السلام عليكم ورحمة الله وبركاته بسم الله الرحمن الرحيم في نام الله سبحانه وتعالى رائعاً رائعاً رائعاً رائعاً الحمد لله كل محاولة بالنسبة لله لله سبحانه وتعالى أمام كل شيء في الحياة والصلاة والسلام على أفضل الخلق أجمعين نبينا محمد وعلى آله وصحبه أجمعين والتابعين ومن تبعهم بإحسان إلى يوم الدين نرى بلسينا ومعاقباته على محمد صلى الله عليه وسلم حسنه ومعاقبه رائعاً رائعاً رائعاً رائعاً رائعاً جميعاً لنا ونقومنا برسائعنا نتكلم بخبرنا اللهم إنك عفوون تحبوا العفوة فعفو عننا يا الله أنت أفضل لله أنت أحبك أنت أفضل لذا أفضلنا يا الله أخي وخائقنا لقد نكملنا القرآن لنوات هذا سيكون أخي من السرية ساعدك إذا كنا نظرنا أبدأ last year لدينا ساعدك قرآن ونوات ساعدك قرآن هذا هو أخي ساعدنا الله سبحانه وتعالى لتتكلم مننا ونقومنا بشيء صحيح في حياتنا لأخي رائعاً ومعاقب ومعاقب أميد أخي وخائق القرآن لدينا كثيراً رائعاً ثلاثة رائعاً رائعاًمرrying تصبح أك saç which means that does not reduce the Quran to a book of أستغفر الله tell like some people say we need to word things very carefully it is a book that has in it the accurate details of what happened before us so when Allah سبحانه وتعالى mentions the story of adem عليه السلام the stories of the previous فهي يتكلمهم لأجلنا لأننا نحتاج لتعلم ما يحدث لهم ما يحدث لنا إذا كنتنا نتتبع بطريقة المخطل والذي هو لأن الله سبحانه وتعالى يتكلم مخصوصاً ويضعه مستقبل بشكل مخصوصاً that perhaps may not be exactly according to his divine knowledge of our relevance. لذا ماذا في القرآن؟ مهم بالطبع. ماذا يساعد من محمد صلى الله عليه وسلم؟ مهم بالطبع. إذا كان هناك أي شيء beyond that in terms of the stories of the past we actually do not need that detail we're not going to be asked about it. الله سبحانه وتعالى ليس going to ask you on the day of judgment tell me what happened to Adam for example عليه الصلاة وسلام. لكن ماذا في القرآن؟ it's our duty it's the word of Allah he has revealed it for a reason all the verses are actually valid the second type of verses the verses that have within them the predictions of what is going to happen in the future so you have for example the day of judgment the description of the end of times what will happen some of the signs etc these prophecies everything mentioned in the Quran these are a large number of verses in the Quran and we as مؤمنين and believers believe firmly that this is the absolute truth it will definitely happen the third type of verses which is extremely important verses that have what is known as حكومة بينا. they have rules and regulations regarding our living that which happens between us that which happens in our lives now in order to fulfill these rules and regulations we need to understand them when Allah speaks about صلاة صلاة is prayer you cannot choose to do what you want and substantiated by saying so I'm going to give one shoe away for example to the man who lives down the road and I'm going to for example perhaps hop on my feet for 10 minutes and then that's my prayer you cannot do that there is a method there is an understanding there are conditions for صلاة you need to have you need to learn about it from the سنة of محمد صلى الله عليه وسلم so the verses are all applicable it's not like it's not applicable but the method of application is where we need to understand we go back to the سنة we understand the context of revelation we look at what happened and we look at how to apply the rules and regulations what is فرد compulsory what is سنة what is نفل this is explained elsewhere not necessarily in the Quran سبحان الله how many صلاة they are where they are meant to be fulfilled how they are meant to be fulfilled where are you facing the conditions the rules and the regulations the same applies to زكا and for your information the same applies to جهد في سبيل الله many of us speak about جهد and unfortunately I have been misquoted and some out of mischief have said that I said that the verses of جهد are irrelevant inapplicable it does not matter anymore etc these were tales of the past اعود بالله may Allah SWT save God that is the furthest from the truth the reality is the verses are applicable but the application of those verses governed by strict conditions rules, regulations, do's and don'ts where, when, how etc if you don't look at it you cannot just kill those who are around you from among the non-muslims or those you disagree with or those whom it suits you to call them for example كفار and you start killing and harming and hitting and taking a verse of the Quran to substantiate your misbehavior and your unacceptable action and then you say this is جهد في سبيل الله it is not at all جهد that is not what the verses were revealed for these verses are indeed valid but let's not be confused the application of these verses are governed with very strict conditions rules, regulations just like صلاح there is a time there is وضو there is a place you have to face a certain direction you will start in a certain way you will do certain things there has to be all these conditions rules and regulations met and then your two units of prayer shall be accepted so the same applies let's not misconstrue when there were instructions that were issued to the صحابة رضي الله عنهم they were definitely for the صحابة رضي الله عنهم like I've always said the lesson is for every one of us to extract rules and regulations from those verses is not the job of everyone it is the job of the specialists those who know those who are the jurists and the jurisprudence experts they will look into those verses and they will translate they will explain this is how you derive a ruling this is when it is applicable this is what was meant by this verse here is another verse explaining this verse and I explained yesterday when I was talking about the صورة الممتحينة and I explained about the relationship of the Muslims with the كفار and I told you that verse number 9 Allah says that He does not prohibit you from having a relationship with those from among the كفار who have not fought you they have not harmed you they have not driven you out of your homes Subhanallah and here comes a wise crack taking a verse of the Quran saying all the non-Muslims need to be killed أستغفر الله how did he get that this is what we say when we say be careful the application of these verses is very, very strictly governed by rules, regulations and conditions we need to understand them إسلام is definitely a religion of peace in this masjid perhaps 10 years back I had said that Islam is a religion of peace it stands for peace it promotes peace it will mean peace when you practice it you will achieve the peace in the dunya and the akhirah may Allah SWT grant us an understanding I felt it important to clarify this because there are so many people out there on social media and elsewhere who put words into your mouth and they make you say things that أستغفر الله you never meant and you never ever said but it suits them and their agenda to do that therefore they try and tarnish not just you but the message of the deen and they try and con the unsuspecting masses into believing that Islam promotes the haphazard killing of anyone you disagree with may Allah SWT forgive us that is definitely something that I felt in my heart needed clarification and I'm thankful to Allah for giving me this opportunity to clarify this my brothers and sisters we move on to Surah Tuddahr where Allah SWT says in Surah Tuddahr many factors and I'm going to pick up a few points from a few of the surahs that we've read as you know we read a lot of surahs in Surah Tuddahr Allah reminds us of the beginning there was a time before you were born before your father was born before you ever existed when you were not in existence at all Allah put you into existence in soul form He blew that soul into a body and then you became known as a person so Allah says in the opening verse هل أتا على الإنسان حين من الدهر لم يكن شيئا مذكورا showing the insignificance of man had a time not passed during which man was nothing to be mentioned of not at all today people refer to you and me with our names there was a time when perhaps or those who don't know our names they might say he or she we were at a certain stage neither referred to by our names because we didn't exist nor he nor she nor it Subhanallah and did you know something very interesting when you die you go back to that think about it what's your name so say your name in your mind okay and then try and remember a day when you were in the presence of people who had perhaps a deceased person of their family with them what did they refer to that person as when they had to carry say for example a person whose name was Abdullah did they say brothers bring Abdullah here no they said bring the body here you became known as the body why? because your name was no longer relevant you are gone it's your body your body needs to go into the grave if you take a careful look at this it goes to show you that this identity of yours is relevant while you're alive for the dunya in the akhirah you will be known by the name but that is only when you are giving the hisab and thereafter but between now and then when you are buried bring the body here lower the body into the grave no one uses your name at that stage may Allah SWT grant us an understanding let's save ourselves from the torment of the grave by realizing that we were so insignificant and we will be returned into insignificance except for those who've done good deeds and who believe so let's believe in the Almighty and in the last day and in Rasool Allah S.A.W and whatever we are required to believe in and let's try our best by doing the best of deeds and by seeking the forgiveness of Allah S.A.W so Allah says in verse number 27 of the same surah surah to دهر is surah number 76 of the Quran Allah SWT says speaking about the evil people the hypocrites those who follow their woms and fancies Allah says those people they love that which is right here right now and they are forgetting about a day behind them which is going to come that will be يوم and تقيل a very heavy day those who commit sin and forget Allah S.A.W and follow their woms and fancies Allah says they are forgetting a very heavy day that's going to come for them at some stage so from this verse Allah is reminding us turn to me S.A.W turn to me no matter what you've done seek my forgiveness that is why I have reminders in the Quran S.A.W may Allah SWT grant us ease the same applies in surah we hear it so many times don't we I'm sure we hear it a lot it's a sunnah to be read sometimes in salat al-witr sometimes in salat al-jumu'a it's a sunnah beautiful surah number 16 that makes mention of the same thing بل تؤثيرون الحياة الدنيا والآخرة تخيرون أبقى the nature of man is such that he gives preference to this worldly life not realizing that the آخرة is actually better and everlasting so don't prefer this worldly life over the life of the hereafter you can enjoy this life on condition that you do not compromise the enjoyment of the hereafter how amazing is Allah he didn't tell you divorce yourself from this world he says live in the world enjoy it but with the rules and regulations every country has rules every place has rules and regulations subhanallah every religion has rules and regulations the same applies to Islam we may be stricter but that is because Allah wants you to be in a better place may Allah guide us and may Allah help us to save ourselves I mean when Allah describes in surat abas which is the 80th surah of the Quran the same day the last day subhanallah it's amazing how Allah says on that day man will be in such a big problem that he will be prepared to give as ransom his own family members take my son take my wife take my mother take my brother but don't punish me I ask forgiveness from Allah in fact Allah says man will run away will run away from his loved ones because he is worried about himself I don't want to carry the burdens of someone else subhanallah may Allah Subhanahu Wa Ta'ala grant us ease verse 34 to 37 Allah says يوم يفر المرء من أخي و أمه و أبي و صاحبته و بني لكل مرء منهم يوم إذن شأنوا يغني on that day man will run away from his brother his mother his father his wife his child each person Allah says will be worried with his own with his own issue with his own problem with his own matter may Allah make that day easy for us my brothers and sisters I want to inform you of something beautiful if you keep on asking Allah to make for you easy the day of judgment he will make it easy for you so ask him often if you ask Allah oh Allah help me in my grave when I'm all alone it will just be you and I have mercy on me on that day if you keep asking Allah that he will have mercy upon you in the grave because that dua you make the supplication it is registered when it is registered you are granted the dua by the will of Allah it is not gone to waste so take your time to make a dua ask Allah to help you in your grave ask Allah to help you in the hereafter ask him constantly to make it easy for you the day you've got a hand in your accounts and to forgive you I promise you you will save yourself from the calamity of that day may Allah SWT save us all سورة الإنفطار what a powerful surah in it that is surah number 82 verse number 6 Allah says oh man what has deceived you against your own maker that you've turned away from him يا أيها الإنسان ما غرك بربك الكريم oh man what has deceived you away from Allah سبحانه وتعالى don't be deceived it is Allah the most honored the most honorable the most honoring he is your lord don't be deceived he made you you have no option but to worship him سبحان الله Allah says الذي خلقك فسواك فعدلك it is he who made you he created you he formed you he gave you the form and he fashioned you he gave you your posture سبحان الله he gave you your identity Allah says and you are turning away from him don't turn away from Allah go back to Allah don't lose hope in the mercy of Allah no matter what happens go back to Allah worship him worship him constantly change your life seek his forgiveness this is a beautiful eve of Ramadan there are people whom Allah frees from hellfire every night of Ramadan including tonight may Allah write our names being from among those so my brothers and sisters what a powerful reminder then we have سورة المطففين المطففين is سورة number 83 of the Quran the opening verses remind us of those who cheat in business short change someone deceive someone lie to them sell them a product cheating them whatever else has happened but we've cheated in business do you know what Allah says do those people not think that they are going to be resurrected on a huge day and answerable for what they've done do they not think before they cheat before they rob people in business just because of a dollar just because of a rand something material you've now gained it in the dunya Allah says but hang on there is a heavy heavy heavy day that's going to come to you don't you think of it do those people who cheat not consider the fact that there is a day going to come when they will never get away with what they did so let's save ourselves let's not cheat in business be honest be upright be straight forward may Allah help all those in debt to pay their debts say Ameen and may Allah help every one of us in our businesses that we are granted profit that has barakah and blessings in it and may Allah make us happy with the profit that we have in a way that we are blessed rather than having so much but in a way that we've robbed and cheated forgive us in the next surah that I'm going to talk about is a powerful surah we read tonight in صورة الضحا this surah has in it comfort to Muhammad صلى الله عليه وسلم and to all those who perhaps may be saddened for some reason sometimes you call out to Allah and you think to yourself that perhaps Allah is upset with me sometimes you want Allah in your life so badly and you think maybe Allah is upset with me so Allah gives comfort in صورة الضحا it is a powerful surah to read when you are sad read it with its meaning and find out why it is so powerful الله says ما ودعك ربك وما قال Allah has not forsaken you no easy upset with you سبحان الله there was a time when revelation had stopped for a while and Muhammad صلى الله عليه وسلم was looking forward to it and he thought for a moment perhaps Allah might be upset with me Allah revealed verses no Allah has not forsaken you no easy upset with you سبحان الله وَالَّا سَوْنْ فَا يُعْطِيكَ رَبُكَ فَا تَرْضَى الله أكبر very soon الله will give you so much until you become absolutely happy that's what Allah says so in this worldly life Allah might not have given you that but Allah says hang on soon we're going to give you in such quantity that you will be absolutely happy so don't worry my brothers my sisters Allah will give you he knows when it is right for you to get what you want may Allah سبحانه و تعالى make us happy so that surah we should be going through it Insha Allah when we go through the entire surah but please take your translated Qur'an and look into the meanings of it and see what it's all about it will give you lots of comfort especially when you're sad the next surah as well called سورة الشرح أو ألم نشرح surah number 94 of the Qur'an الله سبحانه و تعالى says in that surah إنما العسري يسرن إنما العسري يسرار do you know what that actually means indeed with every difficulty there are two points of ease with every difficulty there is ease and with the same difficulty there is another point of ease if you look at the linguistics of this particular surah so magnificent that Allah is telling us when you have hardship search for the ease in your hardship you will find that ease in your hardship there will be two consolations for you in every hardship but you need to search for it you need to understand what is it I can tell you one right here right now most hardship that we have in our lives the first ease is it draws us closer to Allah amazing the first point of ease for the hardship is it draws us closer to Allah as soon as Allah puts a disaster in your life what do you do your surah falls in place you make tauba quickly you start dressing properly you cut your sins you actually come for tahajjud you reading surah what is that it's a beautiful point of ease Allah says well we love you that's why we testing you إن الله إذا أحب عبدن إبتلاه when Allah loves His worshipper He puts a test in his life more and more why to keep you occupied with worship because if Allah blesses you with everything you want you might forget and you might become lazy you might become too comfortable may Allah سبحانه وتعالى grant us from His mercy أمين then in surah to teen what teen was Zaitun we hear the surah often in it Allah says I have created man in the best posture لقد خلقنا الإنسان في أحسن تقويم I have created man in the best possible posture now when Allah says the best it is a challenge challenge for everyone try and come up with something better than man try and put any organ of mankind in a place where you think it's better for that organ to be you'll never ever come up with it so much so that today we have people who've created robots you know the robots they want the robots to take over from human beings what did they do the robot also has two legs two hands the head the face, the side the videos that they see by the cameras right here everything why is it posture exactly like man for what because man is the best posture you cannot come up with anything better than what Allah did look at your five fingers can you replace anyone in any other place imagine the thumb in the center look at your eyes can you imagine them anywhere else imagine breathing from the back subhan Allah I wonder what would happen in the front here you probably have a hairstyle that's what would happen you cannot imagine anything anywhere else your ear where your eyes are and your eyes on the side I don't know I'd be saying I can't even imagine this so Allah promises us why does Allah say this Allah says we created you in such a beautiful posture honor the posture honor Allah who created that by being a person who is upright because Allah says in the very next verse besides those who believe and do good deeds the rest are dropped to a very low level how can you be given something by Allah you don't worship Him you have no idea you don't worship He who made you you are not appreciative of such an elegant respectable posture that Allah gave you subhan Allah what type of respect did Allah give you when people see you they see the most beautiful part of you your face subhan Allah may Allah subhanahu و-ta'ala guide us so let's save ourselves by becoming people who honor that duty that we have unto Allah subhanahu و-ta'ala in the Surah that follows that is Suratu Al-Alaq I just want to speak about the first verse إقارة subhan Allah what does it mean read read now that is an instruction given to Muhammad صلى الله عليه وسلم and you and I know that Muhammad صلى الله عليه وسلم was the most highly educated ever without a doubt but he was unlettered that's why we should not be using the word illiterate because illiterate is a cheap word we use the word unlettered in the sense that Allah did not want him to recognize the letters for a purpose because when he brought what he brought no one could say he read it from somewhere else he studied it somewhere it was revelation from Allah done subhan Allah so Allah says to him read and he said that time I can't read and then he says Allah told him إقارة بسمي ربك اللذي خالق read in the name of Allah who has created why do I raise this point many of us in life we think certain things are impossible I teach you something today nothing is impossible for Allah in the name of Allah everything is possible it's a matter of time Allah tells Muhammad صلى الله عليه وسلم when he was saying I can't read or I'm not a reader actually he says ما أنا بقاري which means I'm not a reader Allah says read in the name of Allah everything happened he became the Nabi of Allah سبحانه وتعالى the most highly educated nothing is impossible for Allah save yourself from thinking bad about Allah by using the name of Allah whenever you want to do things بسمي الله have hope in Allah there is nothing impossible for Allah he can turn any situation he can give you that which you wish for and you want even if it seems impossible to man nothing is impossible for Allah سبحانه وتعالى have that faith and have the conviction we move on to سورة الفيل there is سورة القدر in the middle which speaks about the night of decree I've spoken about it already so I'm not going to go into it but سورة الفيل why I want to talk about it for a minute is because it is the سورة number 105 where Allah makes mention of Abraha who came from Yemen to try and destroy the Ka'ba which was the house of Allah he came with the elephant and it was virtually impossible to destroy that elephant but Allah doesn't know that that elephant but Allah destroyed it with a bird and some little pebbles from that bird you know the whole سورة short one mentions how Allah destroyed that whole elephant and the whole army was gone Allah says we made them perish in no time Allah will defend whatever belongs to him سبحان الله no matter what what belongs to Allah will continue you have a masjid for example this masjid is run by funds people donate if you decide one day I don't want to donate do not think that the work of Allah is going to stop the only thing that happened you jumped off the train the train carried on سبحان الله that's a powerful point think about it Allah kicked you out because he didn't want you in such blessed work that's why in your heart you said I'm not going to give you see this is why keep on giving have your own cause that you always give for quietly in your own way sometimes if people know as a point of encouragement there's no harm but keep on giving don't ever withdraw from good work no matter what because the work of Allah will continue Allah will protect His Deen and if you want to harm the work of Allah Allah will destroy you look at what Allah did you want to harm the work of Allah it's a matter of time before destruction comes may Allah SWT grant us ease I moved to the last two suras of the Quran and I want to end with this صورة الفلق and صورة النس we need to go home tonight and look at the meanings of these two suras in it Allah SWT makes mention of verses of protection of mankind from the devil from the jinn from the evil human beings from jealousy and from the evil that might affect man in the darkness of the night etc. so we are taught that if you want to be protected from jinn kind from evil evil eye from those who intend to plot against you and so on you must read the last two suras of the Quran كل أعوذ برب الفلق كل أعوذ برب النس those two suras every morning and every evening thrice that's the minimum if you want to read them after every salah it's a bonus but if you read them morning and evening so we read what is known as آيات الكرسي thrice in the morning after صلاة الفجر and we read these two suras and we add on to it صورة الاخلاس so what we call the three last suras they all start with كل right? thrice in the morning thrice in the evening each I promise you you will place around you a metal armor of protection against the jinn against the evil eye against black magic against people who intend to harm you against jealousy and if you don't read these you are the only one to blame when some of this affects you الله سبحانه وتعالى to help us the reason I end this way to save ourselves from the black magic from the evil eye from jealousy from the jinn and from being harmed in such different ways we need to read this so let's save ourselves by taking a moment it doesn't take more than five to ten minutes it does not take more than five to ten minutes invest in those five ten minutes every morning and evening after صلاة الفجر after صلاة المغرب after صلاة المغرب sit and read this آية الكرسي these three suras الإخلاص فلق and nas read them thrice each there are a few other very short du'as if you can learn them learn them بسم الله الذي لا يضر معاسمه شيء في الأرض ولا في السماء وهو السميع العليم أعوذ بكلمات الله التام مات من شر ما خلق إن شاء الله we will be protected by Allah and we will save ourselves in the dunya and in the akhira my brothers and sisters we pray for each other that Allah grant us those in the same way He has gathered us here may Allah gather us in the gardens of jannah may He save us from jahannam may He save us from the evil of this world in the next أقول قولي هذا وصلى الله وسلم وبارك على نبينا محمد سبحان الله بحمده سبحانك الله وبحمد


Hi, everybody. This is Donna Prosser, Chief Clinical Officer with the Patient Safety Amendment Foundation. We're here today to talk about infection prevention and the impact on health worker safety. And joining us today is Dr. Christine Listerna. Dr. Listerna is the Regional Director of Infection Prevention and Control and the Heroes Program at Kaiser Permanente. Welcome, Christine. Thanks so much for joining us. Thank you. I'm very excited to be here and talk about infection prevention. Great. I wonder if you could start by telling us a little bit about your background. Yes. I'm an Infection Preventionist. I am a critical care nurse by background. I am currently the Director of Regional Infection Prevention here in Northern California, as you said. We support 21 medical centers across our region. We provide resources, leadership, consultation, and a lot of support, especially during the pandemic. Also under me is a program that helps our medical centers prevent happy or are pressure ulcers and falls. Great. Well, let's go ahead and get started then. I know we got a lot to talk about today. So tell us, start with, you know, what is a comprehensive infection prevention program and what impact does that have on health worker safety? Right. So, you know, a comprehensive infection prevention program is actually, in my mind, quite simple. The primary goal of any infection prevention program, whether you're in a hospital or, you know, a community healthcare setting is primarily to prevent infections occurring in your setting. And that is infection to patients. First of all, that's usually what we think about when we think about infection prevention and healthcare setting and also infections to our employees or healthcare workers. So there are many components or critical components of infection prevention program. And here in the United States, you know, we go by the CDC recommendations on what those are. And a critical element of that is worker safety or healthcare workers safety, patient safety, obviously, environmental safety is another one. Education being a very, very critical component of it. And in the last, I want to say 10 years, and this is very, very true today with what we're experiencing is a focus on emerging infectious diseases, which is what we're doing with the pandemic. So that is a nutshell what a comprehensive basic infection prevention program is in a healthcare setting. Great. And so for those organizations that maybe don't have some of those protocols in place, what are, you know, what are some of the general protocols that hospitals today should have? Yeah. No, thankfully, the protocols are quite accessible and available. In United States, for instance, CDC has a very comprehensive guidance or guidelines and recommendations when it comes to infection prevention protocols in a healthcare setting. And at the international level, obviously, the World Health Organization have quite similar and quite comprehensive infection prevention protocols as well available to healthcare settings. So, you know, you talk about the protocols and I want to think I'm thinking about the basic infection prevention programs or procedures that should be in place in any infection prevention program. I said that twice. You know, standard precautions being one of those, and I can talk about that in detail, transmission based precautions, you know, when we know what kind of disease we are dealing with and we know how it's being transmitted. There is vaccination or immunization program, both for patients and for employees. And then management of harm. And when I talk about harm in this context, I'm talking about exposures to infection diseases. So whether it's the patients or the healthcare workers being exposed to the diseases and how we manage them and how we support them. And of course, you know, again, I want to say education, healthcare worker education and patient education. So those are to me the main components, kind of the foundational elements of an infection prevention program, regardless of where you're at in the world. So with, you know, with that list that you just shared with us, I'm thinking of my 30 years in nursing.  I wonder if you can tell us, you know, shed a little bit of light on what are the typical gaps that you see between these best practices that we know, and what's actually happening on the front line? Yeah. You know, I actually was thinking about this before our interview. And I want to start by saying that there is always a discrepancy between policy on paper and actual practice. And when we ask why, you know, for instance, a frontline worker, whether it's a nurse or an environmental staff or a physician, why they're not doing what they're supposed to be doing, the common answer is that they did not know that they were supposed to be doing this. And we kind of take that for granted. I think we're all guilty when we're doing auditing or adherence monitoring that, you know, this is just a usual kind of trying to explain a way of behavior. No, I did not know it. But when you do ask them probing questions, you do find out that they in fact don't know it. And it could be as basic as hand hygiene. It is surprising to me how we've been talking about hand hygiene or how to properly clean your hands, you know, from the very beginning. And we assume that healthcare workers know this by heart, but it's not true. And simple things like hand hygiene is not quite simple at all when you're applying it at your own work at the frontline. So I think knowledge or lack of knowledge of lack of understanding of technical aspects of anything cannot be taken for granted. So that's why I keep reiterating education. The other thing that is a reason for gaps is that the policy or the protocols as written, while it looks good in paper, is not quite practical or applicable when actually being applied. And when you're working with an actual patient in a real life environment, we find that we always have to adjust our policy and our procedure and expectations once a lot of people start implementing the policy. Because we are working with people and people are just not perfect. So they can have a policy. So they always find a way of making adjustments for a policy to be applied in their own environment and their own practice. And I'm finding that's okay as long as it's safe and it can be done. So the discrepancy between knowledge, between practice and the policies I think are the main gaps that we observe why there are gaps in compliance when it comes to infection prevention protocols. Wow, that's a really great point. I think we can pretty much apply back to everything. Yeah, it's one of our core principles that we believe for hospitals is we got to make it really easy for the frontline to know what to do. Otherwise they're not going to do the right thing. Yeah, and the other thing too that we forget, it just made me think of something is that we often write policies. And I think a lot of organizations are guilty of this, but especially in a system like ours, for instance, where we have our region, or we even have sometimes higher than that, and then you have medical centers underneath you. We are so serious and devoted to standardization that sometimes we forget that we're actually dealing with 21 medical centers, like thousands of different people. And standardization may have different meanings to different people. And almost always when we don't bring in the front lines at the very beginning, we get what we call drift, which I actually think is okay, because we haven't taken into consideration how a policy or protocol would be applied in real life. And then we're surprised why drift happens. Of course it happened because now it's being readjusted and being applied in real life. So that's fine. So anyway, frontline engagement to me, it's very much a critical element for standardization and what you're saying, reliability. You made me think of that. That's a great point. So for an organization who maybe doesn't know that there is a gap between what the frontline is doing and what the expectations are, what can healthcare leaders do to assess whether or not they have those gaps? Rounding, rounding, rounding. Actually going to the frontline, going to the unit. And auditing is one thing. Okay, we do need to audit. That's part of a formal program. You need to monitor adherence. So you have data and there are some regulatory requirements too for auditing. But when you're actually rounding and watching people do their job and having conversation with them, that's when you find out the gaps. And I think that it's more informative and more reliable than or more important than the information or data that you will get from auditing. When you're actually watching people apply the protocols or implement the policies or the initiatives that you've been sponsoring as a leader and listening to what they're saying, what they're finding, and the questions. And being able to hear what their questions are and you as a leader providing that feedback real time. So rounding is very important. And I've also said engaging the frontline. And what I mean by that is actually bringing in a frontline position or nurses or other ancillary staff into committee work or into oversight group so that you can hear what's happening where the work is actually taking place. So I think these are all like communication engagement in addition to adherence monitoring. So leader rounding to me is very important. And so do you have any other recommendations for what hospitals can do to improve their just their overall infection prevention plan for healthcare workers? Yes, I mentioned education being very important. And creating or supporting your your infection prevention program to have an education plan that takes into consideration the actual needs of the frontline and then supporting that program and supporting the frontline to have access to that education is important. And then the education cannot be just an annual education. It has well you need to have an annual education obviously, but it has to be flexible enough that you can pivot you can kind of change what you're offering depending on the needs of the frontline and depending on what's happening like what we were just talking about before we started the recording all that pivoting that your organization had to do because of the pandemic. So you need to have a program with that kind of flexibility and that can only happen if that's being supported by the leadership and the organization with resources where there's human time. Sometimes always money is quite important. And then letting people know that you know that there's this educational plan there's this educational offerings and giving people time to actually take advantage of the programs is important. And what about health workers themselves do you have any recommendations for what they can do to keep themselves safe from acquiring infection at work? Yeah, you know what really came through during the pandemic is to me individual responsibility. It's kind of ironic that given the accessibility of information nowadays that a lot of our frontline staff chose to be uninformed and I'm saying chose because it's hard to ignore the information that's coming through when it comes to benefit. Now it's kind of hard to navigate you know yourself through this all the information and the changing information that's coming through. But I find that our frontline workers tend to rely on their managers for information or tend to rely on their peers. Well sometimes it's important but trying to do their own research and educating themselves I think is it's not coming naturally to our frontline workers. So I think there is that there has to be an emphasis on individual responsibility when it comes to educating yourself as a healthcare worker as a healthcare professional. Asking your manager questions about policies or procedures that you do not understand making sure that you are asking the questions and escalating them and holding your manager responsible for the answers and making sure you're getting reliable answers. The other thing is holding your peers accountable for their actions and I don't need to audit or call out your co-workers but you know being watchful and watching out for that co-worker. If they're doing something that they're not supposed to be doing being able to call that out and have that conversation. But of course you can only do that if you know what the right thing is. So it is important to know what the right thing is not only for the safety of your patients but also for your own safety and that's very critical during the pandemic. As you said there is no patient safety if there's no healthcare worker safety especially with this pandemic. If you are sick yourself how can you care for your patients? How can you care for your family? So you just kind of contribute to the problems in the community when you do not care for yourself and as healthcare worker you know you are in a high risk environment. So you need to be extra careful than a regular person in the community and of course you need to be extra educated because of the environment that you're in. So individual responsibility when it comes to education and being healthy yourself and being watchful not just for yourself but for your co-workers too are important for our healthcare workers. Well that's a really really great point. I think you're absolutely right and I think as clinicians it is our responsibility to practice by policy but it is the organization's responsibility to make sure the policy is followable. That's right that's right and that makes sense. Right yes exactly that's right. Excellent well Christine thank you so much for joining us today. I really enjoyed talking with you and I hope we can have you back again to talk with us about another topic. Thank you so much for having me today.


OK, good afternoon. So thank you, Charles. I find myself sandwiched between two experts who know far more than I in telling you about what ancestry and our individual ancestries and our groups mean to our individual health. So I thought the best way that I could spend my time is to try and emphasize this message and try to tell you the kind of work that we do and others are doing and at least try to find an answer by some independent ways. I want you to note my disclosures. But the general lesson that I'm sure I unfortunately couldn't be in the morning, but I'm sure that this has been emphasized again and again and again, that if you take a number of people from around the world, essentially individuals who are native to their geographies or at least have been native to their geographies for a considerable period of time. And you look at the human genome sequence in a very broad way that it shows highly specific geographic patterns. This is, by the way, a very pioneering study by Luca Cavalli-Sforza. It was done decades ago with much more limited data before the genome was in view. But when it first appeared, and this kind of study has been done with modern methods again and again, and I'm sure the next speaker is going to speak about it, that there was a striking feature to this kind of map. This looks very much unlike a political map that we used to where the borders are sharp and separated from its neighbors. Here's a map. It's a false-colored map of genetic differences, and it shows that there are very few essentially discreet boundaries. In fact, there are no boundaries that this variation is continuous across the globe. Yes, there are distinct colors for the African continent, for parts of Asia, clearly the New World and Australia. But largely, we find continuity in the kinds of genetic variants anyone has, and in fact, their neighbors. Now, this pattern, geneticists have stayed at over the last many decades. Lots of people, both in the room and outside, have contributed to these studies. And the bottom line that we've now known for at least 20 years or more is the pattern that I showed you before is the consequence of our shared history of all humans. We are a very young species. Our history of modern humans is roughly about 100, 150,000 years. And I'm not going to show you the detail, but we started all of our ancestors started out in Africa. They roamed the globe, and some places were colonized earlier than others. Some actually very recently, many Pacific islands have been colonized only in the last several thousand years, this country itself by Native Americans about anywhere from about, say, 12,000 to 20,000 years ago. So one of the questions that modern data, having the kind of tools and technologies we have since the human genome sequence brings up is, well, how well can we reconstruct the total ancestry of humans, of anybody? As all of you know, and you've heard at this meeting that mitochondrial and Y chromosome data are very promising. They're very popular. There are many companies that provide this kind of information to us as individuals. But so far as questions of health are concerned, and I would admit that even questions of total ancestry are concerned, this is insufficient. It is imprecise in the sense it tells you something about our maternal lineage and maybe our paternal lineage. But of course, most of our genome is encoded elsewhere. And so in that sense, it's imprecise that might even be incorrect. And there were last few speakers pointed out the kind of discordancies that might appear to us. So in this day and age, as sequencing costs are falling, we could get genome sequence data from the entire genomes, from any of our genomes, and many have. And there are some technical features that can render the data almost as informative as mitochondrial and Y chromosome DNA, which is to focus on specific regions of the genome that have little to no recombination. I think we are very much there. I think we could do the first and second. And I want to emphasize this last part, that we need samples from many parts of the world. There are problems, and we'll come to them, but we need samples from populations from around the world. And this aspect is extremely crucial. And the resolution with which we can do this analysis depends on this. And we are far from it. And I'm a very big advocate, as most people in genomics are, that these samples have to be publicly available so that everybody can study them and validate them and not be proprietary in any ways. So I think these kinds of public samples have left to not only the understanding of what we call the out-of-Africa hypothesis that's the history of all humans, but of course, the history is far more complex. And I raise this complexity not to say that we cannot infer this, but to say that further study and many other samples are necessary to show that human migration and movement is, in fact, offered in two ways. Our ancestors not only left Africa, but some of them returned. And the modern genomic resolution from the sequence data enables us to do these kinds of analysis. And this is Joe Pickrell and David Reich and others in a pre-published pre-print that, in fact, suggests the scenario. On the other hand, there are other kinds of ancestry we can detect from genome sequence data. The technical word is introgression. And this is, again, a revision of the standard out-of-Africa model that is our ancestors not only left Africa, but they didn't go on to colonize the world just by themselves. They met other sort of proto-humans, the so-called archaic forms, and archaic forms, such as Neanderthals, a one that we know, another potential one called the Denisovans, and that our ancestors mixed with them. And we know this because resolution of the human genome sequence has shown in work by Svante Pavo and David Reich and many others. And some here that our current genomic sequences, in fact, carry the imprints of these DNIs that perhaps go back to 30,000 years ago or more. So when we talk about ancestry, it's not only recent ancestry that there are these imprints of much more recent, much more remote ancestry. I think, to me, much of genetics has been a surprise because there are things that I would not have anticipated. And perhaps that's the greatest part of any new and dynamic science. And these are data, again, published from the lab of our next speaker, Carlos Bustamante, and done by a very bright young disciple of his called John November, that in these analysis suggests that genes mirror geography. There's a study done in Europe. But I'm sure when the equivalent samples come from other parts of the world, the same basic story might be true that if, in fact, you did collect genetic material at very high density from around the world, you could place people, current people, into their geographies from which they most likely came to remarkable resolution. You can't see the bar chart at the bottom in blue, but it suggests that many individuals can be assigned to a region just based on their genetic marker status to under 400 kilometers. Well, we have Americans. The word kilometer is sort of strange to us. That's of the order of a couple of hundred miles. And I'm actually not quite so sure. I would want some of my relatives that close, but nevertheless. And the question is that, are these simply just so stories? Well, we are becoming better at detecting trends as the question came up during the discussion about what is the provenance of ancestry of some African Americans from Sierra Leone. We know that there are gaps in the story. That when we detect admixture, it says we know something about the specific identity of the populations that were mixed. The source populations will, of course, we don't have the source populations. They may be sometimes very good guesses, but they're guesses. Perhaps better sampling is going to remove some of the guesswork. That there has always been significant population movements. I pointed out a few of the very well-known cases. And clearly, the current resident of many individuals, residents of many individuals, doesn't say that their ancestors were precisely at the same time and place. In fact, often we know that that's not the case. But perhaps the most important part of all of human history, including that within Africa and its residents elsewhere, is that we've gone from a story of human evolution from being evolution in populations that were relatively intact, and you might use the word homogeneous, to almost all of human evolution being the history of admixture. This is true within Europe, roughly from the data that I showed you. It's clearly true in Africa. It's true in India, and it's true in the Americas as well. Our ancestors have been meeting others and intermixing for a very long period of time. Clearly within the past 5,000 years, perhaps as much as 10,000 years, not to mention the admixture between archaic and modern forms. So if we can increase the limit of this kind of resolution, as Esteban also said, the question is how much is it going to improve our understanding of human disease and its causes? And the basic hypothesis is that if the current distribution of human genetic variation is nothing more than our cumulative past history, which it is, then the same disease variants that have been carried in our genomes, of course, they not only lead to influence on our diseases, as the last speaker noted, but of course, it is going to be completely confounded or largely confounded with our ancestry. And so unraveling that is actually a very important task. This has been known in many studies. Esteban showed an example of doing spirometry in individuals and looking at their proportion of African admixture. This is similar kind of data on blood pressure, which is one of the traits that our moderator Charles Routini and I have been involved in for a very long period of time. What the graph shows on the left are individuals who have been grouped by their average blood pressure in units of 10 millimeters of mercury. And what the y-axis shows is the degree of African admixture. And what you find is as individuals, if you pick individuals in the population, these are all African-American women in a fairly large study, then what you find is individuals with higher blood pressure also have higher degrees of African admixture. This is similar to the last speaker's story. But this can't be all of it. It cannot be all genes. Also work done by Richard Cooper and others. This is sort of represented in a very large study that he and others, and I think Charles had been involved in, is to look at the prevalence of defined hypertension among six populations of West African origin. And what you find is on the left, the smallest bar are individuals studied in Nigeria. And on the right, are individuals studied in Maywood, Illinois, outside Chicago, with a number of studies from the Cameroon and the Caribbean in between, that the prevalence or the percent of hypertension in these groups vary by almost two-fold. Even though if you looked at the average amount of admixture, it clearly doesn't vary by two-fold. It varies just by a few percent. So it cannot be, although admixture or ancestry and prevalence of human disease or a disease burden is confounded, genes cannot be the only cause. So I'm going to end with a very small story again to give you what is it that we know of blood pressure, which is clearly a clinical problem of very large importance to many, many communities, including those of African-Americans in this country. There's a very large study published a couple of years ago, and I just need to point out this is taken from a meeting just over the last several days in England, and I was lazy and just picked the slides, is to say this has been a very difficult disorder and a very difficult phenotype, the phenotype of blood pressure to study. We are now making headway in identifying genetic variants that are repeatedly shown to be involved in raising blood pressure in many communities and many studies, but these are studies done in individuals of European ancestry. And much more important than the last slide is what our current evidence collectively shows. If we do have variants that we think, genes, if you will, at this level of definition, if they do impact blood pressure, then the question is that does it impact all of the other clinical sequelae, that all of the things that we worry about what elevated blood pressure does. I'm not going to go over the details, but on the top are measures of target organ damage, in this case, in the heart. This is cardiac damage. And when the studies have been done, these are studies done from the studies we did, but compared in independent studies, there's a highly significant effect. If you take even the 29 variants we know, it is a miniscule amount of the blood pressure disease burden, but it clearly has major cardiovascular sort of effect. If you look at the much more serious consequences of stroke, or paureotary disease, and heart failure, it also has major effects, even the little bit that we understand. But here is why we do science, and we do not conflate the two sources of variation that I told you. It is well known that renal disease, kidney failure, is one of the severest causes of elevated blood pressure. And in fact, it's one of the largest reasons of kidney dialysis in this country. In all individuals, including in African-Americans, and what we find is the blood pressure variants that we have explain no bit of the renal damage that individuals have. At least so far suggesting, this has now been replicated, but it's so far suggesting, that in this case, whatever the ancestry effects are, or the blood through blood pressure, at least these genes don't affect kidney damage or renal failure in a direct way, that it is elevation of blood pressure that can happen from the renal failure. Now the results, as the previous speaker clearly mentioned, the vast majority of the studies have been done in individuals of European ancestry. That's true. And so there's at least some attempt here to try and see what the results mean for other communities. I'm not going to go through the detailed result, but what the panel on the top shows is that when we take our results and look at independent communities of European ancestry, the results are highly significant. But more importantly, when we take the same genetic factors and look at East Asians or South Asians or we look at both Africans and African Americans, the results are also highly significant. So this suggests that at least from what we know today, the majority of the genetic risk factors are probably likely comparable and shared between at least many kinds of population groups and ethnicities. But because we have a lack of molecular resolution down to understanding the specific genetic variant that leads to disease, we cannot distinguish whether the differences are due to genetic or other causes. And I'm going to end with the slide that speaks to an issue that all of you know. Sickle Salonemia is a disease largely of Africa, but not exclusively. To Africa, it's found in many Mediterranean countries. It's from widely in the Saudi Arabian Peninsula. And it's found, in fact, very widely is found in one of the most common single gene defect in the Indian subcontinent. This genetic variant, although so closely allied with the history of Africa, didn't arise only once. It's the same molecular variant. It arose at least two times, if not three times, in Africa. And it likely has, or it appears very likely to have had a completely independent origin within the Arabian Peninsula, which later its carriers migrated into India. So the population distribution of sickle sal, here ancestry has helped little. It's helped in a very global way, but not locally, because there are mutations that look the same, but arose differently with different genetic properties and properties of severity. But clearly knowing its molecular nature has helped us sort out the physical identity, its conflation with ancestry, and in fact, the specific effects on severity of sickle salinemia and its relationship to malaria. So I'm going to leave you with the message that because ancestry and disease burdens are confounded, that we have to understand disease not only at the level of genes, but we really have to do so at the sequence level. And we have to do so not using surrogates of race or ethnicity as we have. We really need to identify the specific sequence changes in human disease, not simply as markers, but in aspects where we understand the path of physiology of the disease. Thank you. I want to say amen to that conclusion, because it's really where we need to be getting the right sequence. And let's speak, and final speaker for this section is Professor Carlos Bustumante from the Department of Genetics, Stanford University School of Medicine. He's going to talk to us about population genetics in the personal genome era.


Hey everyone, welcome back for more Exo's Heroes content, today I'm going to talk about Jenae's damage over time team, so it's possible team composition, roles of each member or each hero on that team and the overall team strategy, but before that we want to see more Exo's Heroes content, please hit the subscribe button down below. After the recent announcement of Jenae's October 1 FC release, I actually came across an idea on how to create this damage over time team around her because I think she's going to be part of the new PvP meta, I'm sure there are going to be other team comps out there, but I'd like to build this team around damage over time because number one, nobody has really exploited damage over time before Jenae was more or less announced yesterday, so I will go over first the components of this team, so as you can see here on the screen you have six heroes, but obviously you need only five, so more or less there will be interchangeable parts in this proposed team because number one, I don't have the time yet to test run this team because Jenae has been released yet, it will be by tomorrow, hopefully I could pull her, but there are roles in this team which I will define later and I will also discuss on which are the interchangeable units in this team, also I'd like to discuss probably another hero to be included in this team as a possible option if you don't have some of the heroes that are in this screen right now, so the concept of a damage over time team came to mind also because again if you all know I have been playing Magic the Gathering for a couple of years, I already quit a couple of years ago or around 10 years ago, but there are some concepts that specialize in specialized teams or specialized decks if you call them in Magic, so this one is a specialized team again that the win condition would be mostly that damage over time damage, so I want to exploit that because it has never been done before and after this one we'll start to discuss more or less what each hero gives to the team and I'll discuss more or less my first five, more or less the core than the others that can act as probably sixth man or can be swapped out for other heroes, so currently right now in our game there are emerging specialized heroes, the first one that I noticed was FC Valentina with her specialized ability into having to have mana burn and Jenae I think is the second one, she exploits damage over time that well and she actually gives a lot of attack speed increase to her team so let's try to move on to Jenae's stats first, as you can see here boys and girls, Jenae will be available to be summoned Philippine time by tomorrow and she can be summoned for a week up to October 8th, so more or less the team that I'm building or I'm trying to build and try to try once I have her is again is mainly built around damage over time abilities, so the theme or the purpose of the team is to really control the tempo, control the speed, control the defensive end and really control it's like board control, you as much possible don't give any give an opportunity for your opponents to do something or slow them down so let's go over through Jenae's skills, Jenae is more or less the hero that runs this team, without her new passives this team would not be possible so let's skip her stats and go directly to her passive because her passive is what will run this team eventually so the first one will be her buff so there's a buff increase attack speed of all allies of the same row as self by 20 for 7 turns so she gives her team right off the bat with the same row that she's in and again what's nice about this one is it increases once she gets the chance to debuff the opponent so once she adds a debuff the whole team increases their speed so again it distances your team from the other team in terms of turns so you'll be able to get more I think turns because of this one so the next would be she also has a debuff so decreases attack of all targets by 40% for 7 turns so again she also gives your opponent decrease attack which again improves the survivability of your team and Jenae as well so again she controls the board heavily in terms of what you can do and what the opponents can do which is which is really good and it's a really new dimension how how PvP will be played the next is your charm so afflicts enemies with lower attack than self with charm so mark and decreases their attack speed by 30 so um this is new because last night I seem to not see charm here in her update but it's now included in in this one so they must have updated and included charm so afflicts enemies again with lower attack than self with charm mark and decreases their attack speed by 30 so this this again decreases their attack further attack speed further so she increases your team while decreases the the the attack speed of the other enemy's team so I didn't see this yesterday um I was I this probably is something new I don't know we'll try to we'll try to verify this if charm is really in her final kit um once I summon her once she drops tomorrow um we'll have to verify this because this was added recently the next passive skill is her superstars or afflicts the attention mark for seven turns to target when the skill hits increase hits increase all damage over time to target with attention by 100 percent so again if she lands a skill all damage over time effects on that hero or that unit or sorry or that hero um um takes damage on that damage over time times two so it doubles so again this is why I'm trying to build a team around her because um of the ability that she brings to the to to the PVP meta and her last passive skill is fan meeting so this is pretty much um I'll just explain this as simple as possible when she's attacked um all living here all living allies that she has will will attack that enemy if that enemy has less than 30 percent has 30 percent or less health or less than 30 health so this actually is just a counter but a big counter more or less when she's attacked with an enemy with less than 30 health so it's it's it's it happens once every turn so this is just a bonus but overall um if you can just um if you can then see her skills that she brings to the table she brings a lot she brings control she brings tempo control she brings uh she modifies damage and she gives a lot of um pluses to the game so again um they have added I think flow of mana as well um this is actually from what I've seen yesterday it was not here but anyway my a bit of work I'm not sure I'm trying to recall I'm really trying to recall if I've seen this yesterday but anyway it's good that it's here but based on what I've seen with her passive she's very OP um if this if all of these are going to be out tomorrow man you have to summon for her um there's no really option but to summon for pity for a few if you must um I will actually I will pity summon her I really want to build this deck and let's move on to to the other components of this team so um again Jinnai is is is uh your must-have hero for this team if you want if you don't have her for your damage over time PVP team this won't work at all so let's move on to the next I'll just discuss this briefly because um because these characters you probably know their skills already I'll just I'll just discuss what what they bring to the team so um Dorca is here uh for mana and for healing and for damage over time damage over time in her s1 so she's important here because of her heal and her mana as well so that is what she brings to this team she's number two in terms of what you need to build this team your third person for this team which um I think is a must is Garf Garf is um again adds man as well so uh increases your the defense defense and uh increases defense and health of your team um if Garf has more health than than everyone so let me just double check yes so grants allies with lower maximum health so if Garf um has higher health than everybody then then she gives 20 heal and defense to everyone so her role here is mainly to protect Jinnai because I think you should build Jinnai with the lowest health so that Garf can protect her once she takes damage because Garf gives her gives her um shared heal a shared health sorry um so again um also Garf has damage over time so for his s1 as well so that is why Garf is in this team so your fourth person for this one is actually Kailak so Kailak is you can actually use Kailak now he's actually going to be good in this team because of because of absorb soul so heals 100 percent of all damage over time effect on all enemies if affected with soulbots again you have to activate soulbots you have to increase um Dorca's attack for him to activate this one so you'll be immune to other damage over time um enemies um if you encounter probably another team with with uh Jinnai then this this dude is really going to help you um he's here mostly for that and also he has a damage over time um skill in his s2 uh which contributes to damage over time damage for this team so we've already covered four but the fifth one is actually interchangeable so the fifth one is for now is Naomi here she is so Naomi is um I wanted to use Naomi because I want to take take advantage of soulbond from Dorca so um with this one Naomi provides provoke and she provides um share health to the whole team so again the whole team is built on defense not just on damage over time she exactly is immune as well to to share health damage if she is affected with soulbond that is why she can survive this one um I think the the synergy between the three uh brun heroes would really give this team its core um you have the three and garf and uh and Jinnai um okay so that's five already but as you see the picture you have six so you have iris iris is there because if you want to swap out for damage sorry for for first guardians just in case you encounter first guardians you can swap in iris there so it's a choice again we haven't play tested this this this uh team yet so I'm not sure if the existing first five can take damage from first guardians so probably one if if the enemy has won probably yes but if many I'm not sure so it has to be play tested still so again I just put iris here as the sixth man or sixth woman because she will deal with first guardians once you inserted her in line up you can take out either um Naomi or garf for this one and the the special guest for this one probably your your seventh your team manager is tantalo so again you can try to swap out Naomi for tantalo because again tantalo is here because he has he has better skills and he has damage a damage overtime skill phrase s1 as well so um more or less he he fits better with the team depending on your preference and depending on how you're going to build the team but Naomi is initially there because I wanted to try out the synergy first of the brand heroes or the new brand heroes that uh I ride for update 2.0 well if you take a look at what I have right now so this is more or less your concept team with jenai still in her regular form so I'll try to get her try to soften for her so again um this team is built on defense so for my end game strategy you must put up a lot of defense because jenai must survive here protect her at all costs if you must um this team comp is really not not um not fixed it can be changed into changeable parts but um if I would suggest you try this one first then tweak it with the other suggestions that I gave so and the second strategy or end game strategy or team strategy for this one is dealing as much damage overtime as possible because you'll be you'll be you'll be um providing a shell for everybody while you try to deal damage to the opponent so and while jenai slows them down and while jenai probably makes your team faster so that's basically it for your team strategy so this requires a lot of playtest I'll playtest this once I have jenai and try to upgrade uh some of the heroes here especially for the brand heroes I haven't upgraded kylock and Naomi for my team although they're in six already but their gears is is really really bad so anyway guys um please tell me what you think of this proposed damage overtime team also please try to subscribe to my channel because your subscription really helps me and really drives me to create better content for you guys so that concludes my video let me know what you think in the comments below your disagreements your agreements your grievances whatever it is in your mind so y'all stay safe and I'll see you in the next video work out