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PACEs in Medical Schools

Tagged With "Systemic racism"

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One state. One year. (Partial) Cost of ACEs = $5.2 billion.

Jane Stevens ·
In looking at the impact of childhood trauma, you can’t get much clearer than this: In 2017, ACEs among Tennessee adults led to an estimated $5.2 billion in direct medical costs and lost productivity from employees missing work. That’s just one year, according to the new report, “ The Economic Cost of ACEs in Tennessee ," released on Feb. 1, 2019 by The Sycamore Institute in Nashville, Tenn. And to provide some perspective, $5.2 billion is one-seventh of the state’s annual budget . This $5.2...
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Opinion: All Doctors Should Practice Trauma-Informed Care [calhealthreport.org]

By Bob Erlenbusch and Drew Factor, California Health Report, November 20, 2019 “Adverse childhood experiences are the single greatest unaddressed public health threat facing our nation today,” Dr. Robert Block, former president of the American Academy of Pediatrics, has been widely quoted as saying. According to the Adverse Childhood Experiences Study, conducted in the 1990’s by the Centers for Disease Control & Prevention and Kaiser Permanente, adverse childhood experiences are common,...
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TIC: News and Notes for the Week of October 21, 2019 [dhs.wisconsin.gov]

Scott A Webb ·
ACEs, Adversity's Impact There is only one boat: The myth of normalcy by Dr. Gabor Mate Understanding historical trauma to strengthen community Childhood trauma linked to early, premarital childbirth and poor health for women Early life racial discrimination linked to depression, accelerated aging When mothers are killed by their partners, children often become 'forgotten' victims. It's time they were given a voice Children's language skills may be harmed by social hardship Does racism...
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Tools and how to use them is focus of second webinar on Community Resiliency Model, May 14, 2020

Carey Sipp ·
The second of two free Community Resiliency (CRM) webinars with Elaine Miller-Karas , key creator of the CRM, will be held Thursday, May 14, from 11 a.m. - 12:30 p.m. ET, (10 a.m. CT; 9 a.m. MT, and 8 a.m. PT) and will include the practical application of tools of the model. CRM is an ACEs science-based biological model for helping individuals become emotionally regulated during natural disasters and other dysregulating times. Miller-Karas will be joined by CRM trainers from Wilmington, NC:...
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World Premiere: Stress & Resilience: How Toxic Stress Affects Us, and What We Can Do About It [developingchild.harvard.edu]

By Center on the Developing Child, Harvard University, November 13, 2019 When the stress in your life just doesn’t let up, and it feels like you have no support to get through the day—let alone do everything you need to do to be the best parent you can be—it can seem like there’s nothing that can make it better. But there are resources that can help, and this kind of stress—known as “toxic stress”—doesn’t have to define your life. In this video, learn more about what toxic stress is, how it...
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ACEs & African Americans Community on ACEs Connection

ACEs Connection envisions a resilient world where ALL people thrive. We are an anti-racist organization committed to the pursuit of social justice. In our work to promote resilience and prevent and mitigate ACEs, we intentionally embrace and uplift people who have historically not had a seat at the table. ACEs Connection celebrates the voices and tells the stories of people who have been barred from decision-making and who have shouldered the burden of systemic and economic oppression as the...
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Aligning Systems for Health: 2019 Call for Proposals [rwjf.org]

By Robert Wood Johnson Foundation, November 1, 2019 Required Components Aligning Systems for Health will explore the degree to which health equity is impacted or results from current models of collaboration incorporating health care, public health, and social services. Gaps in health are large, persistent and increasing, and RWJF is committed to a system that meets people’s goals and needs and addresses these gaps that many populations face. Studies should include a focus on health equity by...
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Announcing Trauma and Resilience Competencies for Nursing Education

Kathleen Wheeler ·
The authors are pleased to announce the Trauma and Resilience Competencies for Nursing Education. These competencies serve as a guideline of minimal expectations and reflect essential knowledge, skills and behaviors for three levels of nursing education: 1) undergraduate, 2) graduate, and 3) psychiatric nurse practitioner programs. The Trauma and Resilience Competencies, developed in 2018 at the Egan School of Nursing and Health Studies at Fairfield University in Connecticut by an Expert...
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Association of Exposure to Civil Conflict With Maternal Resilience and Maternal and Child Health and Health System Performance in Afghanistan [jamanetwork.com]

By Nadia Akseer, Arjumand Rizvi, Zaid Bhatti, et al., JAMA Network Open, November 8, 2019 Key Points Question: Is conflict severity associated with the performance of health systems and population health outcomes in Afghanistan during the 2003 to 2018 reconstruction period? Findings: In this survey study of 64 815 women in Afghanistan, notable health and health system improvements were made despite increasing conflict after 2010. However, regions with greater conflict had lower gains in...
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Despite Gains, the Emotional Lives of Children Often Forgotten by Our Medical System [centerforhealthjournalism.org]

By A.K. Whitney, Center for Health Journalism, November 11, 2019 I don’t remember the date, or even the time of year, though the medical records tell me it was 1977. I was 6. But I will always remember that day: the gloomy, wood-paneled exam room at Karolinska Institutet in Stockholm, the hard, high table I sat on, the doctor looming above me as he muttered about swan necks and hammers, though there were no birds or tools in sight. He didn’t bother making eye contact with me. I’m not sure he...
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How do these pediatricians do ACEs screening? Early adopters tell all.

Laurie Udesky ·
Last week, three pediatricians — with a combined experience of 15 years integrating ACEs science into their practices — reflected on the urgency they felt several years ago that prompted them to begin screening patients for childhood adversity and resilience when there was practically no guidance at all. Along their journey , they accumulated a list of lessons learned for other pediatricians and family clinics to use. The three pediatricians participated in the ACEs Connection webinar,...
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"Addiction begins with solving a problem, the problem of human pain, emotional pain"

Laurie Udesky ·
In his groundbreaking book , In the Realm of Hungry Ghosts: Close Encounters with Addiction , trauma and addiction expert Dr. Gabor Maté writes, “There are almost as many addictions as there are people.” ACEs Connection founder and publisher Jane Stevens read that quote as a springboard to asking Maté to define addiction and explain whether or not it is always rooted in adverse childhood experiences. Maté, along with filmmaker Michelle Esrick and Saturday Night Live star Darrell Hammond,...
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What Do We Do? What Do We Do Now?

Jane Stevens ·
People’s response to the great chasms of structural inequities glaringly laid bare by the COVID-19 pandemic have been further inflamed by the murder of George Floyd and deaths of other African Americans in recent weeks. The acute emergency of the pandemic has eased, but the violence inflicted on racial minorities and now those who are protesting the inequities in our society has compounded the outrage. Right after the pandemic began running riot across the US, I often heard people ask: When...
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Advancing Racial Equity Webinar Series [apha.org]

By Tia Taylor Williams, American Public Health Association, May 2020 Alarming disparities within the COVID-19 pandemic — such as higher hospitalizations and death rates among African Americans — are sadly predictable and highlight the urgent need to address the root causes of health inequities. APHA is hosting this four-part webinar series to give an in-depth look at racism as a driving force of the social determinants of health and equity. The series will explore efforts to address systems,...
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Diagnosing and Treating Systemic Racism (NEJM)

Karen Clemmer ·
June 10, 2020. Michele K. Evans, M.D., Lisa Rosenbaum, M.D., Debra Malina, Ph.D., Stephen Morrissey, h.D., and Eric J. Rubin, M.D., Ph.D. For the New England Journal of Medicine. For physicians, the words “I can’t breathe” are a primal cry for help. As many physicians have left their comfort zones to care for patients with Covid-19–associated respiratory failure, the role of the medical profession in addressing this life-defining need has rarely been clearer. But as George Floyd’s repeated...
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Doctor Goes Viral for Explaining How Biases Affect the Healthcare Black Patients Receive (Distractify)

Karen Clemmer ·
By Robin Zlotnick, June 9, 2020, Distractify. If you want concrete evidence of deeply ingrained racism, look no further than our doctors and healthcare workers. Dr. Jennifer Lincoln is going viral on TikTok for explaining just how rampant implicit bias is in hospitals and doctors' offices. She highlights a 2016 study , which found that about half of white medical students and residents subscribed to the false narrative that Black people feel less pain than white people and were more likely...
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Racism's Effect on Health, and the Heartbreak of Being a Black Parent Right Now: California's Surgeon General Speaks [kqed.org]

By KQED Science, KQED, June 14, 2020 The coronavirus pandemic and the recent killing of George Floyd have brought longstanding racial inequities into sharp focus. One of those disparities concerns the high rate of coronavirus transmission among people of color. To talk about the intersection of race and health, KQED's Brian Watt spoke last week with California Surgeon General Dr. Nadine Burke Harris, who is known for her pioneering work on the role that childhood stress and trauma play on...
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Inside Boston Hospitals, A Reckoning With Racism (WBUR)

Karen Clemmer ·
By Martha Bebinger, June 19, 2020, WBUR As calls for racial justice continue on Boston streets, conversations have shifted to what’s next. That’s true inside hospitals as well, where the life-long effects of racism play out every day. “You could almost take any chronic disease in America, diabetes, hyper-tension, and there will be higher rates and worse outcomes in Black Americans,” says Dr. Rose Olson, a resident physician at Brigham and Women’s Hospital. “That’s not due to biology or...
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Hidden in Plain Sight — Reconsidering the Use of Race Correction in Clinical Algorithms (NEJM)

Karen Clemmer ·
By Darshali A. Vyas, M.D., Leo G. Eisenstein, M.D., and David S. Jones, M.D., Ph.D., June 17, 2020, NEJM. Physicians still lack consensus on the meaning of race. When the Journal took up the topic in 2003 with a debate about the role of race in medicine, one side argued that racial and ethnic categories reflected underlying population genetics and could be clinically useful. 1 Others held that any small benefit was outweighed by potential harms that arose from the long, rotten history of...
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Linda Grabbe: Helping her communities develop resilience through the Community Resilience Model

Sylvia Paull ·
Grabbe searched for models that would help her homeless and addicted patients. “There are good body-based models for psychotherapy, which may be the most effective approach for trauma,” she says, “but hardly any of my patients were receiving any kind of therapy. There are thousands of people in our communities who have high ACE scores who will never get the years of psychotherapy they deserve. CRM is a self-mental wellness care tool and is exquisitely trauma-sensitive—so it can help enormously.”
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ACEs Connection Anti-Racism Resources

Morgan Vien ·
Hi everyone! We'd like to introduce our new ACEs Connection Anti-Racism Resources List c ulled from resources shared by Learn4Life, Prevention Institute., Rise Magazine , V A TICN , Vital Village , 10% Happier . and our own ACEs Connection members and staff . You can access them from this widget on the top right side of our home page or by clicking here. The list has the following categories of resources: Racial Trauma, Historical Trauma, & Healing Police Brutality & Reform...
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A Better Normal Tuesday, June 30th at Noon PDT: Reinterpreting American Identity, a Community Discussion

Alison Cebulla ·
"I think that all of us, regardless of our racial or ethnic background, feel relieved that we no longer have to deal with the racism and the sexism associated with the system of slavery. But we treat the history of enslavement like we treat the genocidal colonization of indigenous people in North America, as if it was not that important, or worse, as if it never happened." —Angela Davis, "The Meaning of Freedom" Please join us for the ongoing community discussion of A Better Normal, our...
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Academic Medicine and Black Lives Matter Time for Deep Listening (NEJM)

Karen Clemmer ·
By Clyde W. Yancy, MD, MSc 1 , JAMA. Published June 30, 2020. doi:10.1001/jama.2020.12532 E choes of “medicine as the noble profession” continue to resonate, now 35 years since my legendary Chair of Medicine imbued me with this guiding ethos. Nobility in medicine is not obsolete; the selflessness, courage, self-sacrifice, and altruism on gallant display in the response to COVID-19 reassures that at its core, this ethic of egalitarian service remains intact and deeply established in the DNA...
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Academic Medicine and Black Lives Matter Time for Deep Listening (NEJM)

Karen Clemmer ·
By Clyde W. Yancy, MD, MSc 1 , JAMA. Published June 30, 2020. doi:10.1001/jama.2020.12532 E choes of “medicine as the noble profession” continue to resonate, now 35 years since my legendary Chair of Medicine imbued me with this guiding ethos. Nobility in medicine is not obsolete; the selflessness, courage, self-sacrifice, and altruism on gallant display in the response to COVID-19 reassures that at its core, this ethic of egalitarian service remains intact and deeply established in the DNA...
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Resilient Georgia and Georgia Public Broadcasting present "Mental Fitness for Resilience" Second Panel - The Trauma of Racism

Carey Sipp ·
Resilient Georgia recently presented a roundtable discussion, featuring a distinguished panel of professionals, on the trauma associated with racism and racial discrimination, as part of the Mental Fitness for Resilience Campaign. The distinguished panel for this Georgia Public Broadcasting production included Dr. Patrice Harris, MD, MA, psychiatrist and the first African-American woman to be elected president of the American Medical Association; Dr. Terri McFadden, a General Pediatrician...
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Reimagining Healthcare as a Community Investment

Jennifer A Walsh ·
At this point, COVID-19 has been a part of our lives for nearly six months now. While the most recent current events are not unfamiliar social problems, this pandemic has provided us with a stronger lens with which to see many of the underlying inequities within our communities. This article, “The Moral Determinants of Health,” explores these inequities by illustrating the systemic imbalances within the field of medicine and the amount of resources we allocate to solving problems as opposed...
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Re: Reimagining Healthcare as a Community Investment

Jeoffry Gordon ·
Let us be clear: Guaranteeing medical services as a right to all Americans is not only a moral mandate, it is an investment in individual freedom and capacity, in family security and opportunity, as well as community solidarity and peace. The rest of the mature developed world places this priority along side fire departments, schools, and housing as collective public goods guaranteed by the government. Here in the USA this moral mandate has been retarded first by racism (those states which...
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Donor to help School of Medicine students understand and address systemic racism (SC.edu)

Karen Clemmer ·
By Alyssa Yancey, July 1, 2020, SC.edu. A surprising gift and commitment from bestselling author and Giraffe University founder Chris Jarvis comes at an important time. In support of the University of South Carolina School of Medicine Columbia’s commitment to diversity and inclusion, Jarvis has ensured all first-and second-year medical students receive a copy of “ Fatal Invention: How Science, Politics, and Big Business Re-create Race in the Twenty-first Century ” by Dorothy Roberts.
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Do safe, stable, and nurturing relationships work? New research has important findings for responding to ACEs

Alyssa Koziarski ·
While we know that adverse childhood experiences (ACEs) can cause risk behaviors, research has told us that the presence of protective factors can help mitigate the effects of ACEs. Common risk behaviors such as smoking tobacco and alcohol misuse can be a result from the trauma of childhood disadvantage. In responding to ACEs, public health research proposes that protective factors such as safe, stable, nurturing relationships (SSNRs) with a caring adult can mitigate the long-term effects of...
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Donald Trump is the product of abuse and neglect. His story is common, even for the powerful and wealthy.

Jane Stevens ·
“In order to cope,” writes Mary Trump, “Donald began to develop powerful but primitive defenses, marked by an increasing hostility to others and a seeming indifference to his mother’s absence and father’s neglect….In place of [his emotional needs] grew a kind of grievance and behaviors—including bullying, disrespect, and aggressiveness—that served their purpose in the moment but became more problematic over time. With appropriate care and attention, they might have been overcome.”
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Structural Racism, Social Risk Factors, and Covid-19 — A Dangerous Convergence for Black Americans (NEJM)

Karen Clemmer ·
Perspective by Leonard E. Egede, M.D., and Rebekah J. Walker, Ph.D. July 22, 2020, DOI: 10.1056/NEJMp2023616 . *Author Affiliations: From the Division of General Internal Medicine, Department of Medicine, and the Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee. Current protests throughout the United States are highlighting the history of marginalization of and discrimination against Black Americans, including 250 years of slavery, 100 years of Jim Crow laws,...
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‘Death by structural poverty’: US south struggles against Covid-19 [theguardian.com]

Carey Sipp ·
Monica McCasklill, left, and her daughter Kena Johnson, at their home in Greenwood, Missisppi. They respectively lost their grandmother and great grandmother, Ethel Huntley, to Covid-19. Huntley lived in a nearby nursing home and the family allege failings in her primary care. Photograph: Rory Doyle/The Guardian. By Oliver Laughland, The Guardian, August 5, 2020 Poor access to healthcare, failed political leadership and the endurance of segregation and racism have contributed to a surge in...
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Does racism make us sick? Amid a national reckoning, the question gains new importance [sfchronicle.com]

Karen Clemmer ·
By Tatiana Sanchez, San Francisco Chronicle, August 24, 2020 Elaine Shelly has lived with multiple sclerosis for 30 years. But she said she still panics whenever she has to see a new neurologist because of racial discrimination she’s experienced in the past. Even getting a proper diagnosis for her illness was a battle. “I’d go to these neurologists who would tell me that Black people don’t get M.S. and that I must be mentally ill,” said Shelly, 63, of San Leandro. A former print journalist,...
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Free 2020 Virtual Trauma-Informed Care Conference

Bharat Sanders ·
Each year, STAR hosts a Trauma-Informed Care Conference to help educate the next generation of leaders and build a strong network of Trauma-Informed professionals in the state of Georgia. The conference will be held on Saturday, October 3rd from 10:00am- 1:00pm EST and Sunday, October 4th , 2020 from 2:00pm-5:00pm EST conducted virtually via Zoom.
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Medicine and medical science: Black lives must matter more The Lancet

Dennis Haffron ·
The following quote appeared in an editorial in The Lancet on June 13, 2020: "What can medical journals do? Our task is to educate ourselves and others about racism. We must support Black and minority ethnic health workers. And we must use evidence and our values to speak out for Black and minority ethnic communities. The Lancet is a journal with a deep colonial history: the journal has published work that supported the health of settler colonialists and that prioritised their health over...
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'A Better Normal:' Can universal ACEs screening be equitable? -- Concerns and solutions

Laurie Udesky ·
Can universal ACEs screening be equitable? A conversation about concerns and solutions. When: Tuesday, Oct. 13, 2-3:30 pm PDT/5-6:30 pm EDT This webinar explores what it takes to ensure that equity is built into the process of screening and providing support for families who have experienced trauma and want help. REGISTER HERE Background At the beginning of this year, California, through the ACEs Aware initiative began rolling out universal screening for adverse childhood experiences (ACEs),...
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Addressing the caste system in U.S. healthcare in the era of COVID-19 (International Journal for Health Equity)

Karen Clemmer ·
Sivashanker, K., Couillard, C., Goldsmith, J. et al. Addressing the caste system in U.S. healthcare in the era of COVID-19. Int J Equity Health 19, 184 (2020). https://doi.org/10.1186/s12939-020-01298-x Abstract In healthcare, we find an industry that typifies the unique blend of racism, classism, and other forms of structural discrimination that comprise the U.S. caste system—the artificially-constructed and legally-reinforced social hierarchy for assigning worth and determining opportunity...
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Hope and Progress, No Matter What! — an ACEs Connection/Cambia Health Foundation “Better Normal”, Oct. 22, 2020

Jane Stevens ·
The election is upon us. In two short weeks, we voters in this country decide who will lead us for the next four years. We have the opportunity to embrace — as a national priority — the tenets of understanding, nurturing and healing that underlie the science of adverse childhood experiences and move in a direction that embraces cultural and racial equity and anti-racism. Or not. What is clear is that no matter what, the ACEs movement will continue.
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The Intersection of Systematic Racism, the Pandemic, and SDoMH: Reality Mandates Change

Ellen Fink-Samnick ·
Systematic racism is at the core of mental health disparities and social determinants of mental health (SDoMH).Upstream factors obstruct patient access to needed and appropriate assessment, timely intervention, with treatment for these populations often reflecting poorer quality, and ending prior to completion of treatment. COVID-19 and the recent pandemic have only amplified meso and micro-level gaps in care. considered, provided, and reimbursed.
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"A Better Normal" Community Discussion Series- Our Reckoning with Race and Equity at ACEs Connection

Donielle Prince ·
Register for A Better Normal- Our reckoning with race and equity at ACEs Connection
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A New Hippocratic Oath Asks Doctors To Fight Racial Injustice And Misinformation [NPR]

Jennifer A Walsh ·
First-year medical student Sean Sweat "didn't want to tiptoe around" issues of race when she sat down with 11 of her classmates to write a new version of the medical profession's venerable Hippocratic oath. "We start our medical journey amidst the COVID-19 pandemic, and a national civil rights movement reinvigorated by the killings of Breonna Taylor, George Floyd and Ahmaud Arbery," begins the alternate version of the oath, rewritten for the class of 2024 at the University of Pittsburgh...
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The Pandemic Is Raging. Here's How to Support Your Grieving Students [edweek.org]

By Brittany R. Collins, Education Week, November 12, 2020 Over the past few decades, trauma-informed teaching has gained ground in the United States, yet rarely is grief included in the conversation. In the midst of a global pandemic, with teachers and students confronting loss in and outside the classroom in new and myriad ways, it is more critical than ever to apply a grief-sensitive lens to our conversations about curricula and trauma in the school system. We are not the people we were a...
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Make “Giving Tuesday” your day to support the work of ACEs Connection. Help us meet our matching grant goal of $50K, and your gift will be matched, dollar-for-dollar!

Carey Sipp ·
"This Giving Tuesday, and every day, we thank you for your support," said members of the ACEs Connection staff on a recent "all staff Zoom." L-R (top row) Laurie Udesky, Carey Sipp, Gail Kennedy, Lara Kain (second row) Cissy White, Rafael Maravilla, Donielle Prince, Jenna Quinn (third row) Ingrid Cockhren, (off camera) Alison Cebulla, Jane Stevens. Out that day, and grateful all the same, were Karen Clemmer, Dana Brown, Elizabeth Prewitt, Marianne Avari, and Samantha Sangenito Called “the...
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How U.S. Medical Schools Are Training a Post-Pandemic Generation of Doctors [time.com]

By Jamie Ducharme, Time, November 24, 2020 In February 2019, the Kaiser Permanente health system announced a new kind of medical school. The school would be built “from the ground up” to prepare students for the complexities of the U.S. medical system. The curriculum would emphasize cultural competency, patient and provider well-being, and the elimination of socioeconomic disparities in the medical system. Students would see patients right away, and hands-on learning would replace many...
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Opportunity to sign on to “A Trauma-Informed Agenda for the First 100 Days of the Biden-Harris Administration”—Deadline Dec. 8th

The Campaign for Trauma-Informed Policy and Practice ( CTIPP ) is inviting individuals and organizations to express their support for a set of executive actions for the Biden-Harris Administration to take “to address trauma and build resilience throughout the country.” Most of these actions could be taken early in the Administration and would not require congressional action with the exception of some recommendations that could be included in a new stimulus package. The recommendations are...
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A Comprehensive Policy Framework to Understand and Address Disparities and Discrimination in Health and Health Care: A Policy Paper From the American College of Physicians [acpjournal.org]

By Josh Serchen, Robert Doherty, and Omar Atiq, Annals of Internal Medicine, January 12, 2021 Abstract Racial and ethnic minority populations in the United States experience disparities in their health and health care that arise from a combination of interacting factors, including racism and discrimination, social drivers of health, health care access and quality, individual behavior, and biology. To ameliorate these disparities, the American College of Physicians (ACP) proposes a...
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We’ve changed our name to PACEs Connection! 

Jane Stevens ·
We have some very exciting news! As of today, ACEs Connection is now PACEs Connection. PACEs stands for Positive and Adverse Childhood Experiences.
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The pandemic is changing how we think about domestic violence, new survey shows (centerforhealthjournalism.org)

Amid a pandemic that shined a harsh light on domestic violence , Californians are increasingly viewing these abuses as a pressing social issue, according to a new survey of nearly 2,000 adults. Two-thirds of Californians consider domestic violence a public issue rather than private family matter, and 91% of participants said domestic violence is a serious societal issue, the survey found. “This info has given some validation to things folks have been talking about for a long time...
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To solve the Black maternal mortality crisis, start with upending racist practices

Laurie Udesky ·
It’s been all over the news for months: Black women in the United States are dying from complications during their pregnancies or in childbirth at alarming rates, and those deaths are preventable. Less well explored is how systemic racism and historical trauma have been at the core of what’s driven up these rates over several decades. A March 20 conference entitled The Impact of ACEs on Black Maternal Health took an in-depth look into why Black maternal mortality and complications during...
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Learn how to secure federal funding for your community. A Better Normal with CTIPP, Dave Ellis, Dan Jurman

Carey Sipp ·
The nearly $2 trillion American Rescue Plan Act has several buckets of funding that can be used to promote trauma-informed and healing-centered projects. PACEs Connection communities can apply for this funding, according to leaders of the Campaign for Trauma-informed Policy and Practice (CTIPP), the National Trauma Campaign, and PACEs Connection. The “Better Normal” webinar on Friday, May 14 at 3 p.m. EST; Noon PST, Dan Press, Jesse Kohler and Marlo Nash of CTIPP will begin by describing...
 
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