Yeah. Okay. Yeah. So, we looked at what is grief, what is bereavement, we looked at the normal stages of grief, what is expected from that. And this next couple of minutes we can, we're just going to look at what are some of the things that we can do. And if there are, you know, kind of specific principles or things that we can look into, that's also something that we can, we can just focus. So before we get into what is it that we can do, just a couple of broad principles that we really need to keep in mind and what as counselors or those who are helping need to focus at. So one is to come, the goal is definitely to help the bereaved to come to a place of awareness or an acceptance that the death has occurred. And this happens like we said through the, through the process. So, ultimately, we are hoping that the person who's morning accepts this reality before, as they are dealing also with the emotional impact of the loss. And the best way to actualize this loss or to come to a place of awareness is to talk about the loss and the road of a counselor here is to be a patient listener and encourage the person to talk about the loss, maybe including certain memories of the past and of the present of the person they've lost. Even bringing the person to a sense of awareness that the death has occurred can actually be achieved through some questions. So when you meet, when you're meeting with them to actually relive what happened. And if you see one of the, one of the, the things that people who, who are bereaved only talk about in those initial few hours, maybe lasting up to the funeral is talking about what happened. Okay. What happened through that period of death, what, you know, and that in itself, a repetition of that as they say it in itself brings them from that place of not being in that preferred reality into a place of an accepting, accepting reality. So maybe questions of how did the funeral go? Or what happened? How did this happen? Where were you when you heard the news? So this is actually helping them to come to a place of building more awareness that the death has occurred. The other thing that another basic principle that we need to remember is to help the bereaved identify and experience those feelings. So there may be many feelings that they, that they may be going through. And it, and often it, it could be intentionally avoided by the bereaved because of the pain that they are going through. So the feelings that we spoke about is anger can be guilt, it can be anxiety, hopelessness, loneliness, these are all problematic for the bereaved individual because at the time of, because in times of the significant loss, the level of this intensity with these emotions are extremely strong. So these need to be properly dealt with and effectively targeted. Guilt sometimes, yes, need to be discussed and also evaluated and maybe even resolved in time. Remember, these are not, you know, like one sitting kind of sessions we're looking at or anxiety also needs to be identified in man. So the role of the counselor is to assist them to explore these feelings in order to resolve and manage and overcome them. So identifying and experience these feelings enables them to feel a sense of release and encourages them to look at other options as well. Okay. What you're also doing, another goal that you're having is to help them live without their loved one. So this actually involves them accommodating the loss by facilitating their ability to live without the person who's passed away and also make those independent decisions. So to assist this, a counselor needs to use a problem solving approach. The counselor will need to help the bereaved identify the problems that has arisen since the loss has occurred. So this again is not immediate at the time as soon as the death has happened, but then maybe a week or so in like, for example, if it is a breadwinner who has passed away, right, working alongside with the bereaved about how they're going to financially stabilize themselves. So here, these decision making techniques are very valuable here. And especially, like we said, when one person is the primary, you know, the breadwinner, and when that person dies, a survivor has to experience has to begin to make those decisions. So here is where the counselor helps to develop those coping skills and decision making skills to enable them to take over the role of that decision maker and minimize that distress. And often, just to have someone actually talk about this and have a plan and, you know, giving them hope that we can that there can be a plan that's that can come up in itself is very helpful. The counselor counselor also needs to help them find the meaning in the death of a loved one. For example, you know, some people who have experienced a loss may set up, you know, maybe an organization or a charity in honor of the one who is diseased or they would want to lobby in for something that has happened. So this helps create a feeling that the death of the loved one was not in vain, especially, you know, when those who've gone through significant struggles and you've seen that in some ways where you've seen bereaved families who've lost people to suicide or maybe young teens to bullying and thereafter suicide or to depression, that is they kind of form a collective group or have a support system. So all of this are maybe finding meaning through the loss, you know, so the counselor helps to facilitate that. So meaning is also found in reassessing that those perceptions, what do they think about the death and also about the loved ones impact on the on their own lives. Kim, you're also helping giving them time to grieve sort of reset grief is a process and it requires time and certain points in time maybe can be very difficult for the survivor. For example, like we said, birthdays or anniversaries or holidays, they have the potential to evoke that experience of that loss and it is the role of the counselor to recognize these critical times and assist them in assist them earlier to to prepare to this. Yeah. Okay, I hope that answered your question. Yeah, so that that helps them to. Sorry, I'm just going to read that out for the benefit of the e-learning students. So Samuel said, so the the next thing that a counselor can do is also, you know, have I lost my am I am I audible? I think I lost everyone for a moment. I'm in between. Yes, but now. Yeah, you can. Okay, I think for the last we heard was for the benefit of the e-learning students and then. Oh, okay. All right. Okay, so I just for, okay, I just wanted to make that make the comment that Samuel had put up. He said, I had always wondered why people started these organizations and charities in the name of the deceased. And he's written now it makes sense. So it is to find meaning. Okay, another thing that counselors can do is to examine, you know, as people go through grief is to examine what can be people's defenses and coping styles. So your goal also is to find out how are they coping. And because this helps to identify what kind of functional coping strategies or good productive coping strategies they are using to dealing with the loss or if there is anything that is a dysfunction and anything that is destructive. For example, one common ineffective way is to get into substance abuse, you know, to maybe take on to alcohol or take on to drugs. And the counselor will have to look out for these ineffective coping mechanisms, because, you know, substance abuse, particularly alcohol, or any kind of stuff substances that you take can actually intensify the experience of grief and depression. And thereby it kind of impairs that process of bereavement also. So the counselor, what as a counselor you can do is to help highlight these coping strategies that are employed and encourage the survivors to evaluate the effectiveness and together, that is you as a counselor as well as them, explore new or better ways of coping that the client that the person can actually employ. Okay, so looking in for coping strategies is very important. And the last part, which is also important to understand is to know when is it that the normal grieving process is moving into something that is pathological or moving into something that is not normal. So if you identify the existence of some kind of an extended pathology or extended disease factor that's triggered by the loss, it is suitable that you as a counselor make an appropriate referral. Now, what do I mean by this? So we say that grief is normal when a person is grieving for the initial six to nine months post the incident of loss, six to nine months is seen as a normal time of grieving. Anything beyond that, and especially when it comes with symptoms of dysfunction, that is they're not able to get back to their normal sense of functioning. They're not able to find any hope to move on. There is significant feelings of helplessness, death wishes, suicidal ideations, intense loneliness, complete withdrawal. The depression is becoming more clinical in nature is where you would classify that as pathological. So they may for people who continue this kind of a nature of grieving may require a specific intervention and it may be beyond the scope of point is where referrals need to be made so that you also understand whatever boundaries of training and expertise that you have and see that a little more. So these are in broad what counselors do. Now what I'm taking you all into the next section is something anybody can do. This is not specifically what a counselor should be doing. It's something that anyone in a position of care or a position of ministry can do. One is yes, they needing your presence. As believers we are called to comfort and encourage and be at somebody's side. So being there has the greatest calming effect or the thought of being one with their loss and their comfort. So your presence is an important factor. So however much it is possible it is always recommended that you are there in presence. Because it's often like I had earlier the first thing that I said was we may tend to withdraw because of the emotions that's rising up within us but when we strike this at a balance what they may be going through is far more significant than your inability and your presence in itself. So just helping us you'll see just your presence with absolute maybe just silence is more than sufficient to help them go through their loss. What else do they need? They need your sensitivity to be able to help to accept whatever place of feelings or emotions that they are at you know wherever if when we look at that process they may be at a place of anger, they may be at a place of denial, they may be bargaining all of that but just being sensitive to that process and recognizing that it's okay that they are struggling in that area. So you know in your notes it's kind of given simple forms it says if someone is struggling says something like I can't do this anymore avoid comments like oh yes you can or don't talk like that you're going to be okay. So what it says is what you're doing is to pushing away what is actually important in their place of healing. What you need to do is to help them to accept that those feelings are numb and you are there to support and listen and take those emotions very seriously. Your all that you're called to do is to be there as a source of comfort and not feeling pressured to make it all right for them by minimizing the pain or the suffering that they are going through. The third one is practical assistance like I was like we had brought about the case earlier it is just knowing of just being there practically to help maybe it's making a couple of meals for them maybe it's some form of childcare it's maybe a hospital visits or finishing certain needed bank you know legal documental work so knowing what care can be done can actually bring about a great sense of relief and help to people who are in bereavement. Okay how do you help what are the other ways some practical ways to help is one yes to be able to go to visit those who are bereaved they need to see and feel that they aren't alone and this is not just during funeral and the days summing to that but even at a later point of time to be able to keep in touch to stay in contact and if they were to shun you like not shun but if they were to express that they needed space not taking it personally but giving them a place of understanding to help them know that you are there and maybe reaching out to them a couple of weeks later to just find out how they are how they are doing. Okay the next is yes to be swift to hear slow to speak slow to react towards and things that may be said that is un-christian okay often saying nothing is the best thing to do okay saying nothing rather than saying wrong things like I think Rupa was saying they are an angel right now or you know God takes away only those he loves I mean those things are extremely insensitive things to say or the work of the person has been finished right now you know you should be happy that you had such a lovely person in your life all of this are unhelpful and sometimes whatever we say can create a greater sense of bitterness or despair or anger so just keeping in mind that it's best not to just say anything or even if you do just being able to reflect what is happening like for example this is this can be so sudden and really shocking and unbelievable it just seems so unbelievable so they begin to see that you have understood what they are going through right and so it also matters what kind of a stage they are in like you would have noticed some people in those who are bereaved can actually just be in such a state of shock they're so numb that they are not able to move and to you know to being in a place to getting them to do something may not be needed but just support and helping them through that phase of shock okay is what is is best needed okay just being a good listener being there not to solve the problem but just being there in silence is all that is also expected not do not try to explain everything sometimes the opinions can bring a lot more of pain and sorrow and you know it can bring about a lot of guilt so the the opinions that you may have can cause more anguish especially when they may ask you difficult questions you know why did this happen did my like I think Rupa was asking right the other thing is it because somebody sinned um I think the best thing to at that point of to say is yes it's hard to understand all of this and trying to grapple it all at this point of time can be extremely overwhelming best in anything at this point in time but just to um stand along with them and maybe even see you know even I'm like Rupa said I'm I'm not able to understand either I can't grapple this entire thing myself and but then I'm here with you here with you as we try and figure this out over time to come so that's more important to giving them that sense of understanding okay um often words is something that may not express as much but just a loving hug a handshake or a touch is something that is most helpful okay just just so that again you're showing your presence over there okay avoid yeah I think avoid saying I know how you feel because often that isn't that isn't very true because you can only you can only hear about what they are going through but do not understand the depth of it okay and in fact this is something that we are told in counseling never to make that statement of I know how you feel or you know I understand what it is that you're going through um you're you're not able to understand you're you're only able to be able to reflect that this is probably what you may be going through and I'm not able to completely grasp the entire gamut of emotions that one may be going through yeah um the next one is not to rush them to get better or to play down that grief but to give it but helping them do it in the process that is comfortable for them in whatever you know how much ever times they may actually want to talk about the bereave you permit that giving them that that place of helping them take it at the pace that that they are in like like for example not to really rushing them being patient with the process of mourning and so so it is it's important to not bring in statements like are you all aren't you over with this yet you know it's it's been such a long time you should move on you should get over it you should be in a place of functionality okay uh that the the place of trauma can only heal um in time okay and uh to understand that for to to understand or to think that their expectations for them to move back into how they were is something uh that we got to be careful about as we stated that they may never feel that they are the same person like what they were because of the kind of loss that they have gone through and lastly it is to continue to minister to to visit as as and when needed and to ensure that you keep confidence often um you know there may be many things that erupt in a mourner's life about the person who has passed especially if the relationship has been difficult and just a place for them to really talk about their anger their guilt or whatever regrets they have it is to find a safe space that they can do that and giving them the confidence that one is there to help them through that process okay all right um i think i'm i'm open for questions i'm i've completed that you know this unit uh any specific questions that y'all would like to look into nobody yes yes kennedy go ahead thank you very much what i wanted to just to get some guidance on like in where we come from during bereavement there's a lot of fisting a lot of so that actually people celebrate that and uh it becomes a time hard just the way mention that we are insensitive but things will become insensitive so at times it's touching and it's of course you are bereaved on one end people are celebrating people are fisting how do you advise on that feasting is it people are feasting is that what you said uh okay feast that is that is on a funeral is that what it is actually upon receiving the bad news it's like people celebrate that people celebrate it okay okay and uh can so can you tell me is that a cultural practice yes but it's nice being it's it's being taken over it's not particularly limited to one culture but saying it's being practiced across the border because people go online people will come make parties like people just start patting okay um i actually uh because i i think we've noticed that in in some cultures here does anyone have any insights on that i'm not too sure if i if i do understand what a cultural no pastor yes shei i use my grandmother as an example back in 1999 when she passed on uh at the age of 70 so uh we did the wake keep with the the church service she was buried then after that followed the reception which was more like a celebration in week um everybody was not mourning everybody was laughing dancing eating so yeah depending on the age in most african cultures depending on the age the person passes on there tends to be if the person left the earth maybe um at a very old age yes there will be celebrations even though yes people wouldn't mourn um but if it's a young person who died in their prime um very very rare would you see any reception done or celebration it's usually a very sad one you know so it's just depending on the age um for most african countries i start to be corrected but that's the extent of my knowledge and and so what do you what do you i mean i think we have a few of you representing that culture so what do you see is the idea behind that and this is not just among christians right this is across cultures right yes across cultures yeah christians and non christians yeah exactly um but apart from so what is this is behind that sorry what generally is the intention behind that or the cultural practice behind that yeah just like celebrating the life the person left so oh it's the life of the person yeah and then also just to entertain those who have left their homes particularly some people leave from far away just to come and um come and reach the the barrier you know so you just want to entertain them but majorly it's to celebrate the life that they have lived yeah and this is something that's organized by the bereaved family that's correct yes the bereaved family organizes it yes it's difficult i must do it it's not something easily done you know but yeah i witnessed both sides of my family so at the young age when they planned and all that so um yeah it's not as easy as as we see but but eventually they just get over it you know and yeah that's it so is it an expectation that it needs to be done yes yes when the person older so from the ages of maybe 70 and above you know there's an expectation that oh we have to do a big reception a reception depending on the size most times is always big right so but if it's someone who left that they are praying uh no it's there's no reception even if there's going to be anything to give anyone it just be taken away because it's a sad as a sad thing to have someone who would have lived longer you know pass on so but if the person's older there's usually like a reception to celebrate the life of celebration okay anyone else has an insight i think i have three hands here anyone has an insight on what kennedy and shei bought up you could bring that up uh yeah either abney kennedy christopher any of you yeah i can just add over here yeah community that i i belong to um i wouldn't call it a celebration what they would do is um they would you know organize some kind of food for you know people who attend um you know during the summer service and also people who are you know kind of who who go to the cemetery and um that would be you know across uh you know people who attend that you know those those uh those events uh but in the you know in a more kind of a closed group of people who are actually you know they make it family members um and usually it's actually main dominant there will be a you know a session of um you know where people meet at at the house or at the home of you know the person who has um who has passed away and typically they would also be um and at least the community that i have to be there would be our courts out there so just to sort of use the tension people will you know kind of just get a little more relaxed and uh you know there'll be sharing of some some of some of the um you know what is actually uh you know when there'll be some stories talked about you know the person who has passed away and everything but it's it's not it's not actually a celebration it's more of a gathering of close members of the family okay apni you had something to add or kennedy one of the apni apni you could go and then yes yes i belong to rajasthan mam so there is a culture there in christians basically where when someone passes away so from the time we get the news the there is you know no cooking in the house they don't burn the flame that is a culture so the entire community the church community will carry food for them for the relatives everyone who's visiting for three days like the third day and the third afternoon they arrange for a big feast kind of food they prepare uh non veg gravy and you know they have some tradition of some kind of bhajiyas and all and i don't have been out like 25 years but when i go there i find it very interesting to see how you know they then they have this food where they culminate and they say now the cooking will start in the family so what happens is those who are grieving don't have to worry to feed the people who are visiting so the food comes from the community everyone serves that cooked food they bring into fence they feed and then they go away so for almost like two days so the third day it says like they will burn the flame now they will start after that uh evening they start cooking in the family uh so until funeral and until the relatives leave the family is not supposed to cook basically so this cooking is done outside the house and after that they start cooking in the house so this is how and then they have a condolence meeting on the third evening after that when everyone leaves then the family starts cooking for themselves and you know managing with the food so this is the culture in rajasthan in our office yeah there are so many adaptations can't hear you ma'am can't hear me now now the voice am i audible no you're better now yeah so i said the yeah the adaptations you know how culture adapts and copes with with loss is um is very different because here in south in south india especially among one community you will find um as they're taking the cops to the to the burial ground you have a whole band in front of the hearse and they are dancing and singing and half of them are under the influence of alcohol they'll be dancing singing throwing flowers and you know just making a mayhem and this is the middle of of a main road that you know and it's a very slow process because you have a band right in front and all of this goes goes on with the family or the hearse behind so yes different kind of cultures are are are are amazing to see yes kennedy i think you i don't think i answered your question but i think it's a good way to just understand this yes okay okay thank you maybe this just could be a side question as i know we have a structural difference what i want to just to inquire as a side question i see in most burials or in most this briefing session people tend to dress in black or this is a particular kind of color what's the need for what's the idea behind it okay i think that again it's just probably i mean there is no the it's black black black is generally black is the color of morning and i think that's why some cultures do it but then from from the time i remember in the kind of community i've been built up coming from earlier it always used to be white but now i do a lot of people dress black i think generally to show a sense of morning yeah i think that's that's probably why i don't know if there's anything else that has and anyone else would like to contribute please feel free to unmute and talk shei you had a thought or you had something to say i have a question but yes i'm in line with the idea of the color it shows one is sad morning breathing breathing lost one so that's the color my question basically is just to get your view on what i observed so there was a lady who lost her husband due to an illness so the husband was buried yes and then there was a service for thanksgiving just to thank god for the life of the person who had left who had passed on now the lady because i was just reflecting on all your teaching and i was asking myself if this was the right action so the lady was told to or rather the whole family including the lady the wife of this man who had passed on was called out to you know just dance and basically a time of thanksgiving for the family members and we could see that she was still grieving right and and even though she tried dancing you know trying to just show that she um at least he's in heaven and all that but we could see she was still grieving but the man of god compels her then you know to dance well while the husband was alive he was one who used to dance during church service and compelled her to dance you know like he did um i understood both sides of what he was doing i mean one side of what he was in and another side my i was like i think we shouldn't have forced her i understood that he was trying to encourage her right to let go of the sorrow and all that but i think based on what you've taught maybe my question is at that moment should we have you know compelled her you know to show that she was even though she was mourning but thankful that he lived a christian life and he's with jesus christ and we should just burst out in praise is she's just burst out in praise without feeling sorrowful or should we just have allowed her express the way she wanted to you know praise god at that moment that's just my kind of question i'm i'm trying to yeah shei i i agreed which should be the latter that you permit each one to express their grief in the way that they feel most comfortable in so um i actually it is quite interesting to see when people in funeral services loved loved ones of those who breathe the way that they respond in fact just recently i was seeing a video of one woman who um you know just believed that there can be resurrection at that time and so then she it was a wife she gathered people there to pray alongside with her to raise the dead man to raise her dead husband and comes to a place of you know saying that uh you know she's willing to let go and this is all in forum being recorded but then i think it's important for people to allow them to grieve the way that they see best so they may be depending on the kind of people that they are like you said you know the the minister here had asked her to her to dance she's probably someone who's a quiet personality maybe would just like to shed tears and in the within the four walls of her room and you know to be to be to give people the space to do it in the way that that seems most helpful for them and i think that's important and that we should be sensitive about that and not push them into something um that is expected rightly to get thank you pastor for that clarification thank you thank you yeah anybody else samuel did you have a question you had quickly unmuted did you have a question or an option okay all right okay great okay so um yeah i think we'll we'll close our session here just uh just a reminder i will be uploading the assessment today the second grade the second assessment you have a week to complete it um and please ensure that you complete it for your final um this this goes into your final grading so also for the e-learning students that it also would be uploaded to ensure that you completed before the 29th of april so that it reflects in your certificate as well right close with the word of prayer and may i request uh any one of our students to kindly do so anybody could close with the word of prayer kennedy would you like to close with the word of prayer please yeah yeah no it's okay thank you for having me father thank you for this course thank you everybody who's attended and just thank you for giving us opportunity to come in your presence of free land more about counseling it's not by our own knowledge over that's through your guidance might be that you're able to understand everything i commit everybody as we as we come from ends of this course that we're going to implement whatever we learned it's my prayer my humble prayer is over i feel open and feel open our minds give a display of knowledge and here's to our father as we as we go to other various courses where we are and you know i mean straight follow the hope i commit everybody into by hand in the mighty name of your son he gave us christ amen amen thank you kennedy so we will meet next next week that's our last class so please do ensure that you're coming next week okay god bless we meet next week again thank you thank you ma'am thank you ma'am thank you god bless thank you ma'am


Welcome to Much More on Medicine on the ThinkTech live streaming network series broadcasting from our downtown studio at Pioneer Plaza in downtown Honolulu. I'm your host, Catherine Noor. Much More on Medicine is an opportunity to learn about all aspects of health care. I talk with guests about medical and alternative care treatment, insurance, medication, surgery, rehabilitation, prevention, and much more. Joining me in the studio is Dr. David Samsami. Talk about his invention, a do-it-yourself pap smear. Dr. Samsami is board certified by the American Board of Family Physicians and the American Board of Disability Analysts. He earned his medical degree from the Carol Linska Institutes.com in Sweden. He served his residency and family practice at the UC Davis affiliated program in Merced, California. Dr. Samsami has been a community family physician in Hawaii since 2004. He has volunteered as an assistant clinical professor at University of Hawaii John A. Burns School of Medicine, Department of Family Medicine. Dr. Samsami, welcome. Thank you. It's great to have you here today. It's an honor to be here. Okay, so this do-it-yourself pap smear. What is the technical name for it? The technical name for this is a cervical tissue sample device that it takes samples of the cells from the cervix. Okay, and so can you explain how this is done? Well, it's, in reality, in concept, it's very simple. So it's a sort of syringe that has been designed in a way that once you push it in, so it opens up a shroud that there is a brush inside there. So the woman can do this at home on their own privacy. Okay. And the instruction is a very simple. Okay, so why don't we take a look at it? Okay, let's bring up the side view. Okay, okay. The closed one. The closed side view. Okay, yeah, there we go. Okay, so what is this? What are we looking at? This one is just a syringe that usually, you know, we use it in a daily using in health care. And that is designed now in a way that I put a cap on the syringe that has fluid inside it. And it is locked by aluminum foil or something that can hold the fluid inside the cap. Then that is the body of the syringe. And inside the body, when we push in the plunger, the bottom part of the thing, it pushes out inside the chamber of the syringe. Okay, so let's look at the open front view. Please are sure. Okay, so what what are we looking at? This one is now that once we push in the plunger inside push it out, then it opens up on the top of the syringe. It opens up like a reverse umbrella. So it opens up. And then there is a brush that takes the sample cells, it will appear inside the shrouds. Okay, and then let's look at the open side view. Okay, and what how does what is this show? Yeah, this one, if we say that, okay, now it has opened up. And the upper part with the shroud that is covering the brush inside. So once this inserted inside, so with a little push automatically will align with the tip of the surface. Okay, and so doctor, you're a family physician. And this seems to be something that what a gynecologist would do in your work as a family physician. Do you actually conduct pap smears on patients? Yeah, well, it's a big part of the family physician is women's health.  But in my practice, it has been everything, you know, as a pediatric to geriatrics and gynecology is some portion of it. Okay, and so we know that a lot of inventions have inspirations. And so tell us about your inspiration that caused you to invent this. Right, I mean, beside hearing all the time that, okay, this position or this test is embarrassing. These comments, I was inspired mostly because one of my patients delayed incoming and doing the test that you were supposed to do repeatedly and it went a couple of years and finally when the test was done, unfortunately, it was invasive cervical cancer. And that gave me an idea that okay, why don't we find a easier way for women to be able to do it themselves. So in this way, you know, we will avoid. Okay, so essentially, this device allows a woman to insert that that what we should we saw. And they do that at home. And by doing that, they extract cells. And then what do they do after they complete that procedure? Well, the thing is that first we target which group, you know, because this one is designed for those people that are, you know, underserved community or hard to reach people. So we say that with these people that you're not not coming for some reason. And so how can we reach them? Then we mail this device home to them. And, you know, then the instruction and I say that okay, now, can you at least do this, you know, it would be anything better than nothing. So if you do this, then send it back to a lab. So instruction they read it. So it's very discreet when it goes home in a mail, then they open it and then do according to instruction, collect the cells and then mail it to the lab. And the doctor will get the result. Okay, so let's just say this procrastinating woman who doesn't have time to come in to see you and they get the they get this in the mail to do it and they do it and then they forget to mail it out. But how long will it last before it's spoiled? Well, I mean, I cannot say exactly the time wise. But basically, if it is a shorter period of time, I don't believe that, you know, because this preservative met it preserves the cells. And just looking it on their microscope to see whether the cells are pathologically or no normal. I don't believe that it would be. But the goal here is and I don't believe that any person that would do the test would delay in mailing it. You know, they don't want to have any samples of anything left over. But in case if they forget, I still think it's good to mail it and see what the lab would say. Okay. And can any laboratory analyze the cells? Those that they are, I mean, a standard laboratory that the laboratory that they do this stuff, yes, they would be able to do it. Is it difficult to use this device at home? Not really, because they're already a lot of patients we prescribe medicine that they use the same sorts of applicator to treat other bacteria, as you know, says stuff like that. So if they follow the instruction, it is very simple. Okay. And does it collect cells from multiple parts of the cervix? Yes. Well, this is designed that the brush inside the thing, if we look at another picture from above that we can see the brush. That one, the middle part of the brush is longer than the sides of the brush. So the middle part goes into in the cervical area. And the outer part is gets the cervical area. And any purpose we should have both endocervical and peripheral. Okay. So how important is early detection of cervical cancer? Well, early detection of any disease is very important. And especially if it comes to a cancer form, that's almost life saving. And prevention is almost everything in medicine. So if we prevent it, we would never end up with the disease and would not cost so much, both, you know, economically and also emotionally. So if the test is positive for pre cancerous cells, are there things that doctors can do? Absolutely. I mean, the test, it does not need to be positive for pre cancerous. It can just say that they are normal cell or inflammatory. That just is a source of light that you know, say, okay, now, you really need to go and get checked. And then now when they do the check again, and it is pathologically or or has changed. So of course, early intervention, preserve life. Okay, fantastic. So this kind of reminds me of something like 23 and me or a home pregnancy test. Is that kind of the what this is about doing something at home rather than going to a clinic to do it? Yeah, exactly. The home devices are designed to do that, that patient would be able to do it on their own privacy of the home. And pretty much, that's the same. Okay, and so and I also understand that they have tests that you can determine like for, for problems with the colon and issues, where they you could do a home sample. That's right. Yeah, those, those like polo guard or stool samples and stuff, they're similar, but of different type of the test. Yes, patients does it at home and send it. Okay. So now, this is an important question. What other benefits are there to this test? Is it capture any other cells? Or absolutely, they capture is almost all sexually transmitted infections, as they call it STI. So as I mean, they are going to re HPV, more virus, and they're also found on the infection bacteria of vaginosis, trichomonas, anything that could be captured this one. So I think that sounds like a wonderful thing for people that are kind of embarrassed about going to a doctor. Absolutely, absolutely, because they especially younger generation that, you know, if they want to do this, and then, you know, so it stops the spreading. And then also it gives them a source of idea. Now I have to go to the doctor and get treatment. Okay. So now, how prevalent is this problem of cervical cancer in the world? It is.  And so that they develop cervical cancer that leads to death. Okay. All right. So doctor, now, is a device difficult to use? I mean, we know, I mean, if they really read the instruction properly, like any other, as I mentioned, maybe prescribe medicine with applicator, if they have to really that, okay, how is it do that? It's not difficult at all. Following the instruction is very simple and safe. Okay. Fantastic. This is Catherine Norr, much more on medicine with Dr. Samsami. Aloha, this is Rob Hack. My show is exporting from Hawaii every other Thursday from 12 to 12 30pm, where I bring in people involved in the entire exporting infrastructure in Hawaii, including government, academia and manufacturers and shippers themselves. Please join me every other Thursday, 12 to 12 30pm and exporting from Hawaii. Mahalo. Aloha, I'm Mellie James, host of Let's Mana Up, Tuesdays, every other Tuesday, from 11 to 11 30. This show is meant to dive into stories of local product entrepreneurs and how they're growing their companies from right here in Hawaii. I'm so thrilled to have our show kicked off. And so please join us on Tuesdays at 11 o'clock as we talk to local entrepreneurs and hear their stories. We're back. We're live. I'm Catherine Norr. And this is much more on medicine on the Think Tech live streaming network series. And we're talking with Dr. David Samsami about his new invention of a do it yourself pap smear. Dr, do you have a patent? Yes. This one is US patents recently. That's been patented. That's big news. And it sounds like it's just going to be an amazing product for many populations. Yes, that's the hope that that we can reach those that are very difficult to reach. And then we would save lives. That's the whole idea behind. Okay, so the type of populations that would benefit. Those are people in rural areas and what other types of populations? I mean, any population can use this as we mentioned also, some people due to privacy, you know, or religion reason, they don't want to go to their doctors and stuff. So those will be identified and then they can request. So, you know, a device will be sent home to them, at least to get it done. Now, of course, we don't say that this would replace the doctor's examination. We still say that that would be the best if somebody can go be examined by the doctor. Okay, so I think this might lead to some cost savings. Is that correct? Absolutely. Absolutely. I mean, one of the good benefit of this device is the cost. But saving lives is priceless. So we cannot say that, okay, just because it's cheaper, we got to go, you know, to do that. But no, in today's society, we need to have a low cost healthcare, the best source of service. And so that one is a fraction of the price of pap smear. But still, we won't say that, just because of that, that for this reason, we are going to introduce this. No, we want to introduce it in order to get more people to get tested. Okay. So in this way. And you know, one thing that I didn't ask you, and I think this is important, what is a pap smear? Yeah, a pap smear is a sort of test that before was yearly that women need to do it. Then nowadays, they say that if it has been normal, so it is a test that the ladies go to their doctor and the doctor take the same method that we're doing with the brush, take tests from the cervical area, and then send it for analysis and see that, you know, whether it's normal or abnormal, or if it is an infection, or that's what the pap smear means. Okay. And how often do women normally get a pap smear? Before, yeah, before was recommended to be done yearly. Then as years went by, so now they recommend that, you know, every two to three years, three years, that would be the maximum if the pap smear consequently is normal. Okay. But if the patient somehow would like to get it done yearly, still, they wouldn't say no, they would recommend it to do. Okay. So if now, before your invention, people would have to go to their doctor and have this done. How much would a doctor's office visit cost? Well, I would estimate that in the office pap smear does even you charge the insurance and some pay somewhere around $180. That would be the cost of the office visit and the service that the doctor is doing. Then, of course, this one is not embedded the lab cost in it, you know, lab I have absolutely no idea how much they would charge to do with the charge insurances. And so it would be a quite big difference between get it done privately or get it done at all. Okay. So and then the cost of this device about like, if let's just say an insurance company was paying for it, what would be the range? Well, it is, of course, you know, I would guess I'm not professionally making manufacturing this, but it shouldn't be expensive. I would guess I'm around $15 to $20 would cost so it would be around one fifths of the price of there. Okay. So we're looking at the difference between a cost of like $180 office visit and a 10 to $15 test that someone could do in the privacy of their own home that would not only perform a pap smear, get those cells to be tested for cervical cancer, but also could detect the STIs. Okay, that's right. Okay. So that seems like a huge benefit. Absolutely. Okay. So when I when I kind of think about the potential advantages of this, I think about all these countries that like such as Africa, or, for example, Africa, lots of remote areas, not served, potentially by doctors, is that correct? No, absolutely. In Africa, it's not the need to be remote, you know, even in their cities, every house, they don't have that much of a doctor's pair in a population that they should serve. There's a lot of underserved people that that that could be targeted and safe. And then when I think about the Middle East or parts of Asia, I think about the need for privacy. Absolutely. Okay, where some populations, they can't see a male doctor. Absolutely. The cultural set, there are a lot of cultures that women don't like to be, you know, examined by a male. And so in this way, I don't believe that they would mind to do it themselves. And any woman would like to be tested by a, you know, female examiner or male examiner. Still, they would say that I would prefer, if I can do it myself, I would prefer to do it myself. Okay, and then we even have populations like in the North, for example, I know you went to school in Stockholm. That's right. Yeah. When I look at those countries, Scandinavian countries, they have a lot of really remote areas. Yes, absolutely. You know, there are some places in Sweden or Norway or Finland that is about four or five hours to the closest facility. So this would be a lot easier. Absolutely. I think that they would be very much interested in because they usually invest in preventive medicine. Okay, fantastic. Okay. And so and then when I look at countries like the UK or Canada, they try to provide care to all of their citizens. And so this would probably benefit them as well. Absolutely. I mean, now if we we shouldn't go that far to UK or so in the United States now, almost everywhere, every state, their goal is to give the best health care and lowest cost. All insurance companies, you know, encourage doctors that, you know, to bring in people for annual health examination, just to prevent. So even in the United States, it would be very much benefited. Yeah, and especially Hawaii where we have islands, right? Absolutely. Yeah, and we even have islands that don't have many doctors. Absolutely. Sure. Yeah. That is that that was the whole goal to target those people. Okay. Fantastic. Okay. So does the using the cervical tissue sample device, does that mean that a patient doesn't have to see a gynecologist? No, exactly. As I mentioned, we even recommend the very hard nothing can replace a doctor's examination. So that's why we encourage them. This is just that for some reason, if they cannot do it, so it will not take two years, three years after, you know, whatever test has shown that it become like so late like the other patient I mentioned that. So this says, okay, now if you cannot do it, you can or you have no possibility to go to doctor.  At least, you know, it gives us some idea very in time that person is. So it really doesn't replace that hands on visit with the doctor who checks other health issues like like breast health and other. Absolutely. Absolutely not. Absolutely not. Nothing in reality can replace doctors visit test. Sure. Yeah. Even even now if they send a test for colon cancer, steel colonoscopy is a gold standard that needs to be done. But of course, it prevents a lot of time, you know, for earliest age. So they find out that yes, okay, there was a blood in a stool, or there was this and was that. So it captures it, you know, earlier. So if there is a, let's just say that there's a positive finding and the lab comes back with a positive finding, does that go back go? Does the test go to their physician? Yes, they they it is that way since they are sent home from the physician to those targeted patients. So the result will go to to doctor and the doctor, you know, will write a letter or stating that okay, was this so come, you know, for for a real more thorough examination. Okay. And so if it's positive, then they'll probably have a repeat in the office? Yes, absolutely. Yeah, then it's like any other tests, even we do Pap smear and it becomes in the office setting positive. Then we say that okay, if what the stage it is, then whether in six months or one year, you have to repeat the test, but it is on alert that something is wrong. Okay, so the the person who has always had negative pap smears or hasn't had one yet, they could probably do this. But once it starts being positive, then we're really shifting into actual hands on medicine. Absolutely, absolutely. And so but the younger generation, of course, we recommend to do these tests and not just for the purpose purposes, just for the STI, you know, because a lot of them go silent. Sure. And spreading in a community and so and so it not only is a good thing in relation to cervical cancer, but also could could help prevent the spread of absolutely. Yes. Okay, well, doctor, it's been fantastic talking with you today. And I'm so excited about your about your invention. Well, thank you for having me. And so well, I just want to say we really appreciate it. And so we're out of time today, but we'll have to and we'll have to wrap this up. I'm Catherine Norr. This is much more on medicine on the ThinkTech live streaming network series. We've been talking with Dr. David Samsami about his invention of a do it yourself pap smear. And thank you for joining us today, Dr. And thanks for our broadcast engineer, our floor manager, and to J. Fidel, our executive producer, who puts it all together. Please join us for future ThinkTech productions. Thank you.


We've been talking about this playoff simulator where we simulate the favorites to win each game this Saturday and this Sunday and see how that affects the playoff picture moving forward. Now, there's a lot of playoff scenarios for many teams, which we're going to update after we simulate these games. So what we're going to do is we're going to go to week 18. I'll go ahead and pull this up here in just a bit. And then we're going to simulate the games. I just want to go ahead and give you an idea of what the playoff picture looks like. So for the AFC, that's where the most, I guess, implications lie as far as not only seating, but also who's going to be making it into the posting and who's not because there's two playoff spots still available that are currently held by the Indianapolis Colts and the Los Angeles Chargers. Now the Southern Night Football game between the Chargers and the Raiders, more than likely, more than likely, there's a chance it's not going to be like this, but more than likely, it's going to be win in your end, lose in your out. And I say more than likely because the Raiders can still get in if they lose. It's like if the Ravens lose and the Colts lose as well, then the Raiders get in, but we'll update you guys on the playoff picture and which teams have a chance after we simulate each game. So let me go ahead and pull up the favorites to win each game on my iPad right here and then show you guys on my computer the playoff simulator. We got the two Saturday games, right? The Chiefs in the Broncos, the Cowboys and the Eagles. If we elect the Chiefs to win, for instance, because of the favorites to win, we go update that and then momentarily, the Chiefs, they move up to 12 and 5 and they move up to the first seed. That means after Saturday's win, if the Chiefs win, they got to have their fingers crossed and be like, Hey, Tennessee, I hope you lose to the Houston Texans. I hope they sweep you in the series this year because we want that number one seed. So the Chiefs move up to the first seed temporarily. Now, for the Cowboys and the Eagles, if we simulate that game, which the Cowboys are seven point favorites in this game, we update that. It doesn't really update. It doesn't change like the Cowboys stay at the fourth seed. And, you know, that could be because of the Tampa Bay Buccaneers, the tiebreaker that they lost to them. The Los Angeles Rams have been really good in the NFC as well. But yeah, that's that's what it looks like after those games have been simulated. Now, let's go ahead and simulate the remainder of the games. The Steelers and the Ravens, both these teams are in line to make a playoff spot potentially. But let me go ahead and read off what is on the line for both the Steelers and the Ravens. For the Baltimore Ravens, I have it pulled up right here. A lot needs to happen for them. They need to win. The Chargers need to lose and the Colts need to lose as well. And the Dolphins need to lose as well. So one win and three other teams need to lose for the Ravens to have a chance to make it in for the Steelers. It's a little bit easier just because they tied the Detroit lines. They have that half game over the Baltimore Ravens. They need to win the Colts need to lose. And that's it. That's it for the Steelers. And then they would make it into the postseason. So let's go ahead and pull up who the favorite in this game is. And it's going to be the. Wow, actually the Pittsburgh Steelers are the underdogs in this game. So the Ravens who have been on this five game losing streak. It doesn't matter. The Ravens are a five and a half point favorites. So they win. If that happens, the Steelers lose. Now, all of a sudden, the Ravens are in contention of making a wild card spot. But again, Chargers, Colts, Dolphins, all three of these teams need to lose. Is that going to happen? Keep that in mind with the Baltimore Ravens. Moving on over here to the Bengals and the Browns. This one doesn't really have many playoff implications. I mean, the Browns are out of it. The Bengals already have it locked up. They're the third seed. So the Bengals are favorites to win in this game. They stay at the number three seed for the Packers in the Lions. No playoff implications here. The Packers are the favorites. Aaron Rodgers might be resting up. We don't know. They already have the first seed win or lose, regardless. It does not matter for them. The Titans and the Texans. OK, remember, the only thing that matters at this point is if the Titans win, because if they beat the Texans in this game, they move on back up into the number one seed for the Chiefs. They drop down momentarily to the number two seed. So the Titans are the favorites to win in this game. Let's go ahead and click them. And then they have the number one seed locked up for the season. All right, now the Colts and the Jaguars. This is a very, very, very important game for playoff seeding. And for the Baltimore Ravens, who are the favorites to win in this game against Pittsburgh Steelers? Can the Colts beat the Jaguars? Well, if you look at the favorites right now, Indianapolis is a 15.5 favorite against Jaguar, so they are going to win. So that already eliminates the Baltimore Ravens. The Colts just need a win and their end. So the Colts lock up that playoff spot if the favorites were to win each game. The Bears and the Vikings. This game does not have any implications at all. But Minnesota is a favorite. So let's just go ahead and pick them. And we scroll a little bit down. We've got on this side, Washington and New York, no playoff implications in this game, but the Washington football team are the favorites to win. So let's go ahead and pick them. The Saints and the Falcons. OK, now transitioning over to the NFC, the only thing that really matters for the wildcard as far as the Saints go is that they need to win and the 49ers need to lose. OK, so the Saints are four and a half point favorites to win it in this game. Let's go ahead and pick them, pick them to win. Nothing changes right now. But the 49ers down here, when we get to their game, keep that in mind. They're nine and seven right now. If they lose, the Saints move on up and clinch a wildcard spot. Then we move over to the Jets and the Bills. No playoff implications here, except that the Bills could potentially win the AFC East if they were to get this win. So the Bills are the favorites to win in this game, actually 16 point favorites. So let's go ahead and pick them to win. And they lock up the AFC East for a second straight season. The Patriots and the Dolphins. It was going to be a playoff implications if the Ravens were still alive at this point, but since the Colts won, they're out of it. And since the Bills won, the Patriots can't really lock up the AFC East at this point or the number one seed. So the Patriots, they're six and a half point favorites. Let's just go ahead and pick them. They're locked in and you'll have a Buffalo versus New England matchup coming up next week in the playoffs. The Panthers and the Bucks, the Bucks are the favorites to win in this game. So they win. They momentarily move up to the second straight second seed. And it depends on the matchup between the Rams and the 49ers on what the future holds for the Tampa Bay Buccaneers. Then you've got the Seahawks and the Cardinals. The Cardinals just want to continue moving on up after having that victory against the Dallas Cowboys and the seeding aspect of it. But I mean, if the favorites win in all these games, it doesn't really matter at this point. The Cardinals are the favorites to win. And since the Cowboys won and all these other teams, then the Cardinals, they remain the fifth seed. But depending on the matchup between the Rams and the 49ers, if the Rams lose, the Cardinals win the NFC West. If the Rams win, the Cardinals would stay the fifth seed and they would have to face the Dallas Cowboys next week in the wildcard. And the Rams are the favorites to the win in this game. So look out. The Rams win in the Saints clinch a playoff spot. Can you believe that? So this is a big game for San Francisco. They have to beat the Rams or the Falcons have to beat the Saints for the 49ers to get inside the playoffs. But if the favorites would have won each game, you've got the Saints now going into the postseason. An offense that has been trickling down, that has not been looking great, has a good chance of making the NFL postseason. Now we go here to the Sunday night football game between the Chargers and the Raiders. You know, it's going to be a close one. It's going to be a close one, but the Chargers are three points favorites to win in this game. So if the Chargers win, let's go ahead and click them. They get the seventh seed. If the Raiders win in this game, then the Raiders would get inside of the playoffs here at the sixth seed that Colts would drop down to the seventh seed. So if all the favorites leading up to Sunday night football were to win, then truly you'll have a win and you're in, lose or you're out game for Sunday night football, which is going to be so entertaining to watch in Las Vegas, but the favorites to win are the Chargers. So let's go ahead and take a moment to recap and see what happens. If the favorites were to win each game this weekend, you've got the Titans and the AFC locking up the number one seed, the Chargers and the Chiefs and then AFC West showdown and the wild card is going to be happening. They've had some pretty good matches this year, so don't count out the Chargers even though they're the seventh seed. The Colts and the Bengals would be a pretty good matchup with Jonathan Taylor against Joe Burrow in that high powered passing offense. Should be a good one. And then an AFC East battle between the Patriots and the Buffalo Bills. They split their series one on one. So it's going to be up in the air on who's going to win that game. Over in the NFC, the Packers, they lock up the NFC's top seed. It does not matter. Win or lose in this week. The Saints and the Rams, like we mentioned, the Saints get in due to the 49ers having a tough matchup this week and the Saints have an easier matchup against the Atlanta Falcons. So it's in their favor really to clinch that wild card spot. And I know that they want some revenge against the Rams and the playoffs for sure. I don't want to bring back some distant memories because I know Sean Landry is probably tuning in. But the Eagles in the Buccaneers in the playoffs as well. This should be a good game with Jalen Hertz, Nick Siriani clinching his first playoff spot last week in his coaching career. And then the Cardinals and the Cowboys rematch. Hey, at AT&T Stadium, Kyla Murray, you know, beat the Cowboys just last week, and he has a chance to do that again. If that were to happen. So that happens. If all the favorites win, we're going to release our weekly picks later on today on who you guys voted on. Social media is the favorite to win each game, as well as give our opinions on who we think is going to win each game. But if you agree to disagree with these playoff scenarios, do you think this is going to happen? Leave your comments, leave your thoughts down below. Would love to talk to you guys, interact with you guys on what's going to happen in an exciting week 18.


Okay, so NMR, as we've discussed it so far, doesn't actually appear to be all that useful a technique for a chemist. What we understand about NMR at the moment is the difference in energy between two nuclear spin states is proportional to the magnetic field, even with this extra complication that the shielding due to the electrons that surround a nucleus tend to reduce that magnetic field as experienced at the nucleus, but still when we increase the magnetic field, that increases the energy difference and that increases the frequency at which we should see absorption causing a nucleus to change its spin state and go from the lower state to the upper state. With just that understanding, if we apply a particular magnetic field which is shielded to produce some lower magnetic field at the nucleus, we can predict what frequency to look for absorption or resonance of these hydrogen nuclei, and if the system absorbs electromagnetic radiation at that frequency, we know there's protons there or hydrogen atoms. If it doesn't, then we know there's no hydrogen atoms there. But just detecting hydrogen atoms is not all that useful. What is useful, however, is the fact that this absorption takes place at a slightly different frequency or a slightly different shielding strength for every different type of hydrogen atom and different types of molecules. So what we mean by that is, remember, if we have an H atom surrounded by a proton surrounded by a single electron that we call a hydrogen atom, those electrons are responsible for this shielding. If we have a molecule like H2, that is a neutral molecule, the two hydrogen atoms are equally electronegative, so those electrons are equally shared between the two hydrogen atoms. But if we compare that to an example like, let's say, hydrogen chloride, where the chlorine is more electronegative than the hydrogen, then the electron that belongs to the hydrogen will be somewhat depleted on the hydrogen side. It's kind of a net positive charge here and net negative charge on the chlorine. So the chlorine, of course, has more electrons than the hydrogen to begin with, more valence electrons, and in addition, it pulls some of the electrons away from the hydrogen because of its electronegativity. Key point being there's less electron density surrounding this hydrogen in HCl than there is around either one of the hydrogens in H2. So on the proton anyway, the H2 molecule has higher electron density. The proton, the hydrogen in the HCl molecule, the proton is surrounded by a lower electron density. Higher electron density leads to stronger shielding effect. There's more electron density around the hydrogen, so that does a better job of shielding, so that means the value of this constant sigma, the shielding constant, is larger in H2 than it would be in HCl. If sigma is larger, that reduces this quantity. I'm subtracting sigma from one here, so this quantity is reduced. So that means when the shielding is large, you could think of that as saying the frequency at which the molecule absorbs is also, I'm sorry, going to be the opposite of large. It's going to be decreased. When I increase sigma, that decreases the frequency, or another way to think about it is, if I ask what magnetic strength, what magnetic field strength do I need in order to generate a particular frequency, if this quantity is reduced by large shielding, the B0, the external magnetic field, would need to increase. So that's an important feature of shielding, and these magnetic resonance measurements is that when the shielding is stronger, when there's more electron density and more shielding, the external magnetic field strength needs to be larger. So that same phenomenon happens in every proton in every different molecule. The chemical environment, the amount of electron density surrounding every proton in a molecule is different, and it gets a little bit more complicated for more complicated organic molecules like, for example, if I put up on the screen here a picture of the NMR spectrum for a somewhat complicated molecule like this ethyl acetate molecule. So let me just make sure all the protons are visible. So this carbon right here is a methylene carbon with two protons, two hydrogens on it. So we've got three hydrogens here, which are all identical to each other, two hydrogens on this methylene group, three hydrogens on this methyl group at the other end of the molecule. The chemical environment of each of these protons is different from all the others. The shielding is going to be different in each one of these molecules. So what that means is the magnetic field strength and or the frequency at which they absorb are also all going to be different from one another. And that's what's shown in this NMR spectrum for this molecule is what's plotted here is not the frequency directly, not the magnetic field strength directly, but something called the chemical shift. And that's this idea that the magnetic field strength, the external magnetic field strength is a little different for every proton. Zero on this scale is not zero field strength or zero frequency. That's where resonance takes place for a reference substance. In particular, in most cases, when we do proton NMR, that's a molecule called tetramethylsilane. Details of that molecule are not terribly important other than that's a neutral molecule. The protons in tetramethylsilane are not surrounded by any particularly electronegative atoms. So the electron density around the hydrogens in that molecule is about as high as we can get in many different compounds. So this compound has the most shielding of most hydrogen atoms in typical organic molecules. So this is our reference state all the way at the right end of this spectrum. And then progressively, the more electronegative a nearby atom is in a molecule, the more electrons get withdrawn from the hydrogen, the less shielding is taking place. So the lower the external magnetic field strength. So the way to interpret an NMR spectrum, as we move in this direction, we can interpret the peaks over on this side of the spectrum as having more shielding and consequently higher external strength. So usually we call the chemical shift upfield. The magnetic field is larger, so we call that an upfield shift. And the opposite is true in this direction. Peaks that appear over at the left side of the spectrum with larger values of this chemical shift, those are hydrogens that are experiencing less shielding usually because they're near some electronegative atom that's withdrawing some of the electron density. Lower amount of shielding results in what we call a downfield shift in the chemical shift. So let's take a look at this molecule and see if we can identify which of these peaks should belong to which protons in this particular molecule. And remembering that let's take this set of peaks, for example, these are the ones with the strongest downfield chemical shift. So that's the least amount of shielding. That's going to be the hydrogens with the smallest amount of electron density around them because that electron density has been withdrawn to some nearby electronegative group in the molecule. And in fact, this oxygen in this ester group is fairly electronegative. It will have withdrawn some of the electrons from the methylene group in this ethoxy side chain of the ester. So let's see if I label that group, that methylene group, as A. Those are the protons with the lowest amount of electron density around them in this molecule and they're going to absorb with the strongest downfield shift. On the other hand, these methyl protons in the methyl group of this ethoxy side chain of the ester, those methyl protons, I'll call that side group B, or those protons B, those are farther away from the electronegative ester group and it turns out that those protons appear in at a much lower chemical shift, further upfield, less downfield. And in between, we have this methyl group alpha to the carbonyl, if I call that those protons C, label them C, those are sort of intermediate. They're not as reduced in electron density as the methylene hydrogens over here but they are next door to a carbonyl group so there's still a substantial amount of withdrawal of electrons from that methyl group toward the electronegative carbonyl. So what that means is this large peak in the middle here, that's responsible, the methyl group that's alpha to the carbonyl is responsible for this peak here at about a chemical shift of about two parts per million. So that also brings up the fact that the units of chemical shift, typically those units are given in parts per million, it's worth understanding what that means. The chemical shift that we denote by delta, that is a measure of the frequency at which a molecule absorbs, a particular proton absorbs relative to the frequency for this reference molecule, tetramethylsilane in this case. So a molecule with a downfield shift and less shielding is going to have the opposite of this situation so if it's got less shielding it's going to have a smaller external field that's the downfield shift and it's going to have a larger frequency. So the frequency of these hydrogens is larger than the frequency of the reference hydrogen, that difference is taken relative to the frequency of the external magnetic field. So if there were no shielding at all, the frequency that would be needed to excite the nuclear spin excitations in a bare external electric field, that's this nu not value. But the point is it's just a shift, a chemical shift, the amount of change in the frequency relative to some reference molecule taken normalized relative to the external electric field. So when we say the chemical shift is four parts per million or two parts per million or one part per million, what that means is the frequency and or the magnetic field experienced at the nucleus is different from the value for this reference molecule by four parts in a million, four times 10 to the minus six. So it's a relatively small shift, the shielding values are pretty small but they're certainly large enough to measure and the fact that we can measure different values for a methyl group on one side of the molecule and the other side of the molecule, sorry methyl group and methyl group and the methylene group helps us to use NMR to identify different functional groups in a molecule. There's other things to interpret about this NMR spectrum as well such as why we have four peaks here and only a single peak here and three peaks here. So there's definitely more features of an NMR spectrum to examine that require a little more quantum mechanics to understand. But this basic idea of a chemical shift telling us something about the chemical environment of each of the protons in this molecule is one of the powerful features of NMR.