John is the Director of Pediatric Bioethics at Children's Mercy Hospital in Kansas City and the Director of the Children's Mercy Bioethics Center and Professor of Pediatrics at the University of Missouri, Kansas City School of Medicine. At Children's, John has developed a new NIH-funded program in pediatric ethics and genomics. John received his MD from the University of Pittsburgh residency at the Children's Hospital National Medical Center in Washington, D.C. and then came to Chicago to train in the McLean Center Ethics Fellowship Program. Between about 1988 and 2008, John worked closely with me as the Associate Director of the McLean Center and then went off to Kansas City. John is one of the few people who has served as President both of the American Society of Bioethics and Humanities and of the American Society of Law Medicine and Ethics. His research is on ethical issues in innovative therapies in pediatrics, decision-making for babies at the borderline of viability on issues like ECMO, both bone marrow transplant, growth hormone, and liver transplant. Some of his books include Do We Still Need Doctors, another book that he wrote with Bill Meadow on neonatal bioethics, the moral challenge of medical innovation, another one about the last physician, Walker Percy, and the moral life of medicine. I'm delighted that John is here today and he will speak to us on the topic of scientific uncertainties, mystical certainties, and the ethics of comparative effectiveness research. Dr. Landers. Thanks, Mark. Isn't this just the best conference any of you ever go to, like ever? Thanks both to Mark, of course, to the prior speakers who set me up beautifully, but also I just want to acknowledge the McLean Center advisory board who's here too, Rachel Kohler, who's president, Stan and Ed Dudley, and many other members of the advisory board who work closely in, I mean, if you can imagine a more thankless task giving Mark Siegler advice. I think they deserve a big round of applause there. When I say people set up this talk nicely, talking about doctor-patient relationship, about costs, shared decision-making, empowerment, solid evidence for treatments that we do. My talk is really about how we developed that solid evidence and particularly the recent controversy over the support study. The other theme that David Rubin just talked about was the power of the anecdote. Last August, in the sort of middle chapter of the controversy over the support study, there was an open meeting at the Department of Health and Human Services where people were invited to give testimony, and there were lots of heavy hitters speaking at that meeting, like Jeff Dresden, editor of the New England Journal, and George Annis, the New England Journal's legal affairs correspondent and the head of the AAMC, but the story that made all the newswires was this family, Sean Pratt and his daughter, who held a press conference outside Health and Human Services and said to reporters, tell me that the support study did not hurt Dagan, my daughter, in any way, and Dagan stood there by him wearing braces on her legs from the cerebral palsy that resulted. She had been born at 25 weeks and enrolled in the support study, and her dad said the support study looked good on paper. We were guaranteed the study wouldn't hurt Dagan in any way, and we were shocked to learn that the care she received was based not on what she needed, but on some protocol. They turned her into the subject of an experiment instead of a participant in a study. I think the central question, which I'm going to try to address and that I think is the central question facing OHRP and in the regulation of research is what would it mean to tell people they're not harmed by research, and specifically, can we tell Sean Pratt that his beautiful daughter, Dagan, was not harmed by being in the support study? Now OHRP says no. They said the study was risky and parents should have been warned about those risks before they decided whether to enroll because the study involved changing the treatment of enrolled infants from treatment according to the standard of care with attendant changes in the risks and potential benefits. Particularly, they said there were reasonably foreseeable risks of blindness, neurologic damage and death that parents should have been informed about. The advocacy group, Public Citizen, said it went beyond the informed consent form that the very design of the study was so flawed that it was both illegal and unethical. Any study, they said, comparing different oxygen levels would be not compliant with HHS regulations and the support study was highly unethical because in their words, it exposed 1316 extremely premature infants to increase risks, either death or retinal damage. The New York Times agreed with this assessment and in a lead editorial echoed Public Citizen's concerns and called the failure to disclose these risks startling and deplorable. And the title of the editorial was an ethical breakdown. The New England Journal, interestingly, disagreed in an editorial of their own, said the informed consent documents spouted out the risks clearly and succinctly, addressed prevalent knowledge fairly and reasonably, and the OHRP investigation was the ethical problem because it cast a pall over the conduct of clinical research to answer important questions in daily practice. The NIH itself weighed in making this a fratricidal battle within the Department of Health and Human Services since both the NIH and OHRP report up to the Secretary at that time, Kathleen Sebelius. But here the head of the NIH, Francis Collins, and the head of NICHD, the Child Health and Development Institute, wrote in the New England Journal, the babies were of course at risk because of their prematurity, that their care was never compromised for the sake of the study. Bioethicists, it turned out, were split about 50-50. A group of 45 bioethicists wrote a letter to the New England Journal saying that OHRP's conclusion that the study exposed subjects to additional risk is not supported by the evidence. Another group of 44 promptly fired back saying the potential risks and benefits could not be said to be the same as those receiving care outside of the study. And so our field was deeply divided. I was on this side, we had 45, they just had 44. So if you just did a vote, we would win. But that may be a topic for one of Peter Hubel's studies of social networking or something. So which was it? An important well-designed study conducted to the highest ethical standards or an egregious violation of ethics and federal regulations. The interesting thing is this sort of thing has happened before and has happened many times over the years and is a fundamental question about whether it's possible to do clinical research in a way that is respectful of persons. One of the famous stories in pediatrics was written up by a guy named William Silverman, who was one of the pioneers in the study of retinopathy of prematurity then called retrolental fibroplasia. And he wrote a book about it 35 years ago actually in 1980, a book called Retrolental Fibroplasia, Modern Parable. And he describes a baby that he took care of in 1950 before there were NICUs, before there were ventilators, before we could do oxygen saturation. When the treatment for tiny babies with breathing problems was to put them in an incubator and give them 100% oxygen, something that led to a very high incidence of retinopathy and blindness. And nobody knew how to treat this. And he described a premature baby girl born to a woman who had five miscarriages. They put a baby in the incubator and at eight weeks the ophthalmologist did an eye exam and diagnosed developing retrolental fibroplasia. And Silverman had heard about and wanted to try previously unstudied treatment, ACTH, a hormone, steroid hormone on the rationale that it's a connective tissue disease and premature babies might not have enough of this and nothing else seems to work. So what the hell? We'll give it a try. And they tried it and the baby's eyes started to get better. So they lowered the dose and the eyes got worse and they raised the dose again and the eyes returned to normal and the treatment was stopped and the infant gained weight and was sent home. And that was a beautiful thing. And they decided that this should be the standard of care. And he reported how over the next year and a half, 31 babies at baby's hospital were treated with this and 25, 80% left the hospital with normalized and had an affiliated hospital across town. Seven infants who had RLF were not treated with this and six of them became blind. So they said this seems to be the standard of care. And many doctors said it would be unethical to do a randomized control trial. But Bill Silverman was a pioneer of evidence-based medicine and he said we really need to do a prospective randomized trial to settle the question. This was in the early 50s, you may recall that randomized control trials were really first invented at least in their modern sense just in the post-war period. The very first randomized trial in the United States was a VA trial for TB that failed because they couldn't get enough patients enrolled. The Brits succeeded with a similar trial. The most famous randomized control trial of course was the polio vaccine trial in 1954. But what you may not remember is that 33 states prohibited randomization because it was seen as unethical. And instead what they did in those states was vaccinate second graders but not first and third graders. Whether that's block randomization didn't seem to occur to people but 11 states did allow randomization. Actually, there was a famous randomized control trial from before the 50s. I'm sure most of you remember Jane Lin's study of treatment for scurvy in British sailors where 12 sailors were divided into groups of two and received either cider, weak acid, vinegar, seawater, nutmeg and barley water or oranges and lemons. And after six days the two who got the citrus treatment were back on their feet. Here's a report from that famous study of James Lin giving the scurvious British sailors citrus. And this is of course why British sailors were referred to as limies. There's the polio study. Eventually a million and a half kids participated. Only about a third of them were randomized. Because as Silverman wrote in his book, randomization is pretty ethically complex. And when he was doing the ACTH study, they did randomize people but he wrote that they didn't tell the parents because the thought of random allocation to treatments in which blindness or life are at stake is. He wrote at first flush a repugnant one. We are all prone to feel that a well-meaning guess is somehow not as cold and unfeeling as the flip of a coin. This trope reappeared in the lawsuit that resulted from the support study in the charges against the investigators in the class action suit against the University of Alabama at Birmingham. They write the study was unethical because the amount of oxygen initially received by each subject was determined by the flip of a coin. In his comments at the HHS meeting, George Annis, who really should know better, said randomization always increases risk. How worried are we about the loss of physicians' individual decision when nobody really knows what the right answer is? We're really worried about it. The doctor's judgment matters. We think medical education means something. Here are the results of Silverman's randomized trial. With ACTH, 33% of babies got eye disease. And with placebo, 22% of babies got eye disease. The mortality was also lower in the untreated group. And three-quarters of the babies with early RLF showed spontaneous regression to normal with no treatment. So the issues aren't new. And one of the things Silverman wrote when he was discussing this is how medicine's in the midst of an identity crisis as it struggles to become scientific, which he described as a slow and uneven shift from mystical certainty to scientific uncertainty. And he said doctors are viewed suspiciously when they ask questions, a switch from their accustomed role as providers of answers. So what was the state of knowledge about oxygen when the support study was designed? Well, this was a paper written in pediatrics in 2002 by one of the leaders in the field. And he said 50 years of uncertainty, we still know very little about how much infants actually need, how much it's wise to give.  There had been many small retrospective studies of different oxygen saturation targets. And a Cochrane meta-analysis of these showed that restricted compared with liberal oxygen had no significant independent effects on death rates in premature babies. So the best available evidence at the time suggested that there was no risk of mortality. And so leaders in the field decided to do a large, unprecedentedly large international collaboration to try to settle the question of whether targeting a slightly lower oxygen saturation within what was then the generally accepted standard of care, that is 85 to 95 percent, could lower the rate of eye disease. There were actually three separate studies supported in the US, one called Boost in the UK, Australia, New Zealand, and one called the Canadian Oxygen Trial, which interestingly also had places and centers in the US, Argentina, Israel, and Europe. All together there were 82 sites, that is to say 82 IRBs reviewed these. They randomized almost 5,000 babies. And the studies were done and the controversy followed. So let me come back to the question that Sean Pratt threw out at the HHS public meeting and see if we can answer it. Was Dagen Pratt harmed by enrolling in this randomized trial of two different oxygen saturation targets? Well, let's look at her outcomes. The first and most important, as you saw on that slide, she survived. And the main focus of criticism was that the mortality rate was higher in one arm than the other. So Dagen clearly did not suffer that harm. More generally, there's a question of whether overall babies who were enrolled in the trial had a higher mortality rate. It's clear that there were differences between the arms and this somewhat complicated slide shows the three different international trials caught support and boost, the outcomes in terms of mortality for the two different oxygen saturation targets, the lower one 85 to 89, the higher one 91 to 95, and then the combined overall survival rate. And the focus of concern really in the United States was that middle line where the mortality difference went from almost 20 to about 16%, a difference in mortality that achieved statistical significance at a p-value of .05. But look at the overall survival rates, 16%, 18%, and 19.5%. And compare those to what we know about survival rates for babies born at 24 to 27 weeks that come from national databases in quite a few different countries. Canada reports, support actually reported outcomes for babies who were eligible, approached for consent, but then didn't enroll. And there's also a database from the National Institute for Child Health and Development, Neonatal Research Network. The Swedes do a similar thing and actually there's about 10 others, but the slide got too busy. But what you'll notice is there's no dataset of babies 24 to 27 weeks that's ever reported a mortality rate under 20%. And to go back to the mortality rate in the three studies, all of them had an overall mortality rate of under 20%. So it's an interesting question whether somebody who was in the study and died could be said to have been harmed by the study. What about eye disease? Dagen Pratt had severe retinopathy. Babies in both arms of the support trial had lower rates of retinopathy than babies who were not in the trial. And here's the data. In the low oxygen arm, about 8.5% of babies had severe retinopathy. In the high oxygen arm, it was about 18%. And in the comparable database of babies not enrolled in the study, but born at the same gestational age, it was about 24%. Dagen had cerebral palsy. I'm not going to belabor this, but there was no difference in cerebral palsy between the arms of the study. And again, the cerebral palsy outcomes for babies in the study were lower than in comparable databases. Trust me on that, I'm going to skip over it fast. So the bottom line is that the only unexpected finding in support was that babies in the high oxygen arm had better survival rates than any group of 24 to 27 weekers ever reported in the world literature. And when I teach this to medical students, I say get out your iPads right now, and if anybody can find one, tell me about it. Nobody's found one yet. So it's hard to conceptualize this as a risky study when everybody in the study, on average, did better than people who were not in the study. But here's the thing. The controversy is not about measurable risk. So that when the 45 bioethicists who say there was no risk argue with the 44 who say that there was risk and cite these statistics, they say it doesn't matter. It's about something deeper and more intangible. It's about this idea that researchers have different obligations than clinicians. And the compromise loyalty of the researcher is really what puts research subjects at risk. OHRP said this in their letter, their initial finding of noncompliance that they sent to the University of Alabama. Ultimately, they said the issues come down to a fundamental difference between the obligations of clinicians and those of researchers. Doctors are required to do what they view is best for their individual patients. Researchers do not have that obligation. Or Ruth Macklin and Lois Shepard in the American Journal of Bioethics. Doctors, not researchers, have a fiduciary obligation to pursue the patient's best interests above all other considerations. Or George Annas at the public meeting. A physician must be guided by a fiduciary obligation. A researcher has no such obligation. So the real fear about these studies is not so much actual measurable harm to babies. It's the dark and conflicted heart of the medical researcher. And the question is, are these people, these people who want to study this, angels or devils, are they doing a service to humanity or are they exploiting vulnerable individuals in pursuit, in reckless pursuit of this thing that they value more highly than patients' well-being? That is knowledge. And this is crucial because actual studies can be safer or riskier than conventional therapy. But if the problem is the loyalty of the researcher, then all studies put people at risk because they have no protector. And once you sort of become aware of this trope, you start to see it in discussion after discussion of what's problematic about medical research. Steve Joffey and Franklin Miller. Joffey's a pediatric oncologist. Frank Miller is a bioethicist and philosopher at the NIH. The context of medical care beneficence entails the health provider to do what's best for patients in clinical research. Investigators have to promote social value by generating scientific knowledge. Sam Hellman, former dean of the University of Chicago and the New England Journal of Medicine, researchers are required to modify their ethical commitments. It's not even a choice they're required to.  The researcher subject relationship compels and urges certain priorities or inclinations to perceive and act in certain ways. The researcher is seen as driven to pursue knowledge committed to utilitarian ethic and thus in need of constant oversight. They're meant to be treated like addicts who can't control their own moral impulses to pursue truth at any cost and will thus exploit patients and harm them. But is it true? I mean, it's a serious charge. And it is, I think, the understanding of research upon which we've built our current system of IRB oversight, where every tiny change, I mean, if you move a comma in your informed consent form, you need permission to do that because that might be a way to... But researchers themselves see it a little differently. What they say they're doing is trying to do what's best for their patients in situations where they don't know what's best for patients. So Norm Fost imagines having this conversation with a patient who he's recruiting would not be responsible to give an unsteady treatment to you in an uncontrolled way because neither you nor I nor future patients would ever know whether it helped or hurt. Or Keith Barrington, a neonatologist who was involved in the Canadian Oxygen Trial, says, yes, I have a fiduciary obligation to provide optimal treatment. I also have a moral obligation to know what optimal treatment is and I have a moral obligation to keep trying to find out what the best treatments may be. So researchers see themselves as less compromised than they are seen by current regulations. And the other aspect of this that I think is even more important in understanding what's at stake in the support controversy is it assumes a kind of purity about clinicians that doesn't bear scrutiny. Physicians have all sorts of conflicts of interest in their acting out their fiduciary obligations. Physician-induced demand, physicians get paid for doing more. It's what we heard about some this morning, defensive medicine. Docs don't want to get sued. People can get incentivized from drug and device companies or different payment systems. And as Dave Wendler and other NIH bioethicists said, clinicians have appropriate interests that compete with providing the best care, including earning a living, helping other patients, conserving resources, training new clinicians, et cetera. But I think perhaps the most important factor that's overlooked in the sorts of critiques that have been leveled at the support study is one that was essentially discovered by the first winner of the McLean Center Prize, Jack Wenberg, who in the late 70s and early 80s discovered the phenomenon of small area practice variation. And as I'm sure many in this room know, when he tried to publish that in medical journals, nobody would take it because they said that simply can't be true. So he had to publish in science and nature and second tier stuff. But he showed things like this, and this is more current data, but it's based on the older data. If you look at different counties in New England and just look at how many kids get tonsillectomies, as recently as 2007 to 2010, varied by a factor of four. In Littleton, 11 per thousand. In Burlington, under three per thousand. Now, it may be that there's epidemic strep in Littleton that hasn't spread to Burlington and that all these consillectomies are medically indicated, but it seems unlikely and Wenberg has found this everywhere he looked. So the interesting question is, are the children who are going to see their doctors whose doctor's clinical judgment is determining their care at higher risk, the same risk or lower risk than they would be if they enrolled in a clinical trial in Littleton, Burlington and St. John'sbury, where they were randomized to an aggressive or less aggressive approach to tonsillectomy that resulted in a similar distribution of outcomes. Wenberg has looked at everything he looks at, he finds the same thing. Which is riskier, undisclosed and unstudied idiosyncratic practice variation or deliberate formal randomization with careful monitoring and evaluation. Now OHRP, after the public meeting, promised to come out with new guidelines to clarify what is required of researchers. And this is my favorite slide in the slide set just because this is supposed to be the clarification to help you decide what you need to disclose. If a research study examining standards of care includes as a purpose of evaluating identified risks associated with those standards of care, the identified risks associated with the standards of care being evaluated that are different from the risks of the standard of care and at least some subjects would be exposed to outside of the research study are generally considered by OHRP to be reasonably foreseeable risks of research. There's really just one comma. Those draft guidelines are now online and a key claim until December 23rd you can respond, you can read them yourself or if you're too busy I would suggest you just write down this bottom sentence and go to their website which I'll show you in a minute and send in a comment. OHRP essentially says any deviation from the treatment that any doctor would recommend creates a reasonably foreseeable risk. And the alternative which I think would be a preferable guidance for standard research is to say standard treatments cause risk. Well-designed studies teach us how to understand and sometimes reduce risk. Write it down and send it to this website because you know nobody reads these they just count how many they get or against so you know. Last point I'm gonna make the battle lines on this have changed a little bit in interesting ways when Silverman was writing about this he was trying to convince his neonatology colleagues that good well-designed prospective randomized controlled trials were appropriate and ethical and many of the doctors said we can't randomize our patients. What's happened today is the neonatologists have recognized it. They designed an incredible study and they're being criticized now by bioethicists and federal regulators and citizen advocacy groups in a way that reminds me of the old saying that no good deed goes unpunished. It's best we can tell too the public actually supports this research after the controversy broke many IRBs required support study investigators to call all the parents who were in the trial and places that did that reported that the parents generally said we understood the study we knew what we were getting into and we understood the risks and we don't have any complaints so we need to get the message out not so much with the sort of data and theory and rational arguments that I've presented here because data means nothing compared to photogenic parents and acute kids so the way to counter this I think is with something like this I'll let you read that this is our grandson who was a preemie born around the time of the support study little too premature to be eligible for the support study but he might have been and they now their family now supports medical research in this area and have become the biggest fundraiser for the March of Dimes so simple message treatment isn't perfect research can make it better and consent forms should accurately explain risks by saying that well designed and well regulated studies are good for both the people in the studies and for people or in this context babies in the future thanks children's mercy by the way doesn't that look like Disneyland? Hi, Niranjan Karnak from Rush. John, great talk. I wonder what your thoughts are about PCORI's focus on outcomes research that's sort of more naturalistically drawn less experimental in design how you think that that changes or is possibly a response to these types of events? So I mean I think one of the big things that's changed since the Belmont report was written and since the current federal guidelines is the availability of electronic health records in big data which allows a different kind of research than was ever possible before so for example one of the questions in the support study was well what were doctors using in 2003 before the study was done how many NICUs targeted what oxygen saturation and the answer is we don't know I mean there were surveys and people said oh this is what we target but now we could get actual data and that makes it possible to do all sorts of different kinds of studies but they straddle the line between purely observational subtly interventional and more or less subtly interventional and I think figuring out how to regulate those is going to be a huge and important problem. Aib Schwab, IPFW so I guess I wonder what you would say to somebody who would respond to this with well so the lesson here is clear what we need to do is we need to get patients to trust their physicians less and so ultimately the problem here is not that they're distrustful of research but that they're trusting the physician because of exactly the data you're presenting. I'd say they're exactly right within parameters right I mean so it's not like any oxygen level was just right I think doctors knew very well that 100% oxygen was terrible and 70% oxygen was bad too but when doctors get together and experts in a field say this is an area where that's an important area to do research because within this after having reviewed all the PCORI type electronic health record retrospective data we realize that this is an important unsolved problem people should realize that if in that domain their doctor says look 92% trust me I'm a doctor that's what's best for your baby people should be skeptical and that's what the informed consent form should tell them. We'll take one more question. Thank you Dr. Lantos when you look at the fact that no good deed goes unpunished I think no good crisis should go unexamined or be wasted so given the crumbling of institutions and trust the present outbreak of Ebola provides a forum to framework the discussion about biomedical research I think part of the problem is we have not taken enough time to educate citizenry about research so how can we step away from the argument the physician the researcher and just get that sweet spot of educating the public what research provides So the question of whether the public distrust researchers is an interesting one that I don't think it's true at least it wasn't in support that the public as represented by the parents of babies who were actually in the study distrusted researchers the public as portrayed by public citizen distrusts researchers but it becomes a question of the extent to which self-appointed advocacy groups can be taken as legitimate voices for the people who they claim to represent Go ahead September short I just have to you know September Williams the surviving inaugural member of the bioethics center at Tuskegee University and its opening and of course these issues are where we started right this is where we started I'm pretty sure a number of people in this room have read the Belmont report in its entirety I know I keep going back to it but the division between who is a doctor and who is a researcher and that their obligations are different is a really big deal so we saw it again in the AZT trials in Thailand how do you separate these things and I think the fact that we have a clinical ethics center and many clinical medical ethicists actually we have fallen victim to the dicing and slicing of different fields of medicine as though people were able to be diced and sliced so when I came to the center it was because me as a clinician and me as a researcher were the same entity and I don't know how that got changed around we had obligations that were the same so that's my comment I had to I mean in some ways the question the debate about the sports study comes down to the question is this Tuskegee all over again or not and which is asked all the time and many many of the people who spoke at the public meeting criticizing the study specifically made the analogy usually in a sneaky backhanded way like I'm not saying this is like Tuskegee but this is like Tuskegee. Well the one thing that we did with the AZT trials in Koteva and Thailand of course was that the level of stringency for the informed consent goes up with the probability of high risk and that question was asked of course around those trials and what we came up with was three points of contact for informed consent. Right so the central informed consent question is how do you accurately describe comparative risks of both two arms of a randomized controlled study and the risks of being in the study or not being in a study in a way that in a decision-aid kind of way actually helps people understand. So one anecdote that I'll end with I talked to our neonatologist there are a bunch of other studies done by the neonatal research network and one of them similar to support except instead of oxygen it's transfusion so at what level do you transfuse a premature baby and so I asked the neonatologist what have you changed your consent form and he goes oh my god yes we have death. Death is written all over it I mean every paragraph says death and I said are people like not signing up because he said nobody reads those things.


Hello, what do you miss about dating besides the women? Very kind of it's a very Jack Nicholson thing to say Besides though now you do it better.   I mean good health. Leave it to Corbyn to spread the love We need another plague there it is again There it is again trailer acts here comes a new variant There's like one every day because you keep saying stuff like no monkey park.  You can now say a pox on you and it's actually current luckily I'm married don't have to worry about monkey pox Actually, you do you got dogs it can be spread the dogs in it.    I got I got 500 red trees up here What am I supposed to do? You're supposed to let the trees die sly. You don't want to hear what the Kardashians do with their jets Yeah, take a nine-minute flights Taylor Swift. Oh, I thought you had water jets up there, but The Cobra trailer yeah with Vikram. Is this a remake of Sly's Cobra? I'm serious. I don't think did you ever see that movie? No, it's gloriously awful. I don't see a lot of Sly's films. Why not? You know you love sly Come on. There's some great ones like rock you still haven't seen first blood. Have you the very first never seen a Rambo film You need to see the very first Rambo film which is just first blood Yes, I've got Maverick's out.  No Digital that's still in theaters so so's Maverick. Yeah, I can go I could definitely go I'll just tell your wife to take care of things would you know Not gonna do that to her Here we go Clearly doesn't like algebra So he's an undercover spy essentially is he well, yeah, that's that he was all those people well I know that yeah, but he's a spy or an assassin Oh, it's I don't I don't know which one but he's something like that because he I was like I thought there's a lot of math teacher, but I think it's just a cover of it Surely surely I was like why does this math teacher know jiu-jitsu but that that's where I see you saw Tom Hardy, right? Yeah, exactly. I did see that. Yeah, that was awesome. Anyways, no, but I just I was like I don't I know he he's in He's in costumes. Yeah He's either an assassin. Yeah a spire. He's both. Yeah There's a love interest But who's he going after and why is he going after him? He took his pet snake That's why it's called Cobra.  I know the bad guy is gonna laugh when people bleed Well, that's a lot of blood But I what's going on. Yeah, I don't know. Yeah And I know obviously Vikram is a is a very beloved star and a lot of people Think call him like he's a really we haven't sound Because I keep saying this like we haven't seen an actor Well, then we do like I did it with Chirivan, right, right, and we had see right right that in theaters I Don't think we've seen I know like he's obviously in that the split personality scene. Yeah, that we loved that we he was great in it He's an eye. All right all those we've seen all those songs, but I don't He's the lead in the new ps1 though The money right now. Yeah, right. He's the lead right right and he wasn't in Ega That's the only thing I'm wondering if he was maybe in See there's that was slot that was the loans Cobra right there. I don't think he was in Ega But I don't I don't want to say for sure What year was Ega? That I don't remember I know he's in that film with Ashwarya that he's like she's the concubine of the the captor yeah, and it has like a beautiful song Yeah, we're looking at his resume, and I don't think we've seen Anything of his as of yet. I don't believe so. So yeah, I was equally confused as to why they he was doing it but right maybe he's just Like he's a Vikram character, but he's like Undercover yeah Obviously very undercover. Yeah, or he's trying to kill people right but I think Because there's an actual bad guy that it looks like so I don't yeah, and I'm sure I'm sure There's countless people were gonna see this just because he's in it Yeah, I however would feel the same way like no matter who it was if it was a Actor that I loved and would go see their film no matter what I would still be asking the same question of what's going on here Is there a story or is it just gonna be yeah three hours of action? Which is fine if that's what that's all it's gonna be then it's it's advertised as such yeah Do you the remember this for the MMA film the lycor yes that has a Tyson appearance. Yeah apparently it's terrible. I Saw that I didn't even read the review, but Times of India was like two out of five I was like, oh, like everybody and I saw that this morning. We haven't seen it Obviously, I can't I can't say I'm just telling you what I've heard like it's just real and like everyone like you normally like there's fans That's right. I love it. It's amazing and then maybe there are but I haven't seen any of them It's all been like this film is terrible. How much how much is Tyson in it? I bet he's in like a scene I bet because that would be good because I also think he'd like forgot I saw an interview. He's a tiktok.  I'd leave the room. I would not want Tyson I wouldn't want Tyson mad at me period add shrooms to the level. Oh nah Have you seen him hit recently now?  Yeah, so that was interesting Let us know what you thought about the trait. Yeah, did it say when it comes out?  Okay. I was gonna say I don't know that J. R. K. Did that's not ours. Thanks. Thanks to whoever that is. Thank you out there The original trailer did not have subs on yeah, so who'd been even more confused. Yeah So let us know what you thought about the trailer down below


Elsewhere, the National Agency for the Great Green Wall says it has planted 10 million trees across 11 front-line states, considered to be worst hit by climate change. Its director-general Yusuf Minar Boka stated this while, during tree planting in commemoration of this year's Great Green Wall Day, represented by Somalia Nasirudu, the DG says. The aim of visiting schools, traditional institutions and public places is to inculcate the habit of tree planting among Nigerians. On his part, Zanfara State Gov. Dal Dalawal, represented by the Permanent Secretary of the Ministry of Environment, enjoined citizens to embrace the habit of planting trees to tackle climate change degradation, among other major challenges. The 11 front-line states are Sokoto, Kebe, Katsina, Kaduna, Jigawa, Bolchi, Gumbay, Ademawa, Zanfara, Yobay and Bonu. So far we have planted over 10 million trees in Nigeria, and it has affected enormous lives of people living in that corridor. And there are other programs again, they are doing for empowerment for youth and women to alleviate suffering of people living within those communities. We all know we are facing a lot of challenges in climate change due to desertification and land degradation. So the importance of tree is so enormous, which cannot be over-emphasized. It reduces the heat level of the environment. It maintains the ecosystem as well as top the emission of carbon dioxide, which will absorb carbon dioxide by tree and release oxygen. It's a global issue. Even if you are not concerned with our climate, our climatic environment, I think we have been suffering from inconvenience. The banditry we have been witnessing all has been not limited to environmental climate change. Between the farmers and the poachers and what have you, Gresil and Rasul reserve have been taken away either by desertification or by encroachment of farmers into lands. So I think there is a need for us to have green belts, follow these trees, fortify ourselves against desertification. In fact, it has been reported that in every year, we lose more than 16 kilometers of our country out of land to this desert desertification encroachment so far.


Dr. Strange in the Multiverse of Madness is out and I've seen it, and I have thoughts on it, this time spoiler-filled ones. So if you haven't seen the film yet and you don't want it to be ruined, walk away. I have a spoiler-free video review if you want to check that out. Otherwise, let's go.   This should have been called Dr. Strange in the Wandaverse of Madness. There's very little multiverse going on. A lot of Wanda, a lot of Wanda happening, which is also bizarre because her character development in this movie is garbage. Now I know what some of you are saying right out of the gates, hold your horses, sir. WandaVision had the character development for this character. Even where the Disney Plus show ended, I wasn't convinced she was gonna scorch earth. She was gonna start killing friends or anyone that was in her way. She was in a dark place, sure. And yes, she has the dark hold, which got ahold of her. But they don't do a good job presenting that at the beginning of this movie. She's there already. She's already changed. The first act should have been the dark hold corrupting her, taking her harsher side and really bringing it forth, really setting things ablaze. But instead, we're kind of hoodwinked into believing she's still got it all together and then boom, she shows the reality what it really is. If you haven't seen WandaVision, you're going from multiple movies showcasing her as a hero to just suddenly, boom, she's bad. And I think that's a piss poor way to handle this. It's one thing to have movies required to see in the MCU, but to now bring in the shows that require a Disney Plus subscription on top of watching all the films. It's just no, it's nonsense. I don't like when you have to read comic books in order to get certain character traits. That should be done in the movie. That's its job. So don't make me start watching TV series, especially if they're as bad as Moon Knight has been. Couldn't even finish it. Maybe it gets better, but episode three I thought was atrocious.  Poorly done. I'm sorry. Now before I get into the things that maybe didn't work for me, let's talk about what did. Well, the pacing was very breakneck. It didn't feel bored during this. It entertained me. Kind of like going on a roller coaster for the 40th time. I've been on it. There's no surprises anymore. It was exciting the first time, but after 30 or 40 attempts, it's just kind of like, yay, this is still fun. I'm still getting some of that exhilaration, but there's probably some better rides out there. And this year there has been. There's been much better movies out, even ones that do the multiverse, like everything, everywhere, all at once. Far better movie. Buttloads of action in this. We got Dr. Strange doing his little moves. He's kind of buses in half. Picking them up, changing reality so we can see invisible creatures. Opening portals. Fantastic Beasts and where to find them are jumping through there, going away. I wish the Fantastic Beasts movies would go away. Newt Scamander. More like Newt Scanever.  The special effects, while inconsistent, get downright gorgeous at times, doing some really creative things, like when they're jumping through the multiverse for the 20 or so seconds that that happens, that should have been the movie, right? I mean, I think, I think the opportunity was there to have Dr. Strange go to different wild universes, meet some of the Avengers from the past. Maybe there's a twist to them. And I think ultimately that's what really upsets people. It didn't bother me that much. I just thought this story was kind of bad, but the fact that they call it the multiverse and we barely do anything with that is a little bit bananas, right? I mean, we have Robert Downey Jr. in the wings. He could come back in one of these other, you know, universes as a different variant of Tony Stark. We could have had variants of characters. Red Hulk could have been in the mix. Maybe there's a version of Captain Marvel that's likeable. Hell, there's a point where Dr. Strange goes through one of these universes and turns into a cartoon. We could have had Miles Morales swinging through there, or someone else from Into the Spider-Verse. No. I mean, Sony probably has a say in that. But still, it's Disney Marvel. They can make anything happen by cutting a check. It's wonderful to have Sam Ramey back in the director's chair, though. I love his vision. I like that he's unapologetically over the top with the horror elements. Later on, we see, you know, zombie Dr. Strange. He fights a version of himself using Fantasia-esque music notes as weapons. I mean, I honestly thought that was great. I'm sure a lot of people thought it was the dumbest shit ever, but to me, it just was full-blown Sam Ramey combined with Disney in such a just bizarre way. Having Strange pull the notes off the sheet of paper. And then the other one, bring them back. At that point, I was looking for some marching broomsticks, or Mickey outside the window on a mountain casting up spells to keep the waves down. It's multiverse of madness, after all, and it didn't get near as mad as it should have. We could have had the OG Fantastic Four show up, which includes Chris Evans as the human torch. That would have been hilarious. All three Spiderman could have been in this, or at least Toby, since it's a Sam Ramey film, or one of Sam Ramey's characters from that film. Maybe we bring him back. Maybe Tofer comes back. Tofer Grace is Venom from Spiderman 3. Critically acclaimed Spiderman 3. We could have had bully McGuire in this, and the fact that we didn't is a slap in the face to anyone who wanted to see a true multiversal film. That's not to say we didn't get any cameos, because we did. The worst kept secret ever, Patrick Stewart, aka Professor Xavier, was there. Charles, he's out on his more classic iconic chair from the comic books. And we had Reed Richards, Mr. Fantastic himself, Jim Helpert. Listen, the Krasinski family Robinson was a fan favorite choice to play the Fantastic Four for many years.  Hey, there's Reed Richards, supposedly one of the smartest men ever to walk the face of the earth, giving away their best weapon by straight up telling the enemy what that person can do to them.  I will say the fatalities in this are great and how the Illuminati died. Beautiful. Shouldn't have been the Illuminati. These are the handcrafted handpicked people, the best of the best, brightest of the bunch that are supposed to keep the multiverse in order, keep law.  I get that she's OP, I get that she's awesome, but she should have done this to some variant multiverse characters, not these iconic ones that were just seen in the MCU for the first time, like Professor X and Reed Richards. I don't know how Into the Spider-Verse got it right so well, maybe because Miles Morales was such a likeable kid, and so was the Peter Parker variants that came through, but I had no connection to anyone here, not even Dr. Stranger Wanda. Wanda, who I thought was incredibly sympathetic and very likeable in her TV show, came up here is very just kind of flat for me, very one-dimensional, she's evil, she's got to get to her kids, very cliche stuff. And I just thought Dr. Strange just kind of went through scene to scene, very cash. Again, kind of how he was in no way home, he's definitely keeping us cool, maybe a little too much. So when the Illuminati died, I felt nothing. I'm not sure if I was supposed to, but then what was the point? You introduced this apparently great thing from the comic book series and dismiss it outright so quickly. And Professor X dying?  It lost all of its weight. That was my favorite kill of the movie though, that next snap was sweet. And because now I know there's a Professor X in a bunch of different universes, nothing really matters. Just get another version of him, we know we're gonna see the Fantastic Four again. So it was kind of pointless shock and awe. Didn't really amount to much of anything outside of having a couple cameos in there that were I guess fun at first, but on hindsight didn't deliver. Last little observation before I wrap this up, Scarlet Witch captures America Chavez and she has her for a good amount of time. How long does it take to absorb her powers?  What are you waiting for? This definitely feels like a film where a lot of footage was left on the cutting room floor. I wouldn't be surprised if that first act maybe did contain some more build for Wanda. I should hope. Because as it stands this script was pretty rough, pretty hacky. As far as Sam Raimi goes, loved all the horror elements, loved the breakneck speed, just wish there was a bit more behind the storyline. I wish things were served a little better. I don't know the comics, I don't know the Illuminati, but if I was a fan of them, I'd be pretty bummed out about this. Not like in the interpretation, these guys came off as clowns, total bozos. It's possible I'm off base and this is the best MCU movie yet. It's also possible they've done a pretty bad job after Endgame to make anything really land. I know, Spider-Man No Way Home, huge massive hit, people love it. It's so overrated. I'm sorry, the story is so bad. The pacing is not very good. We all love it because of the trio. Let's be honest, it's because of the trio and they're only in it in the final act so I'm gonna leave it there. Please think about subscribing if you haven't. I post a ton of movie content, got the new studio going, we're ready, we're rocking, we're gonna put all content constantly and hopefully I'll see you soon.


and I am so happy to have my guest today to talk. You know, let me just back up and say that I thought I was the only Wonder Woman around. And then I came to this exercise class, this Pilates class here in Hong Kong. And lo and behold, this amazing instructor like was just cracking the whip and just pushing us to our limits and just the voice and power and energy just put me to shame. And so I needed to bring her here to talk about what it means to push boundaries. What does it mean to deal with an aging body and go past that and strength and beauty and all these things that are embodied in this person? So without further ado, let me introduce my wonderful guest, Beth Narain. Welcome to our show. Thank you. Thank you for having me. That's so nice.  You were originally from South Africa and you had won a scholarship to go to the Royal Ballet in London. And then you were also was a choreographer, I'm gonna let you tell us about how you got to Hong Kong but just to tell people that you were a choreographer for dances here in a TV station here called TVB in Hong Kong. And you were Hong Kong's first lady DJ, amazing at the Peninsula Hotel, iconic, iconic. And you were the first, you created the first woman's exercise studio here in Hong Kong. So that's just like a couple of your groundbreaking moments as a female, especially an ex-pat female at the time in this post-colonial city. So let's talk about this. How did you end up in Hong Kong? So when you grew up in South Africa, you trained in ballet, obviously. And tell us where it took you and how it took you out of- Started training at the age of five years old and then continued in South Africa with my ballet. And then we immigrated to London. And that's when I managed to get into the senior Royal Ballet School in London and got a bursary to continue there. After that, I danced in Europe in France and then in Italy. And I had an older brother living in Hong Kong. He'd been living in Hong Kong for many years. He was actually the brains behind the rugby sevens in Hong Kong. He started up, yeah. So I was in between contracts and he said, oh, I'll buy you a ticket to Hong Kong, come for a couple of months and see if you like it. And so I came and I didn't really- What year was that? 1966. Whoa, okay. 1966. Tell us what Hong Kong was like in 1966 because I had interviewed somebody who was the ex-governor of Hawaii who had spent time here around that era talking about the Suzie Wong era when he went in Wanchai where there were all the sailors that were coming in. That's the vision, that's the image of Hong Kong at the time. What was it like for you? It was, well, it was very colonial at that time. And it wasn't, I just come from Italy. I'd been working in Italy and it was very, it wasn't my sort of- Cup of tea? Yeah, my cup of tea, exactly. But then what happened was the peninsula opened up the first discotheque in Hong Kong called The Scene. And I got a job as a DJ and then later on as the manager rest of the scene. How did you get the job? Were you in music at the time? You know- I just, I actually went to the opening party and I was dressed in silver B-butt clothes from the B-butt boutique in London. Love it. Mom, head to toe and you know, nobody else was dressed like that at that time. It was really the 1960s look. And the guy said to me, so all the girl that was running the place at that time said to me, I would you be interested in being a DJ? And I said, sure, why not? So I was used to working at night because I've been dancing for many years, working at night. So anyway, I started working as the DJ and then took over as manager rest a little while later. That was during the Vietnam War. Wow. So what type of clientele were coming in at that time? Oh, it was very kind of, they were much older group. They were coming down from the Gaddies restaurant and there was restrictions on code, dress codes. So they had to wear color and tie and a jacket and tie, I should say. But mostly Western, European, European. Yeah, a lot of Westerns. Yeah, a lot of expatriates at that time. Because what I understand, and a lot of people still don't know, the image of Hong Kong as cosmopolitan and multicultural it is today, back in the days, like you said, the colonial times was mostly British expats filled through these spaces, whereas the local Chinese were kind of kept in a very local kind of a life in their own places. Yes, yes, that's true. So it was very expatriate and it was a beautiful discotheque and yeah, slowly, slowly it started to change and we got more relaxed with the dress code and younger people came in and then of course, a lot of people, yeah, sorry. Yeah, you know, I'm just imagining you in some funky outfit, gorgeous, blonde, spinning. And so people see you as this exotic being there. I mean, that's kind of like the presentation of a place. You provide this image of the club, right? How did you feel about that? Did you feel like you were kind of objectified or did you feel like this is brilliant? This is my time, they take advantage of that, but you also took advantage of this for your own experience in Hong Kong. Yeah, I wasn't blonde at that. Oh, what color was your hair? Black. Okay, funny. But no, I didn't feel objectified at all. It was fun, it was wonderful. It actually was the happiest time of my, one of the happiest times of my life and it's what kept me in Hong Kong. Okay. So it was that job. I was also working for television at the same time. I was choreographing for a TV show, pop show called The Starship. Was kind of like top of the pops, you know, in the sixties. And so I worked till two o'clock in the morning and then I worked from 11 till about three in the afternoon. I was working pretty hard at that time. I was also teaching ballet at the same time in the afternoon, we're a ballet school. So yeah. So at that time, how old were you? 19. Wow. Oh my goodness, okay. So as a 19 year old, fresh out, doing all these things that come to you and your body is, you know, Wonder Woman, right? You're on the top of your game. You have a limitless amount of energy and possibilities with your body, right? So you can manage all these things. And I'm just gonna kind of zip through how I met you through the fitness class and it's amazing that you are a grandmother, you've had over 52 years of experience in kind of dance fitness and everything.  You know, from my ballet training, the talking about pushing your boundaries. I mean, you do five classes a day at the Royal Ballet School, you know? You work very, very hard because there's a lot of competition. So you have to push your boundaries all the time. There's no hanging back or I feel tired or maybe I've got my period or I can't do my class today or any of that kind of thing. You do it and you push your body to the maximum. And I think that's probably instilled in me. And, you know, I don't think I get a cold or I feel a bit fluid. It doesn't stop me from going and teaching my classes. Wow. So it's, you just carry on. And I think that that's what makes the body a lot stronger. So do you think it's more mental? Mental and I think it's physical.  Right. Yeah. You have to have that. I see a lot of people a little bit too precious today. You know, they're a little bit too worried about are they going to catch a cold? And of course COVID hasn't helped that situation. Or, you know, are they going to get sick? Or, you know, better not do it because I feel a little bit tired.    Yes. You need to do that, right? You need to do that. You need to do that, yeah. You need to do that. With some, yeah. I think, well, for me, I definitely need to do that. I mean, there are many days when I go to work and I think, oh, God, really don't feel like teaching today. You know, I'm not tired or didn't have a good sleep or something like that. But I have to do it. And I do it. I probably do it because I have to do it, but then once I do it, I realize that I could have done it anyway. You know, it's not that difficult. It isn't- But do you think you set the boundaries for yourself so that you have to get that? So you purposely find jobs like you're working at this fitness center and you're teaching Pilates. You do it to set the parameters so that you have to go in.  And so is that what pushes you? Like, do you create these setups to continue to push? Maybe. Maybe I do, but, well, it's my career. That's the thing. It's what I do. But most people your age will not keep doing it. If you're able to do it, I don't see why you shouldn't do it. In anything, I mean, not just this, in any kind of work. If you're able to work, I don't particularly feel that one needs to retire. Yes. Yes. No, exactly. But again, how did you develop that sense of inner strength? Is it, did you ever have some life-changing experience that made you feel like you really need to kind of stay on track in a certain way? Or have you ever gotten off track where you realize that that's not the way to go in order to kind of fully kind of commit to the ways you strengthen your body? Surely you were a reckless young woman at some point and doing things that were not necessarily good for your body. Sure. Yeah, I used to go out at night, stay out till three o'clock in the morning. Yeah, at the time. Teacher, nine o'clock class, you know? Yeah. Was the hangover. I did that many times, yeah.  I actually had a blood clot and I was in the hospital and I had to stay in the hospital for about 10 days while they dissolved this blood clot. And there was this woman sharing the room with me. I never forget, she could hardly, well, she was paralyzed from the same thing, blood clot went to the brain. And she was completely, well, she was paralyzed. All she could do was slap her leg in order to get her daughter's attention who was staying in the room with her. Anyway, this woman was taken in a wheelchair every day down to physio to do her exercise. And she would pass me as I was lying in the bed and she was so excited to be going down to do her physio exercise.   I can work out. And I thought, how grateful we should be to be able to really exercise and to use our bodies every day. And you know, why think about, oh, I'm tired today, I don't feel like doing anything or I've got a headache. I don't think I'll go to class or, you know, you can. You can push yourself. And you need to really be grateful that you can move your body. It's true. And even my 18 year old son reminds me that movement is medicine. Sometimes I say, I'm tired. He says, mom, movement is medicine. It's like, yeah, you're right, you're right. So can I talk about that? Let's talk about movement because again, going back to your class and I hope that we can share that one little clip that I managed to steal of you teaching. But that was a Pilates class. That was a bar class. But in your cardiopilates class which I wish I had a clip, you were doing these routines where we had to not just do the movement that we had to use our brains because you had these choreographic ways to navigate the ball between the left arm and the right leg. And, you know, so it's not just exercise. There's more to it. You know, we have to follow. And you're strict. You're telling people, listen to the beat. You know, you're cracking that whip. And some people are tone deaf. So I'm like, okay, well, that's hard on them. But you are just hardcore. I've never had a trainer like you who takes the time to tweak people and to make comments that might just make a huge difference on the way they feel that muscle. Yeah? That comes from my ballet training. Yeah. I mean, as a ballet dancer, as a ballet teacher, technique and staying on the beat with music is very important to me. And that makes you use your brain. So you're not just, you know, zooming out on while you're doing the exercise and watching yourself in the mirror. But you really have to concentrate. You have to concentrate on a little bit of choreography that I give and listening to the music because that's what the music is telling you what to do with your body. But some people just don't follow the beat. They have a different sense of timing, right? Yeah. You don't have two left feet. And then what do you do? They have, I think everybody has the sense of timing. I think people just, they don't concentrate. They're looking in the mirror or they're looking at themselves or they're not being present. If they're being present, they can hear the music. They can follow. I'm doing it in front of them. They can follow me. I think that's a very good point. Being present is something we often dismiss. Yes. Especially when we have routines, you know, we just fall into it without thinking about it. Not thinking about it, right? Yeah. And that's how 45 minutes that they spend there, it's a kind of meditation in a way because they can really get into that 45 minutes. They can get into the music. They can get into the choreography. They can get into everything that I'm giving them, the energy that I'm giving them in that class. Yeah. You know what I noticed in your class that there are more men than I expected, especially when people associate Pilates or bars as always more of a female thing. So do you feel like that's more catered to women or is that something that's just been misinformed and how do you think men take Pilates differently from women? I think men, there are quite a lot of men doing Pilates. I don't know about bar classes, but they're very hard. Yeah. The technique is very hard, very difficult to get those small muscles engaged. Men are so used to using the big muscle. They like to get into the big movement. So when they have to work on the small muscle and get that technique of that little muscle working underneath the big muscle, it's quite... Yeah, it's a bit tricky for them. You think it's easy for them to dismiss? Like, oh, I just... It's too subtle, it's not a workout for me. So because they can't find that, right? So they're looking at the larger, more obvious, like you say, the big muscles and they're dismissing those really important subtle movements. Yes, yes, yes, that's true. They do find it very difficult. I remember one guy coming into my stretch and turn class and he looked around, he saw all these women and I guess he looked at me and thought, hmm, this is gonna be easy. That's kind of... Yeah. She looks like she could lie down for a while. You see, judgment. They don't understand what to see. Yeah. So anyway, halfway through the class he started moaning and groaning. I couldn't quite hear what he was saying, but we were doing abdominals and the sweat was pouring off him. And so it was quite funny because later in the changing room, this woman that was next to him said to me, did you hear what that guy was saying? During the abdominal workout, I said, no, I couldn't catch it. She said, he was saying, please God, don't let me die. You see, he's struggling so badly. And that was because he wasn't used to those kind of exercises where you really pull everything in and engage all the muscles. He was used to the big bouncy bouncy. That's why it's such an important topic to have subtle movements, subtle strength because that is something that we don't see on the surface but if you apply it to life, sometimes it's those little things that are, they go invisible because of the larger dominant narratives and the obvious surface level of everything we see in life, right? Sometimes it's the tiny little details that we don't care to look at that are so important to our wellbeing, strength and everything.  Ah, they are the ones that need to be engaged. But to get to there, you have to dig deeper. You have to dig very deep, very, very deep and you have to work them internally. So it's not just the movement that I'm giving that's going to work that muscle. It's you that's going to work the muscle from inside, from really contracting it. It's like you have to feel it yourself. Yeah, we can sit here now as we're talking and we can be doing our abdominal exercises. How? Tell me how. Let's do some. I need, I always need more core. So as I'm sitting here now, why are you talking to me? Can you still talk to me by pulling your belly button in towards your spine? Now this is different from the kegel, right? Not the contraction of the pelvic muscles or is it? No, not the contraction of the pelvic floor muscles pulling up. We want to just draw the belly button in towards the spine. Yeah. Good, feel that. Now it's about closing the ribs a little bit inwards like a corset. So just imagine you've got a corset on. Yeah. Clipping from underneath the breastbone, one clip, and then the next clip, and you're clipping all the way down to the pelvic bone. Right. So immediately do you feel yourself sitting more upright? More upright? But then there's a difference between, because then I feel like I'm contracting my lungs, which I don't want to do. You know, I'm holding in everything, but don't I feel like I want to open up so that I can feel like I'm present and I'm reaching out. You know, I don't... But you're not contracting this way. You're just gently pulling in that way.  By narrowing the waist, you elongate it. Right, right, yeah. So it has to be a conscious effort, like consistently. You don't let that go, you're saying. Yeah. I used to say to people when they walk, when they're walking down the street, just to feel as though they're pulling their flesh away from their clothes. Yeah, okay. It's subtle. It's not like that. Yes. Right. But just simply pulling your flesh, your abdominals or your waist. Yeah. From your clothes, from whatever you wear. Yeah, yeah, yeah. Just get that feeling of lengthening and drawing in. I mean, if you see ballet dancers walking down the street or even ballroom dancers, you can see them straight away, right? You can pick them up like that. Yeah, yeah. So they have that feeling of pulling up. Yeah, pulling up, holding it in from inside, deep inside, right? And you know that. So to wrap up our show is, what are some tips you can give, obviously, to people who, and some people are not as fortunate to have mobile bodies. They have issues, health issues that hinder movement. So again, it's the psychological aspect of it too, but what are some tips you have going forward to deal with our aging bodies, whatever level we have? I think they should do whatever they can. Tai Chi is very good for aging bodies. Exercise are not particularly what I'm teaching or, you know, or Pilates or yoga, but whatever they can do. Movement, everyday movement.  That's a very Chinese thing because you're opening, you're stimulating all the meridians and all the meridians. So any kind of exercise, anything that moves, stretch your legs every day when you get up, you know, stretch your body, swing, open up your spine, try to touch your toes every day, whatever, that's movement because the body needs to move. Yes, that's excellent. And I'm going to spin it back to your experience in Hong Kong back in the days because this concept of movement makes me think about the movement of Hong Kong, of how it's shifted and changed over the time. You know, when you were here, it was a very special time. You know, it was kind of a prime of this colonial era of decadence, so to speak, for a lot of the expats. And, but then at the same time, there was this tension about the riots. You mentioned that you were here during the riots of the 19, was it 67? 67, the Cultural Revolution. So how did that, you know, we look at the riots from a few years ago in Hong Kong, that's kind of changed things. What is, you know, you seeing that transformation and the two different types of riots protest, what type of understanding of this place do you have from that? I don't know, it's, during that time, it was pretty bad in 67, it was really bad. I mean, China cut the water supply to Hong Kong. We only had four hours of water every four days in the middle of summer. Every house was filled with buckets, buckets and buckets, buckets were the premium, you know, you were paying more for buckets than food at that time, because you had to fill the buckets up and they had to last, the water had to last for four days. So people got bombed, there were, you know, bombings going on around central. And I was quite nervous and I said to my boss at the Peninsula Hotel at that time, you know, I think I might go back to London. And he said, oh, well, why don't you just wait and see what the Kuduris are doing? If the Kuduris are not pulling out of Hong Kong, you know, it might pass and sure enough, it did. So things, you know, Hong Kong definitely has a way of bouncing back. Yes, the resilience is really, really amazing. Yeah, I think it's gonna take a little longer this time, maybe a couple of years, I don't know. But I think it will bounce back. I think things will be okay. You know, I've seen it go through tremendous steps, the financial crisis, yeah. I mean, seeing the world through your eyes as a 19 year old girl who comes out from ballet and ends up in Hong Kong, DJing at the most exclusive hotel in Hong Kong and then opening up a studio and doing all these boundary breaking things in Hong Kong is just a testimony to your strength and your vision to kind of continue to break boundaries.  This is brilliant. So thank you so much. This is Beth Norene. If you missed it, please listen. We have so much to learn from this Wonder Woman. The pleasure was all of ours. Thank you.


What's up guys? My name is Michael and welcome to my YouTube channel today. You know, I didn't have enough time to actually record a full video today. So that's why, and I feel like I need to record a video every single day because otherwise I'm not going to actually do anything. And I feel like I'm not actually in terms, in terms of, you know, going ham and on this channel. So I decided to just make a video on what I thought what I learned on code forces 694 contest. So what did I actually learn? So I actually learned that you should skip problems. Like absolutely should skip problems. Normally, when I do these problems, I would do problem A. And then what I would do is that if I get stuck, I just stay in problem A and then just just give up, you know. So always skip, skip problems, if you don't know, because I was actually able to do problem B or close to do problem B. Yeah, I got a little hassled off with the one of the one of the problem B for strange lists with an ordered map. So that is the thing that caused me to not actually get the answer to this solution. So I'll get into that later. But anyway, problem A, I thought problem A was actually harder than problem B. So some of these problems, don't just think that oh, problem A is always going to be easier than problem B. Sometimes you could get problem B or C and not actually get problem A. Because problem A is just like an observation trick, only math trick that you just didn't know at the start of the problem. So sometimes it's actually best if you skip skip problems that you don't know, because maybe you do solve a B, maybe let's say you skip a and then you actually end up solving B or C, then your rankings way higher, like in terms of trying to increase your ranking, it's way higher than that. So yeah, okay, the second thing I learned is actually an important lesson on for problem B. Okay. So originally, I had this code, which was this part, pre test to write in this code, I use an unordered map. And for some reason, the what I had on the unordered map, the answer for the problem, what I had on the judge was way different than what I had in my computer. So on my computer, I actually got the right answer. But in the judge, it gave me 24, 22, but on my computer, it actually gave me 36 and 44. And the reason why this occurred was because here's some tips, unordered map, this unordered map is not based on what you insert into it. It's actually based on a hash function. And that's different for every single compiler. So if you don't rely on the ordering of an unordered map as a way to insert values into it, that's not actually a good way to do it. Because if you just rely on things, rely on some libraries that you actually don't know. So look into all the libraries before you start doing them, before you start completely doing them because I didn't know what unordered map was doing. I didn't know what, what I just thought it's just an unsorted of a regular map. But it's not. It's actually based on a hash function. An unordered map is not the same thing as, it's not based on the order that you insert into. Okay. So that's what, that's what I got for this thing. And so yeah, this code would have worked if I just used like a vector. So I could have actually solved this problem for problem B way better than, yeah, I could have solved this during the contest. So that would have been the thing. So yeah, also, sometimes when you do problems, you could actually just brute force. So look at the constraints because sometimes you could brute force. Because the constraints aren't that large. So let's say this was actually like a thousand, you can actually just brute force it. Like it wouldn't matter. It wouldn't affect anything. Sometimes just typing faster and brute forcing might actually get you the answer. So yeah, you, you don't have to find the most efficient solution. You just have to be able to solve the problem and get on to the next standing. Okay. All right. Another thing I learned is that if you go on a problem C, actually, wait, no, no, not problem C, my bad. Actually that is, that's actually the gist of it. Um, so another thing I learned was that you could actually just, uh, you should look, read, look at other people's code.  So read up what the other codes, what other people done for their, uh, for like top coders like these, uh, this rainbow two, three, three read up on their code because, um, sometimes you can actually learn something. So you could actually learn something like here. They're using macros so to type faster. So maybe, maybe you, maybe you should use a macros. I don't know. It really up to you. It depends on your coding style. So yeah, that's pretty much all the gist. I have to say, um, maybe I should make more videos on what I learned from the contest to, uh, to, if in order to reinforce my memory, but, um, yeah, I don't know. I couldn't actually record a video today. That's also the why this camera is pretty bad. Uh, the microphone is pretty bad, but yeah, that, that's all I have to say about today's contest. Ray com subscribe. Let me know if I should make more of these types of videos on what I learned during the contest, but yeah, Ray com subscribe. I'll check you guys later. Peace.


In page confirmations in Moodle 3.1 You can save on clicks and speed up your course editing by seeing your actions confirmed on the same page. We're in a forum and our teacher is just about to post to the forum. Instead of being redirected and sent to another page there's a confirmation message in green which tells him he's successfully posted and he can get rid of this by clicking the X. Here we are in the recycle bin and our teacher is going to restore an accidentally deleted resource. When he does that, again he gets a message on the same screen telling him this has been done. Find out more in the Moodle documentation.


to Qdoba tonight. But before we go, I'm gonna try and figure out this watch. If you've been watching me on Strava, you probably are a little curious about the elevation gain in a lot of my runs recently. This watch, I think it's kaput. I just, I've reset it. I've tried to figure out the altimeter which tracks my elevation gain, meaning how many feet of elevation I go up and go down in each run. And sometimes it works and sometimes it does not work. So I'm gonna try and get this watch that I won at the 10k two weeks ago to see if it tracks altimeter. I don't know if it does, but it might. Let's see. Figure out how to carry the baby. It's only baby number three. I told her I have never, I can't do, not working. It's like somehow you put your arms through and it's like that. That's the best. This is my third kid. We still haven't figured this out. So what I do is I do this and then right off the hip, right there. There it is. Oh my gosh, like that. There it is. Another day, right? You get this thing. Mango salad. Oh nice. Chicken mango salad. Nice. Say hello to my little friends. Oh, that's smart. Here we go, ball. Brilliant ideas. I just want to say that people keep watching. Like our vlog? Despite the, and I told myself I'd stop. I'll take a bite. Yeah, you will. Saying simple vlogs. Yeah. And I have stopped. Yeah, your life vlogs. But despite the even keel vlogs, people keep watching and it's incredible and we're grateful and thanks for coming along the journey of life with us through the YouTube. And there's a lot of you out there that are new and maybe haven't been watching for two years straight. And that's okay. Good news for you is? 811 blogs. So if you had a nice, you know how people binge watch on Netflix, maybe you should just go have a little E&E's custard, set up your computer and hit that play button and just have yourself a good old week of binge. Take some sick time from work. You deserve it. Uh-huh. I'm still filming with the old camera and the new camera, the newer camera is on its way back. Nice. But in case all of this is out of focus, that's why. That is why. Let me just update you. That is why.