String Theory (Hex One of Epidemic + BBZ Darney) “Currents” Music Video

String Theory (Hex One of Epidemic + BBZ Darney) “Currents” Music Video


String Theory “Currents”
String Theory Cuts by DJ Tha Boss Verse 1
Atrocious tactics to host the masses, behold the madness
We roast the halfwits as cold as cats that holster ratchets
With open caskets for these hopeless bastards posed as rappers
Explosive tracks could make my pulse as fast as ocean rapids
Traverse the unknown expose the atlas My verses uphold subversive drum rolls to
mold the path with Too bold to catch it, so you worthless clones
get shown what wrath is And all below the average actors will get
blown to ashes So watch me settle scores as I relinquish
the snobs With english my linguistics could extinguish
a stellar core A top physician could not incision these metaphors
That’s why my efforts for impressive bars is effin’ raw
The lion that not even Noah could lift up Got an aura like Jehovah from scripture paranoia
gon’ grip ya Rats hide before this flower come get cha
Raps tighter than a boa constrictor (Nigga you know what the deal is) Chorus
Yea, yo I’m that awesome force That’s sure to knock you spitters off your
course Strong winds bring the tide in, to soak you
with the blend we’ve been providing and flood the mental
state you kids reside in Verse 2
I’m the poster child for the folks that wild We invoke the crowd so get a close up now
before I ghost the style The string theory smear sentences sincerely
‘Til kids hear me and give me millions of spins yearly
You been weary I bring merely that bomb shit You sing nearly in every song clearly theres
conflict Really its garbage all that sob teary eyed
soft shit Is nonsense I’m lost why do ya’ll see me as
conscious When I’m just a regular man on a secular plan
For grands trying to stay ahead of the lambs Yo I’ll be writing these incredible jams until
my skeletal sands And niggas read my shit with retinal scans
This one goes out to unforgettable fans who study my lyrics
With grit until they and sever all their cerebral strands
I spin the globe to any sensible land and rip a show
I’m fina blow just like a chemical plant you niggas know Chorus
Yea, yo I’m that awesome force That’s sure to knock you spitters off your
course Strong winds bring the tide in, to soak you
with the blend we’ve been providing and flood the mental
state you kids reside in

The Childhood Obesity Epidemic

The Childhood Obesity Epidemic


>>>GOOD MORNING, EVERYBODY, AND
WELCOME TO THE TENTH PUBLIC HELD GRAND ROUNDS. IT’S UNBELIEVABLE. I WAS JUST TALKING TO A COUPLE
OF PEOPLE A FEW MOMENTS AGO THAT TEN MONTHS AGO WHEN WE STARTED
THIS, WE COULD BARELY GET PEOPLE TO COME IN BECAUSE THIS WAS
GOING TO BE ANOTHER TALK AND SERIES OF WHATEVER. AND RIGHT NOW, WE’RE HAVING
PEOPLE COMING TO US AND WANTING TO GET THEIR TOPICS ON THE
AGENDA BECAUSE THEY UNDERSTAND THERE IS GOING TO BE A LARGE
NUMBER OF PEOPLE AT CDC AND EVEN LARGER AUDIENCE OUTSIDE OF CDC. SO LET ME JUST SAY A FEW OH
OBLIGATORY AND COUPLE OF OTHER WORDS JUST TO REMIND EVERYBODY,
BECAUSE WE GET THIS QUESTION ALL THE TIME, THAT THIS COULD BE
VIEWED BY EVERYBODY WITHIN CDC. IT’S ON OUR INTRANET ON THE
DIRECTOR’S PAGE. BUT ALSO, IT CAN BE VIEWED BY
ANYBODY WHO HAS INTERNET ACCESS ANYWHERE IN THE WORLD. AND WE ARE GETTING, REALLY PROUD
TO SAY, MORE AND MORE VIEWERS OUTSIDE OF CDC. THE LAST TIME, IT WAS RECORD
BREAKING CHLAMYDIA. YOU CAN DRAW THE — WHATEVER
CONCLUSIONS YOU WANT. OVER 14,000 PEOPLE WATCHED US
LIVE OUTSIDE OF CDC. AND WE ESTIMATE THAT IT’S
ANOTHER 1,000 PEOPLE WITHIN CDC, SO THIS WAS RECORD BREAKING. SOME OF YOU WHO MAY HAVE BEEN
HERE REMEMBER THAT, YOU KNOW, OUR AUDIENCE IS GETTING BIGGER
AND BIGGER AND THIS WAS LIKE AFTER A FEW MONTHS, WE HAD
MASSIVE CROWDS. THEN WE WANTED TO MOVE TO THE
JON STEWART SHOW AND SOMEHOW THAT DIDN’T, LIKE, WORK OUT. AND SO NOW WE’RE ATTACKING THE
YOUTUBE. NOW, THIS ONE IS NOT WISHFUL
THINKING. I WOULD LIKE TO INTRODUCE VERY
QUICKLY SHANE JOINER. SHANE, WHERE ARE YOU? WHERE IS HE? HE STEPPED OUTSIDE. OH, THERE HE IS. COME ON IN AND WAVE. I REALLY WANTED PEOPLE TO SEE
WHO HE IS. SHANE IS NOT THE YOUTUBE GUY,
BUT THE PERSON WHO DIRECTS SO MANY ASPECTS OF THESE EVENTS
FROM MEDIA COMMUNICATIONS, POLICY, EVERYTHING ELSE. AND HE IS THE ONE WHO IS GOING
TO MAKE IT POSSIBLE. HE IS WORKING WITH YOUTUBE
PEOPLE TO HAVE US BE ON THEIR — SO THAT WE CAN BE CLICKBLE AND
THAT YOU CAN ACTUALLY WATCH US THROUGH YOUTUBE. AND HE EXPLAINS TO ME THAT THAT
IS BETTER BECAUSE WHEN YOU SEARCH FOR THE GRAND ROUNDS, YOU
CAN BE MUCH EASIER TO FIND US AND ALSO BECAUSE OF THE
CAPACITIES OF THEIR SERVER, IT’S GOING TO BE A BETTER RECEPTION. SO I WANTED TO RECOGNIZE SHANE
FOR THAT KIND OF WORK. ALSO, WE HAVE BEEN POINTING OUT
A RELATIVELY NEW ACTIVITY THAT’S BEEN GOING ON FOR ABOUT A YEAR,
AND THAT’S THE SCIENCE CLIPS, WHICH ARE NOW COORDINATED WITH
THE EVENTS ON THE ROUNDS. AND SO HERE, I DO WANT TO
RECOGNIZE DEB PRELUSCA, FOR HER SELECTION OF THE OBESITY TOPICS
OF THIS WEEK. WE ARE CONTINUING WITH THE
CONTINUING EDUCATION CREDITS. THOSE WHO ARE INTERESTED, PLEASE
GO TO THE WEB PAGE AND MAKE SURE YOU CAN GET CREDIT FOR BEING
PART OF THIS. WE ARE ALSO CONTINUING WITH
SUBMITTING OUR EDITORIALS OR COMMENTARIES. THE FIRST ONE CAME A COUPLE OF
MONTHS AGO ON TOBACCO. WE JUST SUBMITTED ONE YESTERDAY
AND IT WAS ACCEPTED ON RADIOLOGICAL AND NUCLEAR
PREPAREDNESS. AND OUR NEXT ONE IS GOING THE BE
COMING SOON. SO ALL OF THESE ARE TURNING INTO
PUBLICATIONS. THIS IS THE LIST OF TOPICS
COMING UP IN THE NEXT FEW MONTHS, SO PLEASE STAY TUNED. AND SINCE DR. FRIEDEN IS NOT
HERE TODAY WITH US, BUT HE IS WITH US IN SPIRIT AND TRUST ME,
ON E-MAIL, AND WITH COMMENT, VERY INTENSIVELY, WE’RE GOING TO
HAVE A FEW TAPED COMMENTS FROM HIM. >>TODAY WE’RE GOING TO TALK
ABOUT ONE OF THE MOST SEAR WHY YOU EPIDEMICS IN THE U.S.,
OBESITY. OBESITY COSTS ABOUT $150
TRILLION A YEAR TO EAT. IT’S LINKED TO AN UNHEALTHY
ENVIRONMENT THAT INVOLVES OVERCONSUMPTION OF SUGAR, SALT
AND FAT. CHILDREN ARE PARTICULARLY AT
RISK. AS YOU’LL SEE IN THIS SESSION,
CHANGING THE FOOD ENVIRONMENT IS CRITICAL TO EMPOWERING AMERICANS
TO LIVE HEALTHIER LIVES. THE FIRST LADY LET’S MOVE
CAMPAIGN REPRESENTS A FANTASTIC OPPORTUNITY TO MOBILIZE EVERY
SECTOR OF SOCIETY TO HELP FAMILIES MAKE HEALTHIER CHOICES,
IMPROVE NUTRITION IN OUR SCHOOLS, INCREASE PHYSICAL
ACTIVITY AND EXPAND ACCESS TO HEALTHY AND AFFORDABLE FOODS. REVERSING THE OBESITY EPIDEMIC
IS A LEADING HEALTH CHALLENGE OF OUR TIME. KEY ROLES FOR CDC INCLUDE BETTER
UNDERSTANDING THE EPIDEMIC AND HELPING STATE GOVERNMENTS AND
LOCAL COMMUNITIES TO IMPLEMENT AND RIGOROUSLY EVALUATE
PROGRAMS. THANK YOU. >>AND SO WITH THAT, WE’RE GOING
TO BURST THE BUBBLE OF OUR SPEAKERS. BETWEEN TOM AND ME, WE’RE GOING
TO TELL YOU EVERYTHING YOU NEED TO KNOW. THE NEXT THING THAT I DO WANT TO
MENTION IS THAT OBESITY HAS ALWAYS BEEN AN IMPORTANT TOPIC,
OBVIOUSLY. NOT ONLY FOR THE PEOPLE WHO ARE
WORKING ON THIS. BUT A COUPLE OF WEEKS AGO, ON MY
BIRTHDAY, JUNE 2nd, OUR CURRENT SURGEON GENERAL ACTUALLY HAD AN
INTERVIEW IN JMI AND POINTED OUT THAT PHYSICAL ACTIVITY, OBESITY,
NUTRITION IS ONE OF HER TOP PRIORITIES. AND THEN YESTERDAY, AS I WAS
DRIVING HOME, LISTENING TO THE NEWS, I HEARD ABOUT PRESIDENT
BILL CLINTON’S HEALTHIEST SCHOOL INITIATIVE IN GEORGIA. AND ACTUALLY, THEY WERE SAYING
— AND I PICKED IT UP FROM THE WEB THIS MORNING THAT
THERE ARE SEVEN SCHOOLS IN GEORGIA THAT HAVE BEEN
RECOGNIZED IN ATLANTA FOR ALL KINDS OF ACTIVITIES THEY HAVE
BROUGHT TO IMPROVE HEALTH AND OBESITY AND NUTRITION IN SCHOOL. SO THIS IS REALLY MORE THAN
TIMELY AGAIN THAT WE’RE TALKING ABOUT THIS. NOW, AS WE HAVE MOVED OVER TIME,
WE HAVE HAD MORE AND MORE WOMEN PARTICIPATING IN THESE EVENTS
AND AS I ALWAYS SAY, WOMEN RULE. SO HERE IS A SPECTACULAR TRIO OF
WOMEN WHO WILL BE TALKING AND GIVING THEIR PRESENTATIONS TO
YOU TODAY. BUT HOWEVER, YOU ALWAYS HAVE TO
HAVE SOMEBODY COORDINATING THE EVENTS. AND SO, YOU KNOW, OUR
COORDINATOR OF THE DAY AND THE IRONMAN OF THE DAY IS BILL
DIETZ, WHO IS THE KEY PERSON FOR OBESITY, NUTRITION AT CDC. SO ALLOW ME JUST TO SAY WHAT WE
WILL BE DOING IS YOU WILL BE HEARING, YOU KNOW, 01 ON
OBESITY. WE WILL MOVE TO WHAT THE
CHALLENGES AND OPPORTUNITIES ARE. BILL WILL ADDRESS THAT. WE WILL HAVE JUDITH BELL TALK
ABOUT BIG CHANGES, POLICIES AND SYSTEM CHANGES THAT ARE NEEDED
TO MOVE THINGS. THEN, AS DR. FRIEDEN SAYS, WE
WANT TO SEE HOW IT IS ALL DONE AND HOW IT ALL FITS WHEN IT
COMES HAPPENING AT THE STATE LEVEL. SO VICTORIA ROGERS IS GOING TO
CLOSE WITH THAT. SO I AM INVITING OUR FIRST
SPEAKER, CYNTHIA OGDEN, TO COME UP HERE AND I CAN GOING TO GET
YOUR SLIDES GOING. >>GOOD MORNING. MY NAME IS CYNTHIA OGDEN AND I’M
WITH THE NATIONAL CENTRAL FOR HEALTH STATISTICS. MY CHARGE TODAY IS TO LAY THE
GROUND WORK, TO SHOW WHO IS OBESE, DEFINE CHILDHOOD OBESITY
AND DISCUSS THE CONSEQUENCES OF CHILDHOOD OBESITY. WE ALL KNOW THAT THE LEVEL OF
CHILDHOOD OBESITY IS HIGH IN THE UNITED STATES. IN FACT, BASED ON MEASURED DATA
FROM THE NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY, WE
KNOW THAT 12.5 MILLION CHILDREN AND TEENS ARE OBESE. ALMOST 12.5 — ALMOST 17%. THE RATE IS TWICE AS HIGH AMONG
ADULTS. 34% OF ADULTS ARE OBESE, ALMOST
73 MILLION MEN AND WOMEN. OUR FOCUS TODAY ON CHILDHOOD
OBESITY, BUT CHILDREN EVENTUALLY BECOME ADULTS. AMERICAN ADULTS ARE, ON AVERAGE,
24 POUNDS HEAVIER TODAY THAN THEY WERE IN 1960. DIABETES, A SERIOUS CONSEQUENCE
OF OBESITY, AFFECTS 23.5 MILLION OR 10.7% OF AMERICAN ADULTS. MORE THAN HALF OF THESE
INDIVIDUALS ARE OBESE. OBESITY REFERS TO EXCESS FAT
TISSUE, BUT THIS IS IMPRACTICAL TO MEASURE, CLINICALLY OR IN
EPIDEMIOLOGIC STUDIES. CONSEQUENTLY, EXCESS WEIGHT FOR
HEIGHT, WHICH IS EASY TO OBTAIN, IS USED AS A POROSITY FOR
OBESITY. THE MOST WIDELY USED INDEX IS
BMI, BODY MASS INDEX, DEFINED AS WEIGHT AND KILOGRAMS BY WEIGHT
PER METERS SQUARED. BMI DOES NOT DISTINGUISH BETWEEN
BODY FAT AND MUSCLE. USING BMI IN CHILDREN IS MORE
COMPLICATED THAN USING BMI IN ADULTS. UNLIKE IN ADULTS, THERE ARE NO
SET RISK BASE CUTOFFS IN BMI USED TO DEFINE OBESITY. AND THE BMI IN CHILDREN VARIES
WITH AGE AND SEX MORE THAN IT DOES IN ADULTHOOD. SUBSEQUENTLY, A STATISTICAL BMI
IS USED. CHILDREN’S BMIs ARE COMPARED TO
A REFERENCE POPULATION OF THE SAME AGE AND SEX. IN THE UNITED STATES, THE
REFERENCED POPULATION USED IS THE BMI FOR AGE, 2000 CDC GROWTH
CHART WHICH REPRESENTS THE U.S. POPULATION FOUR DECADES AGO. CHILDREN AT OR ABOVE SEX
SPECIFIC 95th PERCENTILE ARE CONSIDERED OBESE. THOSE IN THE 85th TO 96th
PERCENTILE ARE CONSIDERED OVERWEIGHT. TODAY I AM USING THE 97th
PERCENTILE AS A CUTOFF FOR SEVERE OBESITY. CHILDREN BETWEEN THE 5th AND THE
85th PERCENTILE ARE CONSIDERED HEALTHY WEIGHT. TO BRING THIS DISCUSSION BACK TO
ACTUAL CHILDREN, HERE, YOU CAN SEE A CHILD CONSIDERED A HEALTHY
WEIGHT USING THE BMI FOR AGE DEFINITION. THIS CHILD IS CONSIDERED
OVERWEIGHT. AND THIS CHILD IS CONSIDERED
OBESE. BMI IS NOT A PERFECT MEASURE OF
BODY FAT. YOU SEE HERE THE PERCENT OF
GIRLS WITH EXCESS BODY FAT WITHIN BMI CATEGORY. OBESITY IS CLEARLY ASSOCIATED
WITH BODY FAT. THE MAJORITY OF GIRLS IN THE
OBESE CATEGORY HAVE HIGH BODY FAT. IN THE OVERWEIGHT CATEGORY,
HOWEVER, MORE THAN HALF OF U.S. GIRLS DO NOT HAVE HIGH BODY FAT. MOREOVER, THERE ARE SIGNIFICANT
DIFFERENCES IN BODY FAT BETWEEN RACE ETHNIC GROUPS OF THE SAME
BMI LEVEL. AFRICAN-AMERICAN GIRLS ARE
SIGNIFICANTLY LESS LIKELY THAN NONHIS PANIC WHITES TO HAVE
EXCESS BODY FAT IN THE THREE BMI CATEGORY. THIS DIFFERENCE IS PARTICULARLY
STRIKING IN THE OVERWEIGHT CATEGORY. A SIMILAR PICTURE IS SEEN AMONG
BOYS. TURNING TO OBESITY TRENDS, WE
CAN SEE A RAPID INCREASE IN THE PREVALENCE IN THE 1980s AND
1990s. THE PREVALENCE OF OBESITY AMONG
CHILDREN AND TEENS TRIPLED FROM APPROXIMATELY 5% TO MORE THAN
15% IN 20 YEARS. DURING THE LAST TEN YEARS,
HOWEVER, THE RAPID INCREASE IN PREVALENCE SEEN IN PREVIOUS
DECADES HAS SLOWED. IN FACT, THERE WERE NO
SIGNIFICANT TRENDS IN OBESITY PREVALENCE AMONG CHILDREN AND
TEENS. UNFORTUNATELY, AMONG BOYS 16 TO
19 MONTHS OF AGE, THERE WAS A SIGNIFICANT INCREASING TREND IN
SEVERE OBESITY. THE PREVALENCE OF SEVERE OBESITY
ROSE FROM 9.3 TO 15.1% OVER THE LAST DECADE. THE HEAVIEST BOYS ARE GETTING
HEAVIER AND THIS WAS DRIVEN BY AN INCREASE AMONG NONHIS PANIC
WHITE BOYS. SIGNIFICANT DISPARITIES EXIST. HIS PANIC BOYS AND
AFRICAN-AMERICAN GIRLS ARE DISPROPORTIONATELY AFFECTED. COB TEAR TO POPULAR OPINION, THE
RELATIONSHIP BETWEEN SOCIOECONOMIC STATUS IS NOT
CONSISTENT AMONG RACE AND ETHNIC GROUP. AMONG WHITES, THERE IS AN
INVERSION ASSOCIATION. FOR EXAMPLE, A SIGNIFICANT
INVERSE RELATIONSHIP EXISTS AMONG NONHIS PANIC WHITE BOYS,
BUT NOT AMONG AFRICAN-AMERICANS OR MEXICAN AMERICAN BOYS. THE BOTTOM LINE IS THAT OBESITY
IS A CONCERN FOR OUR ENTIRE POPULATION, NOT JUST BEFORE. THE LEVELS ARE NOT DIFFERENT
AMONG THE MIDDLE CLASSES COMPARED TO THE POOR. THE COSTS OF OBESITY HAVE
INCREASED DRAMATICALLY IN THE LAST TEN YEARS. ONE ESTIMATE PUT THE COST AT
$147 BILLION ANNUALLY OVER 9% OF ALL MEP MEDICAL COSTS IN 2008,
UP FROM $78.5 BILLION IN 1998. APPROXIMATELY HALF OF THESE
COSTS ARE PAID BY MEDICAID AND MEDICARE. THESE DATA SUGGESTS THAT OBESITY
IN CHILDHOOD PERSISTENT TO ADULTHOOD MAY CONTRIBUTE
DISPROPORTIONATELY TO THE COST OF OBESITY. IN THE SHORT RUN, CHILDHOOD
OBESITY CAN LEAD TO PSYCHO SOCIAL PROBLEMS AND METABOLIC
SYNDROME, HIGH BLOOD PRESSURE, HIGH CHOLESTEROL AND ABNORMAL
GLUCOSE TOLERENCE IN DIABETES. 30% HAVE TWO OR MORE RISK
FACTORS. ALTHOUGH THE PREVALENCE OF TYPE
II DIABETES IN TEENS IS VERY LOW, A RECENT REPORT ESTIMATES
THAT TYPE II DIABETES REPRESENTS ABOUT 15% OF NEW CASES AMONG
CHILDREN AND ADOLESCENTS WHEN IT WAS VIRTUALLY UNHEARD OF THREE
DECADES AGO. BLACKS, HIS PANICS AND AMERICAN
INDIANS ARE OVERREPRESENTED IN THIS GROUP. CHILDHOOD OBESITY HAS LONG-TERM
CONSEQUENCES. OBESITY IN CHILDHOOD TRACKS TO
ADULTHOOD. OBESE CHILDREN OFTEN BECOME
OBESE ADULTS AND OBESE ADULTS ARE AT INCREASED RISKS FOR MANY
HEALTH CONDITIONS, SUCH AS DIABETES, CARDIOVASCULAR DISEASE
AND CANCER. THIS RELATIONSHIP IS STRONGER IN
OLDER CHILDREN. ALTHOUGH THERE IS VARIATION IN
STUDY RESULTS, IN ONE STUDY, 87% OF OBESE ADOLESCENTS BECAME
OBESE ADULTS AND 39% OF THESE OBESE ADOLESCENTS BECAME
SEVERELY OBESE ADULTS. RISK FACTORS IN CHILDHOOD CAN
BECOME DISEASES IN ADULTHOOD. IN SOME, THERE IS A CHILDHOOD
OBESITY CRISIS IN THE UNITED STATES. ALTHOUGH BMI IS AN IMPERFECT
MEASURE OF BODY FAT, THE PREVALENCE HAS TRIPLED SINCE
1980. BUT THE RAPID INCREASE HAS
SLOWED. THE ONLY SIGNIFICANT INCREASE IN
PREVALENCE SEEN DURING THE LAST DECADE WAS THE PREVALENCE OF
SEVERE OBESITY IN BOYS 6 TO 19 YEARS OF AGE. HIS PANIC BOYS AND
AFRICAN-AMERICAN GIRLS ARE AMONG THOSE WITH THE HIGHEST RATES. CHILDHOOD OBESITY HAS SEVERUS
CONSEQUENCES, INCLUDING SIGNIFICANT FINANCIAL BURDEN,
INCREASES IN CARDIOVASCULAR RISK FACTORS AND THE PRECURSORS TO
DIABETES. AND OVER THE LONG-TERM,
CHILDHOOD OBESITY OFTEN TRACKS TO ADULTHOOD. THANK YOU. OUR NEXT PRESENTER IS OUR
COLLEAGUE, DR. BILL DIETZ. >>THANK YOU, CYNTHIA. GOOD MORNING. MY NAME IS BILL DIETZ. DISEASE PREVENTION AND HEALTH
PROMOTION. TODAY I’M GOING TO DISCUSS THE
APPROPRIATE BEHAVIORS AND TARGETS AND STRATEGIES TO
ADDRESS THEM AND SEVERAL EXAMPLES FROM THE FIELD THAT
DEMONSTRATES THE EFFICACY OF INTERVENTION AND PROGRESS BEING
MADE. THE SHIFTS IN BMI IN ADOLESCENCE
AS CYNTHIA DESCRIBED CAN BE ACCOUNTED FOR BY 110 TO 105
CALORIES A DAY BETWEEN 1988 AND 2002. THIS MODEST IMBALANCE LIKELY
RESULTS FROM MULTIPLE SMALL CHANGES IN ENERGY INTAKE AND
ENERGY EXPENDITURE. THIS PHOTOGRAPH SHOWS WHAT AN
AVERAGE AMERICAN OF FAMILY OF FOUR CONSUMED IN 1952. NOTICE THE ALMOST COMPLETE
ABSENCE OF PROCESSED FOODS. CONTRAST 1952 WITH TODAY’S
FAMILY SHOWN HERE WITH THE FOOD THAT THEY CONSUMED WITHIN THE
COURSE OF A WEEK. NOTE THE NUMBER OF HIGH CALORIE
FOODS AND LESS FRUITS AND VEGETABLES. THESE CHANGES REFLECT MULTIPLE
CHANGES IN THE FOOD SUPPLY, THE DECREASED COST OF FOODS HIGH IN
FAT AND SUGAR AS WELL AS A VARIETY OF FOODS. THESE FACTORS COMBINE TO
INCREASE THE INTAKE OF LESS HEALTHFUL FOODS AND REDUCE THE
INTAKE OF HEALTHIER OPTIONS. ALTHOUGH THE CHANGES IN PHYSICAL
ACTIVITY ARE HARDER TO DOCUMENT, THIS GRAPH SHOWS PHYSICAL
ACTIVITY IS PART OF DAILY LIFE FOR CHILDREN HAS CHANGED
SUBSTANTIALLY OVER THE LAST 40 YEARS. WALKING AND BIKING TO SCHOOL HAS
DECREASED WHILE CAR TRANSPORT HAS INCREASED. THESE SHIFTS REFLECT CHANGES IN
COMMUNITY DESIGN AS WELL AS CONCERN ABOUT CHILD SAFETY. TELEVISION TIME IS ALSO
ASSOCIATED WITH OBESITY. FOOD IS HEAVILY MARKETED TO
CHILDREN ON TELEVISION AND THE MORE TELEVISION THAT CHILDREN
WATCH, THE MORE LIKELY THEY ARE TO EAT WHILE WATCHING TELEVISION
AND THE FOODS THEY CONSUME ARE THOSE ADVERTISED ON TELEVISION. TELEVISION IN CHILDREN’S ROOMS
INCREASES TELEVISION TIME AND ALSO INCREASES THE RISK OF
CHILDHOOD OBESITY. TO REDUCE CHILDHOOD OBESITY, WE
BELIEVE THAT THE IDENTIFICATION OF CAUSES LESS IMPORTANT THAN
THE IDENTIFICATION OF EFFECTIVE INTERVENTION. THERE ARE MANY EXAMPLES IN
MEDICINE OF EFFECTIVE THERAPIES FOR DISEASE WHERE THE CAUSE HAS
NOT BEEN IDENTIFIED. FOR MAXIMAL POPULATION IMPACT,
WE SHOULD FOCUS ON POPULATION STRATEGIES THAT ALTER THE FOOD
AND PHYSICAL ENVIRONMENTS IN PLACES WHERE PEOPLE LIVE, LEARN,
WORK, PLAY AND PRAY. INTERVENTIONS AIMED AT SINGLE
TARGETS ARE UNLIKELY TO HAVE A SIGNIFICANT IMPACT. LIKE TOBACCO, MULTI SECTORAL
COMPREHENSIVE NEED TO BE THE GOAL AND RELY ON PRACTICE BASED
EVIDENCE. I WOULD LIKE NOW TO TURN TO NEW
OPPORTUNITIES FOR OBESITY PREVENTION AND CONTROL. THIS INCLUDES LET’S MOVE. LET’S MOVE ALSO INCLUDED
ESTABLISHMENT OF AN INTERGOVERNMENTAL CHILDHOOD
OBESITY TASK FORCE, WHICH ADDED CHILD CARE AND PREGNANCY TO THE
PILLARS OF LET’S MOVE. AN HHS HEALTHY WEIGHT TASK FORCE
IS DEVELOPING BROAD SECTORS AND YOU WILL HEAR FROM JUDITH BELL
ABOUT THE CONVERGENCE PARTNERSHIP. TWO OTHER PROGRAMS WITH FUNDS
FROM THE AMERICAN RECOVERY AND REINVESTMENT ACT PROVIDE KEY
LEARNING LABORATORIES FOR NUTRITION AND PHYSICAL ACTIVITY
STRATEGIES. THESE PROGRAMS INCLUDE
COMMUNITIES PUTTING PREVENTION TO WORK, WHICH PROVIDES 373
MILLION DOLLARS FOR 44 COMMUNITIES. 30 OF THESE COMMUNITIES ARE
FOCUSED ON NUTRITION AND PHYSICAL ACTIVITY. IN ADDITION TO THE 25 STATES WE
WITH ALREADY FUND TO ADDRESS NUTRITION AND PHYSICAL ACTIVITY,
A STATE AND TERRITORIAL INITIATIVE PROVIDES $120 MILLION
FOR ALL STATES, AND ADDITIONAL FUNDS FOR EIGHT STATES TO FOCUS
ON NUTRITION AND PHYSICAL ACTIVITY. THESE PROGRAMS PROVIDE
OPPORTUNITIES TO EXAMINE THE IMPACT OF INTENSIVE
INTERVENTIONS AT THE STATE AND COMMUNITY LEVEL. OUR STATE AND COMMUNITY PROGRAMS
ARE EXPECTED TO ADDRESS MANY OF THROUGH POLICY AND ENVIRONMENTAL
CHANGES. I WILL FOCUS ON INTERVENTIONS
THAT PROMOTE BREAST-FEEDING, REDUCE ENERGY INTAKE AND
INCREASE ENERGY EXPENDITURE. BREAST-FEEDING HAS SUBSTANTIAL
BENEFITS FOR CHILDREN AND REDUCES THE RISK OF EARLY
CHILDHOOD OBESITY. HOWEVER, OUR MOST RECENT DATA
INDICATES THAT ALMOST 30% OF MOTHERS CHOOSE NOT TO
BREAST-FEED AND ONLY ABOUT 40% OF INFANTS ARE STILL BRETT FED
AT SIX MONTHS OF AGE. A STUDY OF MOTHER’S EXPERIENCES
DURING THEIR MATERNITY CARE HOSPITAL STAY FOUND THAT THE
NUMBER OF BABY FRIENDLY STEPS THE MOTHER PRESENTED IN THE
HOSPITAL EFFECTIVELY PREDICTED HER BREAST-FEEDING DURATION. THESE INCLUDED EARLY
INITIATATION OF BREAST-FEEDING, GROOMING IN AND SEVERAL OTHER
STRATEGIES. NONETHELESS, FEW MATERNITY
HOSPITALS CURRENTLY SUPPORT THESE PRACTICES. SODA AND JUICE ARE THE BIGGEST
CONTRIBUTORS TO EXCESS ENERGY INTAKE IN YOUTH AND SUBSTITUTION
OF WATER TOER SUGAR SWEETENED BEVERAGES CAN REDUCE CALORIC
INTAKE A TAKE BY 255 CALORIES. HOWEVER, THE REDUCTION IN SUGAR
SWEETENED BEVERAGES IS ONLY A FRACTION OF THE TOTAL CALORIES
DERIVED FROM SUGAR SWEETENED BEVERAGES. STRATEGIES TO FURTHER DECREASE
THE INTAKE OF SUGAR SWEETENED BEVERAGES INCLUDE REGULATIONS
THAT ELIMINATE SUGAR SWEETENED BEVERAGES, THE INCREASED
AVAILABILITY OF FRESH WATER IN PARKS AND RECREATION FACILITIES
AND LOWER PRICES FOR HEALTHIER OPTIONS IN VENDING MACHINES. HALF OF ALL THE MONEY SPENT ON
FOOD OUTSIDE THE HOME IS SPENT ON FAST FOOD. SEVERAL YEARS AGO, DISNEY
CHANGED THE DEFAULT CHOICE FOR CHILDREN’S MEALS IN ITS THEME
PARKS TO FRUIT AND MILK WITH NO APPARENT CHANGE IN REVENUE. SEVERAL WEEKS AGO, 16 COMPANIES
THAT ARE MEMBERS OF THE HEALTHY WEIGHT COMMITMENT AND PROVIDE
25% OF THE U.S. FOOD SUPPLY ANNOUNCED THAT THEY WOULD CHANGE
THEIR PRODUCT TO REDUCE CALORIES BY APPROXIMATELY 12.5 CALORIES
PER CAPITA BY 2015. FINALLY, PURCHASING STRATEGIES
BY INSTITUTIONS SUCH AS CHILD CARE CAN REDUCE THE AVAILABILITY
OF HIGH CALORIE FOODS. THE RELATIONSHIP OF TELEVISION
TIME TO CHILDHOOD OBESITY APPEARS MEDIATED BY THE $800
MILLION THAT COMPANIES SPEND ANNUALLY TO PROMOTE HIGH CALORIE
FOODS TO CHILDREN. STRATEGY TOES REDUCE THE IMPACT
OF ADVERTISING INCLUDE LIMITING EXPOSURE BY REDUCING TELEVISION
TIME. THIS STRATEGY INCLUDES
REGULATIONS THAT LIMIT TV TIME IN CHILD CARE SETTINGS AND
KEEPING TELEVISIONS OUT OF CHILDREN’S BEDROOMS. COMPANIES THAT ACCOUNT FOR OVER
TWO-THIRDS OF CHILDREN’S FOOD AND DRINK ADS ON TELEVISION HAVE
AGREED TO LIMIT FOODS ADVERTISED TO CHILDREN IN AN AGREEMENT
KNOWN AS THE CHILDREN’S FOOD AND BEVERAGE ADVERTISING INITIATIVE. HOWEVER, ONE STUDY HAS SHOWN
ONLY MODEST SHIFTS IN THE PRODUCTS ADVERTISED. A WORKING GROUP CONSISTING OF
FOUR FEDERAL AGENCIES HAS RECENTLY PROPOSED MORE RIGOROUS
STANDARDS FOR FOODS ADVERTISING IN CHILDREN, BUT THESE HAVE NOT
YET BEEN FORMALLY RELEASED FOR COMMENT YET IN THE FEDERAL
REGISTER. PHYSICAL ACTIVITY PLAYS AN
IMPORTANT ROLE IN THE PREVENTION OF OBESITY AND CAN REDUCE THE
HYPER LIPIDEMIA AND ELEVATED PRESSURE ASSOCIATED WITH
EPIDEMIOLOGY EVEN IF WEIGHT IS BEING MAINTAINED. PROVIDING CHILDREN WITH SAFE
ROUTES FOR WALKING OR BIKING TO SCHOOL OFFERS AN OPPORTUNITY TO
REDUCE CAR TRAFFIC AROUND SCHOOLS AND INCREASE ACTIVITY. LIKEWISE, RECREATION OF PHYSICAL
EDUCATION POLICEMANS IN SCHOOLS PROVIDES A SAFE ENVIRONMENT IN
WHICH CHILDREN CAN BE PHYSICALLY ACTIVE. RECENT ANALYSIS BY CDC’S
DIVISION OF ADOLESCENCE IN SCHOOL BASED PHYSICAL ACTIVITY
HAS A POSITIVE IMPACT ON ACADEMIC PERFORMANCE. AN EXAMPLE OF A SCHOOL BASED
PLAN IN PHILADELPHIA INDICATES REDUCED TELEVISION TIME,
INCREASED PHYSICAL ACTIVITY AND INCREASED FRUITS AND VEGETABLE
INTAKE. THE INTERVENTION WAS BASED ON
CDC’S SCHOOL HEALTH GUIDELINES FOR NUTRITION AND INCLUDED
CHANGES IN THE SCHOOL FOOD SUPPLY TO MEET THE DIE TEAR
GUIDELINES FOR AMERICANS. THE TWO-YEAR INTERVENTION
RESULTED IN A 50% REDUCTION IN THE INCIDENCE OF OVERWEIGHT AND
A 10% REDUCTION IN THE PREVALENCE OF OVERWEIGHT. BOTH INACTIVITY AND TELEVISION
VIEWING DECLINED. IN SUMMARY, POLICY AND
ENVIRONMENTAL INTERVENTION SHOW EARLY EVIDENCE OF EFFICACY. NONETHELESS, WE NEED MORE
STUDIES OF IMPACT AND EFFECTIVENESS AND WE NEED TO
IDENTIFY AND VAULT PROMISING APPROACHES FROM THE MANY
EXPERIMENTS GOING ON AROUND THE COUNTRY. ALTHOUGH DECREASED CONSUMPTION
OF SODA AND JUICES IN SCHOOLS AND THE REDUCTION OF CALORIES IN
THE FOOD SUPPLY ANNOUNCED BY THE HEALTHY WEIGHT COMMITMENT ARE
STEPS IN THE RIGHT DIRECTION, THEY ONLY ACCOUNT FOR A FRACTION
OF THE CALORIE GAP ASSOCIATED WITH OBESITY. ADDITIONAL EFFORTS ARE NEEDED TO
REDUCE THIS GAP EVEN FURTHER. FINALLY, THE COMBINATION AND
DOSE OF STRATEGIES TO CONTROL CHILDHOOD OBESITY IS STILL
UNCERTAIN. HOWEVER, THE HIGH VISIBILITY
ACCORDED TO CHILDHOOD OBESITY BY THE LET’S MOVE INITIATIVE AND
THE STATES AND COMMUNITIES FUNDED BY COMMUNITIES PUTTING
PREVENTION TO WORK PROVIDE US WITH AN UNPARALLELED
OPPORTUNITIES TO REVERSE THE OBESITY EPIDEMIC. THANK YOU. IT’S NOW MY PLEASURE TO
INTRODUCE JUDITH BELL WITH THE POLICY LANGUAGE. >>GOOD MORNING. I’M JUTH YITH BELL AND I’M THE
PRESIDENT OF POLICY LINK AND THE PROGRAM DIRECTOR FOR THE HEALTHY
EATING, ACTIVE LIVING NATIONAL CONVERGENCE PARTNERSHIP. I WILL START WITH A BRIEF
INTRODUCTION OF POLICY LINK AND THE CONVERGENCE PARTNERSHIP AND
DISCUSS THE PARTNERSHIP’S EFFORTS FOCUS ON ACCESS TO
HEALTHY FOOD, BUILDING THE FIELD LOCALLY AND REGIONALLY AND THE
BLD BUILT ENVIRONMENT. POLICY LINK IS A NATIONAL
RESEARCH AND ACTION INSTITUTE ADVANCING ECONOMIC AND SOCIAL
EQUITIES BY LIFTING UP WHAT WORKS. WE PARTNER WITH EQUITY ADVOCATES
AT THE LOCAL, STATE AND NATIONAL LEVELS TO HIGHLIGHT BEST
PRACTICES AND CREATE POLICIES THAT BUILD A JUST AND FAIR
SOCIETY. BROAD, NATIONAL PARTNERSHIPS ARE
INSTRUMENTAL TO ACHIEVING EQUITY. THE CONVERGENCE PARTNERSHIP IS A
COLLABORATIVE OF SIX NATIONAL FOUNDATIONS AND HEALTH CARE
ORGANIZATIONS WITH THE CDC ACTING AS A TECHNICAL ADVISER. THE PARTNERSHIP SEEKS TO SUPPORT
AND FOSTER MULTI FIELD EQUITY FOCUSED POLICY AND ENVIRONMENTAL
CHAINGS CHANGE EFFORTS TO ACHIEVE HEALTHY PEOPLE IN
HEALTHY PLACES. POLICY LINK IS THE PROGRAM
DIRECTOR FOR THE PARTNERSHIP PROVIDING GUIDANCE AND POLICY
ABOUT THE STRATEGIES TO ADVANCE THE PARTNERSHIP’S MISSION. CHANGING POLICY IS OFTEN THE
MOST EFFECTIVE WAY TO IMPLEMENT AND SUSTAIN THE KINDS OF
ENVIRONMENTAL CHANGES THAT DR. DIETZ JUST DESCRIBED. POLICY CHANGES CAN HAVE BROAD
IMPACTS AND POLICIES NOT TRADITIONALLY THOUGHT OF AS
HEALTH POLICIES, TRANSPORTATION, LAND USE, EDUCATION,
AGRICULTURAL CAN AFFECT HEALTH AND OBESITY RATES. THE CONVERGENCE PARTNERSHIP HAS
FOCUSED ITS FUNDING AND ADVOCACY ON ACCESS TO HEALTHY FOODS,
BUILDING THE FIELD LOCALLY AND REGIONALLY AND THE BUILT
ENVIRONMENT. SO LET’S DIVE INTO THE ISSUE OF
ACCESS TO HEALTHY FOOD. THE LAST FARM BILL INTRODUCED
THE ISSUE OF FOOD DESERTS TO NATIONAL POLICYMAKERS. THE USDA CONDUCTED RESEARCH AND
CONCLUDED THAT THERE ARE MORE THAN 23.5 MILLION AMERICANS THAT
LIVE IN FOOD DESERTS, AREAS WITHOUT ACCESS TO HEALTHY FOODS. LOW INCOME COMMUNITIES OF COLOR
ARE PARTICULARLY AFFECTED. THE USDA DATA AND OTHER STUDIES
CLEARLY SHOW THIS IS A NATIONAL PROBLEM WITH SERIOUS
IMPLICATIONS FOR NATIONAL HEALTH AND OBESITY. THIS IS A PROBLEM NOT JUST IN
URBAN AREAS, BUT IN RURAL AREAS, AS WELL. THE DARKER PARTS OF THIS MAP
SHOW WHERE WITH RESIDENTS MUST DRIVE 10 MILES OR MORE TO REACH
A SUPER MARKET OR FOOD CENTER. IN RURAL MISSISSIPPI, ADULTS
LIVING IN COUNTIES WITHOUT SUPER MARKETS WERE 23% LESS LIKELY TO
MEET GUIDELINES FOR DAILY 23R50U9 AND VEGETABLE
CONSUMPTION COMPARED TO ADULTS LIVING IN COUNTIES WITH SUPER
MARKETS. >>LACK OF ACCESS TO HEALTHY
FOODS IN URBAN AREAS ARE ILLUSTRATED HERE IN NEW YORK
CITY. THE DARKER THE COLOR, THE
GREATER THE NEED. THE AREAS WITH THE HIGHEST NEED
ARE VERY SIMILAR TO THOSE WITH THE HIGHEST CONCENTRATIONS OF
RESIDENTS WHO ARE OVERWEIGHT AND OBESE AND THOSE WITH RESIDENTS
WHO REPORT NOT EATING FRUITS OR VEGETABLES IN THE LAST DAY. SEVERAL STUDIES, INCLUDING THIS
ONE IN CALIFORNIA, FIND THAT PEOPLE IN LOWER INCOME
COMMUNITIES OF COLOR ARE MORE LIKELY TO LIVE IN FOOD
ENVIRONMENTS. THIS STUDY FOUND THAT OBESITY
AND DIABETES PREVALENCE IS HIGHEST FOR THOSE LIVING IN THE
WORST FOOD ENVIRONMENT, A 20% HIGHER PREVALENCE OF OBESITY. EVEN AMONG LOW INCOME
COMMUNITIES, THOSE COMMUNITIES WITH THE WORST FOOD ENVIRONMENTS
HAVE HIGHER RATES OF OBESITY AND DIABETES. IMPROVED ACCESS TO HEALTHY FOOD
IS TIED TO CHANGES IN EATING HABITS AND CHANGED IN EATING
HABITS ARE TIED TO DECREASES IN OVERWEIGHT AND OBESITY. THE FRESH FOOD FINANCING
INITIATIVE IN PENNSYLVANIA IS AN INNOVATIVE PUBLIC/PRIVATE
PARTNERSHIP THAT HAS DRAMATICALLY IMPROVED ACCESS TO
HEALTHY FOOD I WOULDN’T SAY USING ONE TIME LOANS AND GRANTS. SINCE 2004, THE FRESH FOOD
FINANCING INITIATIVE HAS SUPPORTED 83 PROJECTS ACROSS THE
STATE FROM FULL SCALE SUPERMARKETS TO SMALL GROCERIES
TO FARMER’S MARKETS AND CO-OPS. THE STATE’S ORIGINAL $30 MILLION
INVESTMENT HAS BEEN LEVERAGED WITH PRIVATE CAPITAL TO BECOME
MORE THAN $190 MILLION IN TOTAL PROJECT COST. AS A RESULT, MORE THAN 400,000
PEOPLE NOW HAVE ACCESS TO HEALTHY FOOD WHO DID NOT HAVE IT
BEFORE. 5,000 JOBS HAVE EITHER BEEN
CREATED OR RETAINED AND MORE THAN 1.7 MILLION SQUARE FEET OF
RETAIL SPACE HAS BEEN CREATED OR SAVED. THIS IS A TRIPLE BOTTOM LINE
IMPACT. HEALTH IMPACT, ECONOMIC IMPACT,
AND NEIGHBORHOOD REVITALIZATION. REPLICATION OF THE PENNSYLVANIA
POLICY IS UNDERWAY IN MANY STATES. THE CONVERGENCE PARTNERSHIP IS
SUPPORTING EFFORTS TO BRING IT TO SCALE AT THE NATIONAL LEVEL. AND THERE ARE OTHER INNOVATIONS
UNDER WAY IN COMMUNITIES TO IMPROVE ACCESS TO HEALTHY FOOD,
PARTICULARLY FOR LOW INCOME COMMUNITIES OF COLOR. THE PRESIDENT’S PROPOSED 2011
BUDGET INCLUDES SUPPORT FOR HEALTHY FOOD FINANCING
INITIATIVE BASED ON THE PENNSYLVANIA MODEL. THE PRESIDENT PROPOSES SPENDING
$345 MILLION FOR LOANS, GRANTS AND TAX CREDITS TO SUPPORT A
RANGE OF PROJECTS DESIGNED TO INCREASE ACCESS TO HEALTHY FOOD. THE CONVERGENCE PARTNERSHIP IS
SUPPORTING EFFORTS TO MAKE THIS PROPOSAL A REALITY. A BROAD COALITION HAS COME
TOGETHER IN SUPPORT OF THE HEALTHY FOOD FINANCING
INITIATIVE, INCLUDING THE GROCERY INDUSTRY, UNIONS,
HEALTH, CIVIL RIGHTS AND CHILDREN’S ORGANIZATIONS. THE FIRST LADY HAS BEEN A BIG
CHAMPION AND THE HEALTHY FOOD FINANCING INITIATIVE IS INCLUDED
AS A PILLAR OF HER LET’S MOVE INITIATIVE. NOW LET’S SHIFT TO LOOK AT SOME
OF THE PARTNERSHIP’S EFFORTS TO BUILD THE FIELDS LOCALLY AND
REGIONALLY. TO BUILD THE FIELD, INCREASE
EQUITY FOCUSED ACTIVITY ON LAND USE, BUILT ENVIRONMENT AND
ACCESS TO HEALTHY FOOD, THE CONVERGENCE PARTNERSHIP LAUNCHED
AN INNOVATION FUND, AN EFFORT THAT PROVIDES 50% MATCHING
DOLLARS TO FOUNDATIONS TO SUPPORT MULTI STEEL
COLLABORATIVES WORKING ON THESE ISSUES. SO FAR, WITH MORE THAN $4
MILLION COMMITTED, A VARIETY OF 15 PROJECTS IN DIFFERENT PLACES
WITH DIFFERENT TYPES OF GRANT MAKING AND PARTNERSHIPS HAVE
BEEN LAUNCHED. IN ORDER TO INCREASE THE NUMBER
OF FOUNDATIONS ENGAGED IN THESE TYPES OF EFFORTS, THE
CONVERGENCE PARTNERSHIP HAS BEEN SUPPORTING EFFORTS THAT ARE
SIMILAR TO THE NATIONAL CONVERGENCE EFFORT IN MANY
REGIONS ACROSS THE COUNTRY. DR. ROGERS, THE NEXT SPEAKER, IS
A LEADER IN THE MAIN CONVERGENCE EFFORTS. THESE REGIONAL CONVERGENCE
EFFORTS ARE FOCUSED ON POLICY IMPROVE HEALTHY EATING AND
ACTIVE LIVING AND REDUCE OBESITY. THE WORK OF THE CONVERGENCE
PARTNERSHIP HAS ALSO INCLUDED EDUCATING THE FIELD AROUND BUILT
ENVIRONMENT STRATEGIES FOR WALKABLE AND BIKEBLE
NEIGHBORHOODS. PLACES FOR PHYSICAL ACTIVITY,
AND TO ENSURE THAT THEIR ANALYSIS AND ADJUSTMENTS MADE
FOR HEALTH IMPACTS. THE CONVERGENCE PARTNERSHIP
COMMISSIONED A SERIES OF PAPERS, COLLECTED IN THE VOLUME — THE
TRANSPORTATION PRESCRIPTION THAT FOCUSES ON TRANSPORTATION AND
EQUITY AND THE IMPACTS OF TRANSPORTATION ON THE BUILT
ENVIRONMENT AND ON HEALTH. IN ADDITION TO ITS EDUCATION
EFFORTS, THE PARTNERSHIP HAS BEEN SUPPORTING ADVOCACY ON
TRANSPORTATION. EVERY FIVE TO SIX YEARS, THE
FEDERAL TRANSPORTATION LEGISLATION IS REAUTHORIZED. THIS IS A MASSIVE INVESTMENT OF
FEDERAL FUNDS THAT FLOWS THROUGH THE STATES, REGIONS AND
LOCALITIES TO FUND HIGHWAYS, PUBLIC TRANSIT, PEDESTRIAN AND
BICYCLE FACILITIES, SAFE ROUTES TO SCHOOLS AND COMPLETE STREETS. THE LAST REAUTHORIZATION WAS FOR
$244 BILLION WITH 80% OF THE FUNDS GOING FOR HIGHWAYS. THESE FUNDS HAVE CLEAR IMPACTS
ON THE BUILT ENVIRONMENT AND ON EQUITY AND ON HEALTH. IN FACT, RESEARCH SHOWS THAT THE
MORE VEHICLE MILES DRIVEN, THE GREATER THE RISK OF OBESITY. AND THOSE WHO USE PUBLIC TRANSIT
ARE LESS LIKELY TO BE OBESE. THE CONVERGENCE PARTNERSHIP IS
SUPPORTING EFFORTS TO CHANGE IN THE NEXT REAUTHORIZATION TO
IMPROVE ITS HEALTH IMPACT. ALREADY, THE PUBLIC EDUCATION
AND ADVOCACY EFFORTS HAVE INCREASED AWARENESS OF THE
CONNECTION BETWEEN HEALTH AND TRANSPORTATION AND HAVE ALSO
ALTERED POLICY PROPOSALS. IN ADDITION TO SUPPORTING
EDUCATION AND ADVOCACY EFFORTS, THE PARTNERSHIP HAS BEEN ADDING
ITS VOICE FOR CHANGE, INCLUDING FOR HEALTH REFORM, SUSTAINABLE
COMMUNITIES AND OBESITY REDUCTION. CLEARLY, MOMENTUM IS BUILDING. THERE ARE MANY MULTI SECTOR
EQUITY FOCUSED EFFORTS ADVANCING AT THE LOCAL, STATE AND NATIONAL
LEVELS. AS WE MOVE FORWARD, IT IS
IMPORTANT TO CONTINUE TO FIND AND SUPPORT LOCAL INNOVATIONS
FOCUSED ON EQUITY IMPACTS AND THE EFFORTS TO BRING THEM TO A
NATIONAL SCALE. OUR NEXT SPEAKER WILL TALK ABOUT
A LOCAL EFFORT THAT IS TAKING OFF NATIONALLY. THANK YOU VERY MUCH. >>HELLO, MY NAME IS TROY
ROGERS. HE’D A PEDIATRICIAN FROM THE
BARBARA BUSH CHILDREN’S HOSPITAL AT MAINE MEDICAL CENTER IN
PORTLAND, MAINE. I WELCOME THE OPPORTUNITY TO
TALK TO YOU. I’VE BEEN WORKING IN THE FIELD
OF CHILDHOOD OBESITY FOR ABOUT A DECADE, FIRST AS A PRACTICING
PEDIATRICIAN ON THE FRONT LINE DEALING WITH THIS EVERY DAY. THEN I WORKED WITH A NUMBER OF
NATIONAL PROGRAMS THROUGHOUT THE COUNTRY. THEN ON TO ADVOCACY OF MY OWN
CHILDREN’S SCHOOLS AND NOW AS THE MEDICAL DIRECTOR OF LET’S
GO, A MULTI SECTOR APPROACH TO ADDRESSING CHILDHOOD OBESITY. NOW I’D LIKE TO TELL YOU ABOUT
THE STORY. SO THE MAIN STORY STARTS LIKE
MANY STORIES OF COMMUNITY ACTION ACROSS THE COUNTRY. HOWEVER, I THINK OURS HAS A BIT
OF A TWIST, THE TWIST BEING THAT THE MEDICAL COMMUNITY GOT
INVOLVED VERY EARLY ON BY ENGAGING COMMUNITY PARTNERS, THE
MAIN CDC, OUR PUBLIC HEALTH ENTITY IN MAINE. WHAT WE DID IS WE DEVELOPED
SIMPLE STEPS CLINICIANS CAN DO EVERY DAY TO START TO COMBAT THE
OBESITY EPIDEMIC. THEN IN 2006, THIS WORK EXPANDED
INTO ON HER SECTORS TO THE LET’S GO PROGRAM WHICH INITIALLY
STARTED IN GREATER PORTLAND. NOW IN 2010, LET’S GO HAS BEEN
DISSEMINATED TO SEVEN ADDITIONAL SITES AND REGIONS IN MAINE AND
WE ARE ACTIVELY PARTICIPATING WITH A CONVERGENCE PARTNERSHIP
AND THE LOCAL COMMUNITIES PUTTING PREVENTION TO WORK
RECIPIENTS. NOW WE WOULD LIKE TO SAY A FEW
WORDS ABOUT MYOC, ABOUT LET’S GO AND ABOUT SOME OF THE
OPPORTUNITIES THAT WE HAVE EXPERIENCED AND STILL LAY IN
FRONT OF US. SO THIS STARTED WITH A SIMPLE
MESSAGE, 5-2-1-0. IT STANDS FOR 5 SERVINGS OF
FRUITS AND VEGETABLES, 2 HOURS OR LESS OF TV TIME AND ZERO
SUGARY DRINKS. THIS MESSAGE IS ESSENTIAL TO THE
PRIME MINISTER PROVIDERS. I THINK AS YOU WILL SEE, 5-2-1-0
HAS BECOME A PER ZASIVE MESSAGE WHICH IS BEGINNING TO CHANGE THE
LANDSCAPE FOR KIDS IN MAINE. IN MYOC, WE HAD FIVE SPECIFIC
THINGS WE ASKED THEM TO DO. CREATE AWARENESS, HANGING A
POSTER, ASSESS THE PATIENT’S WEIGHT ACCURATELY, LISTEN TO
PATIENTS IN A RESPECTFUL MANNER USING THE 5-2-1-0 APPROACH. TO BE A ROLE MODEL, THAT WAS
CRITICAL. AND ALSO TO JOIN THE LEARNING
COMMUNITY, TO CONTINUE TO LEARN AND INNOVATE. HERE IS A PROVIDER TOOL KIT,
WHICH SHOWS MANY RESOURCES THAT HAVE BEEN USED, ADOPTED AND
ADAPTED THROUGHOUT THE COUNTRY. SO WHAT DO WE ACTUALLY DO IN
MYAC? WE DID IMPRESSIVE THINGS. WE ENGAGED 12 PHYSICIAN
PRACTICES, MAKING OFFICE SYSTEM CHANGES. HERE IS SOME OF THE DATA. WE LOOKED AT PHYSICIAN BEHAVIOR
BY MEASURING A NUMBER OF PROCESS OUTCOMES AT THE BEGINNING OF
MYAC AND THEN AGAIN AT THE BEGINNING OF 24 MONTHS. THE 5-2-1-0 QUESTIONNAIRE. FULL DISCLOSURE HERE, SOME OF
YOU MAY REALIZE THAT THERE’S NOTHING ON THE PRE-MYOC, RIGHT? THAT WAS ZERO. WE.DEVELOPED THE 5-2-1-0
QUESTION HEIR LATER ON. ENGAGEMENT OF THE CLINICIANS AND
IT WAS THE SINGLE MOST EFFECTIVE TOOL THE CLINICIANS HAD BECAUSE
IT CHANGED THE CONVERSATION FROM WEIGHT TO BEHAVIORS. BEFORE MYOC, ONLY ABOUT 25% OF
THE TIME CLINICIANS WERE DOCUMENTING BMI PERCENTILE FOR
AGE AND GENDER, EVEN THOUGH THEY KNEW THEY HAD TO DO IT, AND
AFTER MYOC ABOUT 90% OF THE ENCOUNTERS HAD A BMI DOCUMENTED. OVER THE COURSE OF MYOC, THE
WEIGHT CATEGORIES INCREASED. HERE, ADDITIONAL, THERE WAS AN
INCREASE OF PROVIDER BEHAVIOR IN THE KEY AREAS OF EVALUATING
OVERWEIGHT WITH PATIENTS AND FAMILIES AND SCHEDULING
FOLLOW-UP VISITS. SO THE LESSONS LEARNED WERE
5-2-1-0 WAS EASILY UNDERSTOOD BY CLINICIANS AND PATIENCES AND
FAMILIES. STARTING TOMORROW, THERE WERE
SIMPLE THINGS THAT THE CLINICIANS COULD DO. SO THEN IN 2006, A GROUP OF
LOCAL BUSINESSES AND HEALTH CARE LEADERS IN THE GREATER PORTLAND
AREA IDENTIFIED ON THIS SLIDE CAME TOGETHER AND MADE A
SUBSTANTIAL INVESTMENT IN THE PREVENTION OF CHILDHOOD OBESITY. THEY FORMED A UNIQUE PROFIT AND
NONPARTNERSHIP PROGRAM CALLED LET’S GO. LET’S GO USES THE LESSONS AND
TOOLS SXRE SOURCES DEVELOPED IN MYAC USED. LET’S GO WORKS IN SIX KEY
SETTINGS, CHILD CARE, SCHOOL, COMMUNITIES, WORKPLACE, AFTER
SCHOOL AND HEALTH CARE. SURROUNDING THIS WORK IS A
ROBUST MEDIA CAMPAIGN FOCUSING ON 5-2-1-0. THE CORPORALS OF LET’S GO ARE
HERE. THEY’RE ENVIRONMENTAL AND POLICY
CHANGE WHICH ARE KEY TO INFLUENCING THE BEHAVIOR CHANGE. THE INCIDENTER CONNECTIVITY
ACROSS SECTORS IS CRUCIAL. STRATEGIES ARE EVIDENCE BASED
AND CONTINUALLY BEING EVALUATED. NOW I’D LIKE TO TAKE A FEW
MINUTES AND TALK ABOUT A COUPLE OF THE SECTORS. THIS FIRST ONE, THE SCHOOL
COMPONENT OF LET’S GO IS CALLED 5-2-1-0 GOES TO SCHOOL. THE PROGRAM TAKES SCHOOLS FROM
WHERE THEY ARE AROUND HEALTH AND PHYSICAL ACTIVITY AND NUTRITION
TO WHERE THEY WANT TO GO. WE USE TEN KEY STRATEGIES WHICH
FOCUS ON SUSTAINABILITY ENVIRONMENTS ON POLICY CHANGE. THESE TEN STRATEGIES ARE LISTED
HERE AND YOU CAN SEE THAT THERE IS A BROAD RANGE FROM
ENCOURAGING HEALTHY CHOICES FOR SNACKS AND CELEBRATIONS TO
INCLUDES COMMUNITIES ORGANIZATIONS AND WELLNESS
PROGRAM AND INCORPORATING PHYSICAL ACTIVITY INTO THE
SCHOOL DAY. NOW WE’D LIKE TO TALK ABOUT OUR
WORK IN EARLY CHILDHOOD. WE ARE WORKING ON FITTING
5-2-1-0 INTO THE HOME, AND IT’S A HOME-BASED CHILD CARE SPIKE. WE WERE WORKING ON THE
DEVELOPMENT OF STATEWIDE LICENSING, REGULATION AND
REWARDS. IN OUR COMMUNITY WORK, WE HAVE
INCLUDED TRAIL DEVELOPMENT AND INNOVATIVE WORK XWIEBDING HEALTH
AND LITERACY BY IMPLEMENTING SOMETHING CALLED STORY WALK. STORY WALK TAKES THE BOOK AND
MAKES THE PAGES COME ALIVE ALONG A PATH, SCHOOL, LIBRARY OR
COMMUNITY TRAIL. IT’S ONE OF MY FAVORITE THINGS
THAT WE DO. WE HAVE A ROBUST EVALUATION PLAN
WHICH FOCUSES ON QUANTITATIVE AND QUALITATIVE DATA ALONG WITH
HUNDREDS OF STORIES. AND THE STORIES ARE SO
COMPELLING. CURRENTLY, WE ARE TRACKING LOCAL
OBESITY RATES, BEHAVIOR CHANGES AND ENVIRONMENTAL AND POLICY
CHANGES. AS MANY OF YOU KNOW, IT TAKES
YEARS TO SEE SYNDROMES IN OBESE AT THE RATES. THEREFORE, WE FEEL IT IS
CRITICAL TO TRACK OUR PROGRESS WITH THE ENVIRONMENTAL AND
POLICY CHANGES AS WELL AS THE BEHAVIOR DATA PRECURSORS TO
CHANGES AND THE WEIGHT STATUS IN THE POPULATION. THE FOLLOWING IS OUR MOST UP TO
DATE EVALUATION. AS I SAID, IT’S VERY IMPORTANT
FOR US TO HAVE LOCAL DATA, BUT TO HAVE LOCAL DATA, YOU HAVE TO
GO OUT AND GET IT. IT DOESN’T JUST GET GIVEN TO
YOU. DO YOU THINK DATA GATHERED FROM
PEDIATRICIAN’S OFFICES, WE HAVE DETERMINED A BASELINE OVERWEIGHT
AND OBESITY PREVALENCE WEIGHT. THE LOCAL DATA IS HERE IN LIGHT
BLUE AND THE 2006 HANES DATA IS IN DARK BLUE. OUR LOCAL DATA MIRRORS THE
NATIONAL DATA WITH THE EXCEPTION OF THE YOUNGEST CHILDREN, WHICH
ARE SIGNIFICANTLY HEAVIER THAN THEIR NATIONAL PEERS. WE ARE ON TRACK TO REPORT 2009
DATA IN LATE FALL AND THEN WE WILL MONITOR THIS ON A PERIODIC
BASIS. WE HAVE ALSO BEEN TRACKING
KNOWLEDGE, ATTITUDE AND PERCEIVED BEHAVIOR CHANGES
THROUGH A RANDOM DIGITAL SURVEY TO PARENTS IN THE GREATER
PORTLAND AREA. THERE IS AN INCREASE IN THE
AWARENESS OF LET’S GO AND 5-2-1-0 FROM 2007 CO-2009. ALTHOUGH THIS SLIDE DOESN’T
DESPICKET IT, WE SEE A FAVORABLE RESPONSE TO THE MESSAGE. IF A PARENT IS EXPOSED TO THE
5210 MESSAGE, THEY ARE MORE LIKELY TO BE MORE FAVORABLE,
MORE LICKLY TO IDENTIFY ALL FOUR OF THE HEALTHY BEHAVIORS. OF NOTE HERE IS THAT FROM 2007
TO 2009, THERE WAS AN IMPRESSIVE INCREASE OF 27% IN PERCEIVED
BEHAVIOR CHANGE IN THREE OUT OF THE FOUR 5210 BEHAVIORS. IN SCHOOLS, WE ARE BEGINNING TO
SEE THE ENVIRONMENTAL POLICY CHANGES AND THE MAJORITY OF THE
ADMINISTRATORS REPORT AN INCREASE IN PHYSICAL ACTIVITY
AND HEALTHY EATING OPTIONS. IN THE GREATER PORTLAND AREA,
OVER 90% OF OUR SCHOOLS HAS REPORTED MAKING AT LEAST TWO OR
MORE ENVIRONMENTAL CHANGES DURING THE 208 TO 2009 SCHOOL
YEAR. TO DATE, 5210 HAS MADE PROGRESS
IMPLEMENTING THIS STRATEGY. THE SCHOOLS ARE VERY MUCH
APPRECIATIVE OF THE MESSAGE, THE SUPPORT OF LET’S GO AND THE
MULTI SECRETARY TO RECALL APPROACH. POLICY AND ENVIRONMENTAL CHANGE
IS DISCREDIT KAL TO THE LONG-TERM SUPPORT OF BEHAVIOR
CHANGE. LET’S GO WE START TO EXPAND
STATEWIDE AND BY JUNE 2010 WE ARE REACHING OVER 80,000
STUDENTS IN 262 SCHOOLS, 40 CHILD CARE SITES CARING FOR
THOUSANDS OF CHILDREN, MORE THAN 50 POSITION OFFICES, NUMEROUS
AFTER SCHOOL PROGRAMS SUPPORTING MORE THAN 2,500 YOUTH MEMBERS. SIX OF PORTLAND’S LARGEST
EMPLOYERS ARE INVOLVED AND EIGHT REGIONS ACROSS THE STATE ARE —
WE WERE ACTUALLY PARTICIPATING WITH. THIS IS A MAP SHOWS WHERE 5210
IS. WE’RE IN 149 TOWNS. WE ARE ACTUALLY IN MORE TOWNS,
BUT THEY OVERLAP THE DOT THE SO I JUST HAVE TO SAY THAT. WE’VE BEEN ABLE TO USE OUR TOOLS
AND WE’VE PROVIDED TECHNICAL ASSISTANCE TO MANY OF THESE
SITES. NOW I’D LIKE TO TAKE A MINUTE
AND TALK ABOUT THE CHALLENGES AND OPPORTUNITIES AHEAD OF US. OUR FIRST CHALLENGE WAS TO BUILD
THE EVIDENCE. WE HAD BEEN ENCOURAGED BY MANY
OF YOU IN THIS AUDIENCE, DR. BILL DIETZ, I MIGHT SAY, TO
INNOVATE, TRY NEW THINGS, BUILD THE EVIDENCE. GO AHEAD, TORI, DO IT. HOWEVER, MANY FUNDERS AREN’T
THAT INTERESTED IN FUNDING INNOVATION. THE SECOND CHALLENGE IS TO
MANAGE THE EXPECTATIONS OF THE PARTNERS WHO WANTED TO SEE RAPID
CHANGES. NATIONALLY, WHEN VAULT THE
CHANGE, IT IS DIFFICULT TO GET INFORMATION TO CHILDREN. OUR NEXT CHALLENGE IS RELATED TO
CONDUCTING RESEARCH IN THE COMMUNITY. IT CAN BE VERY DIFFICULT TO GET
COMMUNITY DATA. MANY COMMUNITIES PARTNERS ARE
WEARY OF RESEARCH. THEY THINK IT’S GOING TO TAKE
TOO MUCH TIME. THINK WONDER HOW THE DATA IS
GOING TO BE USED. WILL IT AFFECT ANY STATE OR
FEDERAL FUNDING. COLLABORATION IS ESSENTIAL, BUT
THERE ARE ALWAYS TURF ISSUES AND PARTNERS MAY HAVE DIFFERENT
AGENDAS. THEY MAY HAVE DIFFERENT FUNDING
STREAMS AND THIS MAY BE AN ADDITIONAL COMPLICATION. SOLO THE CHALLENGES MAY HAVE
SEEMED DAUNTING, THEY HAVEN’T PREVAILED. THERE’S A GROWING NUMBER OF
TINTS THAT HAS ALLOWED US TO SUCCEED AND CONTINUED TO BE
OPTIMISTIC. AS WE AWAIT THE BIG CHANGES, IT
IS THE SMALL CHANGES THAT KEEP THE PROGRESS GOING. IT’S CHANGING REWARDS FROM
CHILDREN FROM FOOD TO PHYSICAL ACTIVITY. CHANGING THE HEALTHY OPTIONS,
CHANGING WHAT HAPPENS IN THE CHILD CARE SETTING AND ENGAGING
ALL SECTORS HAS ALLOWED AN INTERESTING NUMBER OF PARTNERS
TO COME TO THE TABLE. AND WORKING IN A SMALL, RURAL
STATE HAS ITS CHALLENGES. BUT WE HAVE ACCESS TO LOCAL AND
STATE LEADERS AND THIS IS CRITICAL FOR OUR WORK. THE COLLABORATION OF COMMUNITIES
PUTTING THE PROGRAMS TO WORK HAS BEEN VERY, VERY HELPFUL IN
KEEPING OUR WORK UP TO DATE AND HAS RE-ENERGIZED THE STAFF. ACTUALLY, I WANT TO LEAVE YOU
WITH ONE LAST SLIDE AND ONE LAST WORRY. MAINE IS KNOWN FOR A NUMBER OF
THINGS, BUT TO ME, IT’S KNOWN FOR ITS COMMON SENSE APPROACH OF
HANDLING MANY DIFFERENT PROBLEMS. HARD WORKING PEOPLE, INNOVATION,
AND A QUIRKSY SENSE OF HUMOR. IN THE EARLY DAYS HOCH THIS
WORK, WE WERE WORKING IN THE DOC’S OFFICES. WE DIDN’T HAVE A CAMPAIGN AND WE
WERE TRYING TO GET THE 54210 PLAN OUT. THIS IS HIS IDEA AND THIS IS HIS
CAR AS HE TRAVELS AROUND THE STATE. SO THANK YOU VERY MUCH. >>THANK YOU. I THINK WE’RE NOW OPEN FOR
QUESTIONS OR COMMENTS. PLEASE USE THE MICROPHONES THAT
ARE DOWN IN THE MIDDLE OF THE AUDITORIUM. >>EXCELLENT AND I’M TERRY
BODRICK, OFFICE OF SMOKING AND HEALTH. GIVEN THE INFORMATION ABOUT
DYNAMIC LOCAL ACTION, I APPRECIATE THE PANEL DISCUSSING
THE PROS AND CONS OF ACCEPTING PREEMPTION TO LOCAL ACTION TO
GETTING A NATIONAL CHANGE, SUCH AS MENU LABELLING AND — WHICH
PREEMPTED LOCAL ACTION. PROS AND CONS. >>I CAN START ON THAT. CAN PEOPLE HEAR ME? >>YEAH. >>SO I THINK TWO THINGS I’D
SAY. ONE IS YOU NEVER GET TO NATIONAL
ACTION OR RARELY DO YOU GET TO NATIONAL IMPACT WITHOUT FIRST
STARTING WITH LOCAL INNOVATION. SO ALL OF THOSE IMPORTANT STEPS
ON MENU LABELLING AND CITIES AND STATES WERE WHAT GOT US TO
NATIONAL ACTION. AND I THINK IT IS ONE OF THESE
BALANCING ACTS. AND BEFORE, I THINK WE SHOULD
ACCEPT PREEMPTION, WE SHOULD MAKE SURE THAT A NATIONAL
STANDARD IS AS STRONG AS WE POSSIBLY CAN GET THERE. AND I THINK IT’S UP TO ADVOCATES
AND POLICYMAKERS TO PUSH AS HARD AS THEY CAN. AND THEN ULTIMATELY, I THINK IN
MANY CASES, WE END UP HAVING TO ACCEPT IT BECAUSE IT GETS THAT
CHANGE TO PLACES WHERE SIMPLY THERE ISN’T THE CAPACITY OF
ADVOCATES OR NO OTHER POLITICAL WILL TO MAKE THE CHANGE HAPPEN. >>HI. DR. JEWEL CRAWFORD. I’M AT ATCR IN ENVIRONMENTAL
MEDICINE. AND THE QUESTION AND THE COMMENT
THAT I HAVE, HERE IN DeKALB COUNTY, WHERE WE ARE RIGHT NOW,
THERE’S A REAL SCARCITY OF PLACES FOR KIDS TO PLAY. WE DON’T HAVE A LOT OF
PLAYGROUNDS OR PUBLIC PARKS. I MEAN, THEY HAVE PARKS, BUT
PEOPLE HAVE TO DRIVE TO THEM AND PEOPLE HAVE TO PAY, LIKE SOME
MOUNTAIN PARKS, YOU HAVE TO PAY TO GET IN THERE. AND IT’S NOT LIKE OTHER CITIES
THAT I’VE BEEN IN, NEW YORK, PORTLAND, OREGON, WHERE CHILDREN
CAN WALK TO PLAYGROUNDS AND PARKS. AND ALSO LACK OF SIDEWALKS. SO I MEAN, THAT IS RIGHT HERE
WHERE CDC IS. BUT ANY SUGGESTIONS, YOU KNOW,
FOR HOW TO GO ABOUT GETTING MORE PLAY SPACES? BECAUSE THERE REALLY AREN’T A
LOT OF PLACES FOR THE KIDS TO GO OUTSIDE AND SAFELY PLAY, FROM
WHAT I CAN SEE. >>THANKS FOR THAT QUESTION. WE’RE VERY INTERESTED IN MAPPING
PLAY DESERTS IN THE SAME WAY FOOD DESERTS HAVE BEEN MAPPED. IT’S MORE CHALLENGING AND WE’RE
NOT THERE YET, BUT THAT IS STEP ONE. STEP TWO, IN MY OPINION, THE
ATLANTA BELT LINE IS PROBABLY THE MOST IMPORTANT PUBLIC HEALTH
INTERVENTION IN ATLANTA SINCE POTABLE BECAUSE WATER BECAUSE
IT’S GOING TO CONNECT COMMUNITIES, BUILD PARKS, IT’S
GOING TO HAVE WALKING TRAILS, PERHAPS LIGHT RAIL BIKE TRAILS. AND THAT IS WHAT THIS CITY
NEEDS. THIS CITY WAS NOT PLANNED IN A
VERY RESPONSIBLE WAY. I MEAN, IT WAS JUST SPREAD OUT
ALONG PEACHTREE WITH THE ADVENT OF CARS AND WE’VE BEEN CAR
DEPENDENT EVER SINCE. SO I THINK SUPPORT FOR THE BELT
LINE AND AS THE BELT LINE COMES IN, MAKING SURE THAT IT CONNECTS
PEOPLE TO PLACES SO THAT THEY CAN USE ALTERNATIVE FORMS OF —
PHYSICAL FORMS OF TRANSPORT I THINK IS GOING TO BE A KEY
OUTCOME AND IT’S GOING TO BE ACCOMPANIED BY PLACES FOR
CHILDREN TO PLAY. >>THANK YOU. >>THOMAS MORRIS, DSLR. JUST TO MAKE A NOTE, I’M
PROBABLY ONE OF THOSE RARE PEOPLE THAT ACTUALLY GREW UP IN
ATLANTA AND I HAD A VERY CLOSE RELATIONSHIP WITH MY BIKE. IN FACT, I WAS THE BIKE RACER AT
ONE TIME. I FIND THE STREETS HERE
APPALLINGLY RESISTANT AND NARROW FOR TRYING TO BIKE. ON THE SIDEWALKS ARE PEDESTRIAN,
GLASS, CREEKS, THINGS LIKE THAT AND AS A DRIVER, THERE ARE
HARDLY TWO RAINS FOR SOME OF THESE VEHICLES, ESPECIALLY
AROUND HERE. >>HOW IS THE PHYSICAL EDUCATION
OF THIS WORK WITH NO CHILD LEFT BEHIND AND THE COMPLETION OF
TEST SCORES WHICH MEANS GETTING THOSE KIDS TO SIT STILL AND
LEARN SOMETHING. >>GREAT QUESTION. THERE IS SO MUCH DATA THAT HAS
COME OUT OVER THE LAST FIVE YEARS ABOUT THE ASSOCIATION
BETWEEN PHYSICAL ACTIVITY AND ACADEMIC SCORES. AND THAT NEEDS TO BE A CRITICAL
LINK. I DO A LOT OF TALKING TO SCHOOL
BOARDS ABOUT THIS. THERE’S ALSO THE SAME LINK WITH
HEALTHY EATING AND ACADEMIC SCORES. THERE’S BEEN SOME CREATIVE WORK
THAT HAS HAPPENED WITH SCHOOLS WHERE KIDS ARE NOT SITTING
STILL. THEY’RE SITTING ON THOSE
EXERCISE BALLS AND THEY’RE ACTIVELY MOVING AND THE TEACHERS
ARE SAYING THEIR CLASS IS SO MUCH MORE CONTROLLABLE BECAUSE
KIDS ARE ALLOWED TO DO WHAT THEY NEED TO DO WHEN THEY’RE FIRST
AND SECOND GRADERS. I WOULD MAKE THE SAME CASE THAT
THAT COULD BE WITH ALL OF THOSE CHILDREN. SO WE HAVE A LINK SHOWING
PHYSICAL ACTIVITY WILL IMPROVE THE SCHOOL SCORES. >>GOOD MORNING. SO PLAYING OFF THE LOCAL
INNOVATION IDEA, WHERE DO WE GET — WHAT SUGGESTIONS DO YOU
HAVE FOR FUNDING TO CREATE LOCAL GRASSROOTS PROGRAMS SUCH AS, FOR
EXAMPLE, BRINGING A NUTRITIONIST TOGETHER AND A TRAINER TOGETHER
AND BRINGING THEM INTO A PARK, A FACILITY OR SOMETHING AND
GETTING FUNDS TO REALLY PUT TOGETHER A PROGRAM FOR CHILDREN
WHERE THEY CAN PLAY, EDUCATE THEM ON EATING HABITS. YOU KNOW, YOU HAVE THEM FOR A
COUPLE OF HOURS AND INCLUDE THE PARENTS. WHERE CAN WE GET MONEY TO FUND A
PROGRAM SUCH AS THIS? >>WELL, THERE ARE NUMBERS OF
FOUNDATIONS ENGAGED IN THIS WORK. SO THE ROBERT JOHNSON HAD A $25
MILLION OBEITY PROGRAM AND THEY ARE FUNDING ACROSS THE COUNTRY. WE ARE HOPING SOME OF THE
DOLLARS WILL BE USED TO FOCUS INNOVATION. THERE IS ADVOCACY TO BE DONE
WITH CITY BUDGETS TO MAKE SURE THAT PARKS AND RECREATION ARE
ADEQUATELY FUNDED AND TO MAKE SURE THAT THERE’S AN
UNDERSTANDING IN THAT LINK BETWEEN HEALTH AND PHYSICAL
ACTIVITY. >>I WOULD JUST ADD TO THAT,
THAT START WITH YOUR LOCAL INSTITUTIONS. I MEAN, IF YOU HAVE CHILDREN IN
CHILD CARE, THAT’S ONE PLACE TO START. IF YOU HAVE CHILDREN IN SCHOOLS,
THAT’S A SECOND PLACE TO START. THAT CHARACTERIZES A LOT OF
TORI’S EARLIER EXPERIENCE WITH THESE ISSUES. >>THE OTHER THING I’LL ADD IS
THAT IS FANTASTIC. SOME OF THOSE MONIES ARE
DIFFICULT TO FLOW DOWN. AND WE’VE DONE A LOT OF ON THIS
WORK. THE LOCAL COMMUNITY GROUPS THAT
GET TOGETHER, WHETHER IT’S THE LOCAL ROTARY CLUBS OR THE
DIFFERENT KIND OF CLUBS GETTING TOGETHER OFTENTIMES ARE LOOKING
FOR THIS. THIS DOESN’T HAVE TO BE A LOT OF
MONEY. THE OTHER THING WE’VE DONE IS
PARTNERING WITH OUR LOCAL HIGH SCHOOLS. ALL THE HIGH SCHOOLS NEED TO DO
COMMUNITY SERVICE AT LEAST IN A NUMBER OF THE STATES. YOU CAN USE LOCAL HIGH SCHOOL
STUDENTS TO DO SOME OF THIS WORK. THERE’S A LOT OF THINGS YOU CAN
DO AND SOMETIMES BY THAT SUCCESS YOU HAVE THE OPPORTUNITY TO GO
ON AND APPLY FOR A LARGER GRANT. GETTING STARTED KIND OOH MOVES
YOU IN THAT DIRECTION. >>THANK YOU. IS MY QUESTION IS ACTUALLY TO
ALL OF YOU, BUT LIKELY MORE FOR BILL. IT’S PRETTY EVIDENT THAT THE
POLICY AND ENVIRONMENTAL CHANGE ARE VERY APPEALING. WHEN YOU CHANGE A SIDEWALK, YOU
ARE HELPING EVERYBODY, ALL RACES, ALL ETHNIC GROUPS, ALL
SOCIOECONOMIC BACKGROUNDS. HOWEVER, GIVEN THE FACT THAT OUR
COLLEAGUES FROM CHS BROUGHT SOME RELEVANT DATA, HIS PANIC KIDS
AND AFRICAN-AMERICAN GIRLS, IS THERE ANY ROOM FOR TARGET
INITIATIVES OF THOSE SPECIFIC POPULATIONS, BILL? >>I’M GOING TO ASK YOU, MS.
BELL, TO RESPOND TO THIS, AS WELL. I THINK THOSE DISPARITIES, THE
GENDER DISPARITIES TO SPEAK A CULTURAL DETERMINANT OF OBESITY. FRANKLY, I DON’T THINK WE
UNDERSTAND ENOUGH ABOUT WHY THAT DISPARITY EXISTS AND HAS BEEN A
COMMUNITY. I THINK WE HAVE ANECDOTAL
EVIDENCE, BUT FROM THE MESSAGING POINT OF VIEW, I THINK IT’S
TERRIBLY IMPORTANT. HOW DO WE TALK TO HIS PANIC
PARENTS ABOUT PARENTING PRACTICES THAT LEAD TO
DIFFERENTIAL LEVELS OF PHYSICAL ACTIVITY OR DIFFERENT PATTERNS
OF PARENTING AROUND FOOD INTAKE AND HIS PANIC FAMILIES. AND THAT IS ONE OF THE AREAS
THAT I’M NOT SURE RESPONDS EASILY TO A POLICY INITIATIVE AS
MUCH AS A MESSAGING OR COMMUNICATIONS ISSUE. >>I THINK WE HAVE TO TARGET
SOME OF THESE RESOURCES. BECAUSE WHEN YOU LOOK AT
COMMUNITIES, WHAT YOU SEE IS THAT FOR PEOPLE TO MAKE THE
HEALTHY CHOICE IN LOW INCOME COMMUNITIES, IT’S FAR HARDER
THAN IT IS IF YOU’RE IN A MIDDLE OR HIGH INCOME COMMUNITY. THAT’S WHY THE DEY DATA LOOKS
THE WAY IT DOES, I THINK. THINK ABOUT THE DATA I SPOKE
ABOUT IN TERMS OF RURAL MISSISSIPPI. IF YOU’RE NOT NEAR A SUPER
MARKET, YOU’RE NOT GOING TO EAT AT HEALTHY. WE FOUND THAT THAT WAS TRUE
REGARDLESS OF INCOME YOU WERE. SO IF YOU LIVED IN A
CONCENTRATION OF FAST FOOD AND CONVENIENCE STORES, YOU HAD AUTO
HIGH PREVALENCE OF DIABETES. THERE’S NO QUESTION THE
ENVIRONMENT MATTERS AND THAT SPEAKS TO TARGETING CHANGES IN
THE ENVIRONMENTS THAT NEED THEM THE MOST. >>THIS WILL BE THE LAST
QUESTION. >>GOOD MORNING. MY NAME IS MICHELLE. THANK YOU ALL SO MUCH. I’M WONDERLING, WHAT IS THE ROLE
OF MENTAL HEALTH FOR THE OBESITY EPIDEMIC? IT JUST SEEMS ASIDE FROM THEIR
INCOME LEVELS WHERE THEY MIGHT HAVE MORE OPPORTUNITIES TO HAVE
SAFE PLACES TO EXERCISE, THERE ARE STILL GREATER AMOUNTS OF
OBESITY. I’M JUST WONDERING WHAT IS THE
GOAL FOR MENTAL HEALTH? >>YOU ARE ALL JUMPING AT THIS
ONE. I THINK THERE’S THE RELATIONSHIP
WITH MENTAL HEALTH IS FASCINATING. FOLKS WHO MAY BE STRUGGLING WITH
MENTAL HEALTH ISSUES AND MAY BE ON MEDICATION MAY PUT THEM AT
MORE RISK FOR WEIGHT ISSUES. THAT’S ONE COMPONENT THAT
CLEARLY NEEDS TO BE ADDRESSED. THE OTHER SIDE OF IT, THERE IS A
LOT OF DAETS IN QUALITY OF LIFE WHEN THEY’RE OBESE AND THE
SEVERE OBESITY GREATER THAN THE 97th PERCENTILE IS VERY POOR AND
IT NEEDS TO BE ADDRESSED. WE WORK A LOT WITH CLINICIANS ON
THAT. I THINK THE ROLE FROM MY POINT
OF VIEW IN WORKING WITH THE COMMUNITY IS THAT YOU NEED TO BE
AWARE THAT THE MENTAL HEALTH ISSUES ARE THERE. >>I’D LIKE TO CLOSE BY THANKING
THE PANELISTS WHO DECIDED, CYNTHIA, JUDITH AND TORI, THANK
YOU VERY MUCH FOR YOUR PARTICIPATION. >>WE HAVE VERY VERY QUICK
ANNOUNCEMENT AND THAT IS BECAUSE WE HAVE RECEIVED SO MANY
REQUESTS FROM COLLEAGUES OUTSIDE OF CDC AND OUR EXTERNAL VIEWERS
TO MOVE THE TIME OF THESE SESSIONS TO A TIME WHEN PEOPLE
ON THE WEST COAST AND OTHER PARTS OF THE WORLD CAN WATCH
THEM. WE ARE GOING TO DO THAT EITHER
IN AUGUST OR SEPTEMBER. OUR NEXT SESSION IN JULY IS
GOING TO STAY AT THE SAME TIME BECAUSE WE EXPECT A LOT OF
COLLEAGUES FROM EUROPE AND AFRICA WILL BE INTERESTED IN
GLOBAL HEALTH AND CHILD SURVIVAL. SO STARTING IN AUGUST AND
SEPTEMBER, WE’RE LIKELY GOING TO START AROUND NOON. THANK YOU SO MUCH FOR COMING OUT
IN THIS LARGE NUMBER IN PERSON. SEE YOU IN FOUR WEEKS, SAME
TIME, SAME PLACE.

7 Bugs e Glitches – Need for Speed Underground 2 (PS2)

7 Bugs e Glitches – Need for Speed Underground 2 (PS2)


Hello! how are you doin’? Before starting the video, I want to thank you all for the 100 views my video “6 bugs & glitches of Need for Speed Undercover” had. Thanks everyone! If this video gets more than 100 views, I’ll do an “7 bugs & Glitches of Need ForSpeed Most Wanted. Now, let’s go! First, I want to start with a simple bug. If you come to this Body Shop and drive slowly on the sidewalk under the bridge, You car will be thrown upwards. It’s a simple bug, but isa bug that i’ve found. All other bugs on this video I saw on sites or magazines. There’s a hole near the airport that you can do de same thing. Now, let’s see some tuning bugs. If you open and close fastly the trunk audio menu, your trunk will stay open while you modify your car. If you keep pressing “square” repeatedly while going down the “Split Hoods” menu, They will open the wrong way. If you enter on a Shop, jump the cutscene, get out of a shop and jump the cutscene fastly, and press select, you will get stuck inside the Shop. To get out, just crash on the shop gate or in a wall. Go outside the airport track. This one is really cool. Idid it when I was younger, but I forgot how to do it, then, I had to search it on internet to remember. To do it, go to the URL called “Airport Circuit Track 2” Do it on reverse and without opponents so they will not bother you. Race it normally until you get into this place. slowly scratch your car into this wall until you pass over it. I am not 100% sure, but making this with a car with big body kits might be harder. Done! Now you can go anywhere on the airport. Try to Race the planes or find some Easter Eggs… Do whatever you want to! And dont worry, its very hard to go back to the track. And take care with the invisible walls. “Free roam while racing” and “very hi jump” This bug is very hard and boring to do. Go to Quick Race ->Circuit ->Bellavista, and go reverse until this point. slowly scratch your car in a angle like that on the wall. Until you get to the other side. Looks like you can do this with any car but some are harder than others. When you’re outside, you can do a freeroam and use the replay option if you want. To glitch harder, come to this place after doing that glitch. You need get at 120 kmh (or 80 mph) and crash into the pole. *Crash into This Pole if done correctly, your car will leave the ground. while it is not on the ground, press select until you fall outside the road, under the bridge. drive slowly where I drive It can take a while, but your car will be thrown away very hard. while falling, you can press select to come back to under the bridge. to do this, come over there at 40 kmh (approx. 30 mph) This is the best glitch. “Do how many drift points do you want” Go to a Downhill drift Drive and drift normally until you do a high value drift. before the counter stops counting your drift points, open the start menu and go to replay. it is important that you didnt hit anything. when the replay reproduction ended, close the menu and you will have the twice drift points you had before. For each time you play the replay, it will double your drift points, since your car didnt crashed or ended the drift. It is better to use this glitch on a downhill, since using it on a normal drift will double your opponent points and yours. So it will not be very helpfull…. And those where 7 bugs and glitches from need for speed underground 2. Please, hit the like button! And dont forget to share it! I’m Arthur Costa and I’ll leave my channel with you. Bye! *Click on the white s13 to go to the next video (if it is avaliable) *Wallpaper link on description

ROLY POLY | Pillbugs aren’t bugs, and neither are a lot of other things for that matter

ROLY POLY | Pillbugs aren’t bugs, and neither are a lot of other things for that matter


hey guys it’s me I’m back in America now and guess what I made a friend I found this lady in my grandparents garden this is a roly poly or in my family we call these things roly polies although I know a lot of other people call them pill bugs but actually they aren’t bugs at all what they are is kind of cool so I thought I’d talk about it but instead of just telling you I thought I would show you how you can figure it out yourself so when you’re outside and you see something kind of small and crawly looking you can be pretty sure that it’s an arthropod arthropods have four basic types you’ve got your Flying type water type ground type and the burn it with fire type the best way to tell these four types apart is by counting how many legs they have insects always have three pairs of legs although there are some butterflies where it sort of looks like they only have two pairs but they do really have three and I’m pretty sure you know what a butterfly is anyway so I’m not going to worry about that spiders scorpions mites that whole nightmare fuel group they have six pairs of legs but the first two pairs are usually pretty different looking so it can seem like they only have four pairs next we have centipedes and millipedes which have a lot of legs that’s kind of their thing the numbers vary quite a bit but it’s always more than ten there is a type of millipede called a pill millipede which looks very similar to our friend here and it even rolls up just like a roly poly but it’s not a perfect sphere not to criticize but the rear end kind of sticks out a bit and these guys they have a butt ton of legs but if we flip our friend over you can see she only has seven pairs of legs which means by process of elimination that this is my crustacean yeah crustaceans have five or more pairs of legs usually under 10 and you can also tell that roly polies are crustaceans because they have gills inside and they like that damp dark soil where they can get a lot of moisture they’re basically land shrimp that crawled out of the water inter now living happily among us in the garden under flowerpots under rocks etc fun fact insects are also crustaceans but they crawled out onto land so long ago that a lot has changed for them since then so it can be a lot harder to tell where they came from anyway I named my friend shrimpy and if you’re wondering I can tell that she’s a lady because if you flip her over again sorry and look at this region right here you can see it’s sort of smooth looking whereas Mela Rolly pollies will have a little pointy bit not to get too explicit or anything um crustaceans are really cool they’ve got lots and lots of different forms like did you know that barnacles are also crustaceans they’re basically shrimp that glue themselves to rocks for their entire lives crazy anyway that’s all for today it’s really nice to be back in sunny sunny California I have officially graduated from into you and I’ll be moving to Massachusetts pretty soon where I’m going to get a PhD or try anyway a PhD in biology and I love it if you guys would come along for whatever adventures I have there so look here for occasional updates and I do mean occasional because as you probably guessed I’ve been pretty busy but when I have time I am going to make some more videos so look out for that and yeah thanks for watching guys see you next time bye

GCTV7: Overcoming Phosphine Resistant Insects

GCTV7: Overcoming Phosphine Resistant Insects


GCTV Ep#7 Phosphine Resistance Narrator:
All around the world wherever grain is held in storage, insect contamination is a problem.
Insects can reduce stored grain’s quality; reduce the price growers receive for their
grain; and in Australia, result in grain deliveries to export
facilities being rejected if live insects are present.
The way to get rid of the insects is to use fumigation but the insects have been fighting
back. Rob Emery: Senior Entomologist DAFWA
“In Western Australia there’s the Rust-red Flour beetle that is very common and has started
to develop strong resistance but there’s also
the Lesser Grain Borer which is a much more damaging insect.” Narrator:
What these insects are developing resistance to is the chemical that grain growers have
come to rely on most. Tony Crowley: Reporter
“For more than 40 years Phosphine has been a safe and reliable fumigant for the control
of insects in stored grain. Over 80 percent of
all stored grain is fumigated with this chemical but
insects are starting to build resistance to it. So when a previously resistant strain
of Red Flour Beetle here in WA was eradicated using Phosphine
it was a remarkable result.” Narrator:
No-one in Australia, quite possibly no-one in the world, has scientifically documented
such a result before.
While many grain-producing countries rely on phosphine to disinfest their stored grain
Australia is the only country with a national phosphine-resistance
monitoring program. A program supported by the Grains Research
and Development Corporation and the Co- operative Research Centre for National Plant
Biosecurity. Western Australia began to monitor for Phosphine
resistance in the early 1980’s some 15 years before the national project commenced. It
was to be the foundation on which this remarkable achievement was built. Rob Emery:
“The lead up to the Wubin eradication was the detection of strong resistance in Rust-red
Flour beetle. Now we’d been expecting that strong
resistance to develop for sometime because it had
been found in the eastern states and we noticed in Western Australia through our monitoring
that weak resistance gradually increasing and we
know that when weak resistance becomes common strong resistance soon arrives.” Narrator:
Three years ago near Wubin in WA’s northern agricultural region that strong resistance
arrived. An isolated insect population had built resistance
to phosphine because of poor on-farm storage hygiene and an inadequate fumigation process. Chris Newman: Senior technical Officer, DAFWA
“The farmer had been fumigating incorrectly for about 11 years. Simply punching holes
in phosphine containers and hanging them in the
head space means that the gas is released exceptionally slowly and there was a very
high selection pressure in the head-space of the silo.” Narrator:
In Western Australia the clinical approach is to first use a rapid test to determine
phosphine resistance so that action can be taken as
soon as possible. Insects are separated from the grain sample,
dosed with a precise amount of phosphine then left
for half an hour. Michelle Chami: Technical Officer, DAFWA
“We’d hope to see in a susceptible strain of insects that there’s no life or appears
to be no life, they’re all knocked down after 30 minutes.
In a resistant sample we’d see some life so some
normalcy in the insects.” Narrator:
The insect sample from the Wubin site was strongly resistant and indicated that urgent
action was required. Chris Newman:
“Rob Emery asked me if I would have a look at the situation on this particular farm,
Michelle had already indicated that it was starting to
look very interesting and so I first went up to the farm and
assessed the situation, discovered what the fumigation practice was; looked at the silos;
looked at the hygiene around the farm and decided
that it was possible that we could do an eradication of the insects on the farm.” Narrator:
Proper hygiene and fumigations were maintained for the next couple of years.
Empty silos cleaned and treated with diatomaceous earth.
Silo seals were renewed and pressure tests conducted.
And when filled with grain the silos were fumigated using the correct procedures.
The final result was that the strongly resistant beetles were eliminated. And what was even
better news was that they had been beaten by the
fumigant they’d build a strong resistance to …
Phosphine. Chris Newman:
“The most important aspect of it was that although we’d eliminated the insects in
the silos we needed to check that the insects that were
flying into the area were also not strong resistance.
And so I put an environmental trap under the silos which was essentially a large rubbish
bin full of grain and sieved the insects out of that on
a regular basis and submitted them to the labs for
Michelle to test and found that there was no strong resistance left in the insects that
were flying into the farm.” Narrator:
The United Nation’s Food and Agriculture Organisation’s resistance test is the more
exacting procedure used to determine both frequency
and level of resistance and it was the next step the
WA team used to document the Wubin experience. The FAO established this test 30 years ago
and it’s been accepted internationally as the standard. Michelle Chami:
“It’s a discriminating dose test so we put a certain dose into the same number of
insects, a hundred per replicate of 3, for a 20 hour
test and that tells us whether or not that population has
strong resistance. I inject a sample that I take out of the desiccators into the gas
chromatograph and make sure that that reading is what I
expect for the concentration required.” Narrator:
The lab’s confirmation that the strongly resistant population of Rust-red Flour beetle
had been eliminated was the news the WA team had been
hoping for. Chris Newman:
“Oh extremely pleased to put it mildly. It’s the first time I believe that its been
recorded that we’ve eliminated the insects from the farm and the
environment. Certainly there have been a lot of
fumigations over East where strong resistance has been eliminated from the storage but in
this case we’ve proved that the insects are no
longer existing around the farm environment itself.” Narrator:
Helping to underpin the program’s work is a national grain insect resistance database
currently holdings the results of more than 60 thousand
tests. Between 1985 and 1990 samples were mainly
recorded in WA and NSW and weak resistance to phosphine was already widespread.
In the next 10 years more sites were sampled and weak resistance was now found in most
locations around the nation. And from Queensland to South Australia strong
resistance was building. As well as tracking resistance the National
Phosphine Resistance Monitoring program developed better fumigation protocols and recommended
changes to phosphine labels. These changes removed incorrect practice and provide the
basis for more improved management of strongly resistant insects. Rob Emery:
”Yeah well this work obviously highlighted the need for continued research and development
on phosphine resistance because it shows that
not only were we able to detect a problem we were
able to deal with that problem as well. But we also learned from that resistance and the
different resistances around Australia that we have
resistance management strategies that allows us to
advise farmers and bulk handlers on how best to use phosphine to avoid resistance developing
in future.” Narrator:
As was the case at Wubin, repeated incorrect fumigations are the biggest risk to maintaining
phosphine as an effective control of grain storage insects.
And a GRDC survey in 2010 found only 36 percent of grain growers using phosphine applied it
correctly. Chris Newman:
“Phosphine resistance doesn’t mean to say you can’t control grain insects. It
just means you have to be better at your fumigation, that
there must be no gas leakage below the required concentration for the correct length of time.
And so controlling very strong resistance is simply a
means of increasing the time and the dose rate to control the very strong resistant
insects. Once they’ve been controlled you can go back
to normal fumigation practice on your own farm.” Narrator:
Used correctly Phosphine will give grain growers many more years of reliable insect control
in their sealed grain storages and fewer episodes
such as Wubin. ENDS 3

Gummy Pickle, Giant Stress Ball, Edible Insects & More! | A.T. #136

Gummy Pickle, Giant Stress Ball, Edible Insects & More! | A.T. #136


Welcome to Awesome time! All of the new stuff happening at vat19 It’s a ladybug- Stick around, we’re doing stupid science! Welcome to episode 136, how about the hair? Did it myself put the comments, which think about there carrot and Eric think it’s terrible if you haven’t Subscribed to our email newsletter do that with the link in the description below That’s how you get a coupon off your next order announcements first announcement. That’s a drumroll No sponsors this time so all you want to put in the comments like when the video starts like video starts at 405 or whatever Started back at 0. There’s no sponsor this time although There’s a couple announcements one if you haven’t seen the vat19 movie go watch it What are you doing go watch that actually don’t finish this whole video Then go watch the vat19 movie and for those of you Who are having a little withdrawal Eric does the internet? Made a little commercial about Dan Italy’s Mexican restaurant. Go check that out also Check out this video from Healthy junk food. They had some fun with our gummy cheeseburger and some of the guys from vat19 and our friend Mathias did another video featuring Five mystery bat 19 items so go check that out alright. That’s it That’s it with the announcements that we’re just going right in the product. Hit me with the first product Boom slime kit from Carina Garcia. She’s like this slime queen of YouTube She sent us this kit to try out cuz she knows we like the putties and whatnot this thing’s only available at Target I was like can we sell this she’s like no don’t we get it at Target But you can talk about it on That 19 if you’d like we were like how about we do that and on your channel you eat a world’s hottest? Chocolate bar what she agreed to do. She’s down. She’s also written a book to check that out on Amazon Let’s try to make some orange vat19 slide okay I’m following her directions to the tea two tablespoons boom done drop those in visit fizzy fizzy make nice orange, okay, we’ve Got a nice color in here let’s throw in a little slime activator. Oh, it’s already like going up the quick activation chemistry and Motion here it looks like jelly we made that nineteen Jam. I made mine translucent. There’s other options She’s got glitter in the kit. You’ve got glue to make it more opaque. There’s even a glow-in-the-dark option This is super fun kit comes with Instructions everything you need to start making and everything you need is right here in the kit if you love Carina And you love her youtube channel. I need to go check out this kit We have a link in the description below. It takes you to Target check that out and check out her channel We’ll see how the queen of slime handles the world’s spiciest bar of chocolate this next product I’m excited about cuz Eric sent me a present. This is from potato parcel It’s a company that specializes in sending messages on Potatoes they mail them to your friends or relatives and it’s got like a picture or phrase written on it And if you want to get your own potato parcel similar to the one I got from Eric here I haven’t seen this yet, so I don’t know what’s on it check out the link below – potato parcel This is a custom product. You know they write on it or put your picture in the potato We can’t sell it ourselves It says not to eat the potato cuz it’s been written on let’s see what does it say it says Jamie as everyone’s favorite? Dot dot dot did you send me? another potato Other more potatoes oh it’s gonna be mean and snarky Competitor of the golden gummy challenge dot dot dot jamie is everyone’s favorite Competitor of the golden gummy challenge so this continues because he always wins dot dot dot I have a feeling this is gonna End poorly at being a sore loser dot dot dot incorrect because to K waiting straight When Eric beats him are there any more dots? Period so Jamie is everyone’s favorite competitor of the golden gummy challenge because he always wins at being a sore loser When Eric Beatson which hasn’t happened for two challenges in a row? This is a type of fun. You could have with potato parcel. You can also get the pictures It’s a stupid size potato get a message or a picture Sent to a friend in the form of a potato just check out the link below to potato parcel Oh, I get excited when I see the gummy friends. This is the gummy pickle it is exactly what you think it is It’s a pickle made out of gummy did it did it That’s a gummy pickle nice texture and everything it’s got a flat bottom But it’s got the pickle II look it’s pickle flavored You just got a gross sounding, but I love pickles, so I’m gonna give it a try Hmm, there’s a strange sensation the chewiness or the gummy with the taste of a pickle. It’s not salty like a pickle It’s sweet is it sweet. Yeah sweet or at least your mind thinks. It’s sweet because it’s chewy like gummy it tastes Just like a pickle is it intense pickle flavor we have gummy pizza, but it tastes like gummy so This is our first gummy that tastes like what it looks like you should buy this now at vat19.com And it’s also this episode’s stupid science come on in here. Let’s do some science stupid science Stupid yes, I am Jamie I was sitting at my desk and I was pondering the Earth’s mysteries that surround us every day And I thought to myself would Jamie be able to tell if a gummy pickle was Touching him or if a regular pickle was touching him. Oh, yes, so my Hypothesis is if I touch you with the gummy pickle in the real pickle while you’re blindfolded You won’t be able to tell which one’s touching your body There’s a excellent question and it can’t be tested so it is a high pop. Yes. I am willing to do this because I have Excellent sensory ability. I don’t care where your pickle choose me Eric I will know if it’s a gummy pickle or your vehicle test number one mmm I think this might be the easiest one I’m gonna start easy here That’s a real pickle all right that is a real pill That’s a real pickle real pickle. I’m so real okay Gummy pickles yeah was it gummy pickle Okay that’s a Goodness all right, and we need you to remove your shirt. Okay, all right kind of lift it up like this. Thank you Pickle there’s the gummy and real pickle simultaneously Checkmate I have to say that I actually felt like that was not that stupid for some reason Yeah, no It’s not stupid at all yeah You’re gonna eat that pickle or what’s going on the one that touched you it was rubbing on your nose pretty good I’m pretty sure there’s some there’s some slime Some homemade slime on that one slime King I’m not like that’s not this segment is over Over all right get out of here. Okay? I’m excited about this next product throw it in here Carol boom This is the giant stress ball look at the size of this thing. It’s about five inches in diameter Which is about double the diameter of most stress balls thing weighs like three quarters of a pound. I mean this could really Relieve some stress. I think but to put it to the test I’m gonna have Eric stress me out from off-screen and see if I can stay chill I could just blow my nose. I don’t care. I use a nose hair trimmer I know my nose is fine a nose is on fleek About your hairstyle I Fixed it you made so much fun of it just a fauxhawk sound like that weird We didn’t get any audio in this video. Are you nah? You’ve done that before Eric. We’ve had to redo whole episodes an awesome time because you got the microphone turned on all you got Yeah, this is fantastic though. This is up there with putty as far as fidget ability giant stress ball get it now at vat19.com Okay, this is straight awesome throw it in. This is color-changing Floof Floof is Amazing as it is it’s just super fluffy Super awesome material the folks that made floof have made it color change It feels the same super fluffy It’s like snow or marshmallow or whatever, but it changes color when you get it warm So I’m gonna kind of get this warm. It’s normally blue and It turns white when you get some heat on it I’ve got two balls of flute to demonstrate the color change So I’m gonna hold both of these and then I’m gonna have Eric from off-screen blow some of his patented hot air get it Full of hot air Eric blow on one of them, so you guys can see in real time the color change blow blow You see it changes, that should be going kind of white and this one’s probably staying blue There it’s magical hot air you? Can go for days he’s so full of it get your color change fluke now at vat19.com I’m really excited about this next product All right these are larvae tson crickets lar vets are mealworms snacks and crickets or Cricket snacks they’re actually not that bad They come in three different flavors each bacon and cheese crickets salt and vinegar crickets sour cream and onion crickets Mexican spice mealworms Barbecue and cheddar cheese look. Here’s the deal I know it’s really gross sounding But they’re an excellent source of protein and they’re way less harmful on the environment to raise than say Cows are it’s a fun crazy snack and luckily Kara’s here today to test them out for you come on in here Why are we doing this which flavour are you gonna try I’m gonna go with sour cream and onion mmm I’m gonna go with the barbecue lar vets you know. I’ve actually never tried this I Couldn’t bring myself to try them the buyers here try them and told me they’re pretty good so I went with their Sage advice. I’m hoping it kind of just tastes like a Pringle Are you going the whole thing or yeah kind of just smells like a soybean? Mm-hmm yeah on three what you like you’re not gonna. Do it. I’m totally gonna. Do it come on go on three one two three Mmm. Not that Kind tastes like a soybean – I did it I had a mealworm Barbecue flavor not bad though. Yeah, if that would have been Crushed up and I wouldn’t have been able to see it I wouldn’t have even know those are the lar vets and crickets buy them now at vat19.com toss it um Training a ten there’s a full electric train inside this tin here what awesome holiday fun is this so cool Get a little train set with a working Locomotive. I got my train all ready to go. I’m gonna get him get him riding Oh Yeah! Pretty cool that this whole thing actually I got I could have made it a bit wider I had two more pieces left over all this fits in this little tin right here This is the train in the tin set available now vat19.com We’ve got so many new products, and I can’t always give them the full awesome time treatment, which is why we have bullet time I’ll just give you the bullet points jump to the next product as soon as I hear that… Okay, this is the holiday cactus. It’s a light up cactus in a potted play, hook it up to your computer It’s a glowing unicorn pillow look at this guy. He’s adorable This is kitt-A-Boo. It’s a you put this on your wall. It’s a hook and when you put stuff on it, a cat Pops up all right Star Wars Droid inventor kit make and design your own R2-D2 Okay, move it on don’t throw that okay Speech bubble light up box that you can you can draw a message on here, and then it lights up Do you see it lighten up all right fine Erik? I’m moving on whoa okay, crazy Aaron’s mixed by me putty kit now has a holographic version. How cool is that, all right get that out of here. Awesome fan art as always. Thank you so much for sending it Here’s our address if you want to send in some of your own fan art I’d love to see it and we will put it up on the wall behind me in a future episode of Awesome time what you heard while the fan art was playing was a voicemail that we received from one of you So keep those coming okay? It’s time to wrap this episode up check out the videos around me especially go watch the Vat 19 movie If you haven’t already we put a lot of effort into it. We’re sure you’ll love it and um Follow us on social media. We do a lot of Giveaways that’s Facebook Instagram and Twitter. Thanks for watching We’ll see you next time bye. Vat 19.com JAMIE IS AWESOME!!!!

Family Health : Treating an Infected Nail

Family Health : Treating an Infected Nail


You’ve got a sore finger. It’s probably sore
right around the nail bed. The fancy name for that is a paronychia. My name is Beverly
Bitterman, ARNP, and I’m here to give you a couple of strategies for how to deal with
that. Sometimes you get them because you might have a hang nail and maybe you’ve pulled the
hang nail out and then you developed an infection, and sometimes who knows why you get them.
But, you’ve got a soreness, either on the side or on the base of your nail. The good
thing about this, is they’re pretty easy to treat. And, what you want to do is apply moist
heat, and because it’s on a finger, it’s really easy to do that. All you have to do is get
some hot water, run some hot water into a cup, and then let’s pretend it’s my index
finger that’s the one that’s hurting, and I’m going to just stick it into the hot water.
And, I can even just kind of carry that around with me, I can talk on the phone, I can watch
T.V, I can do a variety of things, while my finger is being healed by the hot water in
the cup. I suspect that the, keeping it in water frequently also helps clean it, etc.
But, generally, you’ll find that if you’ll do that for two or three days, you can get
rid of your infected finger or your paronychia. You can also see your physician and you can
get an antibiotic, however, it will still take a little while for that to clear. And,
I recommend that you give the hot water a chance to work, and see if that won’t help
you. If you have any fever, or any other symptoms beyond nail redness, of course, you’ll also
want to see your physician. My name My name is Beverly Bitterman, ARNP, and I hope that
your finger feels great soon.

Developing draft national infection prevention and control standards for community services

Developing draft national infection prevention and control standards for community services


today HIQA has published draft
national infection prevention and control standards for community care
services these standards applied to services delivered in the community for
example services provided by public health nurses, community nurses, GP practices, ambulance services and nursing homes these standards are draft because
we want to hear the views of staff working in these services and also the
people using these services before we finalise these standards more and more complex care and services are being delivered outside the hospital setting and as a result infections are no longer confined to hospital settings they are becoming more
and more common in community care settings infections can have a huge
impact on people these standards describe what is required to prevent and
control infection in order to provide safe care in a clean environment antimicrobial stewardship is about ensuring that every person receives the right medicine for the right infection type at the right time
everyone who prescribes, dispenses, administers, uses and disposes of
antimicrobial medication should promote and monitor the appropriate use of
antibiotics community care services are a broad
range of services that are provided outside of the hospital setting
including GP’s and public health nurses social care, mental health and health and
well-being services the standards emphasise that infection
prevention and control is everybody’s responsibility many infections are avoidable the standards say that good infection prevention control practices such as ensuring that hands, equipment, and the care environment are kept clean
reduce the risk of people acquiring an infection the standards provide a consistent
understanding of what needs to be in place in health and social care services
in the community to prevent and control the spread of infections we are currently holding a six-week
public consultation on the draft standards it is very important that we
receive feedback from staff working in community health and social care
services and people who use these services if you would like to take part
in this public consultation you can go to the HIQA website which is WWW.HIQA.IE we look forward to hearing from you

America’s Deadliest Drug: Fentanyl | Patriot Act With Hasan Minhaj | Netflix

America’s Deadliest Drug: Fentanyl | Patriot Act With Hasan Minhaj | Netflix


Tonight, I want to talk about
the opioid epidemic. Okay, I get it. All right, look… Last week we did Fortnite. So our pattern is fun, depressing, fun. So, if we get through this, next week, I’m going to do the whole episode
while jumping on a trampoline, okay? Now, it is no secret
that America is in the midst of one of the most devastating
drug epidemics in its history. For the last two decades, the opioid
epidemic has been getting worse and worse. In 2017 alone,
over 47,000 people died from opioids. But at last… there might be reason for hope. A newly-released government database
reveals the scope of the opioid crisis. For the first time since 1990,
deaths from overdoses declined last year. “The CDC credits the drop
to fewer deaths from heroin and prescription painkillers.” It looks like some of our responses
to the opioid crisis might be working. Isn’t it so weird
to hear genuinely good news? It’s like… when you see your favorite celebrity
trending on Twitter, and you’re like, “Oh, my God, please don’t
tell me he just got #MeToo-ed. Oh, he just died. Thank God. I can still watch his movies.” You haven’t felt that? I know it’s dark, but look,
compared to 2017, 2018 overdose deaths were down almost 5%. Experts say, the drop comes from investments
in treatment and public awareness. Though there’s something else
that should get credit, too. “Narcan also known as naloxone, the generic name for the drug,
is an opiate blocker that can literally revive
an overdose victim.” “Jennifer Plumb,
an emergency room pediatrician, says naloxone is a miracle drug.” Understand this stuff is really good
at what it does. It has one job. You can just save a life with it. I mean, how amazing is that? Does it really bring people back
from death? It really does. Wait, so you’re telling me
I could bring back Al Pacino? And the lady’s like,
“Leslie, Al Pacino’s not dead. He’s in a movie right now. Naloxone’s incredible.” Naloxone is a godsend, though,
and it’s very big business. Last year, the naloxone spray market
was $178 million, and by 2026,
it’s expected to hit nearly a billion. The only other market that’s
growing that fast is Casey Affleck insurance. So that’s the good news. Prescription opioid deaths are down. However,
that graph isn’t telling the whole story. After soaring overdoses
from prescription pain meds, then heroin, now it’s a synthetic opioid, fentanyl,
on a rapid rise. Over half the deaths from overdoses
that we’re seeing right now in America are caused
by the synthetic opioid fentanyl. Fentanyl is often called the third wave
of the opioid crisis. The first wave was when doctors were over prescribing painkillers
like OxyContin. The second wave happened
when addicted patients then turned to heroin. And the third wave is fentanyl. And because of fentanyl, overdose deaths have exploded. Now, when I first saw this graph,
I couldn’t believe what I was looking at. It looks like the income
of everyone in Destiny’s Child. Right, like, you have Michelle… you have Kelly and then you’re like,
“Oh, shit! It’s Beyoncé!” That moment, right here, this part, right here, that is Lemonade. That is when
she stopped talking to everybody else. Fentanyl is 50 times stronger than heroin. This photo is terrifying. Now, not just because it looks like
Honest Abe’s about to get high, but because this much fentanyl
can kill an elephant, and that’s not just
some big-ass novelty penny. That’s just a regular
why-do-we-still-have-these penny. In the last five years, fentanyl and its analogs have killed
an estimated 95,000 people. That is nearly two-thirds
of all opioid deaths. And this thing, it does not discriminate. Young… old, rich, poor, famous. Prince. Tom Petty and Mac Miller all had fentanyl
in their systems when they died. So chances are
you know somebody affected by fentanyl. I personally know multiple people who have lost their lives to fentanyl. And the saddest part is
they didn’t even know they were taking it. And I know for sure,
they weren’t trying to die. But somehow fentanyl got them. So I’ve been paying attention
to how we talk about the opioid crisis, and the problem is… a lot of times we lump all the opiods
together like they’re the same. But they are not. Fentanyl is a completely different animal
than oxy or heroin and the truth is… there is no beating the opioid crisis
until we figure out how to beat fentanyl. So tonight, let’s actually focus on fentanyl
and look at where it’s coming from and why we haven’t been able to stop it. The first thing you need to know is that
the story of fentanyl has two parts. There’s the legal side of fentanyl,
which involves pharmaceutical companies and the illegal side of fentanyl,
which goes by a lot of different names. What’s on the street is
a chemistry creation also known as “Apache,” “China Girl”
or “TNT.” “‘Friend,’ ‘Jackpot,’ ‘TNT,’
and ‘Tango & Cash.’” “Dance Fever,” it’s called.
“Goodfella,” “Jackpot,” “Murder Eight.” Why does it sound like Vin Diesel came up
with all of those titles? He’s just like, “‘Murder eight,’ ‘China girl,’ ‘Cookie Dust,’
‘Tricep Fire.’” Good job, Vin. Way to stay focused. No matter what it’s called, illegal fentanyl usually isn’t sold
on its own. It’s often laced into heroin,
which can have devastating consequences. “Huntington,
once a thriving industrial hub, had been crippled by years of job loss,
rising crime and 1,600 overdoses the previous year. The calls started coming in at 3:21
on a warm August afternoon. In just four hours,
26 people had overdosed on a batch of fentanyl-laced heroin.” This is one of the most tragic parts
about fentanyl. It kills a lot of people
who don’t even know they’re taking it. And that’s because the heroin coming up
from Mexico these days is being laced with fentanyl,
which is really dangerous. Remember a pinch of this
can kill an elephant. So the margin here is just razor-thin
for any error. So you might be wondering… why on earth would cartels risk
killing their own customers? It’s because they can afford to. It is the same business model
as Jack in the Box. Come on! Two tacos for 99 cents. That is not a deal. That is rat poop roulette, okay? No one’s talking about this. Fentanyl-laced heroin
is ridiculously profitable, okay? It is 20 times more profitable
than regular heroin. Here’s how you do it, okay? You start with some pure heroin,
that’s the “H,” okay? And then you cut it with
whatever shit you have, which is the… you guys get it, right? “S,” okay. So you got all this really diluted heroin, and if you sprinkle in
a few thousand bucks of fentanyl, you can make $1.5 million
worth of product. It’s like selling bottled water
at the airport. You ever notice how you just
magically walk into LaGuardia and you’re like, “All right,
I guess Dasani is $17 now?” That’s the fentanyl effect. Here’s what’s weird, though. Most fentanyl doesn’t originally come
from Mexico, which is kind of surprising. Doesn’t it sound like a drug lord’s dream? Like, you would think
El Chapo would have invented it. But what you don’t know is,
he was really bad at o-chem. And it turns out even Mexican cartels
need a connect. “Javier says he sources
the precursor chemicals to make fentanyl from China.” “While doing our interview,
Javier is called by one of his men. They take us to another location
where we wait.” And in the meantime, he just left
his half a kilo of heroin right here. So it’s just us and half a kilo of heroin. Okay, that news crew is
for sure about to do heroin. Like, look at the way she’s looking at it. “Like I’m just not gonna do anything? Let’s do some heroin,
let’s have some fun.” Also, isn’t that the trick you use
when you want to see your crush again? You’re like, “Hey, it’s Javier, you know,
the guy with all that gauze on his face. Did I leave a half a kilo of heroin
at your place? Do you want to just grab dinner?
Let me know.” Like everything else in America,
most fentanyl is made in China. Even though China has regulations
to stop illegal fentanyl, the government rarely enforces them. It’s like taking Costco samples. Like, in theory, there are rules. But in reality,
you can do whatever you want. You know how you go in, and they’re just like,
“Sir, please take one sample.” And you’re like,
“I need twelve for my entire family.” And they’re like,
“Sir, how big is your family?” And you’re like, “Why can’t you just be
like Trader Joe’s and not ask questions? Let me do this.” Dude, sometimes I’ll just run for it. I’m like, “Fuck it. You just have a vest.
You can’t stop me. Let me live. I’ve been a proud card carrying member
since 1988.” I know that’s not possible. Now, the point is… that is why there is
so much Chinese fentanyl around and getting it is super easy, even if you’re not a drug king-pin. “Law enforcement says
it’s just a click away on the internet.” They can order it from China. “My producers and I decided
to put that to the test.” I am interested in getting fentanyl sent to us, submit. “And then, just a few minutes later…” Whoa! The email already came through. “We ship to U.S.A.
We only accept Bitcoin as payment method. Warm regards.” Wow! “Warm regards?” Damn, I feel like those drug dealers care
about me. They’re like, “Hey, here’s enough fentanyl
to wipe out Milwaukee. Warm regards, Xiaofan.” I’m like, “Thank you, Xiaofan.” Americans are buying
illegal Chinese fentanyl on the dark web and then having it shipped to them
through the U.S. postal system. And now you know why millennials
get so excited every time they get mail. They’re like,
“Oh, my God! It’s Fentanyl Friday!” Now look, humans have been trying to get
opium into our bodies for a long time. We love this stuff, and why wouldn’t we?
Look at opium poppies. It is a beautiful flower with drugs in it
that eases pain and gets you really high. That’s why we have found
every possible way to ingest it. We drank poppy tea back in the day. We smoked opium. We injected morphine. We shot heroin, and if you haven’t watched Euphoria
on HBO, now you’re all caught up. But in the mid-20th century, something big happened. Scientists figured out how
to make opioids synthetically without needing any of those poppies. This was a game-changer. Not just for opioid users, but for the companies
who could profit from selling it. Which brings us to the legal side
of fentanyl. Before anyone ever really sold fentanyl
on the black market, there were two important uses for it,
okay? It was given to people for surgeries, and it was prescribed
to a very specific group of people. Late stage cancer patients
with pain so bad… other opioids no longer worked. Those were the only people
it was supposed to go to, but instead… A new study finds as many as half of patients prescribed
fentanyl painkillers should never have received them. “The Journal of the
American Medical Association found thousands of people were prescribed
fentanyl for far less serious conditions.” “Doctors prescribe
these powerful drugs for groin pain, oral pain, and more.” Can you imagine going to the doctor like,
“Yo, my crotch hurts.” And then he’s like, “Okay, here’s the strongest drug known
to mankind.” You’re like, “It’s just an itch, but… fuck it, I guess.” By the way, real quick.
Who’s in their graphics department? What the fuck is this? They’re like, “We don’t have a visual.
Someone open up Microsoft Word and type in ‘groin pain’ and ‘oral pain.’ Make sure you grab it!” Like, what the fuck, man? Now, here’s the question. Besides these shitty graphics,
how did so many people get prescribed a supercharged medication
they should have never had? Well, it has to do
with the drug’s origin story. Fentanyl was first synthesized in 1960
by a scientist named Paul Janssen, and at the time, it was
the most powerful opioid ever created, but in 1981,
Janssen’s patent on fentanyl expired, and the drug
became a generic free-for-all, and the other pharma companies
went gangbusters. They started making fentanyl patches,
sprays, and lollipops, which made for some very strange
instructional videos. “Place the Actiq unit into your mouth between your cheek and gum and actively suck on the medicine. Plan to finish the Actiq unit completely
in fifteen minutes. If you finish Actiq too quickly, you will swallow more of the medicine
and get less relief.” Why is that lollipop so small? They’re in pain, man.
At least put some bubblegum on the inside. Now, unlike with oxy,
the FDA knew how dangerous fentanyl was. So they tried to regulate it. In 2011, the FDA created something called
The TIRF-REMS program, a strict set of rules to make sure
doctors prescribed fentanyl only to that small group
of cancer patients. There was just one problem. Instead of the FDA running TIRF-REMS, they did something really stupid. They out-sourced it
to the pharmaceutical companies, and then pharmaceutical companies
hired a company called McKesson, one of the world’s largest
drug distributors to run it. In other words… The purpose of the TIRF-REMS program is
to make sure that these drugs stay only with those that it’s indicated for. McKesson had no interest
in shutting people down from getting this drug
because they supply the drug. That is the textbook definition
of a conflict of interest. Imagine if Eminem was like, “Too many kids
are calling their mom a ‘bitch.’ You know who can handle it? Slim Shady.”
You’re like… “Em, that’s you.” On top of that, the exam the doctors had
to pass was ridiculously easy. “Doctors who want to prescribe drugs
in this program need to complete an eleven-question quiz, but it’s an open book test
with the answers easily found in this nine-page handout.” It’s an open book test? And it’s multiple choice. How is it that easy
to get something this dangerous? Just for comparison, and this is true, you need to take an eight-hour course
to sell churros in Times Square. You know those guys who sell peanuts? They failed churro school. So the government’s attempt
to regulate prescription fentanyl was a massive failure, but we can’t forget a huge part of the blame also falls
on fentanyl makers themselves. They’ve been aggressively pumping fentanyl
for years, and it’s a tactic that they took directly
from Purdue’s OxyContin playbook. Purdue convinced everyone
that oxy wasn’t that addictive, which is insane. It’s like if Juul told people, “Hey, it’s just water vapor
in a thumb drive, kids.” Meanwhile, every fourteen-year-old
that you know has nicotine shakes like it’s fucking 1920. Look, there’s a lot of corporate blame
to go around for prescriptions fentanyl abuse, but I want to focus
on a few key companies. The first you might have heard about. Either because they’ve been in the news
or because they make SpongeBob Band-Aids. Johnson & Johnson
will be the defendant today when an opioid-related lawsuit goes
to trial. Oklahoma’s attorney general
is suing Johnson & Johnson. The AG says the company
deceptively marketed the drugs by overstating the benefits of opioids
and downplaying the risks of addiction. I know that’s jarring. It’s like hearing
Pantene makes atom bombs. You’d be like, “Wait. The secret ingredient is uranium?” J&J made a fentanyl patch
called Duragesic, and Oklahoma prosecutors say that
the company marketed it as a much safer drug than it actually was, contributing to the 6,100 opioid deaths
in that state alone. But J&J is just the start. When it comes to over the top marketing
for fentanyl, no one went harder
than a company called Cephalon. They sell fentanyl in a number of forms,
including that skimpy lollipop that I was talking about earlier… and pills. They are really obsessed with pills. This is an actual Cephalon sales meeting
from 2006. “Introducing Fentora, the first and only buccal tablet
that utilizes effervescence to improve the rate and extent
of fentanyl absorption. A change is here. Fentora, relief at effervescent speed.” It is a beautiful day. If you’re gonna force something
on people they didn’t ask for, it makes sense to use U2. Also, why are they introducing that
giant pill like it’s Criss Angel? They’re like,
“Fentora, it’s a mind freak!” And then Criss Angel pops out. Oh, by the way… remember those lollipops? Thanks to Cephalon’s aggressive
sales force, doctors prescribed them
to a lot of people who didn’t have cancer. In 2006, only 1% of the lollipop
prescriptions were written by oncologists. 1%. Imagine if finding out only 1%
of drivers licenses were given out by the DMV. Actually, that would explain a lot. Okay. Cephalon knew this was wrong. That’s why when they settled
a nearly $450 million federal lawsuit, they plead guilty to pushing fentanyl
on people who didn’t need it. But other fentanyl makers just went
with good old-fashioned corruption, like Insys. Five top drug company executives
have been found guilty in a bribery case
involving the opioid fentanyl. The multi-billionaire founder
of Insys Therapeutics and four other top execs
convicted of racketeering. Prosecutors say their scheme involved
bribes, kickbacks, even lap dances for physicians
who prescribed large amounts of the company’s fentanyl spray
to patients who did not need it. They were getting lap dances? I don’t want to die because some
horny doctor wants to make it rain. This entire bribery scandal happened
under their former CEO John Kapoor, who looks like Al Franken in brown face. Now, before he was a convicted felon, John Kapoor made himself a shitload
of money. “A pharmaceutical entrepreneur. Dr. John Kapoor. That’s him in the middle. Forbes lists him as one
of the wealthiest people in America.” How does he look like he’s twelve years old
and 80 years old at the same time? Dude, this is messed up. He made all of those people filthy rich,
and nobody would even give him a boost. You know what pisses me off? Even though he’s gonna be in prison,
you know his parents are still gonna be like, “You know John’s a pharmacist, right?” This Punjabi Oompa Loompa
became a billionaire by pushing addictive drugs
through bribery and corruption. And some Insys employees were told
to go even further. I would say, “Hi, this is Patty.
I’m calling from Dr. Smith’s office. I’m calling to request prior authorization
for a medication called Subsys.” They thought you were from
the doctor’s office. Yes, because that’s what I told them because
that’s what I was trained to tell them. “To get a surefire approval,
Patty said she’d sometimes just claim the patient had cancer.” You see a cancer patient,
you were like, “Yes!” That was exciting. This is a slam dunk.
I can do this without any guilt. Imagine how messed up your job has to be if your response to hearing that
someone has cancer is, “Oh, this is a slam dunk.” There was no line Insys wouldn’t cross
to sell more fentanyl. “Sarah Fuller didn’t have cancer. She was plagued with chronic neck
and back pain from two car accidents. But her doctor Vivienne Matalon actually brought an Insys sales rep
to an appointment. Fourteen months after
she started taking Subsys, Sarah was found dead on her bedroom floor.” What killed your daughter? Well, technically fentanyl. But a drug company who couldn’t care less
about a human life. That’s heartbreaking… and infuriating and there are a lot
of stories like Sarah’s, which is why earlier this year,
Insys settled a federal investigation of their bribery scheme for $225 million, which made Insys the first opioid company
to go bankrupt. Insys basically OD’d on its own
shittiness, which sounds like justice, until you hear what’s happening right now. These motherfuckers
can’t sell fentanyl anymore, but they can sell the antidote
for fentanyl, naloxone. So, let me hit that home for a second. Insys went bankrupt because of opioids, and now they’re trying
to revive themselves with naloxone. They’re just gonna spray it
right up their profit hole, and they are the last people
who should be doing this. But our pals at Cephalon
are somehow even worse. Cephalon is now owned
by Teva Pharmaceuticals, and four months ago, Teva got FDA approval
for its naloxone spray. So do you understand
what’s happening here? They’re unleashing a plague
and also selling the antidote. That’s actually the plot
of Mission: Impossible 2, and I know that because last night
I spent nine hours watching it on TNT. These companies help fuel
the fentanyl crisis on both ends, legal and illegal. When they marketed legal fentanyl
to patients who didn’t need it, a lot of people ended up getting hooked, and that intensified the appetite
for illegal fentanyl, which is leveling so many communities
across the country. Now, at this point,
we have seen this pattern. A powerful new opioid is created, the companies in charge
push it recklessly, people get addicted to it, and once it’s out there, it’s out there. The genie is out of the bottle. We saw it with oxy, we saw it with fentanyl, and, guys, this is fucking crazy to say, but we’re about to see it again. The FDA has approved a powerful
and controversial new painkiller. Dsuvia is an opioid taken in pill form,
ten times stronger than fentanyl and up to a thousand times stronger
than morphine. Projected annual sales of this drug–
$1.1 billion. Wow, so people stand to make
a lot of money off this. Dsuvia is ten times stronger
than fentanyl. What could possibly go wrong? Look, we know the problems
this is gonna bring. How do we make sure this drug only gets
to the right people? How do we make sure
people don’t get addicted to it? And how do we make sure
it doesn’t start killing people like the people I knew who never even intended to take it
in the first place? Unless you can answer those questions, guess what, pharmaceutical companies? This crisis is on you. Warm regards.

Witness The Roots of the LA Crack Epidemic

Witness The Roots of the LA Crack Epidemic


This little dot, has massive implications. This little dot, in the middle of south central
LA, affected the course of the nation. This was one of the first arrests of a crack
user in 1981. So what does this dot have to do with you? A lot more, than you might think. As early as 1981, reports of the alleged crack
epidemic, began surfacing in Los Angeles. Crack rock was cheaper, purer and easier to
get than traditional cocaine. And it took lower income areas by storm. TV Anchor: A drug so pure and so strong, it
might just as well be called: Crack of doom. By 1983, the epidemic had taken hold of the city, turning communities into war zones. And soon, crack became a national crisis. Reagan: Today there is a new epidemic, smokable
cocaine. smokable cocaine. Otherwise known as crack. It is an uncontrolled fire. Reagan’s anti-drug abuse act imposed harsher sentences on crack than traditional cocaine use leading to a decades long debate that the law was unfairly targeting minorities and and lower income neighborhoods who couldn’t afford the more expensive cocaine powder. Incarcerations in LA skyrocketed. By 1995 the California department of corrections
increased its black and latino inmates from 21,476 to 88,376. This led to broken families, an overblown foster care system, increased violence, and a growing skid row that crippled the nation. That’s until a long overdue correction was made. In 2010, Obama put an end to Reagan’s anti-drug
abuse act. While many feel it was too little, too late, it was a step towards correcting a racially skewed prison system. But was it enough? Now there are recent debates about a return
to Reagan era laws. Let us know your thoughts in the comments.