So this session is the influences and decision-making in vaccine hesitance parents and pregnant women by Susan E. Smith. Sue Smith is a registered nurse mid-life with over 30 years experience. Most recently, Susan has been employed as a maternal child health nurse working with child and family health in the country's South region of Adelaide. In this position, Sue established an immunization clinic in the Murray-Malley region where her role was to coordinate and immunize clients ranging from six weeks of age to five years. Sue was also responsible for coordinating staff immunization programs as well as managing vaccine orders and cold chain maintenance. Sue has completed a Masters of Midriffy by coursework and research in 2019 with a publication of Women and Birth Journal entitled, Midwriters' Role in the Promotion and Provision of Encinatal Influenza Immunization. In 2020, prior to the outbreak of COVID-19, Susan commenced a full-time pay to PhD at Flinders University. Her project is entitled, Vaccine Decision Making and Pregnancy in Parents of Children Ate Zero to Five Years. The aim of this project is to explore the values, beliefs and choices made by pregnant women and parents regarding their decision not to vaccinate their children aged in zero to five years and to determine factors that influence their decision making and to give a voice to vaccine hesitant parents. I will now hand it over to Sue Smith. Thanks, Bill. And first of all, I do have to apologize. My dog keeps snoring and that's not me falling asleep. So thanks for the introduction. Yes, I am a registered nurse and midwife and a maternal child health nurse, but most importantly, I am a passionate immuniser. So I'm in the final stages of completing a PhD at Flinders University in South Australia. So today it's my absolute pleasure to present the results of a recently published study which was conducted as part of a larger body of my doctoral research.  So as I said, the findings that I'm presenting today are from an exploratory online survey conducted by Qualtrics, which was published earlier this year. The paper that was published is entitled with weighing up the risks, vaccine decision making in pregnancy and parenting. The aim of this study was to explore the values, beliefs and choices made by pregnant women and parents regarding their decision not to accept immunisation, to determine the factors that influence this decision making and to give a voice to vaccine hesitant parents. So the objectives of this research were to explore when vaccine hesitant parents and pregnant women make immunisation decisions, to discover from whom and when vaccine hesitant pregnant women and parents obtain the bulk of their immunisation information and education, to explore the factors that influence those choices that the vaccine hesitant parents and pregnant women make, and also finally to gain an understanding of the experiences of vaccine hesitant parents and pregnant women. So immunisation is universally accepted as one of the most significant public health initiatives in recent times. Childhood vaccines alone have been credited with saving two to three million lives annually. However, vaccine hesitancy is a growing problem in middle to high income countries like Australia and has recently overtaken vaccine access as the primary barrier to immunisation uptake. Vaccine hesitancy has been described as the reluctance or refusal to vaccinate despite the availability of vaccines. This problem was included in the top 10 threats to global health by the World Health Organisation in 2019. Australia currently has high levels of childhood vaccine uptake with the national average for five year old children sitting at around the 95% mark. However, this figure does conceal areas of low vaccine hesitancy, which affects herd immunity and can result in the resurgence of diseases and has done in recent years. But up to 50% of parents and pregnant women have reported some degree of vaccine hesitancy. Immunisation in Australia is not mandated. However, the no jab, no pay and the no jab, no play legislation which were introduced in 2016 and 2017 respectively, they act as a financial incentive to encourage families to immunise children. While successful, this legislation has created considerable anger amongst vaccine hesitant families and had a greater impact on families from lower socioeconomic countries and areas. So vaccine hesitancy remains evident in all areas of immunisation, including pregnancy immunisation, which continues to reflect suboptimal intake in Australia. Pregnancy has been shown to be a time of high information needs. And it's an ideal time to provide immunisation information. It's also a time when vaccine decision-making commences. There are currently three vaccines recommended for pregnant women in Australia. And these include the Bordetella pertussis or whooping cough vaccine, influenza vaccine and COVID-19 was added to the recommendations for pregnant women in June 2021. So the risks associated with acquiring COVID-19 in pregnancy became more evident and widely known in mid to late 2021. Pregnancy already places women at increased risk of morbidity and mortality from vaccine-preventable diseases. And whilst there are limited studies on the impact of COVID-19 in pregnancy, the virus is thought to exacerbate these risks. However, anti-natal immunisation uptake remains suboptimal, as I previously said, with evidence to suggest that less than 50% of pregnant women are fully immunised in South Australia. Unfortunately, no data is currently available on the uptake of the COVID-19 vaccine. So the larger body of research from which these findings were drawn included three main points of data collection. These included the exploratory online survey using both open and closed questions, semi-structured interviews with parents and pregnant women and a ethnographic study. The latter two studies are currently under peer review and awaiting publication. So the recruitment for all three phases of these studies, previously mentioned, was undertaken via this purpose-designed Facebook page. The page also provided a link to the survey, as you can see here, as well as a chat function for the ethnographic data. A predominantly qualitative exploratory online survey was conducted on vaccine-hesitant parents and pregnant women. 106 used the online survey via Qualtrics. This methodology was chosen as vaccine-hesitant parents have shown a preference for an online environment where they can choose to participate or not in an environment that's relatively risk-free and somewhat free of criticism. This survey included a combination of closed and open-ended questions. Convenience sampling was used to recruit pregnant women and parents who identified as vaccine-hesitant. So all parents and pregnant women who were pro-immunisation were excluded from this study. The survey was promoted by paid advertisements over the course of six months on the Facebook page, which you've previously seen. So prior to dissemination, the survey was piloted on 29 vaccine-hesitant parents and pregnant women, just to assess readability and usability. The survey dissemination began in June 2021 and remained live until June 21. The chat function remained live until December 21, collecting data for the ethnographic study, which I hope will be available to all soon. So the survey included 30 questions with a combination of demographic information and questions seeking attitudes to immunisation, information sources, influences and opinions on COVID-19. The dissemination of this Facebook page was not limited geographically. However, participants were predominantly from across Australia, with two participants from the United States of America. Quantitative analysis was conducted on the demographic data using SPSS version 25. And qualitative data were analysed manually using inductive thematic analysis, following the guidelines of Braun and Clark. Now, the quantitative aspect of this study compared the incidence of vaccine hesitancy with the CIFA or the Socioeconomic Index for Area Schools according to Australian postcodes using an, I can't say this, an analysis of various or ANOVA data were obtained from 106 participants, however, only 104 were included in this aspect of the study as they were from Australia. Only those who stated that they were not in favour of immunisation or undecided were included in this aspect of the study. So over the total 104 participants, 70% self-reported that they and their child were unimmunised, whilst 30% were partially immunised. This was based on a personal assessment of the overall immunisation status and not specific to any individual vaccine. Gender was not a prerequisite for participation in this survey, nor was it asked as opinions were valued from both mothers and fathers. 15% of the participants identified as being pregnant with ages ranging from 18 to 50 with the majority in the 30 to 39 year old age group and children range from zero to five years with the majority in the three plus years. So analysis was compared, compared the levels of vaccine hesitancy with the CIFAS scores I previously said and whilst the results were not significant, they did demonstrate a trend for vaccine hesitant parents and pregnant women to reside in areas of lower, sorry, higher socioeconomic status. So the three main themes which were identified by thematic analysis as the most influential in refusing vaccines included vaccine safety concerns, legal concerns, as well as the effects of a previous negative immunisation experience. 94% of participants expressed concerns about vaccine safety and those concerns included vaccine contents and the safety of the industry in general. However, they didn't differentiate between vaccines or vitamins such as Canakian or vitamin K, which demonstrated a lack of understanding and knowledge in this area. Concern was also raised about the new mRNA or messenger RNA vaccines such as COVID-19. This is a new vaccine and more information should be provided to parents about the benefits of this particularly in pregnancy. These factors combined with considerable distrust of the pharmaceutical industry resulted in high levels of anxiety which negatively impacted their immunisation decision making. A further area of concern raised by parents was the lack of information provided by healthcare professionals which affected their ability to give informed consent. Other level concerns were raised by participants including the belief that the no-jab, no-pay legislation was coercive in nature and legislation which has acted to isolate and marginalise parents and pregnant women and has affected them both financially and socially. Participants also raised concerns about the lack of vaccine injury compensation scheme in Australia. This was a factor identified by many participants as an influential factor in refusing vaccines. These factors combined with a general distrust in the pharmaceutical industry and its practices resulted, as I said, in high levels of anxiety amongst participants and negatively impacted their immunisation decision making. Evidence also suggested that a previous negative immunisation experience could adversely affect future decision making. Participants were asked whether they or someone they knew had a negative experience during or after an immunisation which may have affected their decision to reject vaccination. A surprisingly large number, 90% in fact, stated that they did have a previous negative experience and only 10% had not experienced this. The use of alternative therapies was also evident in this survey and whilst not considered to be a direct cause of vaccine hesitancy, was associated with a lifestyle choice which participants believed supported wellbeing and immunity. So qualitative results obtained in this research indicated that participants held a variety of personal immunisation beliefs. However, most felt that they had the right to choose whether to immunise or not, which of course they can in Australia. Some participants felt that the vaccines were riskier than the diseases they protected against. Whilst one participant stated quite correctly that all vaccines should be considered dangerous medical interventions, when dealing with otherwise entirely healthy members of the population, there must be transparency about the risks and benefits. It should not be a one-size-fits-all nor should vaccination be dismissed as safe and effective without due attention given to the reality of side effects. Several participants believed that insufficient information was provided to parents and pregnant women to make informed choice. The findings of this research suggest that the no-jab, no-pay legislation introduced by the Australian government had the greater effect on people of lower to middle socioeconomic status. The legislation was described by some participants as taking advantage of lower socioeconomic families and a coerced choice. The no-jab, no-pay legislation excludes families of unimmunised or under-immunised children from some financial benefits but also excludes children from access to preschool education in Australia.  Whilst other participants in this research immunised only enough to continue to receive financial support. So participants are asked to identify the sources of immunisation information which they used to support their decision-making. These sources included friends and family, the internet, social media, scientific evidence such as PubMed, as well as books and websites by anti-vaccination advocates like a Robert Kennedy junior, as well as traditional sources. One participant stated that she'd read the entire hand side of Andrew Wakefield's fraud case. Now Andrew Wakefield was a discredited doctor who fraudulently linked Measles' vaccine with autism. This information suggests that we should not, as immunisers, assume that vaccine-hazardant parents are uninformed. However, the sources of information may or may not be credible sources. So vaccine decision-making was influenced by many factors including the source of immunisation information which included the use of alternative practices to support health and wellbeing. Many participants reported that the use of alternative practices often referred to as oscillogenic parenting were used, included therapies such as alternative therapies, lifestyle factors, dietary factors and supplements as well as public health factors such as fresh air, exercise and avoiding crowds. Homeopropyl axis or the use of diluted preparations generally provided by a homeopath to provide infectious diseases was also mentioned as a source of information and support by some participants as was the use of long-term breastfeeding. Participants who did not use these sources of information or methods of support for their immune system stated that they only could not do it because of financial reasons. So participants were asked who were the most trusted sources of immunisation, information and general practitioners, nurses and midwives made up 65% of that source of information. Whilst less than 16% of participants cited obstetricians as an information source. This is despite 21% of women receiving pregnancy care from an obstetrician in 2017 in South Australia. So it could be argued that only those women who elect to shared care or midwifery model of care will have access to these important sources. Additionally, women who elect an obstetric model of care could arguably remain under informed. Nurses and midwives as well as general practitioners are trusted sources of information as I said making up 65% of the information sources. However, there's a clear need for an enhanced syllabus to support nurse and midwifery undergraduate immunisation education across Australian universities including in areas of vaccine hesitancy and motivational counselling. There's also a need for a reminder to be placed in pregnancy handbooks to remind healthcare professionals to discuss both pregnancy and childhood immunisation at the first pregnancy visit. So participants in this study expressed a desire for balanced information and several had notable quotes when saying I've always been open to getting information from both sides and weighing up the risks. Whilst another said I didn't want to rely on just one source but a personal experience with a family history of adverse reactions is hard to ignore. So based on the importance of providing accurate and credible immunisation information to pregnant women, participants are asked whether they had received information on childhood immunisation in pregnancy. Whilst 65% had received advice a whopping 35% had not. This lack of information at this critical time of decision making can result in information seeking from non-traditional and less credible sources such as the internet and social media. So participants were also asked to provide their understanding of the risks versus benefits of vaccines. A surprising 91% believed that vaccines were a greater risk to an infant than the diseases they protected against. This demonstrated a lack of knowledge and understanding which should have been provided by healthcare professionals as a priority early in the decision-making process. So in conclusion, this study has confirmed that over 70% of participants began immunisation decision-making in pregnancy. This is clearly the optimal time to provide information about both pregnancy and childhood immunisation. This study has also shown that many vaccine-hesitant parents and pregnant women are from areas of middle to high income. Hence immunisation promotion activity should also be focused in these areas. So whose job is it? Of those who did receive advice, nurses and midwives are among the most trusted source of immunisation information in pregnancy. Along with GPs, midwives and nurses play a significant role in the provision of anti-natal immunisations. However, nurses, midwives and GPs have demonstrated the lack of knowledge in dealing with vaccine-hesitant parents. Additionally, nurses and midwives have reported feeling inadequately prepared for their role. Evidence has also shown that midwives currently receive minimum or unregulated graduate immunisation education, on average less than four hours of immunisation education in a three-year degree with many reporting inadequate preparation for this role. This must be improved to adequately prepare new graduates for their important role and changes are already happening at Fenders University where immunisation has been included in the midwifery syllabus. 35% of participants reported receiving no immunisation information in pregnancy. Pregnancy has been shown to be a time of high information needs and a critical time for vaccine decision-making. Therefore, it is vital that parents and pregnant women have the opportunity to discuss both pregnancy and childhood immunisations early in pregnancy. Concerns over vaccine safety have been shown to have a major influence on vaccine uptake and this is an area that needs support with accurate and timely information in pregnancy, along with assistance to work through the risks and benefits debate. This study has also revealed that a previous negative immunisation experience influenced vaccine decision-making. It's become clear that adverse events, even minor ones, must not be overlooked or understated as they are potentially influential in future immunisation choices. Finally, the role of midwives in the promotion and provision of immunisation, both anti-natally in the first week of a child's life, cannot be understated. Educators must include immunisation and motivational counselling in the syllabus for all midwives to adequately prepare them for this vital role. So recommendations from this research include the development of an enhanced syllabus to support nurse and midwifery undergraduates in immunisation across Australian universities. A reminder must be included in all pregnancy handbooks to discuss both pregnancy and childhood immunisation in early pregnancy, when information seeking is at its height and decision-making is beginning. Additionally, the inclusion of pregnancy as a reason for immunisation in the Australian Immunisation Register would be ideal. The Australian Immunisation Register is an all-of-life register in Australia which records individual immunisations. It currently has the capacity to record Aboriginal status as a reason for immunisation, but does not have the capacity to record pregnancy status as a reason for immunisation. Inclusion of immunisation status in all pregnancy outcome statistics should occur. This is the only way we can provide accurate data on perinatal outcomes and the association with the vaccine status. Additionally, midwives must discuss the importance of childhood immunisation in the first days of a child's life. Many participants in the study reported being confronted by the nature of the first vaccine, which in Australia is the hepatitis B vaccine given in the first week of life. With inadequate education, large numbers of families are likely to refuse this vaccine and sadly, many midwives are unaware of the rationale behind the timing of it. And finally, immunisation, education and promotion must be universal, but should also include families from middle-to-high income countries. And I can see there are some questions there. Mel, did you want to... I'm getting it on. Just I've got my, um... Publications. Publications. Publications are coming up. They're there. It's not there. It's not there. That's okay. It doesn't matter. Not important. There's my references. There we go. And go ahead. So I haven't seen the earlier questions, but I can see some later ones. Yeah, thank you. So I think like I would love to dive deeper into your data. I imagine there'd be other people the same, knowing a bit more about the cohort and a bit more about specific aspects of them and what we can do. So it does definitely sort of indicate that we do need to incorporate a bit more into the intonatal period. Sorry, I can hardly hear you. Could you speak up? Can you hear me now? Yeah, sorry, it's raining here, so I'm not getting a good connection. It does sound that we do need to add a bit more focus in the intonatal period about a bit more than what we're currently doing. Yes. But we do have some questions. So Gemma, so Gemma sort of says that it is likely that new maternal vaccines will become available in the near future. For example, ROC. As a midwifery and immunising provider, what are some of the challenges that you see? And secondly, how can we better prepare the profession and parents from maternal vaccine in the future? Well, that's a very cool question. Well, that's a very cool question. Yeah, so there you go. Yeah, I'll have a go at it. Thank you, Gemma, for a very insightful question. Yes, there will be new vaccines and I think the only way to prepare parents is to prepare providers. And unfortunately, our education has been pretty shoddy up until now, and I think once we are better educated we'll be able to explain the rationale behind these vaccines better and then we can pass on those gems of wisdom to mothers and fathers in pregnancy. Are there any specific points that you think would be good to include in the education program? Well, I think, yeah, some wonderful courses available in South Australia and I presume they're available nationally and internationally which includes every aspect of immunisation from cold chain management through to immunisation provision and the rationale for inclusion of vaccines and the times for the inclusion. So I would like in a perfect world I would like to see all midwives having access to that course or courses like those in the undergraduate area. I don't think that will happen but I think they will be available in a postgraduate environment. I think in Australia and I don't know if it's Australia or just in our state that we have access to a certain amount of funding for our professional development and I think it would be lovely if midwives could prioritise immunisation knowledge because it's an area of knowledge that will cross all spheres of midwifery practice from antenatal to postnatal to labour and delivery and my particular area which is community and postnatal so it's really important that we are all informed all the time. Yeah, you mentioned that you don't think we'll end up in the international education soon for midwives. Is there any specific barriers I think time, the time out of time I think certainly at Flinders they've been looking at increasing the year like adding another year to the midwifery course to fit everything in and at the moment it's a low priority I'm working on it. I know there's educators and researchers listening so it would be interesting if anyone has any comments in the chat box about what they're currently doing programs, is it a three year undergraduate degree, is it a four year at what point do you think could actually be good to introduce it so would it be a second new topic and where would the postgraduate midwives in Australia fit into that? Yes, very good question. We can move on to Emily's got a question as well so we can move on to the next question but people are welcome to throw those answers into the chat box. Do you think there can be some conflicts felt by some midwives between women affected and individualised care and providing vaccine recommendations? I believe there already are some conflicts in this area but I think we must look to the bigger picture and recognise that without the correct information pregnant women and immediately postnatal women aren't informed to make an educated choice but they're facing a lot of their decisions on information they glean from the internet and social media which is highly emotive and highly critical of some immunisation aspects. For example, the COVID of all the participants in my study 100% we're going to refuse the COVID vaccine now that's based on emotion rather than knowledge so it's okay to be women-centred and provide individualised care if you're also providing accurate education in my mind. I can speak for a moment of personal experience with other people so they're adding to the chat box we do know that one of the leading things that help people to make a choice around vaccines is care providers discussing it with them and making a recommendation so there is a bit of work happening around decision aids which I believe people have been finding helpful so I know I used the COVID-19 one a lot so I did a group of six women in my antinatal group antinatal care at some point during last year I think it was and initially all six were planning on declining the COVID-19 vaccine just because of fear and we all understand the reasons around it they're quite individual on that at the end only one of them declined it so five of them after having a couple weeks of different education and individualising care to each woman they five of them actually changed their mind and got the vaccination that's what it does so there are things becoming more available so there is decision aids and cosy and that sort of thing to help us provide the information to the women we probably do need a bit more time and probably a bit more midwives in this space so if anyone out there is interested in joining the research world come along yes I agree I totally agree does anyone else have any questions I have one from one PhD candidate to another Susan what was your most interesting part of this PhD study for you oh challenging my personal beliefs about people who refuse vaccines that was just so confronting as a long term immuniser and a passionate immuniser at that meeting people who have a vaccine hesitancy was a real learning curve for me and I found you know what they are normal people with normal fears and anxieties just getting the wrong information and I think it was that aspect of my studies that really woke me up and said you know what the fault is not theirs it's ours because a recommendation from a healthcare professional is a predictor in the uptake of vaccination there is nothing more certain than that and if we can't communicate the correct information the problem is ours I think at one point Covid-19 vaccine was because it was so new it wasn't so much the wrong information there was so much different information correct yeah correct no worries so we are sort of getting to the end is there anything else you want to mention no I think that's all good unless there's any other questions I'm happy to answer questions so this year's got vaccine hesitancy and those not taking vaccines is due in Canada so even with the best information many prefer to wait to get Covid or Covid? wait to get Covid or the vaccine? the vaccine I guess potentially not maybe not there's some wonderful immunisation researchers in Canada Eve Jubay is one of them she's extremely well published she does some wonderful work in this space yep so they wanted to get natural immunity so long as she survives the process and that's sort of an individual decision that everyone has to make absolutely but in pregnancy it's a little more concerning


You know really enjoying my Advil brakes, but the one thing I think I've noticed about it is that it definitely masks the symptoms and then you pay the price the next day. How you feeling dude? You ready for an Advil brake? No. What do you do to my bus over there you're breaking stuff? Well I was trying to move it because the ground's all wet because me and Badger are talking about how we need to dry out the ground. Did you get stuck in the mud? Yeah. No. Yeah your bus is stuck in the mud. No. It's gonna dry and we can still work on it. Alright that's true. That's hilarious though.  Well 12 because we stripped out a lot of stuff. Okay true. That's hilarious. Well that's what happens in Canada guys. It's time to do something cool and then don't film it. I feel like you guys are missing out on like a really exciting vlog but today's video isn't about getting stuck or unstuck. But check out these big-ass divots that we made. That's like that's that's a lot of that's a lot of mud going up but part of it's because it's getting pressed between the wheels and stuff. It's not actually sinking that far. Anyways today we're just gonna continue on. We're gonna do some metal work. We're gonna put in a couple windows. Also I have a question and a favor. Could you guys vote and tell Michael if he should do a paid DIY series complete start to start to finish or if he should do more like the traditional YouTube stuff but kind of like and it's more instructional step-by-step stuff like single-topic videos. So if you guys could throw your thoughts on that in the comments that would be highly appreciated because he feels like a lost lamb here. It doesn't know what to do. Look who's back everybody. Badges back. You know what there's probably a couple school bus guys are probably just choked. I just took out probably $5,000 of the wiring and just chucked it in the pile over there. Very true. So Badge is back today. He's back where he you know likes to be with the the wire. The wire is hanging out there. You see that? Oh yeah. They're all in a pile on the floor. Nice. So we're welcoming him back. Mike is pre-drilling some some holes to secure what we did yesterday. So we have a fun little fix here that I think you guys are gonna like. I'm gonna actually tell him right now that he should do a you know man you should do a tutorial on these things. Oh wow. We're filming it. No no with the little plate thing that we just discovered. Yeah. So we just kind of custom made these plate things to secure the like that to secure the the window so it doesn't go in and out because if it does go in and out I guess it can break the caulk and if you get if you break your caulk you get water inside. You don't want to do that. Well what a beautiful day in the neighborhood. It's a beautiful day in the neighborhood. By the way we're in the middle of nowhere. The neighborhood consists of a bunch of fields. Batch where are we going? Tell everybody where we're going. What we're doing? We're going to a big junkyard. Just like every all the junk that you can think of. Every class 8 truck. Yeah. Look at this. That's just a big junk. Oh what is that? A school bus. Oh we might actually, oh that is my old manufacturer of school bus actually. That's a Corbill. So basically, wow look at that engine. So basically this is what we're doing today. We're gonna look for some parts. We're gonna look for, I see an international engine. Wait is that a DT 466 badge? Mechanical. Oh is that another one? Yeah. Uh oh. That's an old mechanical right? Uh oh. I think we're looking for that sucker. Uh oh. I don't know. I don't know. I don't know. I don't know. Let's not even get into the discussion about an engine swap but what we're looking for, what we're looking for today is fuel tanks. We might get a rear end and Mike is that your engine? This is my engine. That's a huge engine man. Yeah dude. That's big. Pulls me up around the country. Um and then we're also going to be looking for a rooftop air conditioner. It's called a red dot and some other parts. So I don't know. I feel like a kidney candy store right now because I'm getting more and more excited about all this, you know, engine stuff here. Especially with badge. Now watch your step. We got some serious options over here. These obviously are a little on the rusty side but is that the center one that goes down the frame? Okay. But boy oh boy do we have some options. Let's check out all these diesel tanks. I hope they come with free fuel. That is a huge, I don't know what I'm stepping on either. That's a well. What is that? 150. Wow. I don't know if we got enough room. That's a nice tank. Oh we can measure it out and check it out. My goodness. Look at the size of that thing. Just for reference. Mike if you fall I'll pull you out because that looks like the well. I think that this thing is about six feet long. We need straps for it. Let's take this one. Dude look how light it is. What? Oh my God. What did I get myself into? Size comparison. Oh my God. That's nuts. So we've got to get straps for that. All right. We'll take that one. Well there's only one of them so. Yeah, all right. So there's straps all over the place but that's you are gonna be mine and you're gonna have a future home holding lots of vegetable oil. Which one? Which one? Oh my God. That's Doug Huggley's truck. My God. I worked on this thing for 10 years. Did you? This one here. Yeah. 10 years. I worked on this for 10 years. Really? I made a ton of money off that thing. Wow. Yeah. Yeah. This is where it lays. In the boneyard. Yeah. In the boneyard. All right guys. Let me show you what one thing we're looking for here. There's an AC unit. Just for example look at how old this truck is here. But what we're looking for is that thing right there. A red dot. Looks pretty old. We'll try and find a newer one. That is basically a part that we're looking for. Brand new. They're like I think a thousand bucks just for the unit. 1200 bucks. So if we can find something, you know, repurpose it. Bring it back to life. Spit shine it. This is something we need to put on there for you. It's a road of deco valve, right? It goes on by air, shuts the air off. They can't steal it. You can't steal it unless they reset that. Really? Yeah. So it's a manual thing? It's a manual. They set it with air and you flip the switch and it'll trigger it.  And you just shut it off when you park at night and it won't start. They can do whatever they want. Interesting. Unless they know, they won't ever get it going. That's hilarious. Didn't even know something like that existed. Only promise now they know. Yeah. I just have it a trip down memory lane. What'd you find now, badge? Did you know what you do to it? Do you remember? See, it's a Peterbilt too, right? That one there, I did brakes on it and cab jacks. I did the cab jack a couple of times on that one. Two or three safes on it. Oh yeah. Yeah, I worked on that one. I was a little buck when I worked on that one. Holy smoke. Alright, so here's the update. Is that an hour house? I think so. Alright, here's the update. There's one tank over there. Possibility, it is a 23 inch diameter.  So, if we mount it to the frame, that's 150 gallons over there. But just remember, you have to times it by eight for eight pounds. So, quickly to do the math, that's 1200 pounds. 1200 pounds. What do you think about 1200 pounds on this side? I think it's pretty good. I'm thinking 150 gallons is pretty good because times 10, if we were to get 10 miles per gallon, that's 1500 miles. We'll get 10 miles per gallon. Alright boys, so what's the plan? The plan is we're going to take and trade the bus off for that red truck. Well, I'll definitely need a new license for that thing. I think we'll go get a cherry picker. We can get up in life. Well, you know, I could put my Wi-Fi signal up there. That's how the Wi-Fi is on the road. Oh, can we tell you how shitty the Wi-Fi was? Oh yeah. So anyway, so there's a plan. We got a few things to fix, measure. We're coming back here in a few days. Yeah, we're going to take some measurements because I still think we should put the two 150s on the back end, one for water, one for gas or for diesel, and then we'll be laughing. Then everything's underneath, right? Yep, most of it. And then we're doing a gear change in the rear end. Gear change, yeah, and you don't want them to div them things there when you're doing a gear change. Yeah. Imagine trying to drag that different. I don't want to think about it. We'll make him do it.  Look at that, an elk ranch. Whoa.  Those are farm ones. Really? Yeah.  Raise them there. There's elk right there. You don't see those, babies. Wow. That's an elk ranch. Yeah. Do you all hide the fences? Yeah. 12 feet up. That's where the elk is. The only time I ever saw anything close to that was Texas, and they have trophy hunting within the gates like that. Can't trophy hunt them. Those are, they raise them to, they raise them like cows, and they cut them, right? Yeah. Cut them down. Alright guys, we're back at Squattersville, Alberta, Canada. It's got me an inside joke. We're gonna go for some dinner. Did you have fun today? Yeah. I think we found some good prospects on the tanks. Yeah, we sure did. This is gonna be super, super exciting. Like I said, if I get 10 miles per gallon and I have over, you know, say 200 gallons of fuel, eight pounds of fuel per gallon, I'm gonna have a 2,000 plus mile range. So for all those people asking me, oh, well, you know, isn't that gonna be hard to find? There's mosquitoes. Let's close this. Yes, it's not readily available everywhere. However, with such a large capacity, I will only have to fill up every 2,000 miles. And it should be a lot cheaper than diesel. Diesel prices are going up. So that's about it for today. Tomorrow we're going to start working on the bus again. Do you want to say any final words? If anyone's worried about us carrying that much weight on the bus, don't worry. It's totally rated for it. There we go.


Hello, my name is Alan Pryor, President of Davis Oral Health Project. We're a non-profit organization serving low income and disadvantaged residents of Davis. Our mission is to provide desperately needed oral health care supplies and education to help develop and maintain a healthy oral environment and at risk individuals in the Davis community. Our current flagship project is to make and distribute thousands of dental care kits including toothpaste, toothbrushes, floss, a flossing tool, and bilingual instructions and distribute these kits to many hard-working service organizations serving the disadvantaged communities in Davis. To learn more about us, please visit our website at www.davisoralhealthproject.org or call<PHONE_NUMBER>. Thank you.


Welcome to the Nutrition Facts podcast. I'm your host, Dr. Michael Greger. Many of us are feeling helpless in the face of the current pandemic, but the good news is there are things we can do right now to reduce our risk of falling seriously ill and dying from COVID-19 and preventing even greater infectious disease threats in the future. Today we look at the transmission of the coronavirus and ask how long can the SARS-CoV-2 coronavirus survive on various surfaces? The best way to survive COVID-19 is not to get it in the first place. Governments can only do so much. Preliminary evidence from Japan, such as the cancellation of events, gatherings, and meetings may slow the spread of COVID-19 by as much as 35%, but that has not been enough to contain the outbreak. During the unbridled phase of a pandemic, the best thing we can do is shelter in place, staying home to reduce contact with those outside our households as much as possible. It's something non-essential workers can all do, put simply, the American Journal of Emergency Medicine staying home saves lives. And you can't just wait until you hear it's in your area. I grew up in Wyoming, which months in only had a few hundred confirmed cases in the whole state, but by the time a single death occurs in your community, hundreds or even thousands of cases are likely present. We just haven't done the testing, so unless you're on some remote desert island somewhere, well then you should just assume the virus is in your neighborhood wherever you live. Those of us who need to leave our homes to provide essential services from direct care to food delivery should strive to keep a safe distance from others and sufficiently sanitize our hands every time we touch a public surface before we touch our mucus membranes, meaning our eyes or the inside of our nose or mouth. Once the pandemic is more under control, ample testing is in place, and the healthcare system is no longer overrun. These social distancing precautions may start to be relaxed, at least for less vulnerable individuals. The good news is you can't infect others if you're not infected yourself, and you can't get the virus unless the virus can get to you. The COVID-19 coronavirus is thought to be transmitted from one person to the next via respiratory droplets coughed out by the infected, propelled through the air, and then landing up the nose, in the mouth, or perhaps even on the eyes of a person nearby. As a sign in 1918 put it, spit spreads death.  The levels of virus swarming in the snot of COVID-19 sufferers can reach close to a million per drop, which explains how easy it is for them to so thoroughly contaminate their surrounding environment. The presence of the COVID-19 coronavirus in stool samples for up to weeks after infection, in fact, sometimes you can have a negative throat swab, but a positive anal swab, suggests another way toilets may potentially transmit infection. Modern flush toilets aerosolize a plume of up to 145,000 droplets of toilet water into the air, which can remain floating around for at least 30 minutes. This may be one of the ways polio virus is transmitted. So, put a lid on it, close the lid before you flush, and then, of course, thoroughly wash your hands. The presence of the coronavirus in feces is also why the Oregon State Health Authority recommended people press pause on their beach emoji, and why the New York Post asked if coronavirus could be spread through farts, suggesting flatulence may be an aerosol-generating procedure, something I was surprised to see was actually put to the test. It all started with an inquiry from a nurse. She wanted to know if she was contaminating the sterile environment of the operating room. Investigators were determined to find out. A colleague was asked to toot onto two Petri dishes, either fully closed or with trousers down, and only the bare bottom fart sprouted bacteria, suggesting that clothing acts as a filter. Pants are like a mask for your butt. Both for the gut bacteria and the splattering they found of skin bacteria thought to be blown from the cheeks by the sheer velocity of it all. Their final conclusion, don't fart naked near food, or at least within two inches of food. Similar advice was given in the New York Post piece, advising people to throw caution to the wind. Whole nother meaning to silent but deadly? Coft virus may make it more than two inches, though, which is why it's safer to get groceries delivered than to go shopping yourself. During the SARS outbreak, traces of the virus were not only found on items handled directly by patients, like TV remote controls and surfaces touched by those who interacted with the patients, like the refrigerator door at the nurses station, but also floating in air samples taken from an infected patient's hospital room, suggesting the possibility of more robust airborne transmission than just coughed droplets. A similar study performed in a COVID-19 patient's hospital room found the virus on a majority of sampled surfaces, but all the air samples were negative. Since then, though, we've learned differently. Studies performed at the Nebraska Biocontainment Unit at the National Quarantine Unit found the majority of air samples tested positive for traces of the virus, even in the hallways outside of patients' rooms. However, the researchers were unable to verify if the airborne virus was infectious, given the extremely low concentration, less than 100 copies per cubic foot of air. Nevertheless, because we know the virus can remain viable for hours when experimentally misted into the air, special care should be certainly taken for healthcare workers during aerosol-generating medical procedures. How long does the virus last on contaminated surfaces? You may have heard that coronaviruses, like flu viruses, are enveloped viruses. Enveloped in what? As coronaviruses butt out of infected cells, they cloak themselves in the outer layer of our cells. They're wrapped in a stolen swath of our own cell membranes. That oily coating helps them hide from immune surveillance because it looks like us, but it also makes them susceptible to disinfection and environmental inactivation. Non-enveloped viruses, like polio, can last for weeks outside the body, whereas envelope viruses tend to only be able to survive for days. As envelope viruses go, though, coronaviruses tend to be relatively resistant. There's a coronavirus that infects pigs, for example, that can last for a month on non-poor surfaces, like metal, plastic, or glass, but at most human coronaviruses only make it about a week. On copper and brass, coronaviruses may not be able to survive more than a few minutes at low levels of contamination and a few hours at higher doses. But different coronaviruses have different environmental stability. The SARS coronavirus lasted more than six days dried up plastic, whereas one of the common cold coronaviruses didn't even make it three days. The SARS virus lasts up to four days in water or soil, but survived for just minutes after drying on paper, when lightly soiled or up to a day, when heavily contaminated, and less than an hour on cotton cloth. But what about SARS-2, the coronavirus that causes COVID-19? The COVID-19 virus appears to be more stable on paper than the SARS virus, with infectivity extinguished only after 24 hours at the same viral load that led to SARS to become inactive after eight hours. The half-life of the COVID-19 virus on steel or plastic is about six hours, so about 99% is gone by 48 hours, but it may take as long as 96 hours for all infectivity to disappear. On cloth, the COVID-19 virus may only last for one day, but on the outer layer of surgical masks, it can survive for at least a full week. On printing paper, though, the COVID-19 virus appears to survive for less than three hours. The virus can only infect you, however, if it can get inside you. Having the virus on your fingers is only a problem if you then inoculate yourself by transferring that virus to your eyes, nose, or mouth. It's funny when they do experiments for like the common cold to see if transmission is more through the air or through touch.  Having the virus on your fingers is only a problem if you then inoculate yourself by transferring that virus to your eyes, nose, or mouth. It's not your face in general, touching your forehead, cheek, or chin is presumably no more dangerous than touching your elbow. The virus can't pass through your skin. The virus can only replicate in live cells, and the outer layer of your skin is covered by protective strata of dead skin cells. To get into your lungs, the virus has to find its way to your mucus membranes, the moist lining of your eyes, nostrils, or mouth. The reason your nose starts to run when you cry is that tears drain through tiny channels that tunnel through the nasal bone and spill into your nostrils, and viruses in your eye can travel the same route to get to your lungs. As long as you don't touch your face, why does it matter if surfaces are contaminated?  The oft-repeated 23 times an hour statistic is an overestimate since of the touches recorded in the cited study on university students. Most were just to the skin on the face, but 10 touches an hour were to the eyes, nose, or mouth. Adults videotaped in an office-type setting did worse, each touching their nostrils, eyes, or lips, in average of nearly 16 times an hour. What about doctors? Medical professionals were covertly observed during a grand rounds lecture at a hospital, and about one out of every three subjects picked their nose at least once. In family medicine offices, clinicians and staff touched their eyes, nose, or mouth in average of 19 times in two hours, with a range from zero to over 100 touches. More concerning in terms of patient safety, however, was defining that doctors only washed their hands about 30% of the times they should, even in intensive care units. And even when they did manage to wash their hands, it was for an average of less than nine seconds. We would love it if you could share with us your stories about reinventing your health through evidence-based nutrition. Go to nutritionfacts.org forward slash testimonials. We may share it on our social media to help inspire others. To see any graphs, charts, graphics, images, or studies mentioned here, please go to the Nutrition Facts podcast landing page. There you'll find all the detailed information you need, plus links to all the sources we cite for each of these topics. For a vital timely text on the pathogens that cause pandemics, you can order the e-book, audio book, or actual book of my latest book, How to Survive a Pandemic. For recipes, check out my How Not to Die Cookbook. And if that's not enough, my How Not to Diet Cookbook will be out this December for everyone on your gift list and all proceeds I receive from the sale of all my books goes to charity. NutritionFacts.org is a non-profit, science-based public service where you can sign up for free daily updates and the latest in nutrition research via bite-sized videos and articles. Everything on the website is free. There's no ads, no corporate sponsorship. It's strictly non-commercial. I'm not selling anything. I just put it up as a public service, as a labor of love as a tribute to my grandmother, whose own life was saved with evidence-based nutrition.


You can't be autistic. I never see you stimming. I hear all about on the Instagram communities online. A lot of autistic people actually don't stim in public although it's something that we talk about a lot and something that we promote. It's not always something that we feel comfortable or safe doing. That would be applicable to me but I do actually stim in public.  When? Why do you think I randomly do my little dances or tilt my head from side to side? That's a vestibular stim. Wow. That's a stim? I know it's not a stereotypical stim. Most of the stims that I have tend to be socially acceptable. They tend to be neurotypical stims like bouncing my leg or clicking a pen or biting my nails. Those things are all stims. They're just not stereotypical autism stims.


If you could get seated, we'll get started. My name is Rudy Slingerland. I am the chair of the steering committee for systems and a lifelong promoter of systems.  Gives me great pleasure to welcome you all here. Of course, the folks who make the meeting happen are the folks at the integration facility here in Boulder with James Savitsky, who will be replacing me up here very shortly. And if you have any problems, you can see them. Marlene is, is Marlene in the room? There she is, right there. She's the go-to person. And then she can delegate, right, Marlene? All right. Next point, this is being recorded for video. And so if you ask questions in the audience, even though you're up front here, please do get up and go to the microphone. I mean, if you don't want your question on the video, I suppose, don't do that. But it would be good if you did, so that it can be hydrated and edited and posted on the system's website as a record of what went on in this meeting. Now, it gives me great pleasure to introduce James Savitsky, who is the chief allied commander of systems and without whom I don't think systems would have ever gotten to the stage it's at now, where we're looking towards our renewal after four years. And James, where are you? You're right there. And he will introduce the next speaker and then come back to the podium and give you a little update about systems.


Hello, my name is Julian, and I'm a PhD candidate at the University of Applied Arts in Vienna. I'm part of a doc team sponsored by the Austrian Academy of Sciences, called the Various Stories of Ethosos. We are three members. One of them is studying the geophysical part and concerns with what's not visible in Ethosos. The other one was the restoration, and I'm doing the heritage part, which is mostly this presentation, like an overview, since we started the project in June 2018. So, the ancient city of Ethosos was transformed by natural processes and human interventions into a site of memory, at which stories are told. The Ethosos of today is nevertheless not simply preserved, but instead is artificially created. Various narratives still exist and depends on who's telling them. In this case, archaeologists, restorators, local community, national stories, or tourist guides. Additionally, the cultural complexity in Ethosos is also influenced by its Greek or Roman past, its location in the Republic of Turkey, and the fact that it's been excavated by an Austrian mission for over 120 years. Ethosos is located in western Turkey, next to the city of Seljuk, the nowadays Seljuk. And in ancient times was one of the most important cities in Asia Minor. Nowadays, it's one of the biggest excavations in the world as well, but also one of the most visited archaeological parks with approximately 2 million visitors every year. The ruins of the ancient city were never completely covered by soil, and they already aroused interest of travelers and researchers since the late 15th century. The first excavations were conducted by the British Museum. John Turtle was looking for one of the seven wonders of the world, the Arcanitian. But soon after, they ran out of funds, and then from 1895 the oceans took over the excavations with small breaks. The scientific focus of the research was strongly influenced by the respective excavation directors throughout history. A collaboration between archaeologists and conservators did not exist at the beginning of the activities. Extensive rebuilding of the ancient ruins and intensive excavations led to a radical alteration of the appearance of the city. So nowadays, Ethosos is like a small laboratory of restoration, you have different techniques. Some of them were done in touristy purposes, some of them are properly done, especially the latest. And since 2015, Ethosos is on UNESCO World Heritage List. The research aim, the common goal of this planned project is to demonstrate through an interdisciplinary analysis which parameters and reasons are crucial for the image of Ethosos, as it is presented today, and how and why change over the course of its long period of research. Particular attention will be paid to the methodologies and research strategies which were used and which were strongly formed by individuals, as well as administrative guidelines and social circumstances. Cultural heritage is fundamental to the identity and human dignity of communities and it's an integral feature of every landscape that we as archaeologists explore, excavate, study or redevelop. The way we engage with communities and stakeholders to protect and manage the heritage of archaeological sites and landscapes greatly affects the quality of our relationships with those communities. And positive relationships with those communities help the engagement with the heritage places and a better protection of those. And although Ethosos is a major site in Turkey, no extent the cultural heritage studies were done, just a few studies on tourism but compared with other world heritage sites as Angkor Wat or Fetra, there's not much. So I believe that this is why this research was necessary in order to fill this gap, but also to highlight differences between archaeological world heritage sites and also compare them. The study focuses on the role of the excavation at the world heritage sites in the life of the local community, explores the effect of cultural heritage processes of local identity formation, remedy the current lack of data and insights concerning archaeological heritage management, designing community engagement projects, but also the impact of mass reuse. These are the three overarching questions of all our three projects and there's disability and eligibility alterations, agents and agency. I'll just walk you through all of them now. The problem of visibility and eligibility of Ethosos has been strongly shaped by archaeologists, conservators and architects. The legibility of the ruined site is also addresses questions dealing with the relative importance to the visible monuments in research, preservation and communication and their connection to the non-visible monuments. To the case of alteration, the problem of ability or even willingness to represent historical processes and settlement questions in the ruined city. The cause of alteration of Ethosos are found in natural environment since it's an area where earthquakes happen quite often. But it's also human interventions and the development that has not yet been concluded. Today, no romantic ruined landscape untouched by human hand informs the character of Ethosos, but instead it's a concentration of excavated areas, conserved buildings and reconstructions that attract tourists. The third overarching team is that of agents and agency. Ultimately individuals and groups are responsible for the appearance and narratives of this ancient site. The impact of Ethosos provokes reactions not only within the scientific community, but also in the public realm as an identity enhancing power, but also as a cash cow since tourism is one of the main revenues of the site. The research questions will deal with the influence of individuals and groups to the development of research strategies and methods in the area of field archaeology, preservation and cultural heritage management. As well, Ethosos is a really wide site and in order to fit all four of us we also choose four specific case studies where we can apply this interdisciplinary approach to it. The first case study is the antiquity urban districts, which usually form the character of the city. Today there are architectural colleges of put together ensembles. The questions will deal with the comparison of the ancient city quarters and the modern re-erected ensemble. If the ancient urban image finds expression in the modern presentation and if not is this mediated to the visitors. The public space was the center of social interaction in antiquity. In this regard, plazas and streets attain particular significance, which is also valid for the phases of reconstruction and presentations of ruins. It would be asked if the concepts and the appearance of the reconstructed plazas reflect the original significance and dimensions of the plazas in antiquity and what role do those play nowadays. The third case study focuses on Christianity and already since antiquity, Ethosos was one of the most important pilgrimage destinations in the ancient world and housed a lot of chapels, basilicas and monasteries, but only a few of them are excavated. With the Geophysical Survey prospections, a lot more Christian structures can be detected. The two largest church sites, the Church of Mary and the Basilica of St. John and the I.S. Lucchio, have been reconstructed and restored partially reconstructed. Additionally, they are available for the celebration of masses and therefore location for the extensive pilgrimage tourism in Ephesus. Even the Pope was there on two occasions and gave a mass during the celebration of Mary. On this question will be how does the Christian sacred topography of Ephesus can be reconstructed and how does it shape the landscape and what role do the Christian monuments play in tourism? For the basis of the individual research and by answering those research questions as a team, we are able to illustrate the development of the Christian sacred landscape in Ephesus from its expansion in the late antiquity to the conserved re- erect constructs we find today as in modern usage and significance. And the latest case study is a Byzantine city quarter, which is a project that started in 2011 and it's supposed to finish this year and hopefully two weeks. And this represents a new approach of an integrated research strategy in Ephesus. It's a project that combined archaeology restoration and heritage management as early as the beginning of the planning stages. And it will be constantly supposed to re-evaluation. It's probably going to be transformed and it's going to be put on the tourist path in a couple of years when they'll do the arrangements to it. To what concerns cultural landscapes and intercultural dynamics of Ephesus, there are a few cases where contesting values are clashing or they go hand in hand or values that in theory would be contesting by they go hand in hand. So, for example, the case of Shininger, which is a village that was populated by a Greek population, but which since 1923 when this exchange that was mentioned earlier was repopulated with the Turkish community. And they haven't changed none of the traditions and they still look a bit back to the Greek heritage although there was no continuity. And then there are other examples as the House of Virgin Mary or the Cave of Seven Sleepers, which both represent values of Christianity and Islam. They're both presented in the Koran and it attracts annually pilgrimage from both sides. And unfortunately, this is just an overview. There's no preliminary results, but hopefully in three years I can come and present more results. Thank you for your attention.


All right, as Anthony so eloquently pointed out yesterday, raise your hand if you're an API developer, API designer. OK, what happens when you want to get rid of an API? You break it, OK. But as an API developer, you need to make the people who use your API comfortable with removing pieces of your code so that somebody else can do with it. So I had to do this recently. I wrote launchy, which is used by Cucumber and a couple other things for launching the results of test cases and things. And I changed the API completely, did two version number changes, and I removed two pieces of the API. So I wanted to make it nice for everyone else to be able to upgrade their code. So I was like, well, what's the best way to do that? So I wrote a little gem called deprecatable. And the way it works is, hey, exactly like this. Oh, there we go. So say you have a piece of code. You want to deprecate that? That's all you have to do. Oh, horrible, horrible. Let's actually bring up some code then and do it. And we'll call. So right here, you want to deprecate me. So this is a way to use it. And then the benefits of using deprecatable is that it will alert you and actually tell you the line of code, where your code, where the deprecated code was actually being executed. So example. So this is just some examples I have in the gem. We're going to do once. So there we go. We call the deprecated. This is what happens when you call it. Hey, there's a warning. And it pointed out the exact line of code that was where the deprecated method was called. And then it also has an interesting thing with, if you want to change this alert frequency to say every single time it was called, then you can just change it in the code, use an environment variable, something along those lines. We also have an ad exit handler. So it will automatically call. And it will record every call to the method in question. So this one we call this method a whole bunch of times. There's a final ad exit report which is actually marked down so you can dump this to an HTML file and put it anywhere. And it'll list every single call and tell you how many times it was called. So we called this method four times and this is where it was. We called this method two times and this is where it was. And a final report. So I encourage all of you to go out and maintain your APIs very well. Be kind if you write an API that someone else uses. Because I knew Cucumber and Capybara used this, I actually went to those pieces of code and gave them a pull request and said here, update your usage of my API. So as a person who writes a public API for something, be kind to your users and help them move forward. Don't make them to do stuff but tell them how to fix stuff that if you're changing your code and you're gonna cause a breakage and they're a piece of software. So gem install deprecatable, have fun, enjoy, and there you go. Two minutes spare. Any questions, comments? You know, I'll probably use deprecatable but there's only one method. So yeah, there's literally, I mean, this is all you do. Is you extend deprecatable and then you say deprecate, deprecate me. There's other things, you can add a message, you can say here's what you need to do instead, all that kind of good stuff. So yeah, I'll bring up this piece real quick. So there's all your, the way you can say, you can say I'm gonna move at this date, I'm gonna move at this version, here's a message to do. So it works out pretty well. I'm, as far as I know, I'm the only one that uses it, so hey. But it was a fun, interesting project and sort of a meta thing about Ruby where it had to open up the file, find the right line, print it out, do all sorts of fun stuff, so. I enjoyed it, I thought you guys might too, so. Enjoy. Thank you, Jerry.


Yo people watch this, the flacket is officially back. Ok so I won't be around the bush people, at the moment I believe this is only possible to do on moles, but hey, watch the video, source out how this works and you might just figure out how you can do this on non-moles vault hunters. How's it going guys, my name's DP Jen, I'd like to thank you for stopping by and checking out my video, if you do enjoy it leaving a like really helps out and subscribe if you want to see more Borderlands, also guys I'm giving away copies of Borderlands every week. To win one for yourself or a friend simply subscribe and make sure you have notifications turned on, drop a like on this video and leave a comment down below. Ok so this information was given to me by Jake who was also kind enough to allow me to use his account to bring this information to you people. If you guys would like to go show him some love and appreciation hit Twitter and Instagram are linked within the video description. Ok so the flacket within the latest hotfix was nerfed, the main nerf which pissed most people off was the fact it now only has one shot within its magazine. Yet the damaged nerf was kind of expected because the thing was absolutely ridiculous but given this thing won in the mag led to many people throwing it away or storing it within their banks until further notice. Well guys if you play moles or think you can achieve this on any other vault hunter I'm pretty sure you will be using that flacker yet again. So for this to work you need a certain few items which I will explain how each works towards this build and this build basically allows the flacker to go full auto no reloading spamming all over the place ridiculous. So firstly and obviously you need a flacker what kind it doesn't matter as long as you have one then you need any weapon which damages yourself. These are real easy to find and most weapons offering elemental damage effects or splash damage effects can damage the user. Within this guide I will be using the hornet. You also then need to have a shield and on it you need the added benefits of either adrenaline trigger happy or fleet if you can get one with more than one of these even better. Now these are quite common so you moles out there may have one already. The class mod here though is a must the blood letter. This is what you need to make this truly work. This as you can see if moles would be healed she gains shields instead. If she would regenerate health she also gains shield regeneration. This is kind of how this works and I explain it in a second. The artifact isn't a must but the mod it offers kind of helps and that's the health regeneration. The plus 148 health per second really does help this out. Now you can get health regen on the class mod here if you are lucky enough but health regeneration is definitely a plus. So how this works is as follows. If we have a look at the shield plus 10 fire rate while shield is depleted and plus 23% reload speed while shield is depleted. So what we are doing here is taking those shields off ourselves that's where the hornet for instance here is needed. Shooting the floor right next to you damages you again you can use any weapon which damages you to do this. So if we start shooting the floor and eventually take off our shield you will notice the corrosive damage effects you have done to yourself once your shield is depleted will continue trying to take your health and shield off. But because of the bloodlet a class mod granting health and shield a crazy rate with the artifact too you get a constant loop of losing your shield and then regenerating it. And what this is indeed doing is stacking the benefits of the shield we are using here with its reload speed and fire rate. Because every time you lose and regen your shield these benefits keep stacking and because it's happening numerous times within a few seconds it allows us to achieve what seemingly looks like a full auto flacker when in fact it actually isn't it's just the game has stacked the reload and fire rate so much it just looks that way which is just auto craziness people. Now because this actually stacks both fire rate and reload speed I indeed have a feeling this may do crazy things to other weapons which I have tested out and you guys can expect that video later and let me tell you guys it is 100% truly game working. So yeah at the moment as far as I know this only works on moles but I will try and figure this out on other vault hunters as I do have a feeling there may be a workaround. So yeah guys with this method the flacker is back to its old self in fact even better. Now this does work until you either die or I believe fast travel or quit at the game but it's so easy to replicate you can do literally every time you land in a different location. So yeah guys I hope you enjoyed the video I really do if you're new around here and want to see more videos of this kind on Borderlands 3 be sure to subscribe if you never want to miss a video or upload you can turn notifications on by hitting that bell button. Hopefully you enjoyed video people and hopefully I will see you on that next one


Lifeblood of the platform is people you know with it without it. It's just a hunk of steel You know people people are the difference one of things the Admiral Burke said to us the ship is built to fight You would better know how the sailor dictates the platform's atmosphere if you have a good sailor They're highly motivated. They highly trained It would tend to do things the correct way and they were doing better and more efficient when this ship get underway It's gonna be the I would say the The new wave of the Navy it's gonna have a lot of eyes on her I think any sailor can expect that when they get to Zumwalt they're gonna be expected to Perform at a seasoned petty officer level not anything less The thing that excites me the most is the history behind Admiral Zumwalt. I just love his philosophy I think he was a great person once you read about Admiral Zumwalt and You see his legacy it just makes you want to Be on his ship. You know they're embarking on the adventure of a lifetime You are on the leading edge for the Navy, you know You are doing something that none of your peers are gonna have the opportunity to do You are taking the first of a class to see and nobody else can take that from you I have all faith in my shipmates I believe that we will all come together and once the ship get underway. Everybody will see that this is a great ship


Welcome to Learning English, a daily 30-minute program from the Voice of America. I'm Ashley Thompson. And I'm Dan Novak. This program is designed for English learners. So we speak a little slower, and we use words and phrases, especially written for people learning English. Coming up on the program, Ashley and John Russell report on a new study that found small plastic pieces in drinking water. Gregory Stockle has a story on high inflation in Argentina, and Brian Lin has the technology report on hypersonic weapons. Later, Andrew Smith and Jill Robbins present the lesson of the day, but first... The average liter of bottled water has nearly a quarter million invisible pieces of very small plastic, known as nanoplastics, a recent study says. Researchers found the nanoplastics with a microscope using dual lasers. Scientists long figured there were lots of these very small plastic pieces. But until researchers at Columbia and Rutgers universities did their calculations, they never knew how many or what kind. Looking at five samples each of three common bottled water brands, researchers found particle levels ranged from 110,000 to 400,000 per liter. The average was around 240,000, the study said. The research appeared recently in the publication Proceedings of the National Academy of Sciences. Nanoparticles are particles that are less than a micron in size. In comparison, a human hair is about 83 microns wide. Previous studies have looked at slightly bigger microplastics that range from five millimeters, which could be seen by human eyes, to one micron. About ten to one hundred times more nanoplastics than microplastics were discovered in bottled water, the study found. Much of the plastic seems to be coming from the bottle and the filtration system to clean the water itself, said the study's lead writer, Naishin Qian of Columbia University. She would not name the three brands because researchers want more samples and they want to study more brands. Still, she said they were common and bought at Awalmart, a popular store in the US. The researchers still cannot answer the big question. Are those nanoplastic pieces harmful to health? That's currently under review. We don't know if it's dangerous or how dangerous, said study co-writer Phoebe Stapleton of Rutgers University. We do know that they are getting into the tissues of mammals, including people, and the current research is looking at what they're doing in the cells. The International Bottled Water Association said in a statement, there currently is both a lack of standardized measuring methods and no scientific agreement on the possible health effects of nano and microplastic particles. The statement added, therefore media reports about these particles in drinking water do nothing more than unnecessarily scare consumers. The American Chemistry Council, which represents plastics manufacturers, declined to immediately comment. The Associated Press spoke with four co-writers of the study. All of them said they would cut back on their bottled water use. Columbia chemist Wei Min said he has reduced his bottled water use by half. Stapleton said she now depends more on filtered water at home in New Jersey. But study co-writer Bei Jianyan, a Columbia environmental chemist, who increased his tap water usage, pointed out that filters themselves can be a problem by introducing plastics. There's just no when, Stapleton said. Outside experts who praised the study agreed that there is a general unease about the risks of fine plastic particles. Still, it is too early to say anything certain about the risks. The danger of the plastics themselves is still an unanswered question. For me, the additives are the most concerning. Said Jason Somarelli of Duke University in North Carolina. Somarelli was not part of the research. Somarelli said his own research has found more than 100 known cancer-causing chemicals in these plastics. About 15 years ago, Min invented dual laser microscope technology that identifies specific compounds by their chemical properties and how they respond when exposed to lasers. Jian and Xian talked to him about using that technique to find and identify plastics that had been too small for researchers using established methods. Carl Lavender of Law of the Sea Education Association said the work can be an important advance in the detection of nanoplastics. But she said she'd like to see other chemists use the technique and get the same results. Jian said he is starting to study water supplies in the U.S. cities of Boston, St. Louis, Los Angeles, and elsewhere to see how much plastics are in their tap water. Previous studies looking for microplastics and some early tests suggest there may be less nanoplastic in tap water than in bottled water. I'm John Russell. And I'm Ashley Thompson. Argentina's yearly inflation increased to 211.4% in 2023. Numbers released recently by the government show. It is the highest rate in 32 years. The data from the National Institute of Statistics and Sensuses, called INDEC, shows the effects of strong and difficult economic measures. They include a 50% devaluation of the country's money by President Javier Millay in hopes of bringing the country's high inflation under control. The yearly inflation number was much higher than the 95% number in 2022. For December, the monthly inflation rate was at 25.5%, up from 12.8% in November. But it is under the 30% the government had predicted. Millay said before the numbers were released that if the monthly inflation rate came in below the prediction, that would be a success. If the number is closer to 25%, it means that the success was tremendous, Millay said. In his inauguration speech, Millay announced a painful plan meant to avoid extremely high inflation. He warned that the measures would at first have harmful effects on the level of activity, employment, real wages, and the number of poor and indigent people. It is estimated that around 40% of the country's population lives in poverty. Food and non-alcoholic drinks, which have the largest effect on the yearly inflation rate, saw an average increase of 29.7% in December, INDEC found. Other products used by the general population rose by around 30%, while medications had an average increase of 40%. I'm Gregory Stockle. North Korea announced earlier this week it had carried out a test of a hypersonic weapon attached to a missile. It was not the first time the country has claimed to carry out such a test. North Korean officials announced the first one in 2021. Several other nations have confirmed they are also developing and testing hypersonic weapons. What are these weapons and which countries have them? A hypersonic weapon is designed to fly at super-fast speeds equal to at least five times the speed of sound, known as Mach 5. This is about 6,200 km per hour. These weapons are similar to ballistic missiles, which can also reach hypersonic speeds. But the difference with hypersonic weapons is that they are highly maneuverable. This means they are easy to direct and control in flight. Ballistic missiles generally have set paths with very little maneuverability. Since the path or trajectory of hypersonic weapons can be changed, they are harder to identify. This means they are difficult to destroy with existing missile defense systems. The two main kinds of hypersonic weapons are hypersonic glide vehicles and hypersonic cruise missiles. Hypersonic glide vehicles launch from a rocket. The glide vehicle then separates from the rocket and glides at speeds of at least Mach 5 toward a target. Hypersonic cruise missiles do not have a glide vehicle and are powered by high-speed air-breathing engines. Hypersonic missiles generally launch warheads at speeds of at least Mach 5 while traveling at fairly low altitudes. Newly developed hypersonic weapons fly higher than less speedy missiles, but lower than intercontinental ballistic missiles. Hypersonic weapons are more difficult to identify and shoot down. North Korea's first hypersonic missile test carried out in 2021 used a glider-shaped warhead. Another launch in 2022 involved what South Korean military officials said was a kind of ballistic missile warhead with maneuverability to hit a target. North Korean state media said the country's latest launch came on January 14. It aimed to test the performance of a new multi-stage solid fuel engine attached to a hypersonic warhead. North Korea described the test as a success. South Korean military officials said the missile flew about 1,000 kilometers before landing in waters between the Korean Peninsula and Japan. International experts have said North Korea is interested in hypersonic technology because it can be used to distantly deploy weapons while avoiding missile defense systems. North Korea could, for example, use such weapons to target U.S. military bases in Japan and Guam. The United States, Russia, and China are all developing hypersonic weapons. Additional nations are carrying out research while others have claimed tests that have not been confirmed. U.S. military and intelligence officials say China is building and testing both hypersonic cruise missiles and hypersonic glide vehicles. U.S. officials say China is believed to have carried out hundreds of hypersonic weapons tests between 2016 and 2021. Reuters reported on one Chinese test in 2021. A hypersonic glide vehicle flew through space and circled the world before heading down toward its target, the news agency said. Also in 2021, Russia successfully tested a hypersonic cruise missile. President Vladimir Putin described the launch as the start of a new generation of missile systems. The United States confirmed in September 2021 it had tested an air-breathing hypersonic weapon. The next year, the U.S. military requested $3.8 billion to develop hypersonic weapons plus another $246.9 million for hypersonic defense research. U.S. hypersonic weapons can be armed with additional warheads. The Congressional Research Service describes the U.S. Army's long-range hypersonic weapon as a ground-launched missile equipped with a hypersonic glide body and associated transport, support, and fire control equipment. The Army says such weapons are designed to reach the top of Earth's atmosphere and remain just out of reach of missile defense systems. I'm Brian Lin. Brian Lin is here now to talk more about his technology report. Thanks for being here, Brian. Sure, Dan. Thank you for having me. This week, your report took a closer look at hypersonic weapons. You've explored what they are and which countries are currently developing the technology. What are some of the main concerns being expressed about these kinds of weapons becoming more and more common around the world? So, it was explained in the report that one big advantage of using hypersonic weapons is not just their speed. Something that makes them truly unusual is their ability to be maneuvered in flight to quickly change directions. So, as many experts have pointed out, because of this unpredictability, hypersonic weapons can often escape identification by missile defense systems. Is this situation expected to change so that existing defense systems will be able to detect hypersonic weapons? Yes. So, as mentioned, hypersonic weapons can essentially trick existing missile defense methods by quickly changing course in flight. And this can make it difficult for those systems to find, lock onto, and then destroy the weapons. But some experts of the technology have said this could change in the future. It would take new detection methods, though. So, some existing ground-based radar systems can, for example, detect hypersonic weapons. But these systems are not yet equipped to give advance warning of a missile attack, so that would have to be changed. Great. Thanks again for being here, Brian. You're welcome. Thank you, Dan. Welcome to the Lesson of the Day on the Learning English Podcast. My name is Andrew Smith. And my name is Jill Robbins. Thanks for joining us. Today's lesson will help you learn more about the English you hear in our video series Let's Learn English. The series shows Anna Matteo in her work and life in Washington, D.C. Here's Anna introducing herself. Hello. My name is Anna Matteo. In our previous Lesson of the Day, we heard Anna and her friend Bruna talk about hopes and wishes. In today's podcast lesson, we're going to give you more ways to practice using the verb wish. But first, let's listen to Anna and Bruna again. This is from Lesson 10 of Level 2 of the Let's Learn English series. Hi, Anna. Hi, Bruna. What's up? I thought we could meet for lunch today. I wish I could, but I can't. I have to research Peru for a story. How's it going? Not so good. I've been reading about Peru and listening to Peruvian music. I really want to understand Peru. I hope it's enough. We wish for things we can't do, have, or be. That means we wish for things that are different from how things are now. To show this difference, English changes the form of the verb or modal that follows the word wish. For example, can changes to could, have changes to had, is, was changes to had been, and so on. So it sounds like this. I wish I could. I wish I had. I wish I were. I wish I had been. Of course, those are not complete sentences. So now we'll explain how you can practice making sentences with the word wish. First, write or think of a sentence that describes a real situation in the present or in the past. Then use a sentence with wish to express the idea that we want a different situation. Jill and I are going to give you some examples. First, we say one thing, and then we wish that thing were different. Are you ready, Jill? Ready. I can't swim. I wish I could swim. I don't understand the question. I wish I understood the question. My head hurts. I wish my head didn't hurt. Okay, notice that after the word wish, we use a word that sounds like we are talking about the past, but we are not talking about the past. Listen again to this example. I don't understand the question. I wish I understood the question. The verb understand changes to understood, but we're not talking about the past. In fact, we want to understand the question now, but because wish means that it is not possible at the present time for us to understand, we change the verb to understood. We could also say, I wish I could understand the question. This change of the verb form also happens in conditional statements, like sentences that start with the word if. Right. For example, we say, if I had more time, I would study more. The verb had does not mean the past. Instead, it shows a situation that is not real, because it comes after the word if. Okay, now let's give more examples with wish. Are you ready again, Jill? Ready. I didn't see the game. I wish I had seen the game. He is not here. I wish he were here. I smoke cigarettes. I wish you didn't smoke cigarettes. They talk really fast. I wish they didn't talk so fast. You were not at the party. I wish you had been at the party. Notice that for real statements about what people do, we change it to negative when we use wish. They talk really fast. I wish they didn't talk so fast. In the same way, the negation, shown by the word not, disappears when we use wish. I didn't see the game. I wish I had seen the game. Now it's your turn, listeners. We will say a sentence about a real situation and then give you time to say a sentence using the word wish. After you will hear us say a sentence using the word wish so you can compare your answer. Are you ready? Okay, here we go. Well, sentence number one. I can't visit my family. I wish I could visit my family. Sentence number two. I don't have a car. I wish I had a car. Sentence number three. He is always late. I wish he weren't always late. Sentence number four. They are not here. I wish they were here. Sentence number five. I didn't go to the beach. I wish I had gone to the beach. Sentence number six. She didn't help me. I wish she had helped me. Sentence number seven. She never talks to me. I wish she would talk to me. Sentence number eight. I don't know how to swim. I wish I knew how to swim. Listeners, how well did you do? Was it easy or difficult to change the sentences and use the word wish? There are a lot of forms to learn, so don't worry if you could not change all the sentences. But you can always go back and play the examples again and try to say the sentences with the word wish. We hope these exercises will be helpful. Now, before we finish, here's a little chant with more examples using the word wish. Ready? Listen. I can't sing, but I wish I could. And you don't dance, but I wish you would. You don't cook and you don't try. I wish you would cook and I wish you would try. I would if I could, but I don't have the time. I wish we had a much longer day. I do too, but what else can we say? How about this? We wish we had more time with you. We wish we did. You know it's true. But it looks like time is running out, so one more thing before we go. We hope you'll write us and let us know. Something that you wish that we would do to help you learn and have fun too. Well, we really do have to go now. Write to us and tell us your wishes at LearningEnglish at voanews.com. And remember, you can also find us on YouTube and Instagram and Facebook. I'm Jill Robbins. Thanks for listening. I'm Andrew Smith. And that's our program for today. Join us again tomorrow to keep learning English through stories around the world. I'm Ashley Thompson. And I'm Dan Novak.