The Distinguished Colloquium Speaker Series brings national leaders to the IU School of Public Health-Bloomington throughout the academic year. These events, which are free and open to the public, highlight key topics and contemporary issues in public health.
Professor Kenneth Ramos
Alkek Chair and Director
Texas A&M University, College of Medicine
September 8, 2021
Noon–1:15 p.m.
Description of the video:
Good afternoon everyone. My name is Sarah Commodore and I'm an Assistant Professor in the Department of Environmental and Occupational Health here at the IE School of Public Health implemented. And today I'm super honored to introduce our first goal. Can speaker of the academic year, Dr. Kenneth, famous most realistic match from Texas A&M University. Dr. Amos is an accomplished physician scientist with designations in the National Academy of Medicine. And the National Academy of Sciences is a transformational leader who is recognized throughout the world for his scientific contributions in the areas of Genomics, Precision Medicine, and Toxicology. When he had formal training in a number of fields and now just received to name a few pharmaceutical sciences, chemistry, biochemistry, pharmacology, and medicine. That very much is helping to steer the changing landscape of medicine, biotechnology, and help here. In this context, he leads translational clinical research and educational programs that integrate diverse approaches to elicit a genomic mechanisms of disease. And also to develop novel therapies for several oncologic, all unary and vascular disease. It's Dr. Amos has provided academic, executive, administrative, and scientific leadership in the areas of genetics and genomic medicine, as well as toxicology for us and various academic institutions. And over the course of his career, he has positively influenced the career of numerous clinicians and scientists, including myself, engaged and who are engaged in in the medical field, in veterinary their pharmaceutical practice. He is deeply committed to initiatives that advanced more than a technological applications to improve the quality of healthcare and also to reduce disease burden and all the associated us that comes with that. He currently holds the volume positions. He's a professor of translational and medical sciences, is the chair of Medical Genetics, is Executive Director at the Institute of IS-IS. And technology, is also the Associate Vice President for Research and he and vice chancellor for the health services for health services at Texas A&M University Health System. Now, as you can see, we have a great person here today to talk with us and we're so excited to learn from him. And I want to thank you all for being here with us this afternoon. I wanted please join me to welcome Dr. Kenneth primase list given a very wild special welcome to the School of Public Health. Thank you Over to you doctoring that. Thank you so much. I'm humbled by your kind words and greatly look forward to interacting with you over the course of the next hour. Obviously, I wish being able to come in person and build personal connections with each of you. But in different times I think we need to make adjustments and you guys have become masters, I think at hosting people via the Internet since I almost felt your presence here in the room that I'm occupying right now. So thank you very much for that. Since it's hard to see all the faces of people, you know, are clustering around the seminar. So please make sure that if you run into me anywhere in the future, remind me of his visit and and make a connection that's personal and I look forward to that very much. When I receive a mutation of Dr. Allison too, to come and visit with you. I wanted to talk about something that was hopefully meaningful and relevant to the t all in the space of Public Health. I must confess that I'm a, a, an avid fan and an avid follower of Public Health. I've actually held faculty positions in the problems of public health. And a very strong believer in the power of public health in transforming the health of populations. And so I'm hopeful that what I have to say, working at the intersection between individual medicine, genetics and genomics and the space of population science. My resonate with some of you and of course, there'll be some of you that will challenge some of those concepts and I certainly look forward to your thoughts and your comments in that particular space. So my presentation this, this afternoon, this morning, really focuses on the application of what we have learn lessons learned into precision medicine space towards prevention domain. One that of course, many of you happen to be experts. And, and to remind ourselves. That it's going to be really at the intersection of Medicine, Public Health, Regulatory Science, Artificial Intelligence that we really are going to be able to make a damped in the health of our communities and the health of populations and in the health of individuals. And that oftentimes the tensions that take place when we tend to focus in our own little micro domain need to be minimize if we are to really have an impact in changing the needle in health in our country and beyond. And so I need to disclose the fact that some of what I will have to say today, build some partnerships that I've established for the private sector. I work closely with two companies that both in the precision medicine, precision prevention, space wave neuroscience, where we are using transcranial magnetic stimulation as a means of treating PTSD and then preventing started the sequella that comes from PTSD related disorders. And we're doing so using algorithms that individualized the level of transcranial stimulation that these patients receive. I also work with gold black cyst, building artificial intelligence platforms to improve Pharmaco genomic services, primary care service with a focus, of course, in a discrete set of populations including pulmonary patients, which is a group of patients with job I actually work with. And one said I will highlight in the course of the presentation. So the, the, we are right now in the midst of what I call it precision revolution. I think it all started with Toyota car company because if you remember Toyota about 20 years ago, sexual them up precision, you know, services in the Toyota car industry. And I think that might have open, you know, the, the, the flood of precision, this position that I'm precision, the other I'm precision medicine, I think evolved out of what we used to call molecular medicine. And now, you know, sort of as, you know, transform itself into what we call precision medicine from precision medicine. And we now recognize that that alone is not enough and that need to be to build a precision health initiative that captures, I think all of the advantages that presumably precision approaches provide. The framework of any precision bass intervention that we can think of freely is built around technology. This is the whole idea of a technological revolution that I see now that sort of began, you know, 40, 50 years ago and that sort of reached its climax, you know, in 2007. And then of course, we've continued to expand by would actually submit that actually many of the problems that we face as a nation today actually are function of that technological revolution. We could chat about that later on. The real question for us, scholars interested in making a difference in healthcare is, how do we take advantage of those technological advances and put them to work for the betterment of individuals and the betterment of society. Three important catalysts to that hadn't been the realities of which we have to leave every day. Health care costs. For instance, an area that I'm sure faculty in your school are keenly interested in. You essentially have a health care system in the US that we can no longer afford to leave. The affordability of that healthcare system issues beyond limits and astrology. Now, we're actually know, scraping the battle, trying to figure out ways in which we can overcome some of those challenges. The saddest part of that reality is that our health care is not any better than other countries despite the fact that we spent trillions of dollars that healthcare delivery and that in fact, the quality of that health care is sub-optimal relative to countries and places that actually invest less dollars. And of course, what that screams is the fact that we have inefficiencies in the system that need to be overcome. And I'm one of those individuals that beliefs that precision approaches can actually be part of the answer to what are coming. So some of those sub-optimal efficiencies. Health care has continued to accelerate integration of technology. With of course, another basic sample being the electronic health record and the utilization of computers to be able to accumulate information and use that information to generate new knowledge. And I think the ability of us to be able to do that, we'll continue to transform the way that healthcare is delivered. And then last but not least, I think if reframing of expectations on the part of different groups with a huge emphasis on prevention, which I think is the major reason that I wanted to kind of highlight my thoughts and perspectives on how prevention can actually be important. Part of a health care delivery platform. We're trying to create that base conundrum that we face is that whether you're thinking about individual health or whether you're thinking about population health, we'll make one big mistake. And that is, we tend to think that one size fits all. And we tend to make generalizations and recrafting no recommendations that are really very broad in scope. Thinking that obviously that's going to be easier to manage, easier to generalize, easier to disseminate. But the reality is that many of the inefficiencies that we have in our healthcare system really revolve around the fact that one size does not fit all. And that there are differences that we need to recognize, that we need to integrate into decision-making, that we are not efficiently doing so. So exemplified in this particular slide or two of those differences, we have different from males and females, as you know, many of us in the research base and in the health care delivery space have ignored that for years and years, where we don't reflect sufficiently different from men and women. Although that's beginning to change in recent years. And then the recognition that each one of us as an individual and we have a unique set of characteristics that actually make us who we are and that if we are to optimize delivery of health care, we're going to have to find ways in which you gain a grade, those differences into decision-making. And so a lot of the drivers for precision approaches rely on that to compound is problem. Here in this particular slide, you could see the results of a, a, a in-silico randomized clinical trial which is a gold standard for evaluating effectiveness of any kind of intervention. Whether it's a public health intervention or whether it's a, a pharmaceutical or whether it's a another therapeutic modality. And recognizing that the results of randomized clinical trials as good as they are, actually remind us of the large degree of heterogeneity that exists in populations. And so when you distill the information that comes from any one randomized clinical trial in which to try to best match your controls and your intervention populations to the best of your ability. You recognize that the results that you generate, I really only going to be relevant to up 50% of the population that you study. There's going to be 50 percent of those individuals that are really going to be falling on the details of this Gaussian curve on that adults are people that meet or get it negatively impacted by the intervention or that may gain no benefit from the intervention depending on what side of the bell-shaped curve you know, you're sitting in to make it even worse. What happens is that then, because you've tried to control in this randomized clinical trial, as many variables as you can possibly try to control when you take this data and this information on the scene sets that you generate from nitrile into real community seem to real patients into real populations. You find that of course, the answers are not necessarily the same and that in fact, many of the risks that you attempted to control for may actually have been ignored. And so this creates a problem because if we're trying to address the inefficiencies of the system. And we're trying to optimize the way in which we provide and deliver care for patients and populations. We're going to have to address this degree of heterogeneity. And so a big part of what precision health care approach revolves around is recognizing that degree 180 and trying to understand it in ways that actually are going to be effectively used to wieder, tree, stratify, or manage patients and populations. And so when President Obama, back in 2015, launched the Precision Medicine Initiative, it was launched under the premise of, you know, one size does not fit all. So let's find the best treatment at the right time for the right patient in order to improve the quality of care that we've delivered. One of the tensions that was created by the launching of the Precision Medicine Initiative originated actually in recognition that individual health care interventions might not actually be effective in addressing the health of populations. And so this being a continued sort of evolution into concepts. Precision medicine migrating more towards precision health center approach thinking that what you learn from individuals might actually be relevant to populations, especially as you think of stratification of populations. And so this sort of a revised healthcare platform that's highly new gradient is, is attempting to bring together all the different components that we know contribute to the health status of individuals and populations and trying to make sense of the information that is generated, taking advantage of technology. The three pillars of precision else are the biology from my perspective, of course, genetics and genomics. Lifestyle on the importance of lifestyle, you know, I say contributor to health outcomes and then the environmental factors that actually drive a lot of those sort of interactions between biology and lifestyle. And so dumping all of this information together and then making sense of that information is really what the efforts in precision health care are all about. And so technology, as I've said before, I'm just going to be a major driver to our ability to do that. Exemplified here in this slide is racing advances in molecular imaging allow for a level of resolution of patients in vivo real time in ways that we had not being able to recognize, you know, before. And so the days are not too far from now when you can actually take an individual into a machine and actually get a readout of any potential problems, much like the way that Star Trek, you know, and, and somebody's futuristic movies actually do. And I think we're really not that far from there. But the problem remains that what you understand about that particular individual, you need to try and use that knowledge to apply to larger too for people into populations. And so That's where I think advocating for development of precision prevention in public health programs is going to be extremely, extremely important and critical because nothing will be achieved unless we are able to reach out to the masses. And of course, COVID-19 is the best example of that, right? The tension between individual choices that people make and the pressures that we face as populations. And so we could reflect on that later on in the talk. For my own research efforts over the years, being interested in particularly three domains, have been very interested in taking advantage of genomic insight to enhance diagnostic precision for a number of different conditions, you know, primarily in the cancer cells and in the pulmonary disease spades. I'm also keenly interested in use in that genomic insight to understand how to develop better pharmaceuticals. Pharmaceuticals where we can actually increase efficacy, decrease dose, and hopefully decrease adverse reactions. And this is of course, very important area under precision health care space. And because a major contributor to the inefficiency of the system actually lie in this particular ecosystem. And then last but not least, I'm very interested in, in population stratification. And you use in genomic inside to stratify populations in ways that allows us to better understand the heterogeneity of populations and how precise interventions might actually be tailored to individual sub-populations. And so this of course translates and he's tied, very tightly connected to prevention. Because I think at the end of the day, what we all seek to achieve is to prevent disease rather than tree disease. And I don't need to preach to the choir by telling you that the biggest perhaps, you know, challenge that we face as that fascination is the fact that all of our efforts in the vast majority of our efforts are directed towards treatment. Once the problem is, you know, they're rather than preventing that particular problem. And it hasn't been until now until we basically ran out of cash to support and treatment modalities that we're now turning towards prevention. A way of understanding better what we're dealing with and us a way of finding solutions that we can actually begin to afford. So health promotion and health prevention, which is, you know, the forte for schools of public health, is going to be the mantra that I think world would I be seeing into a nice, Of course, you know, now being encouraged by payers, slowly migrating towards that position, government agencies and of course, you know, they will, Will markets for the reasons that I've already articulated for you. Suffice it to say regarding this point that that a big part of the problem is that agencies and governments, I've struggled figuring out how is it that we reimburse ourselves for prevention strategies, right? Because positive predictive values when you do prevention are very difficult to calculate. And so you have very limited ways of figuring out how we see the bay interventionists actually going to make a difference. And of course, now that we don't have the cash to pay for the expensive technologies, now we need to figure out how is it that we use all of that technology to actually help prevent disease? And of course, one important driver to that is the fact that people now recognize that they rather not get sake rather than get good treatment. And so I think when those different forces come together, I think we're going to be able to actually. Make a difference. For me, a very important piece of the equation is making sure that when we strive to advance precision approaches to health care, whether it be at the level of prevention, whether it be at the level of treatment, whether it be at the level of prediction. We need to make sure that we do not enhance disparities. And as all of you know, the likelihood that if you are not careful in, in the delivery of the service, you actually could really magnify disparities, which is a major problem that we face as a nation. And so we need to make sure that in fact, this technological revolution that I alluded to, that precision revolution, He's actually utilize and the sign in ways that actually can be utilized to address health disparities, to reduce health disparities, them to actually bring equality to the cup health care delivery system that we have in place. And so an example of things, and I'm sure that you could have added a 10 or 20 more items to this partial listing that I've got in year is things that public health programs typically are focused on and that addressed in very important ways, you know, linguistic barriers, cultural barriers, education level, literacy, insecurity with food, access to food, in-migration, structural racism, that's as you know, very popular these days, neighborhood safety and so forth. And I think one of the take-home points that I would like for you to take from my presentation this morning. Is that for any one of these items on this slide, if they are relevant to your research programs and do your scholarship, you need to reflect back and put in place measures that address the who. How. That when they aware. And in some instances, even the watt. And oftentimes researchers focus on the prevention phase. Ignore that. And big, a big part of the problem I think with prevention strategies that, that, that I think we need to as a community of scholars try to address is that as I said in the early part of the presentation, one size does not fit all. And so we have to balance that tension between providing prevention recommendations and prevention conclusions that are population-wide relevant and that are generalizable. With recognition that some of these interventions might be better suited for some populations than others. And that, and that's some degree of segmentation, some degree of stratification in the way that we deliver prevention recommendations would actually be helpful to help advance the system. Trust us, all of you know, is one of the major problems that we deal with health care today. Again, COVID-19 being a very good example of that. And a big part of the problem with it with trust is the fact that we generalize prevention recommendations that may or may not be relevant to particular populations. When we make those generalizations, what are the simple minded individual will say is, well, that doesn't apply to me. I know for a fact that that recommendation isn't true because x, y, and z, and now you've lost credibility. Now you've lost the ability to impact in a meaningful way. And I would submit to you that part of the reason for that is because we have not spend enough time thinking about the who, the, what, the, when, the where, and the how. I have a story to share with you. With regards to that of how effective communication on the basis of adequate stratification becomes extremely critical. The early days of HIV, when the government was putting together the massive public health communication campaigns for HIV, the government put out a message that says, all it takes is one time for you to get infected. Maybe many of you remember this. When post marketing surveys for that messaging were completed. Teenagers actually rejected that message and continue to engaging in high-risk behavior. And when they were polled and an unexamined and interviewed for why there were no neglecting to respond to that public health message. They did a response that was most popular was, I know I cheated once and nothing happened. And so this is the way that the human brain integrates information. And so when we think about disparities, when we think about health prevention platforms, we need to start thinking more carefully about who, when, what, where, and how. And, and so I would like for you to reflect on that and maybe we can come back to that point later on. So what can we do then to address health disparities and health prevention space, we can take advantage of this partial list and that we have here AI, I think is going to be a big part of the solution. So all of you know, massive, large amounts of big data. I'm not something that the human brain can easily discretize. I remember the days when I ran my first, you know, microarray experiment where I generated 20 thousand data points. My hands went up in the air. I said one, Why am I gonna do with these data? I don't know what to do with this. And so obviously we have learned over the years how we take that information and put it to good use. And so healthcare information is to use analogous to that, let alone when you're trying to integrate genetic information with environmental exposure information, with lifestyle information, with personal family history. And trying to dump all of this into one bowl and making sense out of all of that complexity. Complexity I think is something that we're going to have to embrace taking advantage of AI. And of course you have the partial list in there. A lot of my own efforts in my own research program. I really focus in the omics face and you guys know that. And so I'll share with you some examples of how we've taken advantage of omics automation to try to address important health prevention and promotion strategies. And so here in this slide you have the genomic toolbox, right? You collect samples from Bayesians. You submit them for DNA sequencing or RNA sequencing, high-throughput information with large amounts of data under different set of conditions. Then you put them through a custom analysis pipeline, has to be developed and sort of specified for the specific questions that you're trying to ask. And then generating reports and interpretation of that data in ways that hopefully start making a difference for the patients that you're trying to process or for the populations that you're trying to investigate. And so you have some examples below in this slide that sort of guide you through the options that you would have in any one of those particular domains and so on. I've used that type of approach to study a set of sequences in the human genome that are called Line 1 elements. Line 1 stands for long interspersed elements of the one-family app. And these are essentially jumping genes. And that might be the way in which you remember them when you try to reflect on these presentation. Two years from now. If you happen to want to think about the presentation two years from now. So the best way to think of them is this jumping genes. These are genes, a gene like sequences present in the human genome that have the ability to move around and they jump. And when they jump, they change your genome. And so when these sequences were first discovered, hell broke loose in the field of genetics. Barbara McClintock to force it First Lady to do that. I'm naturally ended up winning the Nobel Prize for it after having been declared heresy in the first 20 years of her career. And, and the reason that she created such a motion that field of genetics is because up until the point that she made her first set of observations used in maize. Corn. To make the observations, we used to think that the genome was static, right? That you got your set of genes from your mom. You got your set of genes from your dad. Those things come together through meiosis and you end up with another human being that has a particular set of characteristics and that, that was the end of it. And of course, we also recognized that there were mutations to that sequence and that those mutations might actually give you the CDS. Especially when we think of cancers that's sort of became very popular, but we never thought that the genome will have plasticity to it. We never thought that the genome could be model itself. We never thought that the genome could vary as a function of time. And so these sequences provided a tool to be able to do that. I spend a great number of years of my life, maybe far too many. Some of you might think that only four people, foolish people would do that. But I do like to dive into the woods sometimes. And so I spent about 20 years actually dissecting out how the sequences are regulated in the human genome keeps them in, check. How are they activated and sort of what the consequences of their activation are. Suffice it to say that there's about a 100 copies of these sequences in the human genome that we mean active even today. And we're talking about 500 thousand years, million years of evolution. And so the sequence is actually constitutes 17% of the human genome. And you know, nature is y. So y would nature hold onto sequences that basically remodel your genome and asked one of the questions that we are trying to answer. You need to put that observation in the context of the fact that what we understand about the human genome, we presented less than 2% That genome. And so you've got attempts to study less than 2% of the genome because that's what encodes for proteins in the way that we tend to think of genetics, right? From DNA to RNA, from RNA to protein. And then you've got 45 percent of your genome that does not behave that way. That basically are transposable elements that actually jump around all over the genome and that we model it. And from that 45 percent, 17 percent of it, maybe now up to 20 represents the sequences that I studied in the past. And so here you have a, a representation of what the genome looks like up in the context of lung cancer. So one of the observations that we have made is this rendition that you see, you know, to your left basically shows you what lung cancer looks like at any 1 in time. And the important take home message from this slide is that the shape of that representation changes as, as that tumor evolves. And that those genetic changes that get reflected as a function of that change, gene expression actually are what's responsible for the individual dying. By responsible for the individual responding to treatment are responsible for individual having quality of life, are responsible for the ability of the individual to manage a condition. And so it becomes extremely important for one to be able to understand that plasticity, that evolution an end obviously find ways of regulating that in a way that allows for intervention. So we are, is that prevention piece here, that prevention piece to this research comes from the fact that individuals who suffer from chronic obstructive pulmonary disease, an environmentalist, clearly linked to 80% of these patients are smokers, are people who are exposed to pollution. Those individuals are at very high risk of progression into malignancy. And the trajectory of that illness, the trajectory of that progression from COPD to what's known cancer is one that is crying for prevention strategies. How do you prevent those individuals that happen to have the hyphen suitability to progression from COPD towards lung cancer, from actually progressing into malignancy. And so we've devoted to met for genome into that particular space. And so again, to reinforce, you're, you're transitioning from COPD to lung cancer and the prevention strategies that we're putting in place. Or prevention strategies that hopefully will change the trajectory of illness or prevent progression towards a malignant phenotype. One that of course is going to kill you. And a very oftentimes, more, lung cancer is actually the highest mortality cancer in the world. And the reason for that is because he said malignancies are typically detected too late. I should note that despite the fact that this is an environmental disease, both COPD and lung cancer, you have a very large segment of the population, about 25 percent of it that can get both COPD and or lung cancer in the absence of any known environmental exposure. So there's some genetic predisposition factors that we need to know better understand Asian women, I think are a good example of that. And so we have put in place a number of strategies towards be a being able to address that prevention strategy that I alluded to before. And so a lot of our efforts have really being directed towards stratifying COPD populations and then applying individualized and personalized approaches to be able to do that. I don't, I want to leave my presentation without reminding you that genetics alone is not going to be the answer to disease prevention. That it is really the intersection of genetics and epigenetics that really gives rise to prevention and that huge advantage in the field of genetics when we discovered, you know, the epigenome and epigenomic interventions is that unlike the structural aspects of the genome, but you cannot modify the epigenome is modifiable. And there's interventions that you can make that actually make a difference in that trajectory of disease. And so any interventions that we make in preventing COPD from progressing towards lung cancer has to be built around a genomic strategy that focuses on structure of the genome, that mobilization aspects of that line one element, if that's what you're focusing on and modify our last bits of the genome as a function of epigenetic intervention. This is very critical for line 1 retro elements because these elements actually are heavily silenced out in the human genome. Through epigenetic mechanisms. And so what that means is that if you wanted to start out the element from jumping around, from modifying the genome from a line for genetic progression of that cancer. Well, that you have to do is manipulate the epigenetic aspects of it. This cartoon only is there for you to get, have an appreciation for the widespread localization of a 100 elements that I told you remain active in the human genome. There's variability to that activity on the ten of these elements are actually highly active. And those are the ones that we're actually working with in my laboratory towards understanding disease progression. This particular slide actually shows you that polymorphic variation, the single-nucleotide polymorphisms in that sequence that actually accounts for variability in activity. And, and the important take home message here is that from the epigenetic standpoint of flying one biology in COPD towards no lung cancer transition. There's three biological domains that appear to be important for regulation of extracellular matrix, regulation of inflammation and inflammatory signaling and regulation of cellular metabolism. Very critical elements to disease progression. We're used to in the information being generated in the line one space to actually develop Pharmaco genomic tools for the management of COPD. This is extremely critical because COPD as a disease entity, he said he sees that's only treated symptomatically. Any of the treatments that you think of all that they're tweeting his symptoms, they're not treating pathogenesis of disease. And so one of the theories that we are advocating for at this point in time is that line one might actually provide a pathogenic mechanism that you could target to prevent progression of disease. And so we're continuing to build data that actually stratify that a lot of our interventions are based on this really complicated cartoon that you have in front of you that represents about 10 years worth of effort. In my laboratory where we reconstructed the molecular complexes that actually are assembled on the DNA template to actually silence line one elements. And the understanding of a silencing mechanisms that came from these studies is what enable us to then identify molecules that we could actually target selectively to develop therapies that could actually prevent the mobilization of these elements in the genome of COPD patients. And presumably, if you prevent the activity of the elements, you prevent the progression of disease. That's a hypothesis that we are avidly Destin from the information that came from that and molecular assembly that I showed you before. We are developing therapies that are focusing on TGF beta one as a target. The reason being that TGF beta one drives 91 expression in COPD. We're focusing on Tarzan kinase inhibitors because those are the signaling mediators that actually allow for growth signaling and epithelial-to-mesenchymal transition in COPD. And we're using a number of other strategies that we are thinking that that might actually be useful. And so maybe at a different time, I'll be put back on that. I will use the last few minutes of the presentation to remind ourselves that no effective prevention strategy at the individual level is going to be meaningful unless you make efforts to translate it to populations, whether that population is of 102000, thousands or millions. And so one of the things that we have done in the laboratory is convert our fancy, difficult, expensive genomic analysis into a cheap, easy, translatable asked say that we could actually utilize as a readout of the activity of line 1 elements in the human genome. And the way that we did that was we actually developed an elisa platform for one of the proteins encoded by line 1 elements. If you remember the original cartoon that I showed you. Or if one ESA revenue equal protein encoded by the element that takes the RNA of the line one element, the RNA transcribed from this line one element back into the nucleus for the copying of that RNA into cDNA and the insertion process. So the jumping piece requires, depends heavily on the activity of that or one protein. And so what we do is we measure or one protein in the blood of individuals under different conditions and then make inferences about the level of activity of ln 1 elements in that particular group of individuals. And so we salts of some of an experiment that actually we did in smokers is captured in this particular slide. Notice that Initial frame basically focuses on sex differences in 91 activity. The second frame focuses on smoking status. And the third frame focuses in case status. And three major conclusions can be drawn from this initial epidemiological study that we did taking advantage of flying one readouts in the blood of COPD patients. The first one he is that males have higher levels of females in the circulation. These differences between males and females are actually a reflection of the silence in status of these elements between the two sexes. We also discovered It's add, never smoker females compared to females. With ever smokers irrespective of gender having higher levels. And then basically that smokers with COPD have higher levels of SEO above or F1 in blood than controls. And of course, from these data, we are continuing to build the hypothesis that in fact line one might actually be utilized as a liquid biopsy. Copd patients that might be of height, that heightened risk of progression into malignancy. What we're doing now to test that hypothesis is correlating the result of low-dose CT screening of smokers, which are patients at risk of malignancy to actually correlate line 1 levels to solitary nodule findings and then clinical progression of those individuals with solitary nodules. And the data supports the idea that 91 is an early read out of malignant progression in patients with COPD. Given the large heterogeneity that exists in terms of polymorphic variation of line 1. A question that we need to answer is whether it is polymorphic variation of these elements or epigenetic dysregulation that are driving the differences between COPD patients. And of course, a smoking data that I showed you suggest that actually may be a combination of both that might actually be driving those differences. And so I'll close with, with, uh, for take-home messages as a sort of framework for discussion with you over the next 15 minutes. The idea that precision medicine approaches can actually be effectively used for disease prevention. And that prevention of disease, of course, being the important outcome that we all need to try to achieve. That line one might actually be used as a biomarker, liquid biopsy type platform for development of not only individual level assessments, but, but relational level strategies. Because the idea here is that we can segment populations as a function of line 1 patterns of behavior. And that information might actually be informative about trajectories of disease and, and outcomes. Identification of COPD endophenotypes as a function of epigenetic regulation, might actually be a good strategy to stratify heterogeneous populations with just one of the major problems in the management of these patient populations. And then last but not least, the fact that this genomic inside and prevention strategy can actually be used to develop targeted therapies that can actually prevent progression of disease and improve health outcomes. And so I'd like to close by thanking family at home as well as work and the funding agencies that have made the work that I've presented for you in a snapshot pattern possible. And with that, thank you for your attention and I look forward to our dialogue and discussion. Thank you, Dr. Unwin's for your presentation today we do have a list of faculty and staff who are asking questions, so I'll go through that list ID this time. And the first question is from Dr. Bill Ramos, associate professor in our department and help them honest is not down to Ramos. Thank you for your presentation. Backing up earlier I was intrigued. He said one of the goals or processes was to look at treatments and balancing the efficacy versus the toxicity. And I was just curious, long your road. What are your thresholds? How do you develop those? This may be a little rudimentary, but I often think about and this might tidy your example with HIV and messaging. And I'm watching TV commercials and they made less than new treatment. And by the time you're done, listening to the side effects, probably wonder if you want to partake or not. I'm just wondering in your field as you're moving along with your work, how do you balance the threshold between efficacy and toxicity? You now, it's a very important question that it's essentially risk versus benefit is essentially the equation that you really are trying to balance here. And that's certainly very true of pharmacotherapy. You need to balance out the benefits that come from taking the medication relative to the risks associated with it. The major problem that you have in making that decision of balancing benefit versus risk is he goes back to this slide that I put together, you know, sort of complaining about clinical trials. And that is that early set of information that guides, you know, prescribing decisions that guides the utilization of any one pharmacotherapy for a condition may or may not actually accurately predict what the adverse reactions in a particular individual aren't going to be. So a big part of the problem is that you only discover adverse reactions after the fact, right? If you give the medication and then he's not have done until after the find that you actually discover that it's this and that presented itself. What I'm arguing is that using the predictive tools that come from precision health care, you might actually be able to identify apriori, individuals that are going to be likely to respond one way versus, versus the other. Oftentimes, adverse reactions actually are a function of dose. And so you might actually be able to make dose adjustments and what's called being cold now, precision dosing. And because the dose recommendations that come from the pharmaceutical industry reflect the set of circumstances on patients, our crying that particular critical trial. I may not reflect that we couldn't, you know, the the the behavior or the patterns that any one individual gives you. At the end of the day. The balance between the benefit gain versus the adverse reactions that comes from it is something that we're going to have to stratify in a better way. And I don't think that they carrying modalities that we utilize allow us to do that. Excellent point. Thank you. Thank you, Bill. Next is at Dean David Alice. Alice, your brush. Aren't you? Well, first thought professor Ramos, Thanks for Terrific. Really enjoyed that. And the breath of concepts covered is extraordinary. I had a concept question about the transposable element Burt. And we know that that increases with age. And there's some speculation that that may be one of the drivers of senescence in humans. We think there's been speculation that some of the transposable element burden that occurs with age that's not present in the germ line may be the result of lateral gene transfer. Microorganisms in the gut microbiota. And I'm wondering to what extent do you think that's plausible? Why or why not? If it is plausible, what should we be doing about that, either in research or practice? Wow, that's a profound question, Dr. Allison, and a very important one. I do believe in lateral gene transfer. I actually believe that exchange of DNA sexually something that we're going to have to investigate anymore avid way. And I think a lot of the questions that you're racing related to this lie at the intersection of our ability to, to better understand the microbiome. Whether it's a microbiome or the microbiome in the, in the lung or the microbiome in other organs. That might actually be unique to specific sites within the human body. And so, you know, we're only now beginning to scratch the surface. In our understanding of microbiome complexity. I actually think that a big part of lateral gene transfer is going to be extremely relevant to infectious diseases. Especially infectious diseases that appear to be refractory to accepted treatment modalities. You know, sepsis being perhaps a good example of that. And the genetic instability that comes from that lateral gene transfer that might actually actually influence outcomes, clinical outcomes, you knowing patient populations. And so the greatest difficulty I think attached to this study of this is the fact that you have continually changing bacterial populations and bacterial behavior in the light of a changing landscape for the host. If you think of the humanness, the host as supposed to spin the invading species. And so gaining, I think the ability to take snapshots that frees the biology one moment in time might actually be required for you to better predict. How is it that lateral gene transfer, it might actually be influencing health outcomes. If I had to take a guess, an educated guess, I would actually submit to you that probably infectious diseases might be a very important place to begin to scratch the surface. Because oftentimes the resistance that bacteria acquire, they acquire it through lateral gene transfer. And so that means that bacteria are experts at being able to, you know, to do this and how they intersect when they interact with the human genome, it's going to be something that I think needs to be studied more aggressively. Till now. As you know, we've mostly focused on cytokines and signaling molecules coming. Microbiome and not pay that much attention to, to actual genetic transfer of material. But it's a very provoking, an intriguing possibility. Thank you. Thank you. Denouncing next is add minutes, who is an adjunct associate professor in the IU School of Medicine. And and again, thanks Dr. And also a tremendous presentation today, I worked in the COPD field for many years, but I left about 15 years ago. So this is the first I've heard of this line one, inhibition. And I'm curious because I have for the last seven years worked in the IPF space space. Idiopathic pulmonary fibrosis, in which there is similar mechanism of action as you declared for c, a, b, d, e, TGF beta, TNF-alpha terrorists in kindness inhibition. So I'm curious, are currently, are you aware of any interest in applying this line one, retro element technology to address the untoward effects of IPF pathogenesis of Ikea. Yeah, actually, I've actually interacted with a couple of IPF folks trying to study IPF populations in the context of language activity. So those are studies in progress. And there's another group in, in France who, who's actually beginning to look into, into that. A lot of the connection between line one and IPF is, is well-grounded on the whole idea of genetic instability. That IPF noise characteristic of, you know, and, and the whole idea of telomere shortening that might be associated with IPF phenotypes. And so the, the approach that we have taken is one where we think that line one expression might actually modify the different trajectories of illness. You know, BF can be very slow progressing, it will be very fast progressing. It could be a disease that kills you in Lesson five years, or it could be a disease that continues. And a lot of the sort of plasticity attached to IPS through proliferation of, you know, of a fibroblastic type cells. And fibroblasts might actually be driven through the genetic instability, this afforded by Lang when elements and L11 elements actually talk to telomeres because of that repetitive nature of both of those sequences. And so we're exploring that possibility at pharmaceutical company was so interested in our hypothesis that we actually engaged roach a little bit, trying to entice them and we got very far along, but then leadership changed. And so this study got holds it but I guess way maybe a couple of years. And what might be able to give you a little bit more insight into whether lying ones might actually be play an important role in IPF. Some of that same remodeling that takes place in IPF also takes place in COPD, which might explain why there is some similarity there. But the jury is still out. Fantastic. Thanks very much, very interesting. Thank you, Ed. We are approaching one at this moment, so I'd like to thank our speaker today, handed over to Alice and the pros and cons. Well, given the time, I will be brief and I will simply echo your words. Thanks. Professor Ramos. This was not only intriguing, it was entertaining and enjoyable. You are a wonderful interlocutor. Boyd our time learning from you, Dr. Commodore. Thank you for the outstanding introduction. Dr. Howell, Amy Oakley, thank you for organizing this, so well. Everybody. Thank you for joining us. Take care everyone.
Dr. Jandel Allen-Davis
President and CEO
Craig Hospital, Denver Colorado
October 26, 2021
Noon–1:15 p.m.
Description of the video:
Well, good morning, everyone. Thank you for joining us today on this beautiful October afternoon. We are a year for the October distinguished Colloquium Series event with Dr. Janda Allen Davis from Craig Hospital in Denver, Colorado. And we're really the static, the hammer and join us tonight on me. Her and her expertise to the hospital in her past works and my c is Dan, so I'm going to kick it over to delousing. They gave a brief welcome, and I'm also to introduce Dr. style, likely today as well. Thank you. Excellent. Thank you, Amy. Thank all of you. Coming year. It's good to see so many of you here today and I know more will be joining us. We have a very exciting program today. This is part of our distinguished colloquium series. And these are challenging times for our society in many ways there times rich with opportunity, there times rich with challenge. As, as I hear they say in the Air Force, it is a target rich environment, which means you're surrounded by fighter planes. So that's the positive way of seeing being surrounded by fighter planes. You're in a target rich environment. And in today's world of a pandemic of health disparities, of escalating tensions in social group dynamics. Racial tensions were tensions, political divides. We are at a target rich environment where there's a lot of opportunity to do good and a lot of challenge. And we need leaders. And I was looking around and I came across Dr. John Doe Allen Davis. And it was clear That's leadership. And so we've invited her here to speak about leadership during these difficult times, what she's done, and how we can do better. I also want to talk about future leaders, because leadership is something we need to cultivate throughout our lives. And one of our future leaders is still alerting. And I have the privilege of working with Stella for not quite a year, getting close to a year now, since she joined us, she's an outstanding scholar and she is a health economist and is working on many things evolving, aging. And she, like the rest of us, have faced the opportunities and the challenges of the recent past and has risen to all of them with equanimity and with a plan and with grace and with courage. And I'm very pleased to have her here and she is going to do the formal introduction of Dr. Allen Davis. Stella, welcome. And key. Send everyone. My name is Stella on a stepchild Center at the School of Public Health. And I still of Public Health. Today, I'm honored to introduce at October colloquium speaker at the agenda L. Allen Davis, President and CEO of Craig Hospital in Bemba cloud around it, a well renowned Greek Rehabilitation Hospital of that exclusively specializes in new and Rehabilitation and Research of patients with spinal cord and traumatic brain injuries. Dr. Allen Davis is board certified in obstetrics and gynecology and was in active practice for 25 years ago I breeds of dam and colleagues and demo hospital and medical school. Dr. Allen Davis completed her residency at Thomas Jefferson University Hospital in Philadelphia. Flowing had training. She spent four years in the Indian Health Service in Chiba City, Arizona. Proud to move into Colorado. Dr. Allen Davis is an active participant in the community and currently serves on the boards of diamond got a gazelle medical school, then Metallica, botanic garden, sorry, Denver Metro Chamber of Commerce, national Jewish health, Colorado, trice, the cooler I do Hospital Association, the Denver branch of the Federal Reserve announces as a commissioner on the Colorado State Economic Development Commission. Now, I want to thank you all for being here with us this afternoon. And I ask that you please join me in giving Dr. John Doe Allen Davis a wall visual speech. Welcome. Thank you. Hello everybody. Thank you. Thank you. I'm going to pull up the slides and hope that we don't end up like often happens with these things having done things not work as well as we want them to. But first of all, I am very honored to have the opportunity to skip this right here. This there we go. The opportunity to be with you today. It is funny what you just never know who's watching and and, uh, Dean Allison, you prove that? I just feel incredibly humbled and blessed to get the Come on. Get up every morning to come work very hard here at Craig Hospital where I've been for about three years. And I'll come back to a little bit. That story in a minute. When I was asked to come and speak, and this was the title that I was asked to talk to. I said, Boy, do I have a story to tell? And one that in my wildest dreams. And I got my wildest dreams, was actually having the opportunity as a board-certified OB-GYN to actually serve in national Neural Rehabilitation Hospital that's well-known for their work and spinal cord and brain injury. I thought that was my wildest dreams, but then it only became Wilder where we think about the times that we're living in. I do want to start though by thanking you, thinking those of public health. I know that the APHA conferences going on here in Denver, I remember the last time which probably was about, I want to say 67 years ago, having an opportunity to interact with folks at APHA, but also another the deans the deans and program directors. And instead of laying at the feet of them in some ways that I believe this is public health's time. But the time we thought our biggest issue was obesity. And up just saw the growing burden of chronic disease and our country that's due to any one of a number of social determinants of health. And I bet you all Bu dat is one of the biggest things that you had to contend with. Now to find ourselves once again needing your guidance, your wisdom, your expertise, and your sort of sense of how we walk through of all things. A pandemic is something that, while we trained for these things, but we knew someday they would come in our wildest dreams. I'm not sure any of us really, ever, really thought we'd live in this time and yet here we are. So thank you for what your profession, your field, whether in your local communities there at the universities and colleges across the nation, training the next-generation scientists and public health. Or certainly in your, your own state, the things that you're doing in your account thesis. This is nothing short of miraculous and no matter how tired we are, I know that you're tired and you've also been beleaguered, beaten up in some ways that I know have also made an incredibly tough. So it says a whole lot that you continue to stay the course, have chosen to follow the science as it's evolving. And I, I, as a leader of a hospital, trying to keep our patients safe, couldn't be more grateful for the connections we have to our local public health or state public health folks, and certainly both at the federal level. So healthcare, it has been under so many incredible strains and stresses brought on by a few things. Now, a nice sort of alluded to it a little bit just a moment ago. But when we think about what's happened with the cost, the quality of the care experience of the United States healthcare, which we have been crackling and talk to you about for far too long. And R, D and R still in my view, too slow to sort of make the pivot to do something about it. It does, I think it's because it is time for a different sort of leadership. And then you take those three, the so called coins, triple aim, and you add to it a bunch of related topics that fall under it, which have this interesting intersection of sort of social forces, geopolitical forces, political forces, economic forces, things like end-of-life care or aging population, the explosion of all the technology, let alone pharmaceuticals. In many cases that only bring about incremental, if any, real improvement in terms of health care outcomes over existing therapies. Then we add workforce shortages, something called the medical industrial complex, vertical integration. You name it so many things that are really sort of weighted the feet of leaders and those of us who serve our communities and healthcare where you sort of wonder, thanks, I'll tell you just a little funny. They asked, we're going out my trader yesterday morning, which I've been doing in the basement on FaceTime because I'm not going to jump in anytime soon. And he said, What are you doing? And I was sitting on the exercise ball. I said I'm thinking he says, What are you thinking about? Retirement? Is find where yes. You can get pretty darn exhausting. And at the same time, there's nothing I'd rather do or no place I'd rather be than right here doing when I get to do every day. And this is what we're swimming in right now. We're swimming in. And as Dean Alison said, one of the most difficult periods I'd easily saved my life, let alone, Sir, my professional life. Whether it's stand that social and political unrest that we experienced in witness last summer. The way that this virus seemed in the land. On the surface at first my belief as it wasn't as important as it was for a lot of different reasons that was going on. And then the impacts and the implications of trying to figure out how do we actually navigate and walk through all of this, all coming together. At the same time. It is hard to imagine were difficult period in which to serve our teams and our communities. But I also have a strong belief just in terms of my might, the way I sort of think about life and living let alone service is that there are leaders for a time. Now, I couldn't have predicted that this is where I find myself to begin with, let alone certainly in the last year and a half. So what I advise do today is do a few things. First, I want to just sort of talk about the context into which we sort of found ourselves thrust into managing this pandemic. And then lay some real contextual sorts of mixing potential points and then talk about Craig Hospital just a bit because I think describing what we do and how we do it. Gifts, I think actually some great lessons for all of us to learn in terms of how health care probably could they should be better practice. And then I want to end with a few lessons I think, and reflections that I've made over the last. I think we're getting on towards 19 or 20 months box making our way through this. And so if you'll you'll with that by way of how we're going to tee up, what we have to talk about. I think the first thing that's really important, and I believe this about everything and leadership. And in servant leadership is that context matters. We have to slow down long enough to really understand the milieu in which we're learning. Because it's never just sort of one-dimensional. There's so many vectors that are at play that actually make it sometimes difficult to do what we've been told. That is, if you don't understand, those who don't understand history are doomed to repeat it. In some ways. There is absolute wisdom in that, and yet there's always new little things that get thrown in and sort of change things around slightly. I've put a few of them up here because we did enter this period from an interestingly, I think, complex and complicated place. The political uncertainty and the polarization of our country as something that's justice. It's heartbreaking when you really stop and think about it. And it can be concerning and some disruptive ways in terms of whether we use language as colorful as the fabric of the nation pulling apart is the foundation cracking? Nonetheless, we have a lot of political uncertainty, polarization that way predict dates the pandemic globalization, which is a really, I actually, in the original talk I had a plus and a minus next to that with globalization because so many ways it's such a powerful thing and it has enabled so much just produce the level of cooperation and innovation and abundance that we've not seen before. And yeah, we see the manner in which this the strength of interdependency can add complexity. But I wouldn't trade it for anything else. Look at what's happening with social connections and the social media, the implications and impact of the ways that we communicate and presumably connect to. I will do an air quotes because I do have concerns that are sort of sense of how we are closer as a world through these social media channels is also making us feel far more isolated. Cuz it's enabled a facile way of staying connected, sharing each other. But it also goes without saying that it's been used to foment severe divisiveness or divisiveness and myths and misinformation. And then when we think about the implications and some of the new information where learning around the impact of this sort of hyperfocus on how I look, the self-awareness and what impact that's having on Are you, there are reasons to be very, very worried about that. I'm going to assume it is a group of public health experts you're familiar with the happiness index. But the interesting thing is that the United States ranks 19 out of a 149 countries. Maybe have a few fewer this year when they did it in 221 and the happiness index. And this is a decrease from 13 then 2017. And the two biggest contributors are first, the differences that and growing difference between how poor folks, those of lower income folks rate their happiness versus those at the higher end them or income spectrum. And also the pandemic and how poorly. I'm going to use that word we've handled it in our country is seems to be impacting those those rankings. Our health status, I don't need to bore you all with that, but you certainly know that the physical state of the United States and global populations to as follows, her mental and behavioral health has been fraying against these recent, I'd say last couple of decades, if not longer. And then also employee engagement. Employee engagement is for watching what's happening. We now there's also, we've got health inequities that are also playing out in terms of arches that status. Here. We'd been chronicling those for at least three decades and chance I'd like to say it's time, despite me are making some progress. There are some persistent nagging disparities that exist. Racial and ethnic lines cross gender and certainly income level and health status. And then there's employee engagement, which is one of the many things top-of-mind to make given the role that I play here. And the Gallup organization has been tracking employee engagement for us for a number of years. And the interesting thing about this is that to think that these percentages are people who are engaged, is running at the numbers that it is here, anywhere from a low of 26 to a high of 36 percent is not going to be proud about. But probably the other troubling thing is the percent of people in our workforce at any given time who are actively disengaged, actively disengaged. And so we're swimming in all of these things as the following P campus then came trouble as I say it. And if you think about those very same things, very same sort of contexts, that political uncertainty and polarization where we mount politicized, which I never even know how to say the word I've gotten saying that over this last year, the politics of our virus and the politics of the palate, that's globalization. When you think about the fact that we thought this thing was sort of contained in one country, maybe on one continent, maybe in one province, in another country. And we fail to take into account that one of the positives of globalization is that people around this earth quite a bit daily basis. And in fact in 2021. But just over 2.2 billion people boarded planes across the world. And that was half of what it had been just right before the pandemic. So half of it, 2.2 billion people were moving. So 4.4 or more were moving around before the pandemic. And that meant nobody should have been surprised that their affinity with which such a highly infectious or do this and was able to, to, to spread. And certainly our connectedness, what's happened with social media and the ability to, to spew so much miss and disinformation about the pandemic and do so intentionally. There's an outfit called News guard that said that more than they looked at 6700 websites that had analyzed and 519 at publish false information about COVID-19. Whether those were dubious health information, political conspiracy theories, and other of those websites were created very specifically to spread misinformation about COVID-19. I already mentioned what's happened with our happiness index. And we know that if anything has taken a hit in the last year across the globe, but certainly in the United States. And some face some very unique ways that span the decline in our mental and physical in the state over this last time. And then finally, the uncertainty and the disruption that occurred Suddenly. The only exacerbated decline in our social emotional health in our case. And this is what I've said to my team about this. But this was our tsunami. Know that this particular emergency, which is what we called it, you may be, remember at the beginning where I think maybe you all are smarter than the rest of us. But thought, well, we'll see, we'll close down. This economy will close down the world for a few weeks. This thing will die down, go away, and then we'll get back to things. But in fact, that was not the case. This is our forest fire, our hurricane. The thing that's been thrown in our face, we are the front line of this and we couldn't turn away. And interestingly, what's been studied not nearly enough in terms of employees is the impact on your, your community, that is on public health workers. And the CDC did a study that you're probably well aware of, of 26000 public health workers, which I think if I remember correctly, it's about is said about 40 percent or so. Now it's 10 percent of the public health workforce. And about 53% of the respondents reported having symptoms for at least one adverse mental health condition and the preceding two weeks. And those included some of the ones that we're seeing elsewhere, anxiety, PTSD, and suicidal ideation. And there were some populations within the public health community who are disproportionately affected. And again, when you think about all that's on here in particular, that first bullet and the social unrest and everything else, we know that we've been swimming in. And it turns out that the people who are most frequently are more severely affected, were younger than 30, were transgender or non-binary, or were multi-racial. And public health workers also reported social stress related to their positions. We get our little community here and not so little community are part of what's called the Tri County Health Department. It's three counties that for years have worked together to manage the health and well-being from a public health perspective of our communities. And two of the three have said that at the end of 22, they're pulling out and they're going to try to establish their own health department. And at the core of it is a difference in opinions around both the seriousness of this virus and how to handle things like mask wearing. And it's some tragic my own little, I suppose, personal opinion knowing Dr. John Douglas, who I've known since the early nineties. And it's just an amazing, amazing a leader in public health. I saw him on the news last week and he looks to say that John looks beleaguered is The understatement. This is, this is hard what's happening to you in terms of that, but also even people who are being bullied or threatened or harassed because of their work. So we had to make a choice a year ago or more than a year ago, and it was actually the choice between two really bad options. Do you close down an economy, the close down society completely for some period of time, given that we were facing this novel virus that we didn't understand or, but we knew that it was pretty quickly spreading, but also that it was killing an inordinate number of people. And as we all know in the early days, certainly those who are in long-term care. And what we knew is that underneath both of those options, neither of which were terrific, but something had to be done. And I actually grateful that way, even though we've got a lot of work to do. And there may be people or even on this conquer disagree that we chose the path that we chose in underneath. Both of those options are a host of cheating and conflicting priorities. So in my view, looking at that what had to be made at a global level in terms of a decision, let alone locally, that a lot of your own family went on in your own life. It truly is leadership on a line. And I think it takes the special way of engaging in order to lead and time such of those. And that's what I don't want to spend the rest of the time talking about today. But first, let me tell you a little bit about this face and I'm blessed to call my work home. So this is one of our two legs here at it. We're actually in Englewood, Colorado, just just south of Denver. And the hospital Craig is spent around over a 100 years it was founded versus the TB sanatorium. And of course we got TB under control and vaccines and other sorts of public health treatments. As it turns out. The hospital chose to then pivoted into polio vaccines and therapies there to treat polio, which we know came about in the late fifties. The hospital made a decision to treat spinal cord injury rehabilitation patients exclusive way. And it's not for profit where freestanding, where National Center of Excellence, we've been in the top ten of the US News and World Report rankings for the last 32 years in a row. And since 1956 we've treated over 31 thousand patients were at 90 to bed hospital. So we're not huge. About half brain injury have spinal cord injury have come from other states. And that's a really important consideration in terms of how we walk through this pandemic, um, and and have come from all over Colorado. In terms of the admission, here's the mission statement of Craig Hospital. We advocate for and provide exceptional and I'm keen. I've never seen such patient and family centered care given to a group of patients. In fact, I am convinced that if all of health care function the way to Craig Hospital Does, it would be of higher quality. It would be safer. It would be certainly more affordable and occur experience with the unrivaled across the world. And I spent prior to coming here, I was 20. I was at Kaiser Permanente here in Colorado for 24.5 years or for that in the university setting. And as was mentioned, I was an ETA in health service for that. So going around a tiny bit and I like to think that I practiced truly patient and family centered care. But there's something about being able to do it in a supportive environment with my job is to support the people who do the work and make sure I do that as best as I can. And that they know that they've got the agency and the appropriate autonomy backed up by their amazing professionalism to standardize care, but then customize it very much for every single patient that comes through the door. Most of the I said it's the most family centered place. And some of what's underneath that. It's not about the technical, although you can see this beautiful fall adaptive gym, that's actually a community gem rehab here at Craig Hospital. But it's something that finally there, that first sort of modern day CEO coined back in and I found, happened to find it in the drawer when I came to work at Craig called the Craig recipe and a number of bones. I like to call him the ingredients and then how they ingredients work together to create the kind of environment that even with how this last year has gone. When I walk the halls and have a chance to visit with patients and families, they cannot say enough good things about their experience here. Now I get to see the relief on new admits, patients who are admitted here and their families after spend sometimes weeks in intensive care units. These are all people as we know, who woke up with one reality and went to bed with a different line. And so I'm humbled and honored to say the following. I have defined what a glide because it's a date. We have had no COBIT 19 cases than our patient population. We manage so far to keep this virus out of the hospital. And I always say it's not a matter of if, it's a matter of when, but now that I have my bank and aren't yet, especially now, but at least we've got most folks vaccinated. And certainly with the widespread availability of those, we have a little bit more of a fighting chance despite what's happening in Colorado. But all that said, it's the craziest time to be unlettered leaderships, whether we're talking health care or otherwise. But it's also a time where we have and I say denouncing knew you alluded to that. We have the opportunity to create memories and stories and opportunities to show up and do some work that's really significant and really matters. And, and as I think about it, there are some things that I'm sort of back to. Contexts are guiding those. How I have chosen and how we as a leadership team, have chosen to make this walk. Because when we, me, sir, Are those we serve are vulnerable and some very insignificant ways. And here are the follow the circumstances that I think make leading right now particularly challenging. For fall. We're dealing with some we haven't seen in over a 100 years. It's novel. It's highly contagious and deadly. Where in a country that has health inequity challenges for generations and pass that collectively witnesses the most explosive example of racial injustices the decades. And maybe just maybe ready for that reckoning in the context of the most polarized political climates and an election that reach new levels of civic engagement. But then put a chapter to rest on January 6th in a way that no one in the world ever thought imaginable on American soil. So you think about that and that sort of for me, captures the device of times that was highlighted in the title at the top. So what I want to do is tell a few stories and certainly relate to take some questions. Term. This is our whole hospital By the way, we're about to go undergo the capital expansion sometime over the next decade because we're out of space, we're really out of space. But the first thing, and I think this is a foundational part of certainly how I seek tests or is this quote that's been attributed to a number of people including Theodore Roosevelt is like it doesn't matter how much you now, people don't really care about that until they know how much you care. When I walked in three years ago to a place where we are, We understand the importance and the value of interdependence. Team-based care where we respect what each of us bring to the recipe, has it were and are we absolutely put patients and family at the center. And for leaders, I don't think there's anything more important. The, The, remember at the beginning of all this thinking colleague, once, once I think I sort of realize what we were, yeah, Because I think they're what's a little bit of wavelet. Wavelet wherein watch him, this is not going away. We're still here. And you can imagine the sleepless nights. And if you can't trust me, sleepless nights worried, how are we going to make this walk? How are we going to keep this virus about how I'm going to keep our teams for right. Now. The beauty is that if you lead that way naturally and people see you and know that you see them. That is that you care. You're starting from a really strong foundation and I think we had that blessing here. This is, And it's funny because people will say families and say This place is great. I know that tone at the top thing or your leadership, this blah, blah, blah. And I tell them I have a little secret for you. It was like this when I got here. My my goal is not to break it. That's my goal, that's my charges stick to keep throw and the good fuel that people. So they really don't care how much you know, until they know how much you care. What. Theta. Also early in the pandemic. And I'm going to share a, maybe call this an over-share a little bit. I was having some of the craziest dreams. And in all those strings, I found myself trying to get somewhere and never quite sure where I was going. But there were some interesting sort of commonalities regardless of the particular circumstances of the grade, I was always barefoot. Which ones? We're always barefoot. And often having to make my way through muck. You like literally gross stuck on sidewalks are. I remember once having to walk through a field of manure in a tree of all things. I also remember 18 where I was here at the hospital and there was a fire in my office. And I remember going out and telling folks it's fire. We're trying to give people sort of aroused to move on. And I could not. People are very nonchalant about it. In fact, there remember there was that people sit around talking about what are we going to do with the candy? So I think as I sort of figured out there was a pattern went on. I began to call this my anxiety or my vulnerability traits, which are both, you know, sort of maybe two parts of the same coin in some ways. But what I do know is that I work in a place where it's very easy to actually say, I don't know. I'm not certain. It's easy for folks to talk about. I'm not afraid I remember early in the pandemic, we were meeting with the physical therapists and occupational therapists and a couple of the gems upstairs. And I noticed this one woman in the audience, as you know, I've been here what this whole thing started a little over a year and a half and I didn't know who she was. But boy, you talk about body language, say and I'm not I'm not good. I'm down with any of this any of what you're to talk to you about? Just anger and I remember being really focused on her. And after the meeting, I said to our chaplain, I said kinda cool is that and she tell me ignition was assumed. She looks really pissed off and upset is because should go talk to her. And she kind of looked at our initial of demand, said No, Can I looked back and the woman and I said I'm going to talk to our son, went over and I introduced myself and I say Can we go somewhere in top. We went to one of the the treatment rooms and she let loose about how terrified she was literally terrify. She she cried, she was worried about taking this home to her 16 year old kid. She was worried about bringing it into the hospital. She didn't know what to do. She was completely unclear. And the beauty of the moment was, I think was that I cried too. I said I'm I'm right there with you. I'm not worried about bringing home the kids McKenzie ground, but that this is a scary, scary time. But all we have is each other. And we're going to, we're going to figure out how to get through this and behind. And we cried and we close a little bit about what we were going through. And as a result of that, I saw and then we hugged and she went back to work. I went back to work. I'm so glad that I took the chance because I didn't know she was just something I had done to use the colloquial or whether just precisely what was going on. But people want to be seen, they want to be heard, they want in this time for their pain to be felt. Also. I think I felt safe enough to also go there too. And then I think as some of the beauty of being able to deal with these vulnerability treats, our job is to try to create sense. And I don't know if you know this particular where this quote comes from. It could be lost in the mountains or in the Alps. Any map will do it. There's a story about soldiers who were sent out on a mission in World War One. And an unexpected snow storm came and they were in the Swiss Alps and they got lost and back at camp base camper, their, their commander just felt terrible about having sent them out, thinking that they had perished. And turns out they manage to find a map in the bottom of someone's ROC sac and they made their way to safety back to the hospital. And then a few days after they weren't know they're going they're convalescent. They looked at the map and it turns out it wasn't even a math though the Swiss Alps, it was a map of the tyrannies. So when you're lost in a forest or you're lost in the mountain city map will do my job. Our job is to try to create certainty to do with Carl White, termed sense make. In times of great ambiguity. It doesn't mean July, it doesn't mean you paint rosy or pictures then there are I think a lot of what adults and children and all of us need in terms of creating certainty is to be truth tellers. But to say that we're going to make our way through this because we're going to use all the talents, all the gifts of everybody around us. And we started that back in March 11th. March 11th of last year, we set up our incident command and we continue to meet to this day. First, we are meeting every day now. We meet once a week and do our work a little bit more dis-aggregated and come together once a week because there's still things to fight. And one of the most heartening things to hear from staff and team members when I walk around and thank you for keeping us safe because it's been tough duty and we are worlds are a lot smaller than they were a year ago when there was an active and vibrant have Therapy Program and families move out here, there'd be kids running through the halls being part of therapy because this's family therapy. To having to relay rate it in and have fewer family members on campus. There's even a point where we had no family members on Canvas. And I remember when I had to talk to family and tell them that from what was called heartless orientation. Wife even say, this isn't a real hospital. Many people with no real understanding, but the idea and the terror of saying we don't know what we're dealing with. You need to be safe. We need to keep your loved one safe. And where we've come since then is, it's pretty remarkable, but some hard, hard, dark days. The other thing I remember early in the time together was taking a walk one day and trying to figure out what we were going to do with this very early in the pandemic around that. In fact, if it's not a weekend to the whole and we knew that we had administrative staff that we send home. If we can decrease the number of people who were coming into and going out of this building every day. We knew it would be really important part of decreasing the likelihood of bringing the bug in. Most of the administrative folks went home, except for leadership. We had made a decision. I said right from the beginning, leaders will stay here. We will be here every day. It's so important for us to model. Taking a walk. When they said, well, you know how to do this when you get to these points idea. When values are they, what are the values you're going to use to help you do this workshop? And they're listed here. Safety, equity, fairness, trust, and sustainability. Safety wasn't just about keeping the virus out and keeping our hospital, which has already that this amazingly cream place has got an incredible environmental system staff here. They're just incredible ETS folks, but also psychological safety, the ability of people to speak up and give us information and make sure we were getting the best information around out. Any of the things that we're doing or playing out. Equity was about giving people on only what they need it to make their way through this. And so it does require the sort of sense of inclusiveness and really understanding what are the needs. Those that we serve. Fairness was an important one to center, take a hair cut and this one, No one gets a by. We're all going to have to feel some pain in this newer and try to do that through a number of lenses. But to really work for fairness, trust was all about telling the truth and being incredibly transparent about what's going on. We, early on, before we knew we needed to wear masks and we should be socially distance. We started having stand-up meetings from all that with all the supervisor anybody with supervisory responsibility in the hospital. And that's something like 5060 people in a room. And I we started those meetings. We had a once a week just to make sure we were sharing information. We started having family meetings the same way because families are part of our community and they're here so long. They stay so long they needed to have some way of being kept up to speed. We quickly pivoted to zoom. And we're going to continue those practices to this day. And that way we have the ability to have great two-way communication, but also to keep people up to speed on what's going on. And sometimes those messages for R Then, by the way, was particularly helpful, profoundly helpful last summer in our summer of racial injustice and unrest. The opportunity for us to come together and debrief for just Tom about are just sort of be yeah. During that time. And then mommy, the sustainability and not just sustainability of the business, which is important. And we were worried, what do we see a drop in census when people found themselves locked down, but in fact that didn't happen. In fact, if anything, we'd been busier than in terms of sustained high levels of census since it actually Craig's history. But so not just sustainability of the business, but most importantly, sustainability of our folks social and emotional well-being, which has spent a particular focus for me and one that I took one out of all the things I could do because I'm not an infection prevention manager or a safety manager. And and I don't do neuro rehabilitation. They won't let me to deliver a baby in the hospital. So I thought, you know that the most important role that you could play is tending to the hearts and minds of the people you serve. And so that is one part of this journey in addition to leading at and being an active AND gate that actively involved an incident command and help them think through lots of ways to get things done. That was the one thing that I did. And then my personal contribution is that I'm a quilter. Yes. I have more fabric than I know what to do ifs. And so I donated a 30-year fail the fabric collection to the hospital and send it out to volunteers to make masks for family caregivers, as well as a number of us until we got smarter about surgical masks, available, funding to be able to do. And then I said, well, I want to make mass and I'm back to collecting fabric. And I've probably made over a thousand of these really, I think, fun fabric mask that I see all over the place and people seemed early love. That was another way to connect with staff. You know, Gallup has talked about, in their sense of leadership, they've talked about what are the needs of followers, and these are the needs of followers. That's how compassion, stability, trusted my view. Those may sound like mushy words, but there are some very intentional ways that you can actually walk through. And we have walked through all of these throughout the swap, both in terms of how I support our executive team and how our executive team supports all of us to put our directors and on down the line to everyone is that we're going to get through this, keep people abreast of how we're doing with respect to any of a number of these different sort of pivots we've had to make or inflection points the skin that, excuse me. And then, and I believe this and Leinhardt, I've set it on our big all staff meeting Zoom's is that aside from my home, Craig is the safest place that I come every day, keeping that drumbeat, that this is a good and stayed in place and that we are doing great work. We're mission focus, we're purpose-driven and we're going to stay there. The change. And we know that we're still continue on to make the walk through this N0, M0. We managed throughout it not to let much wither and die, which I think is super, super important through all of this, the house still has a ton of joy, which just does. Now, which is surprising yard and sort of this craig recipe. It is not a place despite these catastrophic injuries. Then while I know people have bad days, for sure, nobody wakes up saying I want to go to Craig Hospital. Largely it is a place of joy and we have managed to keep it that way throughout my whole throughout this whole time together. So I'm going to tell you then through the lens of those sorts of things. And I could tell stories forever, but we don't have forever. Sort of what are the top 10 leadership lessons that I think I've learned through the stem that I am still learning and still trying and striving everyday to read. And so I'm going to go through these and they're actually not in any given order, although the first one is the most important ones. I remember sitting in an early incident command and one of our physicians, me or we have nine attending physicians who are accountable for all the care that happens in the hospital. They're all either physical medicine and rehabilitation specialist and we have one neurologist and one of them said on the TM and our doc said, remember we've never done this before. And to hear him say that in the room at the moment, he said that there was this sort of relaxing. Like let's all make sure we're cutting ourselves breaks as we're trying to figure out how to work through this. And make sure that we had in the incident command structure, very flat Hierarchy, very flat. Nobody had all the answers. But altogether, we've managed to get where we are today because we listen, we learn, and we remember that we haven't done this before. So try hard not to put a ton of pressure on any of us. And no one has to totally own name, including that person who walks around in a dream barefoot walking through muck. So remember, you'd never done before. But here's the one that I think is also important tending to the hearts and minds of the t. Now, the team and yourself has to be top of mind. There were no good for exhausted and heaven knows. In the sad thing about what we're going through is that forest fires or tsunamis are hurricanes in terms of the in, in the eye of any of those storms are are emergencies. It has a relatively clearly defined beginning and end. I have no idea where we are in this particular historical epoch. I don't know if you have got vaccines, that's great. You know, you've made some progress. But we thought we did. We thought we were done months ago. Few here we still are. Walk you through this tough, tough time. So the interesting thing about the emergence, the concept of emergence, which is Part 2, or more but two seemingly different things come together for the first time in a novel and unique way and something new comes about. And so emergence of the novel requires constant vigilance. Then we bend that way. They die again for public health and science. And we've had to be vigilant and pay attention to rapidly changing circumstances which at the beginning of this was enough to make our hair. Public health is just as confused in some ways to really what was the best thing to do. And it didn't help that we had politicians and mothers token halls at Cijkl. But we also had to be able to translate and bring the teams along the journey. So this has never been one of those smokes going to come from the Vatican kind of places when we're giving people a particular arming our directors and leaders with what they need to help their teams continue to do the great work they do every day. Integer, real. And I didn't tie a and the I see this, we call it for sure it is all of the executive team. It's infection prevention, safety manager positions do participate. We've had pharmacy there when vaccines came along at the beginning of this. We have our occupational health and safety person on the team. So that's a that's a relatively small and we have our communicating team, that communication's team there to help us with all sorts of messaging and signage and you name it. And what I'd say is that everyone brings their unique gifts. But we don't. We stay in our swim lane, but we don't. And in fact, some of the more wonderful things to emerge in terms of ways to kind of thread any one of a number given the needles comes after. So rho, rigorous debate or questioning and it'll come from someone who has nothing do with whatever maybe. And so we do bring our gifts. We know what we bring into the room, but we are part of owning the solution are universal and unified way. And we've learned to argue really well. And it's, conflict is not anything that any of us say, oh cool, I think we're going to have conflict. But we have learned how to argue in that realm, It's a safe space. Everybody's opinions are respected. And one of the things that requires we walk away as supporting the decisions outside of the room after those vigorous debates and also having the absolute willingness because we've needed to us to come back and question decisions that we've made and make changes. Now the shutting down of Craig hospitalists at where are the closing of closing, making our world super small was a technical exercise that did have some adaptive nuance to it. Opening this place, backup has been on 100% adaptive challenge, and we've done it, I think thoughtfully and slowly, beginning last May, so well over a year and we're still we have miles to go before we sleep. I was so thrilled yesterday to have AT team member, one of our occupational therapists come in. Actually one of our recreation are therapeutic wreck. People come into my office or if they ask for some fabric because she knows there's fabric in life to do some other work in their space, but also just to thank us for letting the pets come back. And she told the story about a very closed down brain injury patient who they had not been able to get to speak at all. Now that we're having pet therapy back, this person is using words, saying words. There is some emotion there. So we know that it's time to carefully figure out how to get back into traffic at a time, frankly, where we're really not the case positivity rate in Colorado yesterday was 11 percent, so we're not out of the woods yet. In our agility and flexibility muscles, I've actually been absolutely been challenged and unfamiliar ways. And that's where it's really important for you to know yourself, to check your ego and your titles at doors has the surprises over this last year because of the convergence of all these different political and social and biological forces, It's really challenged us. And it's required the ability to think quickly, be agile, be flexible, be honest, be truthful in ways that are, we don't do every day and it's been unfamiliar, but we've made our way through it. I swim in these and I will say I may give, I'm a couple of people come in on different. In fact, I just had one this morning that has nothing to do with COVID at all. But we swim in a sea of conflicting and competing priorities and you just got to get used to it. You just have to get used to it and use the values that you have chosen to undergird or we have chosen the undergraduate time together to get it done soon as it were. This one is hard for people to sort of grasp and it's not one that I saw at the very beginning. I was on a panel at something our museum Denver Museum relation science as an Institute for Science and Policy and are taking on some of these issues where there's the clash between the two and the reality of science is important in sorrow other things. And so we know we chose for my mom to very bad options with respect to how to manage this pandemic. And the economic implications of that have been anything but trivial. And I think it's going to take far longer for us to sort of, I'll say both the merge, but more importantly stabilized to whatever is this next phase of what the United States and the globe looks like. And so we can't ignore the economic impact, the socio-economic, the mental health and physical health impacts of what we had been through. And we do need to attend to the science. But we also have to figure out how do we safely even thinking about our pets be back, right, that seems some minor when you consider the service industry, the supply chain disruptions in a number of other things that are the impacts of losing significant and important family members. There are so many other things so we're going to need to think about and then all the, the pent-up demand where we're seeing chronic disease. Come back to our doors and patients being in far worse shape than they were a year and a half ago. So there's so much to think about and that's one that I hopefully remember on the go forward. And at the same time, no regrets and don't second guess, we have to just keep moving forward. Then articulation of those values that I figure it out on that walk and how we apply them to thinking about how are we going to manage the work place, how we were going to manage our financial reality and our worries about our financial reality, how we were going to manage opening, re-opening Craig, and then they, they've just been in invaluable this idea of letting your values and an articulation of your values. Dr. Decision-making. Decision-making. My window is wonderful. I get to look out, say hi to people, sorry about that. There were folks waving. When I tell him I was in the middle of a lecture. So nonetheless, articulation of the values. This is an interesting little story. I'm going to quickly tell you the story. When I was in the Indian Health Service in to the City, Arizona, I used to go to a little seal clinic and I get in this like one of those two senior a little prop planes, the propeller blades pilot would fly me Winslow, Arizona to this field. And there will be times in that little plane where the turbulence was just unbelievable. And yeah, it's terrifying. And I sort of figured out that I look over in the pilot was really cool about and remember even talking to them at 1, he said it's just like a bumpy road. It's just like a bumpy road. And I realized that there's something calming about the person and the lead seat in this case, it was the pilot. If he wasn't panicking, I wasn't going to panic either. And so one of the more important things for leaders to do at a time like this is don't panic. You can drink more if you need. You can find those quiet places to share your concerns. You can share them in the rooms. What those of us when we're in the middle events and it can read. But you can't let people see us in any kind of ongoing way because the minute we don't have, you know, sort of that steady hand on the till. It's not fake. And I mean, and, and a fake way. But really to look around and it was really important. It is important for leaders to look around and say, where is their solid earth? What am I telling myself that eight, so that I think is, so what, what are, what are the ways in which I know that there is a lot of normalcy still out there. And hold on to that. Because the minute you panic, the minute you show that you Don't feel as if we have a solid way forward. That's, that's the game. You sort of lost the game. So I think that so long as the pilot is it panicking, I want either. So that's my, that's that leadership lesson. But the reality is we're not done yet, right? I mean, I've got those 10. It'll be interesting to see if there are others that develop in the coming years. Maybe we've got vaccines, we thought we'd be out of this months ago. We thought, in fact, I write a CEO reflection many months at the beginning of my time here, I wrote whenever my pre-pandemic wrecked everything including that. And it's just whatever is on my mind. It's not about the finances of the quality. It's just sort of share a sort of my musings about what might be going on here at Craig out in the world. And back in January or February, I wrote one called Here Comes the Sun. And I use the lyrics from that wonderful Beatles songs talk about vaccines and when our walk had been like through different parts of this thing. And then here we came to the summer and I wrote one just recently called, where are we and how are we now? Because we don't know where we are historically. Histories to look back and just sort of begin helping people to have a sense of what's ahead and what are the things that I certainly try to use both of my personal life and in this life to, to help me sort of get grounded, to feel and sit on solid ground and walk through some of my thoughts about that. Because the political situation hasn't changed. We are now having a reckoning with the economic climate that we're living in. And the virus is still alive and well. So there's lots to do. And I think with all of that, one of the things that's super important and it's for, I think I'll end, is that the well-being of our teams are important. But I know more than anything else, my well-being, I've got the high despite what I said, sit in on that ball yesterday. Basement with the trainer about what do you think it about retirement? I don't plan to retire and I have to make sure that I take care of myself first, that whole security are on oxygen and asked me for securing others. And these are the things I think it requires that we hire staying connected. I am so grateful that I get to come to work every day. I actually don't think it's healthy for people to work a 100 percent from palm and blurs the lines between the two. But more importantly, we're social animals. And we need to be connected literally, physically, not just virtually. You have to stay physically active. Stay socially active carefully. I don't I still go home and mostly hide under the bed. After work that I do my creative pursuits. Nice. I try to be aware that whole idea of taking notice. It just means the world to me that people know they can pop into this office and ask for anything and there's nothing actually. So thank Laurie yesterday, is that your your your comment about therapy just does my heart good to know that the pet therapy is a good thing? Keep learning and more importantly, recognize that especially for thus privileged, That's not the case for and swaths of this country or this flow. Strong belief that we need to give time, give money, give talent, give both, give all three. If you Kat, there's, there's a generosity of spirit that fuels, kills us in ways that we can see and in ways that we cannot. And so I think those are the kinds of snakes I think that well-being requires with that Awesome Tom, can you just want to thank you for the time? I hope I'm part it a tiny bit of somebody close to wisdom, which mostly is about the people around me. The opportunity I've had to learn from them over many, many years and we're going to stop the share and we're all back together. So thank you. Thank you, Dr. Allen Davis. We are going to open up for Q and a portion. We've got about 15 minutes. So if you have a question, I'm going to set our security now to where you can unmute yourself and ask a question. Or you can also type a question in the chat if you like, or feel free to raise your hand and I'll call on you whenever we can get to you. So if anyone has a question they'd like to ask first. Thank you, Your Honor. Thank you, Your Honor. Helpful. That's helpful. Team. I will ask a question, especially like to let other people go first so that I don't dominate this today. I want to get to the question of intergroup relations. We've seen, we've always had tension around intergroup relations, particularly around race in this country. We need, we know we had a lot of work to do before the pandemic. We know we have a lot of work to do after the pandemic. It would be naive to think these will go away. Medially we're going up there, but it's also we can't be dismissed. It seems maybe we even more challenge with trust. Mutual trust being able to sort of come together with good spirit and trust each other today than we did two years ago. Do you think that's true? And how does that affect your leadership and how do you deal with that? So I do believe it's true. I think personally one of the best things in satellites are relatively recent shift I'd made as I stopped watching as much news. I think I think it's not really news. And I think that's certainly part of it. Now back to the sort of more racial and all the inequities that exist in our community there. The last summer when Mr. Floyd was killed, needless to say, abrupt everybody's world, but certainly those of us of color, probably more than others. But to actually watch somebody literally be killed in front of the world was a super jarring to, to be actually emotionally pretty devastating thing. Craig Hospital is an interesting place and I knew that as three years to go. And I can then because there's me pretty much the middle segments of this 1000 employee base Hawaii until you get to those who clean and cook. That's why you see the brown faces. And I said you're going to need to deal with this at some point because we're not necessarily a reflection of those we serve are the communities in which we work. And it felt a little radioactive to even think about it. How are you going to do that? And then when Mr. Floyd was killed, obviously, it's a door that opened, created the opportunity for a conversation. And we started. I can remember people saying We need to put a message down and it's like we span with you analyze and when you've done it as it, first of all, if anybody comes over here, we're going to pull the covers back. Notice the Rayleigh you've got work to do here. And I was very honest with the teams about that. I said we're going to take our time and we're going to learn. Now we're going to get to know each other and we're going to get connected on this. And we started in last August with what I called a listening tour, as it were, with groups of ten people in circles and be at the recommendation of one of our board members who is, as it turns out, and inclusion, diversity, equity and accessibility expert, she said, keep the group separate by race and ethnicity, which made me a little uncomfortable, but I said, okay, and it was all about trust. And the, the, the, the not at all surprising given mission and purpose and who I know our teams are. These were issues that boy, folks here we're dying to talk about and had been for years wanting to. They, they knew this was not for many in particular for the younger ones who came from other communities. They said This place is odd. This isn't how most other places I've come from. Well worked in luck. So we started there and we talked about the patient experience and what they were seeing on the floors and and then really then set shining castle on the hill. Tell me what you want Craig to look like in five to ten years. What are some of the things we already talked about? We started that way and we're starting our journey and learning as much as anybody else, right? I do participate in a few things around town with CEOs who are working on this within their own companies. I do feel we are maybe making some progress that way. But I'm super clear about a couple things. One, if we'd figured out how to do this, we would have done it long ago. And the second is I am not an expert at this. I am learning as much as anybody else's. And there's something about just being honest about it that opens up the opportunity for conversations. So this year, it's one of our hospital-wide goals to work in this IDS space IDEA's space. And we're starting with the articulation and identification of work that we want to accomplish in five areas. The first is help equity, because when you look at that, there's a disproportionately overrepresentation of Caucasian Americans relative to who gets hurt, the proportionality of who suffer spinal cord and brain injury by race and ethnicity. So there's something there that we need to unpack can get real about. And I don't think it's just insurance status. And that's a and it's but it's it, but if it's anything, it's implicit bias helps to do with this whole idea of what's a great discharge plan. And to what extent is that sort of firm has some bias in it that we need to unpack that health equity as one. Our workforce. We know we've got lots of work to do. And what's our role around pipeline development? Are we recruiting for talent that come work in our therapies where we know we had a challenge statement, the middle of Denver or medulla, Colorado, because it isn't a particularly diverse place, although that's changing our learning agenda. We have a lot in the space to learn and we're going to learn it together. Vendor and supplier or city, you want to have some percent of all of our purchase services that are wrong or purchasing from minority and women-owned businesses. And the last one is using our community voice well through advocacy for people of color, but also people who sit at the intersection of these disabilities or any disability. And race or gender or those sorts of things. So we're just starting the journey like everybody else, the announcement. And I think that it's fed in math so far with some two things I'd say. People are welcoming at daylight guy like a certain patient to see what we can only get done. Any other questions for Mr. Gibbs? Are you there fo fo Jami Johnson, Dr. Johnson, constant. Excuse me. There we go. Okay. Great. Thank you very much for this presentation and you've certainly describe what it's like to lead in some of the leadership qualities. And that was busy taking pictures of your presentation as you were talking. So I appreciate your insight. I teach the leadership course for our masters of public health students and their professional development. Then so do you have any further than what you talked about today? Do you have any advice or resources for the future public health leaders? Just places to get started. Now. So aside from what I say today, I, I, I, um, people well, I was at Kaiser Permanente for 24.5 years for committing a crime. And that last decade, I was purely in administration after practicing for 25 years. And one of my responsibilities was all our community health initiatives. Kp has a big, big focus on the social determinants. And one of the voices, frankly in that whole space, if I can be really can't, but that was missing was public house. And I feel like there were some, many issues and not just sort of lakes. We're going to solve obesity by same way we saw smoking or cleaned up litter sorts of things. But really, uh, somebody held leadership roles in, in a very intentional and forward way around the public health of this nation and even the explaining what it needs. I think in some ways, and this is what I'd say to folks. And that leadership class in some ways, public health can be viewed as the Ministry of NO. And it may be a how do you become the Ministry of yes. Right. I remember back when I had that opportunity and I can't remember the name of the organization, but it's the association of deans and program managers and public health. I forget what the name of that association had a chance to, to speak on a panel and take, for example something that I thought, is there some unifying? And this is back when we were dealing with all sorts of things. But at the time was very focused around specialty care access for those either in rural areas or even those who are socioeconomically disadvantaged. And to view that as a public health issue. How would you frame that in a way that the public health across the nation takes that on. So I think one of the things that, that wouldn't be really good for folks to think about this. How do we reposition ourselves? How I freedom? But it is not the Ministry of don't do but do, do heart and then way of saying it kinda way. I don't know if that's helpful, dr. Adjusted, but that's when I'd bring up. No, that's great. Thank you. I appreciate that. Thank you very much. Someone's asking the breakdown it causes the spinal trauma. Yeah. Great. It's a really great question. I actually want it came over here and it's my Isenheim, right. I think, et cetera. A Ryan I suspect. A DRM Isenheim or I remember when I came home he said, How in the heck does an OB-GYN end up running a Mockingbird? A neuro rehabilitation hospital. It's just the most wonderful thing about life and what's, what can I uniquely break? I think it is using our voice in two places. First of all, Craig and I said Craig has this incredible, not just national but global reputation both in research and clinical care. Neuro rehabilitation. We should be using that voice to prevent these injuries. Me, we need to get into the prevention space because nobody These are no, I said this place disjoint, well, we do have phenomenal miraculous work. Nobody wants to come here. I love nothing better than to figure out a way to put us in a completely out of business. So we have stuff that we've done some advertising campaigns like that or seasonal know to answer the question around us, what are the injuries that we see about path, nearly half of the injuries that we see are motor vehicle accidents that cause either spinal brain or combination of the two. About the next group. So that's about 30 percent or false and those could be false at work or falls at home. As Florence her actually the least common, it's about 12, 15% are sports-related injuries. But the third most common is, sadly, it's medical, either misadventures or no neurosurgery Steiner on things that happen under anesthesia that where people suffer anoxic brain injuries are no others. Things that you couldn't predict did my central cord issues or other cervical stenosis, those sorts of things. So the biggest is motor vehicle accidents and we need to be getting out there and doing more work. That had been the plan until COVID changed, sucked all the oxygen out of the room, but we did do a series, are going to do more around the big skiing place. They had a great advertising campaign that ran there and we have done some stuff, one tentative or inattentive driving somewhere of that. So that's one. But the other place where we want to use our advocacy voice is actually on behalf of disabled communities. No excessive built the ADA, which muscle? You know, something that I didn't pay as much attention to for sure I can tell you until I got here. It sad and think that it just cast in 990, 390 journey when you think about it and it is necessary, but it's hardly sufficient for what's really required. We're working now with a home builder, national home builder here to talk about the notion of inclusive design. This idea that all boats rise with the tie. We know the whole story of curb cutouts. You what that actually why they're cut out but who actually benefits? Who all able-bodied or other photos benefits from curb cutouts. Inclusive design enables us to begin to think about aging in place, which then has important implications for our aging populations. If we were thinking about it from the beginning. So we're starting some conversation to insert that are builder who is nationally headquartered here in actually the business was begun here. And I'm pretty excited to see what could come from that in terms of these really brilliant or professionals that work here around community reintegration. And our thinking constantly about home modifications and other things that we should be thinking about from the time we build homes, for example. So that's again, using our voice to advocate. We recently found out that the US Forest Service has forbidden e bikes on their trials. Well, okay. I get it. That trashes trails that you just now have eliminated for that group of people with a bell with a disability or who are differently abled, the ability to enjoy our parks, if that's the only way that they can get out or their trails. So it's those sorts. Some are done, some work in that space, some absolute around Davis. Just for interrupting. I want to just alert you that Dr. Hsu Cole, who's on this call Here's a national expert on spinal cord injury and I hope you and she will reach out to each other after this because I think there's a lot you could do to help each other. That would be really good. Thank God that Chris Barnes is just free who's not on this call, but as part of our faculty, just received a grant work on many of these things you're talking about, about commute, design and aging. And I'm asking Amy to connect you and Dr. Barnes. After this, we have time for about one more question. And do we have someone to talk to you about Mr. Gibbs to well, we can't hear you there. Yeah, there we go. Thank you, Dr. Allen. I'm I've been throughout my career a student of leadership and I currently serve as our Assistant Dean for Student Academic Affairs. I have always tried to find that balance between challenge and support. I'm a huge horse racing fan and I've often made an analogy. You gotta figure out what kind of courses underneath it as to how much you want to let him run or how much you want to encourage him along, maybe with a little quick body, the eyes should hit the horse. But how do you how did you find balance between pushing folks and sitting back? Well, first of all, I say exactly what you just said is that, you know, there's there's this E-U stress and then there's Stress, know, so true stress, which helps us be motivated. I have a strong, strong belief that most of us are done. We are wired for continuous improvement. And you can improve as long as things are comfortable. You'll find codling to use a phrase. Or in fact, one of the things I know that I brought to Craig was less of a paternalistic sort of way of running things. Where everything was taking care of. The teams never saw the finances, the teams never heck, they certainly were accountable for their budgets, but they never really had to engage in, in terms of the overall organizational health. When I think that's that creates a kind of dependency that is beyond unhealthy and actually puts, puts I think organizations at risk. And so the way that I do it is back to that whole notion that tell the truth and be as transparent as you can in an appropriate way. But not to the point where you have people scared to death. And I think we've done a good job of that over this pandemic and also asking their opinions on things. And then the hardest one for me when should make us would have been, well notice and as a dot gets exactly difficult because we're not wired. This way, is to really think about, am I going to write a book one day? It's going to call everything I ever learned about leadership. I learned at the feet of my patients. One of the things that the first chapter I think it's called, It's all about the relationship. And the second one though is dead. The doctors are good coaches and I think good leaders say that coaches TO. And in the coaching spirit, I have to and animals play a game with myself. How can you take this problem that's just come to your door because somebody is wanting you to solve it and ask the right questions that put them on the path. And so it's a game I play with myself and they've had to do over the last decade or more because otherwise I'm going to walk out with way more monkeys on my back than I can handle. Gigantic actually hold let alone really know how to solve. And I think most people know how to solve their own problems are given the right kind of facilitation. So yeah, we're not any of us. Thank you very much. I love the idea of the questions. I had a difficult parent to talk with a little bit later today, so I'll have some questions. Yeah. I remember asking I remember when I first got my vice president job and Kaiser Permanente. So I left the permanent decided during the health IT side has to be P a government external relations. And then eventually took the Research Unit 2. I went to one of my friends slash mentors to as a VPN after a few weeks on the job. And I say Kerry, I can I ask a stupid question. And he said he said They're out and obviously there are bases, There's no stupid questions. They said, Well, what precisely device President's do? And he said, your job is to be the question. To be the question. It's not to be the answer. And I certainly from this chair, I can't get a 30 year career in any of us. Most of the stuff that's going on around here, I wasn't hired to do neuro rehabilitation are and all that entails. My job is to try to eyeball I said event to inspire, to model the way to remove the barriers and to ask really hard questions and try to stay in the realm of systems thinking and draw the connections and connect people, connect ideas, connect circumstances interesting is essentially to, to sense make. And then out of that since making to bring people along. So and all of that sounds very dilettante ish, but I also know what I'm supposed to be a player coach. And I signal when I'm being a player coach, because I can't learn it. Learn quite a bit over the last three years. But sometimes a docs joke and say, Do you want to take we can call out of the business. Thank you very much. That is a wonderful closing to a wonderful session. Background, Davis, we're so grateful that you've joined us. Amy, thank you for your superb organization. Stella, thank you for your superb introduction. Thank you everybody for joining us and wants are our trial and Davis. Thank you for your leadership. Thank care. Thank care. Really shallow. Well, keep doing what you're doing. We need to Hubei, anybody ALL.
Dr. Chavonda Jacobs-Young
Administrator, U.S. Department of Agriculture's Chief Research Agency
November 9, 2021
Noon–1:15 p.m.
Description of the video:
Well, welcome everyone. Good afternoon. It's a nice day and November and brand and how Assistant Dean of operations or the School of Public Health. Thanks for joining us for our colloquium series for November. And this session is being recorded. So just keep that in mind. I'd like to now pass the presentation to the Nadir Alison. Awesome. Thank you, sir. Here there are few things I enjoy more. Meeting with old friends and listening to wise people tell me about good ideas and we're going to have the opportunity to do all those things. Dr. Shivani, the Jacobs Xiang as an old friend, she has a wise, sage, interlocutor, a good scientist, and she's got good ideas. I'm not going to belabor her introduction because we I'm Dr. Carmen tech way it was going to do the formal introduction. I will simply say that it's a thrill to have Dr. Jacobs Jiang Here. She is a true leader in the field. The field of food is so important to all public health. Food is so much more than simply a statement of the molecules in nutrition. Food is family, its culture, its commerce, it's the economy, it's tradition, its history, its safety, agriculture. It's the sustainability of our planet. It is cuisine, it is art. It is so much more. And so what Richard topic could we explore with one of the major leaders of the USDA? We're so lucky to have her here. Now we are also lucky to have Dr. Carmen tech way here. Dr. tech way is a nutrition researcher and a biostatistician. She is an Associate Professor of Epidemiology and Biostatistics here in our own Department of Epidemiology and Biostatistics. She's also a good friend and a good interlocutor and a wonderful scholar was doing very well with her NIH grant applications. Good collegial team player, couldn't imagine anybody would want to have more to do this introduction of an important nutrition scientists than our own important scientist, Dr. Carmen. Carmen floor is yours. Thank you. Some ISD now and then try the introduction. Good afternoon, everyone, and good luck to your colleagues and friends. Welcome. Alice mentioned my name is Dr. calming tech ray alignment, Associate Professor in the Department of Epidemiology and Biostatistics here and our IU School of Public Health. I am honored to be here today and to also introduce our November colloquium speaker, Dr. Shivani, the Jacobs young Dr. Jacobs neon has served as the Administrator for the Agricultural Research Service, IRS, at the US Department of Agriculture since 2014. Previously, Dr. Jacobs Young had served as areas Associate Administrator for national programs where she led the National of the Office of International Programs. And prior to move any to her roles that ARS Dr. Jacobs young served as the director of the office chief scientist at USDA. Whereas she was responsible for facilitating the coordination of scientific leadership across the department to ensure that research supported by and scientific advice provided to the department and external stakeholders were held to the highest standards of intellectual rigor and scientific integrity. She also served as the Acting Director for USDA's National Institute of Food and Agriculture. Dr. Jacobs Young has also served as a senior policy analyst for agriculture. The White House of this of Science and Technology Policy, where she supported the president's science advisor and officers within the Executive Office of the President on a variety of agricultural scientific activities and worked across the federal government to improve inter-agency cooperation and collaboration on high pry priority scientific issues. Now, I want to thank you all for being here this afternoon. And I also think cute. I also would like to ask you to join me in giving Dr. Shivani Jacobs neon and very warm virtual SBA each. Welcome. Thank you. Thank you. Dot the takeaway and hello, and thank you for inviting me to join you today at Indiana University Bloomington School of Public Health. Now, I wish I could be there together with you in person. And if we were together, I'd ask you some questions to get to know my audience. So I wanted to give this a try virtually. So today I'm gonna talk to you from my perspective as an agricultural scientist. And if you feel inclined to do so, please use the chat. So let me know your area of expertise. Per se. The chat button is like the mute button. It moves every time. Okay. Count the age. I can love that healthy aging. But Dean, Yes. Absolutely. Whoa. Okay. To have some nutrition experts in the audience today? No, no fact checking okay. Nutrition of his creativity and measurement error by statistics. All right, a registered dietitian and nutrition and obesity. I love it. David Allison, rigorous statistics and nutrition and obesity. All I love it. What an impressive audience, Environmental Toxicology and human health. Thank you. All right. What, what an impressive audience. So let me just start by saying, yes, keep on coming. This has been quite a week for me. I'm joining you today after testifying yesterday morning in front of the Senate Committee on Agriculture, Nutrition and forestry and consideration of my nomination to be Undersecretary for the USDA Research, Education and Economics mission area. So you, I think that I will feel more relaxed today, but I do not. Because the day I was speaking in front of B, David Allison. I'm David and I have partnered over the years on scientific integrity and rigor and research. I know firsthand of his stellar reputation, so I've got it. I'll have to tell you all, you are extremely fortunate to work with Dr. Alison. Now, it may not be obvious, but every day at the agriculture research service and a USDA, I go to work with thousands of public health professionals, some of soil scientists, some economics, economists, accountants, policy experts and other roles. But from my vantage point, we are all working to improve the quality of life for America has through the food we eat. 0 is at the heart of our mission. There are six human nutrition centers under my leadership at ARS, each with a slate of research projects unique to their mission area or region. Two of the interests, the children's nutrition research center at Baylor University in Texas and Arkansas, arkansas Children's Research Center focus on stage startup life, nutritional. We know how important those first 100 days arm. While bosses Jean Mayer and Human Nutrition Research Center on Aging examines the role of nutrition and physical activity on promoting healthy and active aging. I think about it most of us, low Smithson in almost 30 years and retirement and how to eat healthy to have an active, high quality of life as we age is very important. The balanced steel Maryland facility is the oldest and most comprehensive about the nutrition research centers. Examining the relationship between our EDA decisions and overall health as functions of age, gender, ethnicity, and grant Forks, north Dakota. The goal is to identify fools and dy is coupled with genetics and physical activity that sustain them and remote health throughout life. Now, by the way, Grand Forks also has a project you may want to check out after this talk today because it's answering an age old question. Why is it so difficult to stop eating chocolate? Seriously, check it out very scientifically based. So finally, in Davis, California, the Western Regional nutrition center is study of many things include and how foods prevent obesity and chronic disease. Sounds a lot like public health, doesn't it? So research in food production encompasses just about every physical science discipline. And it also deals with social sciences like economics in psychology, and education. Combating food is security in America and around the world requires a whole science approach. And there's a particular need for more public health scientists to join us in addressing these challenges. Six years ago, in 2015, the United Nations committed to ending hunger, food security, and malnutrition by 2030. It sounds like an astronomical go, but it isn't. We know this is dual pol, the science is there. In fact, a lot of the science is here at the USDA. Greatest challenge is that the world's population is expected to increase to nearly 10 billion people by 2050, we will all need to eat. And that gives us only 29 growing seasons to figure out how to feed nearly 3 billion more people. To drive that number whole day is like adding one to three times the current population of the continent of Africa to the planet. Not convinced by future risk. We can talk about struggles we have with hunger and food insecurity across the world right now. The Food and Agriculture Organization, FAO of the United Nation repo, I say globally in 2020, between 720 to 811 million people faced hunger, meaning they had limited access to nutritious food. Or routinely wit a day or more without eating. They also report this 660 million people may still be food insecure in 2030. 660 million people is nearly double the population of the United States. Now let's talk about the United States. Let's talk about here at home. According to the USDA Economic Research Service. And 2020, 38.3 million Americans lived in food insecure households. Didn't have nearly everyone in the entire state of California what hungry? That's the enormity of the challenge. 6 quite 1 million children allele lived in food insecure households in which children, along with adults were food insecure. And we know therefore our children, when they are hungry is hard to learn, to discover, to be creative. And while hunger and other out Rosa, poverty tend to predominate in lower income neighborhoods as well as security is everywhere. Hunger and food insecurity may have different, have many faces. Many of us are familiar with the images so far away that we see on television how the hunger, security may very well, not like someone you know, your neighbor, your coworker, your classmate. Now Mayawati, more convenience and dollar stores open up in lower income areas. They have few offerings of perishables like fruits, vegetables, and dairy. And then it's no coincidence that the preventable diseases that kill the most Americas caused or exacerbated by what we eat. I know that now growing up, I didn't recognize the impact this had on my own family. I know medical terms like heart attack, diabetes, stroke, kidney disease, and hypertension. Long before I knew they were the culprits that took my loved ones away from me. Growing up. My mother ATE, is she ate what her mother ate before her. Males seeking culture. Boys by creativity to Tara, well, we could afford until a family meal in LA Georgia household. I'm certain that most of you could listen to me and know that I am not from Washington DC. We fry everything and we ate cake speed and Karl agrees with handbags, macaroni and cheese and Grady lastly, the last great all I have to stop because I'm getting hungry. Eat breakfast. Oatmeal was taught with butter, evaporated milk, and sugar. So it's hard for me to believe that my boring cut oatmeal today with one single pack a Splenda used to be this GUI oasis of deliciousness. You know, I never met my maternal grandmother. She died before I was born just 50 years old. My children never met her son, my father and their grandfather. She died from colon cancer, discovered too late for life-saving treatment three days before the birth of this first branch out. He was only 51. My maternal grandfather and grandmother died in their fifties from heart disease. My maternal uncle, my mother's sister and brother also left us in their 50s, although they're it was kidney disease. We lost my job earlier this year at age 50 to COVID, but she was vulnerable because of multiple other health issues. I am now older than many of my direct ancestors weren't when they got. And despite all I do to try to minimize them, I have my own your concerns. I was 20 years old when I was diagnosed with hypertension. Not only that, but I was also five foot, ten inches tall, 120 pounds soaking wet, and a division one track athlete. So let me tell you Alhazen shape. But I had a genetic predisposition for hypertension. Had I known what I know now, I may have been able to ward off the hypertension. Who knows? What knowledge is power? And with my diagnosis, I learned if I wanted a higher quality of life, I needed to make some changes. I myself with information on my condition and how to take care of myself. Likewise, I had to share my knowledge with my loved ones. My mother I'm happy to say, is now 76 years old and going strong. She's been retired 21 years. She's a retired registered nurse. Ball was a whole without changing her. Book it on diet is one highly effective way to address chronic conditions. And this is a heartbeat, heartbeat place for agriculture, nutrition and public health to come together. See an excellent opportunity gone for, for scientists to better integrate nutrition and public health does good things can happen with the nutrition and public health communities where it together, we can enable America is to live longer and healthier lives. Maybe more made a women can be around for the birth of their Anki. It's like my mom, I invite you want to check out the agriculture research service. It's a pretty great place to work if you love science and I might go every morning knowing that I'm helping to feed the world. Now, I hope each of you have a happy holiday break next week. If you're lucky enough to share some time with your family and loved ones, talk to your loved ones about their yell. Because you are no or very family member, you are the special family member who goes to the University of Indiana School of Public Health. And your words matter, especially when it comes to public health. So thank you again for inviting me to join you today. I am looking forward to engaging with you in a Q and a session, and so I hope that we can start that now and I'll turn it back over to our host. Thank you, Dr. Jamestown by Aida nested NG is a PhD student at Purdue University and Health Sciences. Welcome from Purdue, joining us today. And I'd like to give them the floor to ask the question. Yes. Hi, my name is Eden to their easy. So my question is, are there any solutions or interventions to ensure that good nutritions are provided to underrepresented communities? Yes. You saw in the Department of Agriculture, we are a huge department and we provide a number of critical programs to support health and nutrition for many, many communities and especially communities that are subjected to food insecurity. And so we, we have programs like the the snap program, which is used to be called the Food Stamps program. And it's the snap program and it provides important support for purchasing of healthy foods. We administered the food, the women, infant and children program, that's week. We also do the school lunch program. So we have many big, big programs that are critically important to feeding people. And as psi, as agencies were very fortunate. Remember I talked about a six nutrition centers that those programs are based on science and data driven approach. And so we get an opportunity to work across IT department with those, with those organizations and also those agencies. We recognize that there are there are lots of opportunities to, to use the support that we can make available to communities to be able to create a healthier lifestyle for it, for all of those Americans. Thank you. Thank you for your question. Next we have Dr. Rich hold them, Professor and Chair of the Department of Health and Wellness Design Irish. Well, hello everyone. Hello.com. Thank you so much for your presentation. You know, you talked a lot about access to food versus food insecurity. And one of the things that I've noticed in some of the food and security research that we do is that it's not just having food, is having healthful, nutritious food. And a lot of times, even in a food shelf for food pantry items are not nutritious. Or at least if you, if you, you know, you have to be very careful to finding nutritious foods to provide for your household, as opposed to calorie dense foods that will kind of get you through the day, right? I wonder how you think about the delivery and provision. Nutritious food versus just, you know, chlorine can pick whether we can do both some time. So so you know what I didn't talk about a lot today was nutrition SDK yard, right? Because you have this situation and the America, we already implement some, some children who are food insecure and don't get enough calories in the day. And we deal with some portion of our population who are obese, who get enough a lot of calories, but they're not thy rich, dense calories of nutrition. So we are also talking to Latin Department of Agriculture about nutrition as security and nutrition their security. And some cases I think it's important because at USDA also has what we call the extension service. You guys may have heard of the extension service in and we partner with the land-grant universities. And so we have education. A number of the changes that are going to be effective will also require outreach and education, training. And because it's not enough to say this, this way you should do in some cases, we really have to look at behavioral economics as some of the social factors to figure out how do we increase the adoption of the guidance. For example, I know what I need to do in order to eat healthy and that might want it to live this way too. I know how to get started and my disciplined enough to stay with the Do I know, you know how to implement it for my lifestyle, et cetera, et cetera. We have to do more than just say if this is what you should do, we have to do what? Outreach, education and engagement around it. And for example, my sister was not a small person. But she was terribly nutrition is secure. So but if she went to medical profession, they will see her. And just as she was extremely eating a lot of food and she was not, but she was always nutritionally, I would say below where she needed to be because she could not swallow for some ten to 15 years. And so what she ate with beings that she could comfortably eat and not just always advised her to do. And so I just felt that, you know, we have obesity. You can be obese and be lacking in nutrition. Excellent. Thank you so much. And now we have that Dean David asked him that question in our awesome. Sure. Well, first of all, thank you very much for those astute remarks. Really appreciate that. Will certainly encourage our best students who are going to be moving on from IU to consider careers in the USDA of you. We're actively recruiting both at the student and the faculty and staff and at the leadership level in every department, including nutrition. So I hope you'll send us some great PhD students and some great faculty and so on. But that's not my question. My question is this. We know and frequently hear about breaches in trust in science and people are not sure who they can trust. Turns out that the Pew Charitable Trusts, which publishes a server, and this shows that trust in science overall is actually pretty high in trust and scientists overall is actually pretty high. But interestingly for nutrition, trust in practicing dietitians and medical doctors who dispense nutrition information is high, but trust and nutrition scientists is lower than for practicing dietitians and medical doctors, and lower than for other scientists. What do you think is going on with trust and nutritious charged per shirt, and how can we make it better? What David, I don't have a specific answer to. I don't have an answer to this specific question. It's an interesting dynamic, isn't it? One of the things that we've, we've worked to do an ARS is to provide more people access to nutrition centers. And I can't even count how many people are shocked by the science, by the pause that we use to measure body mass by the, the high-tech equipment about the feeding studies and all of that science that goes behind it, right? And so one of the things that I think we can and I want to help with. That's why we open our laboratories up for people to, to learn more. Is that increase in a transparency of the science that goes behind the nutrition guidance in the information that we're delivery. I know what each one of our six songs, nutrition incentives, we do human subject. We have participation from the community of feeding. And in some of the studies, they get an opportunity to see the inner workings of it. And I think maybe we need to increase the transparency and maybe involve more people and on the science that goes behind the guidance that we're providing. Intimately interested in being in DC, we have an opportunity to albedo out a wide variety of people. Nevertheless, capable decision-makers. You have staffers, you have political appointees, you have a number of people who have not had an opportunity to see and nutrition center and an unjust and see how it works and what we're doing every day. And so I don't have the, you know, I don't have the acid to this dynamic between moose, the difference in trust. But I do know that we can do more in terms of increasing the transparency on how we conduct the science. Or dirt turnkey. Excellent. Thank you, Dean Alison, we have three participants and the queue right now. So next is Aaron Hussein, graduate student and be Anthropology Food Studies program here at IU. We'll go have a theorem. Welcome error. All right. Thank you. And I just want to say thank you, Dr. Alison for that last comment. I am a registered dietitian as well, so that is not dealt big interest as mine. Previously before this, I was in school nutrition where he's actually based in Texas. So I understand completely when you're talking about and I kinda is based on my question of a lot of food and what brought me back to school is so much of food is tied to our identity in what we eat. So how have you found either in personal or professional finding that balance of promoting helpful food while also still being able to incorporate identity of food. So, so this is interesting because my children who have grown up in Seattle and in Maryland, you know, they're eating whole wheat bread and healthiest, there's a green healthy vegetable at every meal we're broiling pork chops me know, we're doing these things that, you know, that I'm doing drastically different than when I grew up. In though on next week for Thanksgiving, I will use. And evaporated milk, a real, you know, macaroni elbow noodles and not the whole week version and not the dude Joe, fat-free milk in the macaroni and cheese. It's HMO. So it's been interesting. It's still you to enjoy a number, the blues that I enjoy growing up, but in a healthy way. And, um, and then when they go to Georgia to my mother's house, I still remember the first time my son hey, why grades as we would call it like breathe in Augusta, Georgia. And he was like, wow, why is this enough? He loved it. He just like, why does it only every whole wheat bread? And so I believe in everything in moderation. That's, that's what I believe. You don't even have such a social social experience, right? In my household, part of our tradition was to have dinner together every day. And that was it. That was important because now my children on our way and I'm hoping that that tradition was was something that they take with them. How do you hold on to your culture? And do it in a healthy way is something that I've been practicing for a long, long time. And they are really trying to teach. My mom knew new things like THE try to feed these UDL likable Nietzsche tries of base. You really deal like, you know, unsolved. It's interested in I'm educating my mother, who is a registered nurse in my senior, but I'm really help in her learn how to eat healthier. And so what can you do to still enjoy some of those things, but do it in a way that's a bit healthier like the oatmeal. Thank you. I really don't. They she needs to butter. You know, I don't like DCTs, this sugar, but I guess I can ask her to give up everything. But this is kind of like you take baby steps because I wanted to be around a long time. Thank you so much. Now it's just on a call this morning. We were talking about registered dietitians. And we're tough because when you're talking about no new efforts around, I'm bringing together the agricultural public health around nutrition is all around nutrition. And try and look at the different facets of the industry to see where are the right places to kind of bridge, to make that bridge. And so registered dietitians came up in that conversation that we're going to be like, and I know NIH is still work in this space. The USDA is going to be doing work in this space. And I do think is the wave of the future. We're looking at precision nutrition and USDA. We have a new partnership with Texas A&M. And what we see is that the metrics don't know, aren't always reflective of many segments of the population. And so how do we be more inclusive? You know? And so I'm very excited by that project gets a new when it's a new a new project between USDA takes the Zane I'm, I'm very excited about that project to look at more sub-populations to ensure that we are representative of those populations. Thank you, Lauren. Thank thank you, Aaron. And Aaron, thank you for the very visible person in a part of the community. Many cases he had not. It helps a lot. The right. Next we have David chlorophyll is an adjunct professor with the School. David, whoa, whoa, whoa. Pose. Here. So I congratulate you first on your testimony yesterday. I'm probably the only one else here who actually saw you up on a screen. Lock to Jake is Young had real strong bipartisan support from both political parties on the heck centered at committee. In contrast to her colleague who was being interviewed for the chief of civil rights at USDA, who I don't think perform nearly as well. To. Davis always gave me a child would sell data Alice and solve this issue date. I misnamed. Thank you. So one of the things that became clear was that have at least half the senators who were interviewing you were asked you, how are you going to spend more money in their state? So what I want, but in execution bond it is, how are you going to convince USDA leadership when you're the Under Secretary for Research to spend more money on research in the department. Because research is really such a tiny part of the budget of USDA overall. You know, you mentioned the feeding programs. That's three quarters of USDA's appropriation from Congress. And is there some secret that you've gotten your back pocket to convince the secretary and other leaders in the department that research needs to be increased just the way NIH is going up, left and right. While, at least in the nutrition program, you know, are real inflation adjusted dollars or where they were 40 years ago. Well, so David, you've been around a while and what are the things that I'm excited about? Is that the President, both the secretary and the breath and half size right at that, at the quest of their priorities. And so backside, so that's that's the first step. The first step. We are in a position to be extremely impactful on the priorities that have been outlined. We talk about feed and more people. We all, we gotta do all of it and protect the environment in response to climate change. So we gotta, you gotta, it's not one or the other. So we get all this important work to do. And I'm very excited at both. The president, secretary have outlined the role as science will play. And saw you Here we are as, as the science agencies be an ally with these priorities in Alice, say am I in my time and leadership, I haven't, I, and experienced this before. And so what I like to say is, let's, let's, let's give it some opportunity. Let's see what happens. I think there we can give a lot to contribute a lot to the priorities. And, um, and I think that part of that begins with telling us stories that, and we know this, we're not, we don't do a great job of communicating the impact of our science and we have to do a better job. And so that's part of my role. You know, I've been doing that since 2014 for ARS and now I get an opportunity to do that across the RE ignition areas. Back to the nutrition science lab. You would all know the science that goes behind it. We have to be more transparent. We also need to be loud and clear and advocates of the work we do not just in IT and USDA ARS, but in Indiana pop up Public Health, School of Public Health. We need to be talking about this is how the science has helped. A, B, or C. We've got to be great communicators. Let's just take an air for nod their head every now and then, you know, I've been I've been told to stop, not am I here, but this adjoint if they I can help it, you know it, but we have to be better story. Tell us. We have to continue to show I am Pat and I believe that we're going to see the size agency show up in a huge way though the next couple of years. And so, I mean, history has shown us that innovation, science, and discovery been the key to meet you. We won't be able to do about without science and innovation. Sounds you're taking tough question, David. Thank you. Thank you, David. Next There's coffee warlike post-doctoral fellow. There are four microwatts. Thanks Brandon. I wanted to come back to you. Point and transparency. So excuse me. I know you were involved in that. You'll see scientific integrity consortium together with Dean House and another so kudos to you. And you work on that. And I just wondered, Are there specific projects, efforts are funding opportunities within USDA that The you'd like to highlight the work to support or that increase in transparency and rigor in nutrition and agricultural research. Yeah, So yeah, I'm very proud of the work we did with the scientific integrity consortium. I'm currently serving on a White House scientific integrity pay a strike action committee. We have a report that should become an outburst soon as we look across government and the role of scientific integrity, I had an opportunity to lead the development of the first scientific integrity policy flutter Department of Agriculture many years ago. So there is a lot of work around scientific integrity. Our secretaries committed to scientific integrity. It's really, really important in terms of transparency. What we've done in ARS, As we've created mechanisms to be as open as we can with the, with the publications that result from the federal scientists, what the data says that support those publications were making as much of that information publicly available online. We have a site called PLA bag. I'm not sure how many people have ever been to Nepal bag. We have a data com is where we keep all of our data sets. We have worked with, with iPhones to create the brand of food Database. A number of those, those tools are publicly available. And so that's that's our that's our effort to really have some transparency around the work they were doing. In ARS. We've published thousands of papers every, every year. And in the poem part, is it that, that's not the end, the store he just get in the publication. And so we're working very hard to make sure the best shared broadly. Anya and scientific integrity is something I could probably talk all day about is just, it's really, really important to end on. We do training in USDA, especially in our science agencies. And not just the scientists who conducted studies, but even the Administrative Officer has a short version of the scientific integrity training because people need to be aware of what that means. Believing that, that we, we didn't have a common definition is when I taught that certain groups we're talking about, we're not talking about the same thing when we say scientific integrity here. So we're talking about in some other groups, they talk about scientific integrity. And for us it's more like research, misconduct. So there's a This, there's not necessarily a straight line when we talk about scientific integrity, but all of it is an effort to improve the quality of the work to ensure that the American people can trust the science that we're conducting. So it's all, it's all good work. And I was scared to speak in front of data, which has, I know David is has an ability to look at some projects that are really rare. Red line. Okay. And I said, Oh no, no, no, no, zygote, a speaker Brent am today. So I try to touch on anything I feel he realized, well, I really enjoy working with David on it in a couple of spaces. So it's been it's been a good husband, good work. Mutual. Thank you. Thank you. Coby. Three more questions in the queue right now. Next is ROM trackway. Lot of our host, Dr. tech wave Associate Professor. Hello again, Dr. Jacob. Thank you so much for your talk. I really enjoyed listening to you and hearing of your experiences. I had when I come back to the topic of race, ethnicity and age and Howard influence, what we eat. And the question I have for you is, we have these recommendations. We are for what people should be eating to be healthy, you are to have optimal health. Do you think that we need two of these recommendations should be the same for everyone? Or do we need to have more recommendations, some more targeted recommendations? That's a that's a great question. Thank you, Dr. segue. So I mentioned the Tufts School of Nutrition Center for Aging. And they don't work. For example, they have a my plate for an age of population, right? And so I have an eight-year-old son, you know, place don't look the same. You know, cal caloric intake needs aren't the same. And so that is the, that is the one of the sole purpose of having these six different nutrition sentence with six different facets of this of this, of this conversation. And I believe that, you know, like I said, my mom, they're retired 21 years. And so how do you then and a lot of us who are going to be in that position. How do we eat, boy, healthy quality of life there we can reduce the impacts of our chronic diseases. We can petition Lord a cost to the health care system that I don't want to put it. We can enjoy both 21 years. Right. Because that's what we're outward. I'm the only dude as a working towards but I am not work and has started to retire, not be able to do anything. And so I think it's really important when we look at programs, my thoughts and their website is amazing. If you have never been to the toughs website. I know then my mom use it it uses a number of pieces of the information for someone her church, outward reach when a missionary work, because it's just palatable to just download it and use. And that's what I think we have to do. We have to kinda reach people where they are, right? So having a message coming from somebody you know, somebody you trust, I think also goes along way. Yes. And yes, I believe that we have to be more targeted and desk lamp the topics like precision nutrition and increasing the inclusion of pocket other populations up all know about their worries. So populations, other populations in our matrix is in our conversations I'd be necessary sovereign poet. Thank you, Carmen. Thanks. Jasmine, June 2009. Dr. She's also a post-doctoral fellow, context scholar, Dr. Jacobs Yang, thank you so much for your talk so, so far. So my question is about the research and community nutrition. So we see a lot of nutrition education. And as you said, a research on telling people what to do and what to eat and community nutrition. And usually pushing for eating more fruits and vegetables for people of lower socioeconomic status. So my question has actually three parts. First, how impactful do you think it was kind of research is? And if you see any room for improvement in those kind of research, how we can change the direction of comedian nutritional research to have, to have more impactful and sustainable research, especially for those who are on limited, more limited research budget because not everyone has millions of dollars to to do the research. And The last part is, how do you think we need to measure the impact to know whether their research, It's actually impact who would have committed nutritional research has actually impacts which are not. And so, so thank you for that question dot there. And those are the types of questions that I would ask my, my, my experts like the clerk, the elites who were, who was almighty if because I'm not an expert in nutrition. And those are the type of questions that are scientists and leaders across the agency work on every day. And I just an ARS but also on Economic Research Service to talk a little bit about behavioral economics, right? So why do people make the choices they may? How do we increase the adoption of the guidance and bow reach? And what type of intervention techniques work best are incentives of effective? Those are the questions that the researchers are answering. And, um, and so you just outline a lot, a lot of questions that I think that we have experts working everyday, China has adults questions. I know that we were when I look at some of the studies that have been conducted on those in the sticks nutrition centers. It's just really interesting to see that that's exactly what they're doing. So maternal infant, the maternal nutrition status during pregnancy and gestation. And how did that impact, you know, that the child those are the types of studies that those six nutrition centers I do write every day. And so if you have a specific age group or life cycle, I'll face it you're interested in I I, I encourage you to go to the website and if they don't disclose who else I reach out to one of the scientists, especially if you're a bulls-eye, you know, we're always looking to hire good people. Sorry David. Seriously, there do us some exciting, exciting work. I was in. Tough, probably the spin a pandemic solid sphere maybe three years ago. And they were doing a study on social, social interaction and mobility on aging. And just do really what's the impact? Do we see a difference if people, you know, just socially exercise are, you know, what type of changes can we make to brain function based off, you know, certain types of foods. That's where those both what those results you see in the news come from those types of studies. And so we're doing that every day. And I am, I am dependent on people. I don't declare fields who are experts in globally reputable in this area. Excellent. Thank you for your question. And the last question goes to a doctor, Nana Miller, who is Associate Professor and Applied Science. And Anna, Thanks Brandon. Hi Dr. Jacob. Thank you for a really nice discussion and I really appreciated some of the things you were saying about nutrition education. And the question I have is to do with childhood obesity and the recent increase in children with type 2 diabetes. And so I work in that space and I'm trying to come up with nutritional solutions for these children. But where I struggle is research, translation. How to get the, you know, these poems, these ideas that I have in terms of how to improve children's eating behaviors to actually be implemented. And so I was wondering if you, since you know what all the programs that are going on in terms of research, can you tell us about potential programs at the school level where they can help children have a better understanding of nutrition and even food preparation, how to purchase and cook food. I mean, just like we used to have an HMAC, I feel like yeah. More. Right? Yeah. I mean, I know they have to compete with so many other things in terms of their learning. But I feel like that is a fundamental way to get children to adopt eating behaviors. And can you tell us any work that's being done in that space? Well, so and so Dr. Miller, I'm certain there's lots of programs, MS. Space, and working through the land-grant university system with the experiment stations in the education experts. This, this, the, the program set up, for example, the school lunch programs are run out of food and nutrition service, which is Santa missionary called Food and Nutrition Sciences mission area. So I know that there are lots of programs. I remember the day my son as much as his mom is working in agriculture, but his elementary school, they grew day on guard and they were able to eat the foods that they grew themselves. And they're way more impact than all of the healthy food out. Put it on Friday. Yeah, I'm into that day because he was so proud that this F bar in the bedded, they got to enjoy it. And so I'd be that that that is indicative of something that I know had impact on at least once. And so when I'm looking for, you know, what, what are the most impactful interventions? And I will tell you we have in another space, not the nutrition space, in the climate space, we'll establish 10 climate within USDA. We have five in the iris and five that are operated by the Forest Service, but we're partners and army right side. We publish thousands of papers every year. And in a climate alone in 2018, we published 500 your papers and that the desk somewhere between 6800 this past year. We pay farmers and producers to go out and read those peer reviewed papers that I would be asking a lot to read them, digest them, and turn them into usable tools and information. That's the role of the climate. And so they take all of that for research, all of that. You knew God is I came out and then they convert it into palatable bytes. So they have producers and consumers can take that information and they don't have to understand what's working under it. They need. Then I'll get a tool, maybe an app on the sale fall. Maybe, you know, it's a model where, for example, in California, there, they're dependent on snowmelt for their water, for agriculture, we can predict how much water they've got on the snow melt. But it's like, I guess it's like Microsoft 365 for me and he says want to open it up and use it. I don't need to know who wrote the code and everything else, but somebody understands how the word. But so that's the role of the pilot loves to just take that information and do that outreach, extension, and education to really help people be able to actually apply it. Because in ARS we like to say we don't do research for research sake. I really should be addressed and a huge challenge and provided a practical solution. So I know that didn't answer your entire question. But I will encourage you to take a look at the Athens yes. Mission area on, on the USDA website. I think you'll see a lot of programs really to find it. I know that was when trying to connect farm, local farms to schools, et cetera. And so, you know, just take a look at those programs. And more importantly, pick up the phone and call somebody or send them an email me and I'm sure they'd be happy to talk with you. That's you know, that's, that's part of our, our roles is to really connect and communicate with the, with the, with the American people. So I pick up the phone column, email. And David knows our Navy nosy abiding Athens. Yes. So you can also yeah, I'll send an email to data clear for we missed I declare fields so much. I tell you he is, he was he was a valuable member of our team and suddenly do this and great. Thank you, Dean House, and that concludes all the submitted comments for the Cuno. Well, I simply want to then end by saying thank you. Thank you. Thank you. Let me say thank you to Brandon and pay me and Patricia and everybody else who pulled this event together, so well, let me say thank you to all of you who attended. Let me say thank you to Carmen for that wonderful introduction. And let me especially say thank you to show Rhonda for joining us, for sharing your insights with us. I know that she has are gregarious, open person. And so I know that if you have more questions or ideas or suggestions or you want to we want to introduce you to people or projects with mechanisms. Reach out. Yes. She'll be there like the song search. Yeah, absolutely. That's yeah, certainly. And and I'm just going to say it just says David Allison had a huge blog. Last year. We hired 770, over 1700 people than ARS and will still look into higher self are all at a pulse stocks out there to consider in the future, you know, consider at some time in public services at the federal, as a federal scientists, we would love to have you and so you can declare field in, out and get some insights on what it's like to be an ARS scientists. But we would love to Happy. Wonderful. Thank you. Well, it remotely the auditors. Thank you.
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