do so? Oh, no, no, we have a couple of different products in that market, yeah. Okay, so how does that fit? When should a customer drop in a purpose-built appliance versus sort of take this, you know, CDP approach? Well, those two don't have to be mutually exclusive, right? Yeah, so an applicant, you know, so we have a couple of different prices. We have a DR-4000, which is based on our Ocarina technology, which is a target-based backup, you know, target-based backup recovery device. So you can point any data stream at this product and mount it on an FS or SIFS share, and you can point any data at it and it will de-dupe it in line, store it in the back, and you can recover data, you know, using the high efficiency, random, you know, IO capabilities of a disk drive, but still get much more cost optimization because you're using, you know, number one, you're using SATA drives, number two, you're compressing and de-duping all that redundant data that comes into that device. It's very good for somebody running, you know, your traditional backup applications or where you have a heterogeneous, like, you know, say I'm running, I may be running a backup exec, Commvault, I may be running Tivoli and several other backup applications in my environment. I can use this as a common repository that will de-dupe across all of those different environments and hold that data and allow you even to replicate that data from one to one or many to one, or one to many. The other kind of purpose-built devices we have, we have a DL-2200 product, which we continue to evolve, which is really more of an integrated appliance, right? So it's got all the backup software and the back-end storage to go with it. So we kind of talk about it in terms of being very easy to use. It's a product that if you want to set up and have your environment protected, you can set this box up and within 30 minutes you can have your data environment being protected and backed up using things like de-dupe, using tools like snapshot replication, but it's all in one. It's an appliance that allows you to kind of have your backup application and your backup server in one device. And the backup app in that instance is... Well today we have Symantec, Combo, and of course we're very quickly adding Apochure to that solution right there. Yes, okay, so Apochure is a Dell-owned IP in the software side, which is very important because you're seeing companies, I mean EMSI is a classic at this, they take hardware and they bring software along with it. Other companies like NetApp have taken a different strategy, and personally I've said that I think that the, if you're going to go for it in storage, you better go for it, and a big part of that is owning software assets. No, it's, I mean, getting things integrated and easy to use is key, right? I mean, I can, right, we have a pretty wide portfolio, and I can sell point products all day long. If you want backup recovery, I'll sell you Apochure. If you want primary storage, I'll sell you compelling ecological power vault. If you want, you know, a backup to disk target, I'll sell you DR, but we're really working on making these products integrated, right? So that, you know, when you buy, no matter where you buy within our portfolio, you're going to get, you know, exposure or the ability to use, leverage all of the IP that we have in our portfolio, right? So what does that mean from an integrated standpoint? Obviously you're talking about the management console, that's something that I get to see, but it sounds like it's more than that. It sounds like it relates to how you move data, how you compress and uncompress or optimize and de-optimize if you will. Exactly, well, I mean, they use Ddupe and compression as an example, right? So we have a common Ddupe and compression technology that we use across our portfolios based on our Ocarina acquisition. So, you know, the DR-4000 uses that technology, we're building that technology into our file system, we're building it into, you know, the, any future product that runs Ddupe and compression, we'll use that common Ddupe and compression technology across the portfolio. So that means when I'm running these devices together and inside of my data center, they understand that compression Ddupe technology, they can talk to each other without rehydrating, you know, there's a lot of efficiencies to begin with using a common technology across the portfolio around Ddupe and compression. That's just one example. Why is it, this is a fascinating discussion to me because I made an observation at the top of the show that a lot of times, companies make acquisitions and they just sort of leave them alone, you know, the integration is left for the customer to do. Now, that's somewhat changing, but it's getting a lot harder because these portfolio, the portfolios of these large storage companies are so diverse. Dell, on the other hand, has made integration a priority from early on. Yes. But at the same time, because Dell focuses on the small mid-sized customer, you would think it should, in theory, be less of a priority. Why is it that Dell is so much more focused on integration than, say, some of the larger whales that you're used to. Well, I would argue for the mid-sized customer, it's even more important, right? The mid-sized customer is the guy who's, you know, I don't want to have to have the- Because they're the resources to do that. Yeah, I don't want, you know, to have, you know, the army of IT guys that know how to script and put things together. That's just not true in a mid-sized customer, right? So what they, what we really believe is a mid-sized customer, he wants enterprise features and capabilities. He wants, you know, more and more you're seeing mid-market products have the functions that enterprise products had just five years ago. And so the mid-market customers looking for products are easy to use, but have all the capabilities. Well, frankly, you know, in my opinion, if we don't integrate, if we don't bring an ease of use capability to all this technology, then we are asking the customer to take on the burden of doing all the integration. And that's not acceptable. So I want to come back to this notion.  I know Dell hates it when I use analogies that involve Apple.  What's the drawback of that approach? Is there a performance overhead? Is there a, you know, CPU bandwidth requirement? And what are the trade-offs? So I assume, let me make sure I understand your question. So you're talking about the ability to go back to your data and look at it, you know, what you did five minutes ago, what you did 15 minutes ago?  Well, like I said, the Aputure DNA is built on that capability. Now, you know, just like any other application, in order for Aputure to capture a baseline of all the data, it's got to do a point, it's got to take the first snapshot and copy that snapshot over. And so that's what we call creating a baseline, right? And so let's see it. Yeah, there's some work that's, you know, so we'd always recommend run that at night or, you know, let's set some time up for that baseline to set. So that could take days, weeks? Oh, no, no, no. Hours. Hours. Okay, so it depends how big your data set are. But once you've done that, now all you're doing is moving incremental bits, change bits, and that's a very efficient process, right? So depending on what your change rate is, but usually change rates are, especially if you're doing, you know, snapshots every 15 minutes. I mean, how much data changes in 15 minutes? So really, it's kind of, you're trickling over a few minor bits, reconciling it on the target side, creating a new baseline, right? And basically a synthetic baseline, but now you can go back and point to it. And we have the ability to do incrementals forever, right? Which means once you create that baseline, you never create a baseline again. So it's a perpetual incremental once you do that baseline, and to do that baseline, that initial seeding, what do you have, some throttling software that can allows me to, you know, not affect my performance, or is it just? Well, like I said, the performance is so minimal. Once you've done the baseline, that we really don't see a problem, customers reaching in and doing another, doing a snapshot every five minutes. Yeah, I mean, if customers don't like the idea of the application needing to be crash consistent every five minutes, they may need to back off of that a little bit, but it all depends on what the customer needs are. But they can dial that up or down. They can dial it up or down. They can say, I can do it every five minutes. I can do it once an hour. I can do it once a day. But either way, it's a very, very light load on the resources for the application. It's great vision. I mean, I think it's, personally, I think it's the future of backup because we've been chasing the backup window for decades. The battle, that is yesterday's battle.  I tell people all the time, if people keep talking about the backup world changing, and my argument now is it's done. It's changed, right? So we had a survey with ESG the other day, we did it about two months ago, which they did out, they went out and surveyed mid-market customers. 52% of mid-market customers are using replication and snapshot as their primary means of backup recovery on their tier one data. So it's done. We're there. Really, I didn't realize it was that high. That's an option. Well, it's smart, 52%. So, excellent. All right, Brett, well listen, thanks very much for coming on theCUBE today. Thank you guys for having me. For sharing your perspectives. We're live at the Dell Storage Forum in Boston. This is theCUBE, SiliconANGLE.tv's continuous coverage of Dell Storage Forum. Keep it right there, we'll be right back.


So you really can't escape it. Math helps you explain the larger concepts of the world. As a discipline to study, it helps with problem-solving skills. As you take math classes and math courses in high school or in college, you learn how to become a better thinker, which can be, you know, applicable to anything that you're going to be doing. I see what I do in my classroom as a math teacher, as giving my students a tool that is going to serve them for the rest of their lives. The more you learn about mathematics, the more you realize there's so many more questions about things that we don't know than there are answers. A lot of people think they realize that mathematics is a rapidly evolving discipline, where there are real research problems being done, but it's absolutely the case. I think that Grand Valley gives great opportunities for undergraduates to learn how to research and experience that research, especially opening up doors for graduate school and preparing us for what we could possibly do in the future. Just here in the department, we have undergraduates involved in all kinds of research. There are research opportunities that undergraduates can take advantage of through research experience for undergraduate programs in the summer that are hosted at Grand Valley and in many other places. We have a number of students who are doing these every year that go off for a summer for eight, nine, ten weeks in work with other bright students from all over the country on live, unsolved mathematical problems with real faculty and get results and get published and present at conferences. If you want a job in mathematics, you can do almost anything. One of the aspects of being a math major is thinking critically. Having significant math coursework in your background on a transcript and on a resume shows people that you have the intellectual firepower to handle quantitative tasks and I think that's very important, but it also shows people that you have your problem solver and you have curiosity and you know how to attack and creatively work on, collaboratively work on difficult problems using technical tools. Besides teaching, math majors can also be actuary scientists. They can be operations researchers. They can be, they can go into finance. There's so many doors that math opens. They're not really pinch and hold in any way. Just find an industry or a company that has core values that match up with you and then that will be a good fit. Employers look at math majors because they have good logic skills, they have good problem solving skills, they have good critical thinking skills. All of those things are necessary to be successful in studying math in college and this is easily seen at a professional level and they're very transferable. A math degree is the tool that is going to set you up for success for the rest of your career.