All right, so I think we'll get started with our next module. So I guess everyone's got a chance to try things out on the command line, get a sense of doing some bioinformatics, got to listen to Will most of the morning, and you're on your way. So this module is a little bit shorter, I guess, than some of our other ones, mostly because it's just focused on a single tool, but it fits in nicely with what we've talked about already with 16S, and it's a tool that we continue to develop, so I guess it makes sense that we bring it up here as well. So I'm going to talk about PyCrust and more generally I guess about metagenomic inference. I was originally supposed to talk again tomorrow, and so usually during that time I do myself plugs about a couple of things, but since I don't have the time tomorrow because I'm not going to be here, Gavin, my students are going to give that lecture, but I will just give a quick plug about a couple of little things. So one is I do run a microbiome sequencing service out of our lab called DIMR, or the Integrated Microbiome Resource. We launched it in 2015, mostly to service local samples, there's lots of different places to do microbiome sequencing, you heard about a service here this morning, so we've done quite a bit of sequencing since we launched, so we've now hit 50,000 samples. Those are over a large number of projects and a large number of investigators, and mostly in North America, but also in Europe and around the world. And so a lot of my research focuses on human associated microbiomes, but at DIMR we've basically handled lots of different things, so if you're not on here, then you know you can send us samples and we can have a new logo just for you. But looking at liquid environments like ocean and freshwater and wastewater, but also host associated and food products that are sold environments. That's all I'm really going to do about that because you didn't come here to get paid advertisements, although it's not a commercial company or anything, it's just right out of my lab. You can check out the website where there is prices there and a queue and some idea about what you would submit for DNA. So we tend to take either DNA that's already been extracted is usually what we take, but we will take samples as well into the extraction for you. Along with that I guess was coupled with it was just this need to come up with standard operating procedures for the bioinformatics and also to provide tutorials for workshops like these. So in last year we published this paper called Microbiome Helper, which was meant as this resource that incorporated different aspects. So one is it has some scripts which are basically some glue which do just some basic file format changes between say biome and stamp or biome to human or maybe paralyzes some steps. It also has a wiki where we have sort of step by step tutorials outlined and so those keep getting developed over time and so that's where we're hosting the piecrust tutorial you'll do today and then also the metagenomics tutorials you do tomorrow and then we also do have some sequencing protocols on there. So if you're interested in the wet lab side and how that's done, that's all hosted there. It does get updated and so I'd encourage you to look at that. Along with that we tend to still I guess develop different or test different methods out there. So we heard a little bit about 16S and Chime2 and methods like Data2 for making Amplicon sequence variants. So we have this preprint that we just got revised. If you're interested in it, I can send you the revised version because it's more newer than the preprint that's out there right now. But just where we compare three different denoising methods. So Data2, Dubler, and UNoise. And just compare those to a reference picking approach. I won't go into the details but overall they tend to have pretty similar results on beta diversity. So if you look at a PicoA plot, they look pretty similar or even at sequence composition. But if you're really interested in alpha diversity or the number of species in a sample, then they vastly differ. And so you have to take that into account. Okay, so moving on to what I really want to talk about is piecrust. So the idea here is that if you're working with, say, 16S data, you're gonna do some biathematics which some of you just did in your previous lab to eventually get to an O2U table. So you can see this here, yeah. Say an O2U table or this could be a table of ASVs or sub O2Us, whatever you like to call them. Where obviously each feature is a row and then each column is a different sample. And then from that, you could do alpha diversity. You could look at PicoA plots and beta diversity. You could test individual taxonomic differences. Look at stack bar charts or heat maps, lots of downstream things. And similarly with Medianomics, you can use different methods also to find out sort of who is there using different approaches to find out what tax are in that sample. And so they'll be covered more tomorrow morning. And then of course, also with Medianomics, you find out not just sort of who is there, but what are they doing? So you can annotate genes with particular functional classes. And then eventually get to maybe a table of, say, in this case, these are keg orthologs or they could be EC numbers. And then you can use that information to collapse them into, say, pathways. And then from there, you do similar things where you want to compare the differences of different functional classes. And maybe talk about the ability to have different, the different repertoire of functional abilities within that community. So that's great. So PyCrust essentially tries to predict this table, so these functional table of abundances of gene abundances, from the information given by 16S data from, say, an OTU table. And so this was published in 2013 and then has been used quite a bit and really probably wasn't updated much until just the past, I guess, six months to a year. We're now, Gavin, my PhD student has been working on it and we're starting to push out PyCrust too. So the idea behind PyCrust is really just from a sort of a basic level, is this idea that we're going to leverage reference genome databases. So we have really large genome databases and say Patrick or NCBI or IMG where we have tens of thousands of reference genomes that have been isolated and sequenced. And then for each of those, you could in theory collapse them or you can collapse them into different functional databases and count whether that's present or absent for a particular gene or whether there's more than one copy of a particular gene. So these are, again, are, say, cake orthologs. So K001 is alcohol dehydrogenized, dehydrogenase. And so, say in genome Y, that's absent and genome X, there's four copies of it, right? So that's just what that's representing, collapsing that information. And the idea here is that you would provide, say, an O2U table where in your community within sample one, say you have ten copies of this O2U1. And the idea is really to say, can we predict what the functional repertoire would be of, say, this O2U that's been sequenced? And so if the 16S was 100% identical between this O2U and genome X, you might have a good idea of what the functional ability is of that genome. You wouldn't still know for 100% sure, because you can actually have 100% identical 16S genes and still get variation in functional content. But you would at least know that it's probably a specific species at that level, and you might have a pretty good idea of what's in that. But then what happens if you don't have a good reference genome for that? And say your nearest 16S sequence is, say, 80% identical, then that's a lot harder to figure out what would be in that genome, and then how to basically collapse that information to come up with some community prediction. And so this is what PyCrest is trying to do, although some methods essentially just do this version and then just take the nearest neighbor approach. So that's what, say, PyFillen does, which basically was developed after PyCrest, which basically just takes the nearest neighbor and then just says, that's what the functional content is. But PyCrest tries to predict it with phylogenetic methods. OK. So at this point, I would usually describe more about PyCrest 1, but now I can talk about its limitations and then how we're sort of overcoming those. So with PyCrest 1, you can only use reference-based O2Us. Will mentioned this briefly. This is where you're assigning sequences to a reference database, but then anything that was left over before you basically had to discard those O2Us. So any sequence that didn't match your database, we weren't making predictions on. It also only worked with green genes, and this is because we pre-calculated most of our predictions ahead of time for those O2Us. And so if you used any other taxonomic database, it wouldn't work, which was not ideal because lots of people have their preference towards, say, RDP or silver, especially now that green genes hasn't been updated for a while. Also, more and more people are often doing genomics on the side, so they might have a particular environment that they're really interested in, and they're doing their sequencing genomes particularly for that environment, and they want to help put those into the PyCrest pipeline so that then that will help enable better prediction. So actually just a couple of years ago, a new tool came out called CalPy, and essentially they use PyCrest to, they use the PyCrest pipeline, but they're supplementing it with genome information from CalRumans, and so they're really interested in applying PyCrest on that particular environment, and so they sort of branded it as CalPy. And with PyCrest 1, it was computationally fast, but that came at the expense of it not really being flexible because it was all pre-calculated ahead of time. Okay, so the new pipeline looks like this, and so I'm gonna walk you through the different steps here, but just to draw into one thing is that our input here is both the sequences themselves, so I'm gonna use the term ASVs for Amplicon sequence variants, but these are the actual 16S sequences, and then also their abundances, and beforehand, when you used to use PyCrest 1, you would essentially start at this step down here, this last portion, and then all of this up here was pre-calculated, but now we're basically, as a user, you're gonna run these parts of the pipeline yourself, but it gives us much more flexibility in what you can provide as an input to PyCrest. Okay, so the inputs for PyCrest are essentially a 16S fast file, and an abundance table for those sequences, and the IDs have to match, between those two, those are the only things. So those sequences can be either from OTUs, so you could do any sort of de novo or open reference approach, and usually with an OTU approach, you would pick representative sequences, and if you've heard of Unifrack, those representative sequences are what get fed into Unifrack for your tree that does that calculation. So you can do that approach, and it's important to realize that this is all phylogenetic, so there's no actual taxonomy used at any point, so it doesn't matter if you're using green genes or silver for signing taxonomy, it only looks at the actual sequences, the 16S sequences themselves, and places them into a phylogenetic tree, so there's no taxonomy involved here. Or you can use some of the newer methods, like I mentioned before, that denoise or correct for 16S sequences, so in theory, you would have a little bit better resolution down to 100%, and you can feed those corrected sequences into PyCrust. Okay, so those are our inputs in gray, and then I'm just gonna highlight what this first step does. So with this approach, basically what we're doing is we're trying to take our reference tree, so if you imagine this being our reference 16S tree for all genomes that have been sequenced in our database, we're trying to place these reads from our environment into this context to get a tree that looks like this, and so we use two existing methods, so Papa Ra is this multiple sequence alignment method that's phylogenetically aware, so it takes as a reference the multiple sequence alignment as well as the tree, and places your 16S sequences into this multiple sequence alignment, and then EPA, NG, EPA stands for evolutionary placement algorithm, don't know what NG stands for, I don't know, do you know? Next generation. Next generation, I should have known that, which was, I guess it's still in pre-print in 2018, but just recently, EPA was published before, but the NG version, which is much faster, has just come out, but the idea is at this point, then we have our community sequences now placed in this reference genome tree, that's shown in blue. Everyone follow me so far? Okay. So then the next part is actually predicting that genome content for our community sequences. And for that, you can use different hidden state prediction methods, and each of those cases, what's looking at is for each trait, and so by trait, I mean a gene family, you're gonna give that to the algorithm and you're gonna load those onto the tree, so this is what the algorithm sort of sees. So those are the numbers in red, so absent, present, absent, and then also it can take higher copy numbers of that trait. And the method is trying to predict basically, for these question marks, what the trait is at that value. And so there's different methods for that, maximum parsimony, maximum likelihood, and other methods within different packages. So originally we used to use an R package called Ape, but this Castor package got published this year in 2018 and really speeds up this prediction so it's much faster. And so before this would take basically weeks on a cluster and so now you can sort of do it in real time. It just takes a few hours or depending on how many sequences you have. So right now you can easily choose that option, but PyCross2 defaults to maximum parsimony right now. And so this idea is that then you're gonna get predictions. So this is a fairly easy example, right? So with maximum parsimony for this question mark, you're gonna probably guess a three because that's both the descendants and its ancestors have three copies. This one may be a one or a zero, although it probably weight more towards a zero with higher probability and this guy would probably be two. And then you're gonna repeat that for each gene family that you're trying to predict. Okay. So now the final part is taking those individual predictions from all your individual sequences that you've given the file and then basically just combining that into the community. So what's nice is you can do this both to correct the O2 table for six and S copy number and also to make functional predictions. So you may know or may not know is that multiple many genomes, microbial genomes have more than one copy of six and S. And so that tends to be pretty much ignored by most of field, although there's been a couple of other papers that have acknowledged that and have tried to address it in different ways. But obviously this can really bias your results where if you have multiple copies of the six and S and that would be represented two or three fold times more in your table. So we make predictions for six and S copy number for each of your sequences and then essentially just normalize your O2 table by that number. So in this case, we're just dividing simply by the copy number for each number in this table. And before it was kind of annoying because you couldn't really use this table because it was only restricted to O2 use for reference space, but now there's no reason why you can't use this O2 table for your downstream methods that rely on that. All right, so that makes sense so far, okay? And then the last part is essentially just doing that those functional predictions now. So again, this is an example where we've used keg predictions but these could be EC numbers and this table was calculated in your previous step and now you're just simply multiplying the abundance of your ASV or O2 by the copy number that's predicted in that genome to then get a sum for your actual functional community table, right? So to get this value 13, you're essentially just multiplying this 12345 ASV by this functional number. So two times four, one times one, and two times two adds up to 13. All right, so that makes sense. Bada bing, bada boom, okay. So the major output from PyCrus is then you can either get functional tables that could be keg orthologs and pathways, EC numbers and metasite pathways, and then you can also remove spurious pathways via minpaths. So the major outputs are keg orthologs or EC numbers or cogs. And then to get to keg pathways, we use minpath to remove any spurious pathways which is a bit different than with PyCrust one. And the same thing with metasite pathways, they require EC numbers to say if they're present or not. And in addition to the functional tables, you would also get links to between the tax and the function so you can get stratified outputs. So you not only get a count of the function, but how the different organisms in that sample contribute to that function. So this is just an example for an individual KO across multiple samples. And so instead of just seeing one, the count of that abundance of that particular keg ortholog across these samples, you also get the taxonomic breakdown for that. And that's sometimes really informative. So this, say the second sample looks pretty much like the others, but you see then that there's actually a completely different microbe contributing that function. Okay, and then so for evaluation, just to, I guess to let you know how we evaluate it, the idea is that right now we pretty much always evaluate by using six nest sequencing and shotgun sequencing from the same sample. So some, a few different studies have done sequencing where they've done six and S and med genomics from the same samples. And then we basically ask, if we take the six and S sequencing and then do predictions with pie crust, how well does that correlate with the actual functional annotations from the shotgun medigenomics. And in the 2013 paper, there's a series of figures which I'm not gonna go into great detail except for two and you can look at more than in the paper if you like. But this is just showing in sort of an overview where this is a PCA overlaying both the pie crust predictions and the medigenomic data correlating with that across different body sites from the HMP dataset. So you can sort of see that the colors match up, although you do see a slight shift with the lighter colors which are the pie crust predictions for each of the body sites. And then we also showed that as your sample has higher diversity and especially diversity that's not well represented by a reference database that our accuracy will tend to drop over that distance. And so this distance from reference databases is represented by this nearest reference genome, sort of nearest NST, I would just say for nearest sequence taxon index, sorry. I should know that. And then so this is essentially the weight of all the members within the community to its nearest sequenced reference genome database, reference genome, sorry. And so what you see with human samples you have really good representation within reference genome databases because that's the bias that we sort of sequence towards. So that NST value is fairly low. And then as you go out to really more diverse samples this hyper-sailing that was really acknowledged for having organisms that we hadn't seen well before are out here. And then this is just a spearman with how well pie crust predicted the metagenome annotations. So you can get this NST value with the pie crust predictions for your particular sample so you can know where your sample lies on this plot. So since, so these are just a couple of results I guess that are new to pie crust too. So first here is just showing the null distribution. So null here just means that if you took a random distribution of genes across those genomes as a predictions this is the type of correlation you tend to get. And so that's fairly high. And that essentially makes sense because there's a lot of core genes that you would expect to be the same.  And this is pie crust one. And then these are some different things that we tried with pie crust two. So PIC is the ancestral state reconstruction method or hidden state prediction method we use with pie crust one. And this is maximum parsimony. So we do see a slight improvement between those two. And then reference sequences and all sequences is reference sequences just means only those that hit the database before and all sequences now is including all variants which we thought would have a bigger effect but it's fairly minimal. But either way pie crust two is slightly better than pie crust one and the correlations are still pretty high. We also compared across a few different methods that had been published since pie crust two. So pie fill and I mentioned before is this nearest neighbor approach. Tax for fun is another approach that was based similarly but it used the silver database and pan FP was another method as well. And all the methods actually do fairly well and so you'll see reports from them about that they're pretty high accuracy. But overall we're still doing better with pie crust two who are shown here with maximum parsimony.  So people often ask what about 18S because this is all 16S focused and we're not really sure about 18S for now mostly because we don't have nearly as many reference genomes for microbial care ads as we do for bacteria and so we're pretty tentative on this. But interestingly enough if you can plug in an 18S tree and 18S genomes into the pipeline and this is just a leave one out validation where we hold out the genome that we're trying to predict and make a prediction for it and see how well it correlated. So the correlation is really good compared to the null but still this should be taken with a grain of salt we haven't really tested this much beyond that it could just mean that it doesn't really represent well if you sample a completely new microbial carryout that hasn't been sequenced before it could really do much worse. But we are trying to validate this on a community dataset where we have paired 18S and metagenomics that's mostly microbial carryouts. Okay and with that I'd like to present you my amazing new acknowledgement slide which was just generated last night actually yeah it's just last night. So this is an amazing PCA plot representing members of my lab that was just sequenced, finished yesterday. And so this is how we place into our PCA plot based on stool samples. If you come to my lab, you're promised a free sample your first one's free. You too can share in the data plot. I won't reveal any more details beyond that. Just a PCA plot, we'll get into how much acromance everyone has. So these are the members of my lab and I should really just point out obviously Gavin Douglas is the TA here and is actually gonna give a lecture tomorrow but he's been the primary developer for PyCrus 2. So all acknowledgements go to him now for the development on that. He's done a great job. And obviously obviously funding on top of that. So I'd love to take questions because I actually kept within my time though PyCrus 2 before I moved to the lab. Thoughts? Yep. I see papers in the last few years looking at state coordination. Sure. And clinical outcomes. Right, so I mean I think that's what people wanna use PyCrus 4 essentially, right? So my default on that is two-sided. So PyCrus has this love-hate relationship where I think people love to use it because if you have 6NS data it gives you some idea about maybe what functions may be in those organisms, right? And then the hate comes I think from the other side where they say but it's still a prediction and so people tend to maybe get caught up in overstating their confidence in that, right? So sometimes I have slides where I have this nice example where I won't go into great detail but anyway a paper got bashed online because it was based on PyCrus predictions and then it got overblown into saying that a particular metabolite was produced which has been associated with a disease and so it got a little bit thrown out proportion with like oral health and I believe cardiac arrest and then coming up with like a magical probiotic mouthwash that could solve everything. So I mean it's the same as with metagenomics, right? So if you do metagenomics you're gonna get gene abundances, right? And that still doesn't mean that one those functions are doing what you think they're doing because the annotation could be wrong and two they're not transcribed unless you're doing metatranscriptomics which John's gonna talk about and three you're not gonna do met, you don't have them metabolites produced as well. So it's, even if it's a metagenome it's not a gold standard that that's completely linked to the clinical outcome. So you can tell there's a lot of caveats there around what I'm saying but I guess the idea is yes it does give a prediction that's fairly robust and the idea is that hypothesis is generating, right? So then the idea is that you would follow that up for something more targeted for that function that you're interested in, downstream. Does that make sense? Okay, yeah, question here. Thanks for sharing, really interesting. I have a question about the source data as well as potentially in the downstream analysis accounting for uncertainty or variability in the phylogenetic red, phylogenetic? Yeah, so I can repeat the question. So she's getting at the point of certain functions being probably better predicted because either their core is better conserved with six-nest phylogeny versus others which may not be as reliable. So that's definitely true. When we looked in piecrust one at functional categories we did see a definitely a change in certain classes of functions although they were all pretty high although the keg doesn't actually focus much on say antibiotic resistance genes which a lot of people are interested in and then are probably notoriously associated with LGT, right? And so that would be a class that we would presume we would do a bit worse in. And we from a long long time ago I did have suggestion that those results were a little less confident. With piecrust two we are talking about we actually get probabilities for each gene family for each prediction. And we're just trying to figure out I guess the best way that end user uses that at this point. So if you dig into it we can provide the probabilities for a particular function being in that genome. And then we're hoping at least to one have maybe some cutoff to say no this function you shouldn't really use it all. And then also on the other side of it is some ASVs may just be really poorly predicted because one they get placed wrong in the tree or are super divergent. And so we're looking at ways to maybe say no we can't make a prediction on these so they shouldn't be incorporated. But with piecrust one we basically just gave it all to the user and left it to them. So we're trying to make a few ways to give warnings that make sense. Yep. So as you mentioned AMR and I had a question like can you predict AMR or something like more virulence of a particular screen. Yeah. It's something we're interested to know which screens are more dynamic versus. Right. So I'm torn on that answer a little bit. So my PhD days would say no. Like and as a microbiologist I think I would say no not very reliably because I think people will understand really well that virulence can easily be dropped right. I mean you have E. coli strains that are notorious for being super virulent or just a lab strain right as a typical example. But I spent PhD days on LGT where you would see genome I got is coming to particular genomes and they would confer new virulence and that's the same you know it's just another strain and so that's not detected by PyCrust. So I would be weary of that. So PyCrust 2 doesn't make say a prediction on virulence. That being said there is a method called bug base which essentially uses PyCrust in the background to make predictions about gram positive, gram negative and I believe virulence either as virulence factors or something around that. And they show all right accuracy so I think it depends what you're saying. I mean it might work as a community scale I mean people even associate just a larger amount of proteobacteria as bad because they tend to have a lot more of the pathogens within them right? And so if that's the sort of scale you're going at yeah PyCrust would actually give you quantitatively that information but is it gonna say for sure if a strain is virulence or not? Definitely, definitely no. I think association of the genes at least categories that these genes could be involved in. Yeah you can, yeah absolutely. So you can get definitely those predictions. It's just I think it's probably the one category that's really interesting and two that will probably have to I think robustly take a look at with PyCrust 2 to make a better comment on that. So it's something that we haven't looked at recently to look at their correlation to say how well it works. But if for example we have the database of virulence and there are many like Patrick has its own specialized virulence database and virulence vector database can we take those set of genes and put them in the pipeline? Yeah so all you would need is, you'll see in the module but you would provide the pipeline this file here trade values of reference sequences right? So you would need those along with their placement in a tree right? And so the methods would be there to make that tree and then also to provide that but yes and then you would just run the pipeline the same way. And when is this coming out? So PyCrust 2 is definitely publicly available you're gonna use in the module today. We sort of technically I guess are calling it beta. We're pretty confident on its accuracy overall. I know Gavin's making still just a few tweaks maybe to the reference tree a little bit just cause there's some long branches there that you might see in the tutorial but we're pretty confident in its predictions right now and it's just more flexible at this point. So yeah, so it's available now. We're hoping to put a paper out maybe late this summer. So with the prediction is there like a persistent type of error that PyCrust can use? Consistent error? Yeah. Well in which way? So what is, so the accuracy is around 85, 90% right now. So what is that error being made? Oh, so that's a good question. So it's being made by and in theory it's being made by certain ASVs or sequences us not making good predictions on their genomes. And that's definitely true and that's what I would say most areas. The thing is our gold standard in this case is a metagenome that's been functionally annotated, right? And it has, we're not doing like an in silico an approximation which we could do but there's problems with that as well. So our gold standard is a metagenome that's been functionally annotated with humon too and so there's lots of different ways to do that. And so us achieving 100% accuracy is just not gonna ever happen even in the perfect case because there's just differences, right? And so there's error coming from that and the sequencing depth of the metagenome are comparing to. We can get as I mentioned before probabilities on the actual individual traits and try to model that and then provide that to the user in some fashion too but it's, we're still working on that a little bit because it's a probability of each trait for each ASV within your community and then you have to do a combination on them. Yeah, one more and then we'll move to the module, yep. So what is the sensitivity of detection? So what is the lowest number of traits that should be there to be predicted? For 16S? Well in our first paper it was actually really low. So we did a rare faction and I believe the cutoff was 100 before we saw a drop in accuracy. I wouldn't wanna go that low nowadays. I mean it's just, I don't think anyone goes that low, right? With 100 sequences. I mean most people have 10,000 or more so I don't think there's a big factor with that with PyCrus at all. I don't have anything, our gold standard would be great if we had really high depth metagenomes because you require a lot more to get that depth. Okay, so we'll cut off questions now so we'll move to the lab.


What is going on guys welcome back to the channel critical overload here? We're gonna talk about a few different horror topics in this video here today We're gonna talk about pretty little liar summer school We're gonna talk about this upcoming cinematic universe regarding these child IPs. We're gonna talk about found destination 6 We're gonna talk about Friday the 13th, and we'll talk about saw 11 So just to start off here with pretty little liar summer school It would appear that pretty little liar summer school is releasing this spring and we have our first look with plot details Cosmopolitan drop this information on Sunday night. I believe it's almost a direct pick up from the end of season one We in sort of on Christmas Eve with our amazing last tag Tag kill which is a killing chip and a on the loose and then we pick up Christmas morning with Imogen and Tabby Unwrapping Christmas gifts with Tabby's mom and getting a panic phone call This is what Roberto Aguirre-Sacasa told Cosmo Cosmopolitan and that's all in the first minute of the episode So we are definitely picking up right where we left off in a really pulse-pounding way Our villain is a female figure of horror, which is something we really wanted to explore in our female centered horror show We also wanted our villain to feel quite Apocalyptic and terrifying and because most of our season is set during summer Besides taking inspiration from our favorite slashers We wanted it to feel a little more apocalyptic like something like the Texas chainsaw massacre or even mid-summer Does the Texas chainsaw massacre feel apocalyptic to anyone doesn't feel that way to me maybe Maybe even more so mid-summer mid-summer, but not even that There's a lot of really horrific imagery tied to movies like that and we wanted to tap into those a little bit And we also knew we had to make a villain scarier than a and it was pretty scary in season one So here's my thing Is this female villain not going to be referred to as a but it's just some crazy person on the loose I guess we'll just have to wait and see these images you saw come across your screen are indeed from the upcoming season I probably will revisit season one before I check out season two But i'm going to do the same thing I did with season one With season two on my channel. I'll probably watch it early I'll probably do it weekly recaps and I'll have a review out as soon as I can But jumping into the next thing Fasten your seatbelts because we are getting a puniverse So this is all coming from bloody disgusting arc on reading Says for starters the growing twisted childhood universe will feature previously announced standalone films Bambi the reckoning Peter Pan's neverland nightmare and Pinocchio Unstrong and introduce new characters such as sleeping beauty the mad hatter and rabbit from winnie the pooh blood and honey All of these characters will come together in puniverse monsters assemble in 2025 when the monsters join forces to take down the world All I can say is I'm literally cringing as I'm reading this All I can say is I still have not watched poo bear blood and honey nut cheerios because I just lost interest in this stuff Once I watched that evil grinch movie The conjuring is a fine horror cinematic universe that we've been getting or been dealing with for the past decade at this point And I'd rather see bright burns teased universe of evil soups before we get puniverse or whatever this is But do you guys like this trend of turning childhood ips into horror? I think but my issue is Not even the idea of turning them into horror movies, but the movies are just trash They're just trash that grinch movie has turned me off so badly And it's not even connected to this universe At some point. I'm probably going to check out the puniverse, but I'm just turned off to it I just I bring it to your guys's attention if you're someone who has enjoyed Winnie the Pooh blood and honey you're looking forward to that sequel And maybe again, I'll give it a chance at some point, but right now I'm just kind of turned off I'm I'm turned off because I think the movies they just look like they're trash That's just being made for the sake of making trash or at least making some cheap horror thing with childhood ips Jumping into final destination six final destination six is opening sequence has been teased by director zack lupovsky On ig earlier this week. He posted this image with the caption If the slate is this big imagine how big the opening sequence is going to be Now as I've been stating on my channel and on twitter if you follow me It should be one of the biggest openings I'd imagine because the premonition is going to involve a tower collapse of sorts Maybe the film will start immediately in the 60s since we know this tower collapse happened decades ago and estrus grandchild Stephanie is going to be having dreams of herself in this tower And their family dying Maybe it starts in the 60s Stephanie has this dream of the past event that her grandmother was never supposed to survive Then she wakes up that could be how final destination six starts that's just my Theory on how the opening could be tied to the premonition in a very different way since this person is not going to be having A premonition about a future event, but it's a past event that is impacting their future But jumping into this next topic here friday the 13th friday the 13th crystal lake prequel show Will have kevin williamson writing an episode and senestelle has tweeted that this episode from kevin williamson Is rumored to be his own self-contained story So I think this episode will explore The relationship between pamela and alias. I just have a feeling about that. It's not me disclosing something I've heard it's just a gut feeling because it's also going to line up with adrian king Alluding to the fact that kevin williamson's episode Seen like its own thing. She alluded to this in a past on the happy horror time podcast. I believe The other rumor that's now being cleared up is the 80s writer That's been a part of the creative team or expected to be part of the creative team that I told you guys I have heard about now senestelle has added some context to it and that name That they've heard is don mancini being in the writing team or being on the writing team Don mancini is of course responsible for chuckie and its ongoing show at the moment It'd be great to have him on board. I don't think don mancini is a terrible writer at all I do just think that what's going on with the writer's room with chuckie with him also being involved I see people that often take issue with don's writing don isn't writing that show alone There's other writers in the mix. I think the other writers are the problem um And I just have to say that as a chuckie fan If this is true This is one of the things that makes me think that season four is not gonna happen If it happens, it happens But if it doesn't I think this might be lending to why not that you can't work on multiple projects at once. Obviously you can Diving into saw 11. So saw 11 might be in some big trouble. Veeranam put out these tweets a few days ago He says here in his tweets Dear saw producers when you guys call all the shots We get saw four five and 3d and jigsaw when you let kevin gruder be in charge We get saw six and saw x Please trust gruder because numerous people involved with saw 11 have reached out concerned about your decisions It's literally a 180 flip from what I heard during pre-production and filming of saw x where everyone was confident They had something that was going to surprise people I didn't know if I would make this post because But we're getting to a crisis point and more and more people every week Some old sources some new or my dms talking about how worried they are And there's a consensus that mark and oren are the problems with saw 11 On top of this according to vink 360 on the saw subreddit filming hasn't even started So a delay is always possible. And I mean do it if it's necessary. Please do it I feel like saw x was just such a good movie and gave me that feeling from a saw film I hadn't felt in such a long time Since my childhood honestly, I would say since saw three.  No, I I would hate for that to happen But let me know what you guys think about this down in the comment section below If you haven't already course make sure you subscribe turn on post notification You never miss a video in the description. I'll have links on my social media accounts I am on facebook twitter and instagram you can message me there to let me know there's any movies news or reviews You let me cover in the future and with all that in mind guys. I will see you in the next video


So thank you welcome to this session about good almost offline learning strategies, so Few words to myself We are a moodle partner in Austria think modular and here meet our lovely team Which is creating great content creating great platforms. We are doing consultancy and also Working with offline content. This is what drives us every day. So we are team of 25 we are based in Vienna and Yeah, but our projects are worldwide and this is also a little bit what we are pursuing to say, okay We have heard today. Maybe in other sessions. I think it was in the morning in in telebord Leave no one behind Get learning out there. This is more or less what we put on our agenda That's the reason why we dedicate ourselves a lot with offline learning because we will see later Not everywhere digital online learning is possible as maybe we understand it here Okay, um, I want to start with you.  So I heard I have 15 minutes sharp. So I will really stop it within the next minute So, please please please vote vote vote ten more seconds nine eight seven ignition six five Four ready for takeoff three two one takeoff. So Yeah That's an interesting result The most of you have practically access on your workplace all the time Yeah, just I see five of you not all the time. So but the most of you have have it Wait a second Sorry We made a very similar question in a different context in this case. It was a TTC teacher training college in Malawi and these were primary school teacher trainings trainees Where we installed a setup a training program and one of the question was okay How many hours do you have functioning internet at your TTC teacher training college? Very similar to question that we have The result is kind of different It's already three years ago. So maybe now this answer will be different things change really quickly But by the time more of half of the students didn't have any let's say reliable internet connectivity and This is what I would like to talk about today because if we go to offline learning, we have a lot of different aspects We have to consider. Yeah, but today Due to time constraints I would really go towards the learners connectivity issue and analyze that and show you how we Dealed with that in several projects. Yeah Okay. Yeah, maybe some facts and figures before we really start so yeah The situation is the connectivity is really growing fast. I myself I was working in just for instance in Mozambique for three years And I was responsible for new technology at a university where there by the time Internet was really really really hard to get and if I look at this figures This gives hope to say okay even in Let's say in continents where there is let's say Not such a good connectivity or was a good connectivity right now. It's getting bad better rapidly if you see just for instance 82% of their Population in the on the African continent just for instance have 3g mobile network. Yeah, this for sure was a boost but so So but we can't look just at continents continents is is a very Broad region of the world We have to look a little bit closer and just for instance if you see where the red regions are people have a lower usage of Internet lower than 20% of the population actually using the internet for whatever they do It's not focused to just to to learning but for all the purposes So there are let's say countries where there it might you might have a target group Which is not able to access for whatever reason economically and with technology But don't worry even Austria where I'm I'm coming from has a lot of blind spots Just for instance if I want to call my mother-in-law I have to do it on the landline there's no way out and Despite of maybe some let's say Serotypes, I really like to call her okay. Let's focus a little bit more on the bandwidth issue Okay, because bandwidth problems is not just bandwidth problems because for each problem There can be a different strategy to work with and I'm really happy that one was around here because one of it is the bootlap But we come to that later Yeah, best case good bandwidth. It's just up here Everything is fine. You have good bandwidth. You can watch videos. You can actually do any digital activity It's not restricted any any kind Next is slow bandwidth. We heard 3g Watching video with 3g. I don't know who of you Likes that. I don't know. I don't the videos are really not so nice So but they're still bandwidth. There's still a few things to do Temporarily not no bandwidth so it can happen for several reasons power cuts whatsoever that you don't have Internet available, but then you have even maybe in a good quality another Problem could be geographically so you are maybe in the valley like my mother-in-law But if she wants to call with the mobile phone, she has to go up to the hill and This is a very common problem if you look at this at this fellow here on the side Yeah, the first thing if you don't have connectivity, I think the most of us put their cell phones in there They are it doesn't make any difference, but it's an instinct we have But there are really strategies and say okay. How what can we do about that or? No bandwidth at all. So the next Possibility where you can get banned with is miles hours of cycling Swimming whatever a way But for each of these are some strategies and I want to show you two Due to time constraints. Yeah, I show you the two that we actually set up the mood lab I think the mood lab in terms of Offline capabilities is a game changer to be honest So it it's already around for ten years. It's mature. It's stable. We heard when what is planned about that I think this is a very promising approach and we really like to use the mood lab and and just for instance What is here on the side? This is one of our projects that we did in Malawi as well and there we implemented the training for epocos This is ultrasound machinery and doctors and medical stuff is we trained them with that and This is actually offline capable We were using videos and we were using quizzes very simple didactical design But it works really nice and to the video I come later because you could imagine video. Okay huge size But we managed somehow to squeeze it in You don't need any complex server structure I come to that also later because you can see here the box. Yeah There's moodle installed but it comes with a little trade-off and this one you don't have with the app The app you can be it can be used you have a server you use it. It synchronizes really. It's a charm When we go back to the scenarios we had with the bandwidth where we would Consider using the app is just for instance with slow bandwidth. Okay, you go somewhere You have slow bandwidth you say download the course and then you wait Maybe you put yourself on here go for a coffee or for a beer come back and then you have the content on it Maybe you need two or three beers. Maybe so it depends Temporarily no bandwidth. Okay, same thing here. You wait until you have internet You download the course and then it's available for you content is there and you can actually use it And relocate. Yeah, go up to the hill download the course fine What are the chances of such a setup? Okay, no end user maintenance. Maybe this is not entirely true. It's you have End users have to install the app anyway, but this is very simple. It's available on any app store You download it you connect ready. This is was really really this works really nice Syncs with server automatically so just for instance you have a forum entry you have a quiz You can even do it offline the quiz with a few tweaks. You have to be honest But you can do that so don't use deferred feedback. I think this is still not working or one I don't know with the quiz It is possible It's not possible. Of course, it's not possible. You can't do that five minutes. Oh my god Okay, let's go to the challenges Yeah, not all interactivity is available. You have to check. Okay, which one you can use actually The mood app renders differently than the the online version means you have to cross check. Okay how does my interactivity I use actually behave and For client servers, of course, you need to be online somehow And it's moodle only The second one. It's the moodle box. We heard it several times already We used it as well.  It's over there So everyone who is around let's say 10 meters could actually log in it switched on I installed a moodle there And it can be used it's based on the Raspberry Pi. It's a tiny moodle server The moodle box initiative itself is is mostly just the software. We pimped it a little bit because we Very often where it was supposed to use there is also power issues and something like that so we put in a UPS and a battery we put in a router a stronger router because this was one of the main drawbacks Um Maybe the chances is this this mood box is well documented. The Raspberry Pi is Against its fame. It's really powerful, especially when you have enough memory eight gigabyte and You can also install other platforms like and next cloud key weeks, whatever, whatever, whatever So it's it's actually more. Let's say broader than the moodle app. I Jump to the next one. Maybe To to have a decision-making if you have a decision to make okay in my projects, which way to go go where there's the most green Please yeah That means if you have to use the moodle box It can get somehow complex But of course there are scenarios where the moodle box makes perfect sense Where there is no internet and people can't get internet then use the moodle box or when temporarily means okay You have every day five minutes internet Or you have content which is Actually impossible to get to the users then the moodle box makes sense But if this is not the case think about it There may be other options are more let's say convenient easier to set up more sustainable at the end Yeah, and of course the most simple solution would be the online the normal moodle online people go online With the browser this would be the easiest solution. How much do we have I? Promised instructional design. I'm so sorry that I have a rush through that, but you see some Some let's say which impact does the instructional design have to moodle I was talking about the project with the ultrasound machinery We used videos, but the cool thing was we used very static videos We used recordings from PowerPoint sounds boring But the thing is we compressed it and the video was smaller than the PowerPoint itself that we recorded Which means okay, we had actually we could make use of the dual channel of visual and of sound and Provided to the learners So if we would have put just friends and I've seen some videos where there's somebody's talking and that's who the PowerPoint Presentation we didn't do that because a person which is moving around you can't compress it that nicely It will be big it will be not accessible for the users These are all Interactivities in moodle. Maybe you know it. This is the feedback. This is the assignment Chris H5P scum packages forum These are all available a moodle and these are offline available Yeah, and here the media of course images, please images video or files or audio This is all available offline on the app. So As well, of course on the moodle platform on the moodle box So here's some you have the slides you can even be analyzed Okay, which interactivity and which content makes sense or which can cause trouble doesn't mean don't use video, but use it with care So do we have time for the recommendations? That's nice Make things smaller. Yeah, please if you use the content Please provide it in a way that define in a final stage. We have seen courses for Regions where we know there is no real Possibility to download they had four gigabyte People were asking why is this not working? Of course, you can't download for a gigabyte if you have a modem like connectivity Please compress it cut its Datic content adapted for the final use case. So if you use an image with 200 Thumbnail, please don't use the original image with 2000 2000 pixel Check your interactivities avoid bandwidth intense activities especially for the moodle app Check if chosen interactivity is available on the app. This is growing every day So please if I say now this is not working maybe tomorrow. It is a line technologies Choose the less complex solution Here are some other initiatives that we are already have experience with and times up. Thank you


Basketball, the fourth, the fifth, the sixth. You got it, you got it. Here you go. Nice. Just like that. Here you go. I remember swing to this when I went. There you go. Go, go, go. Discuss the other things. You can start doing the blood sweep if you want. Go, go, go.


Next up, I have the pleasure of introducing you to an expert in the workspace industry, Ryan Anderson, who is the Vice President of Global Research and Insights at Herman Miller. Much of Ryan's work is centered on how technological and social changes have enabled ways of working and living, and how the places that we inhabit can support positive, productive experiences. So how does that translate at home? We know that a comfortable, intentional workspace can make a huge difference in productivity as well as your physical and mental well-being. Ryan's going to share with us how individuals and organizations can adapt to existing environments, whether it's a small city apartment shared with friends or a large, single-family home in the suburbs, so that you can live your best work from anywhere life. Hey, everyone. I'm Ryan Anderson, Vice President of Global Research and Insights at Herman Miller. I'm thrilled to be able to spend some time with you today talking about creating great home workspaces. If you don't know Herman Miller, we're primarily known for the furniture we make for homes, offices, hospitals, schools, gaming environments, and beyond. We love talking about how great design can impact people's lives, and today we're going to dive into that as it pertains to home workspaces. By the way, I am active in the chat right now, so if you have questions or thoughts as we go through, feel free to ask, and I'll be happy to help you. Our goal for the day is pretty straightforward. We're going to try to talk about how the design of home workspaces can improve productivity, health, and just our general experiences, our enjoyment of these spaces over time. I'll be drawing upon over 60 years of research into future of work and workplace, including home workplace. In fact, we released our first work-from-home product all the way back in 1941, so we've been thinking about this for a while. I'll also include several statistics specifically from a tool that we created to help people have better experiences working from home, which I'll tell you about later. About 20,000 people have used that tool, so the statistics you see will be drawn from that data. And ultimately, I want to provide you with frameworks and tips. Yes, some dos and don't dos as far as the design of home workspace, but more importantly, I want to be able to zoom out and talk about at a bigger level what really makes an effective good positive work-from-home experience or not, so that you're equipped not just to think about the design of specific parts of the space, but to really improve that experience overall. So we'll start with this framework, which is people process place. This is the way we do our research at Herman Miller. We don't start with the spaces. It's tempting to at times, particularly when you make and sell furniture, but you really can't get the spaces right until you ask who's using them and what are they doing. And so that's where I want to start with us today. Your home workspace or maybe this is for your employees. I know some of you might be tuning in to think specifically about your own space. Others might be representing an organization thinking about your employee's space. In either case, just know that homework spaces are often not just used by one person. 54% of the people that have used our work-from-home tool have said, yes, the spaces are dedicated for individual use, but 46% are shared. And we tend to see those percentage of shared even higher in big cities and outside of North America. And so give some thought to your own situation. Are you the only person using the space or is your spouse or partner potentially going to be doing work or other activities from here? Might you be sharing it with older people or younger people? You know, multi-generational households, we're at an all-time high since World War II, even before the pandemic, but we saw them increase in 2020 and the evidence suggests that they're still increasing in 2021. So even if it's primarily you using this space for work, it might be that you've got a child who's using it for homework or an older person in your household, connecting on video with friends or family, think through that as holistically as you can. And try to think about the differences in abilities, physical, cognitive, sensory abilities, activities, and preferences, because it'll make a difference. The way that we'll approach designing the space might be different, even the objects. You know, does it make sense to have a chair that has more manual adjustments that can be really fine-tuned for one person, or does it make sense to have a chair that doesn't require many adjustments so that it's easily shared between people and so that the person who uses it the most doesn't come back and say, oh, somebody adjusted my chair every single time. So these are just some of those factors. So think about the users both now and in the future, who might be using the space next week or next year. And then once you've given some thought to the who, now let's start thinking about the various activities, you know, what people are actually doing. And I'd really encourage you, if you've never done this, to try to catalog what you do in the course of a week. You can go back and look at your calendar, or you can just grab a notebook and start writing some things down. Because the better you get at understanding the full breadth of activities that you do, the more you'll be able to determine whether or not your home workspace really does or does not support it. Because in a more traditional office environment or a hybrid situation, we can rely on corporate offices to cover off on some of these activities. But when it's work from home as a full-time remote or remote first approach, we need these home workspaces to cover off on as many important activities as possible. So that we don't find ourselves saying, oh, I just have a really tough time doing this. So I've put a few words on this slide, process work, email, expense reports, learning, training, concentrated creative work, you know, do you have a place where you can be in PowerPoint or a spreadsheet for a couple hours at a time? How about contemplation or deep thinking? You're not using any tools, you just have to think through something. Video presentations, different types of communications, synchronous, asynchronous. But also, even beyond work, is this a space where you might want to use it for gaming or use it to watch some TV or some streaming media, I should say. It wouldn't actually be a TV, but you know, I'm a parent of some teenagers. Sometimes I lose control over the TVs in our house. I've been known to come to this workspace and use it to stream some content just for enjoyment. And by the way, I'm going to talk to you a little bit about my own home workspace too, just as an example of some of how I approach this, just because it can be a little bit more relatable. But give some thought, what are the full breadth of activities that you really need to make sure that you've got covered or else you're going to find that your productivity suffers as a result? And then as we turn our attention to place, think through the various places within your home where some of these activities can happen. There will be a primary space, probably with a desk and a desk chair, but that's not the only space that some of these can happen. Maybe some things want to happen from your dining room table or your kitchen. We don't want to see you spending hours and hours in a place that's not ergonomic or comfortable. But there might be some activities like I've got a phone call, just an old-fashioned audio phone call that I decided I'm going to take from the back porch. It's good to think of this as a continuum of spaces within your home. Even if you're in a real small apartment in a big city, chances are you'll have a primary, but also a few secondary spaces. And you can then begin to ask the question, what activities can happen where and what should the primary workspace really focus on? I'll tell you, in terms of my work life, I love working outdoors. I spend time working on my back porch a lot. I might take an audio call from my sofa in the middle of the day just to kick back. I spend most mornings starting out in a very consistent way. I get up, have a cup of coffee, sit on the back porch. Think about what I want to get done in the course of the day. And then I take my dog for a 45-minute brisk walk. During those walks, I might use it to think about what I'm going to say during a presentation or think about a conversation I need to have with someone or even listen to a podcast so I can learn. So in my mind, I think about all these spaces, even the sidewalks around my neighborhood as places where some of these critical activities occur. And the more you think about it, the more you can make sure that your primary workplace and your secondary within your space is designed to support those activities we talked about before. Now, let's turn our attention to the actual design of the spaces. How do you begin to go about thinking about creating this space? Well, I'll give you another framework, not surprisingly, which is think about the surroundings, the furnishings, and the tools. I know we're a furniture company, and of course I'm going to talk to you about furniture. But it isn't just the furniture. Like in that image, the surroundings here include these beautiful exterior windows. The furnishings include a chair and a table. The tools can include not only digital, but analog things, books, pens, anything you need to accomplish your work. And when you think about these holistically, it's the best way to create spaces that really work together. So let's focus a little bit on those surroundings. 52% of the people who have used our work from home tool say they have some sort of dedicated space, dedicated room or space that can be closed off from the rest of their environment to do their work. 48% don't have that. Now, as I dig into the data a little bit more, not surprisingly, it's more suburban rural locations and countries with larger homes where we find that to be the case, like the US, Canada, Australia. You get into spaces that are maybe smaller architecturally or you'd have less likely to have a spare room, places like India, mainland China, a whole host of other areas. Then you're going to have to work with different constraints. And it is possible to think through the surroundings, even as taking basically a portion of what is essentially a larger shared area that may be used for living or dining other things and still create a great work from home experience. Begin by thinking about boundary. Boundary can mean a number of things. It can mean walls, but it can also mean screens, foldable modular screens include curtains. Anything that provides you some privacy, some visual privacy, or that can act as a backdrop. And backdrops are important for those of us that spend a lot of our time on video, including me. You can see in this picture, as well as my own home workspace, the desk is pulled away from the wall so that the video camera is pointed at essentially what is a controlled environment behind me. I think most of us remember that BBC video that went viral with that guy being interviewed and his kids busting the room behind him and all this chaos ensues. Hey, that's home life, right? We've got kids and pets and all sorts of other stuff going on. I think it's best to keep the chaos in front of us. So having something with some opacity, something like a wall or a screen or a curtain behind us makes a ton of sense to try to make sure that our views are protected. So those are some of the considerations with boundary, but it's not just boundary. It's other things that are related to our surrounding as well. Lighting, critically important. If you get some natural light, that's wonderful. It's great, great for the body and the soul. But make sure that it's not hitting your screen and creating glare.  If you don't have access to natural light, there are still some ways of using great artificial lighting that you can think through beyond just throwing in a normal light bulb. In this particular home office, I've installed an additional pendant light above my desk. I've used a light bulb that actually can be changed to change the color temperature. There's something known as circadian cycle. I'm getting real geeky research here on you here. Sorry about that. But basically the sun in the morning is more intense with cool temperatures. And then the afternoon, it's less intense with warmer temperatures. You can even replicate that with light bulbs inside your house. So think about the lighting, whether it's artificial or natural. And then maybe even think about some additional natural elements. There's a kind of a school of design known as biophilic design. It's just kind of this movement to try to help create interior environments that replicate outdoor habitats. Really interesting. But it's things like plants. And you can see that I've got plants behind me, fresh air. Fresh air does some really good things. It clears out the CO2, which can actually improve our cognition. There's some really good studies showing that as the air quality of a space gets worse, we don't think as well. And it's just as great getting that breath of fresh air. Living in Grand Rapids, Michigan, I can't always open up my windows in January. But even that might open them up a little bit. And then views. Views are so important so that we can do something other than look at this pane of glass, you know, a couple feet from our face. Sometimes we'll say 2020 rule, meaning every 20 minutes, take 20 seconds to look at something 20 feet away or farther, just as a way of trying to change your depth perception, get your mind thinking. I actually have put an aquarium in my home office on the other side of the wall. There's some good research indicating that looking at aquariums lower blood pressure. That's why you find them in dentist offices and doctor's offices. And so whatever those might be, this combination of views, natural element lighting, really you want to be an environment where you feel nurtured and taken care of. So that's surroundings, or at least some of the considerations for surroundings. Now let's talk about the furniture. We need good furniture to be comfortable and productive. 62% of the people that have used our work from home tool said they experienced some discomfort throughout the workday, top issues, back, shoulders, neck. Those are heavily correlated with our seated posture. Only 24% of people who use the tool said they have organically adjustable work chairs. Interestingly, our research as well as the research many others indicate that when you give people the choice of what they can get to improve their home office, they almost always start with good desk chair and for good reason. Let's talk about why. This is a weird thing to say, but your head weighs about what a bowling ball does. And it is effectively balanced on top of your spine, which is designed to be in an S shape in order to effectively balance that amount of weight. If your head leans forward too far and that spine can't be in an S, it's almost like putting that bowling ball on the end of a fishing rod. And you can imagine the toll that it would take on our neck, shoulders, back. And so we need to try to maintain that S shape in your spine. And as we often say, the eyes will win. Meaning it's usually what we're looking at that draws us into other postures that are sometimes not very helpful. So I'll show you in a minute, making sure that, yes, you've got a great chair, but that you think about what you're looking at. And in particular, if you're somebody that uses a really small device that it's not constantly drawing you forward is really important. In fact, you might even ask yourself right now, what kind of posture are you in?   Ideally, we really don't want that for long durations. The last thing I'll say here about chairs is there's a lot of talk about the importance of lumbar support. It's just kind of gotten into our conventional wisdom that lumbar support is really important. It is important, but you know what else is really important and maybe even more important is sacral support. So our back has different zones, thoracic, higher than lumbar than sacral. That little yellow part of the image is our sacrum. It's right above our tailbone. And as you can see by its shape, it wants to rotate forward like that. And so the picture on the right is one of our chairs in body. That happens to be the gaming version of it. You can see right at that base to support that sacrum, it rotates the person's hips forward, which does a great job of helping to keep that overall spine in S shape. So lumbar support, yeah, but really pay attention to your sacrum and what your overall back does when you fully engage with the chair back. I want you to have an image of what really kind of holistically healthy seated posture looks like. So I'm going to violate every principle of PowerPoint and presentation by putting this image, which is kind of an eye chart out there for you. You don't need to read all the details, but I do want you to just soak in on the different facets of this image, starting kind of at the bottom. Her feet are firmly planted on the floor. That's important. Her legs coming up to her knees and down are in a 90 degree shape. And we often see people not doing this. Either they're putting their feet on their chair base or they just can't touch the floor because their chair is adjusted too high. Probably because their desk is too high. This kind of acts as an ecosystem. Ideally, we want those feet flat. We want those knees at that 90 degree angle.  We don't want that. It can inhibit blood circulation. Likewise, we don't want knees way up above our hips hitting the bottom of the desk because that's going to be problematic as well. Notice that her back is fully engaged. Her arms are to her sides and in a 90 degree angle with her arms moving forward and her eyes are looking straight ahead. And so we want movement throughout the day. We don't want to sit static like this for long periods of time. But if you want your back to be really effectively supported, as well as the rest of your body throughout the work day, keep this image in mind. And if you want to dive deeper into this, by the way, we've got all sorts of videos and other resources on hermameller.com that talks about healthy sitting. Now, let me just talk about a couple other things, which are our desk surfaces and our storage. 72% of the people that have used our work from home tool say they do have a dedicated surface. So they're not working from the dining room table, which is great. Only 11% have height adjustable surfaces, which we understand. It's not something that everyone has had a chance to get or can afford. But a couple of considerations. If your desk surface is not height adjustable either through an electronic mechanism or manual mechanism, do try to think about getting that desk right when you install it at the best proper height. So high enough so that it's not sitting on those legs, but low enough so that you're not trying to get up to reach it. Many desks do have the ability to be installed at different heights, even if they're not necessarily adjustable after they're installed. So get that right the first time, even if you've got a kind of jewelry bed desk a little bit. But then if you can ideally try to get a height adjustable desk. It has all sorts of benefits. One is what I just said, which is just for normal seated work. It's better because you know you can make sure it's at the right height. But then there's also the benefit of getting it up a little bit higher, maybe from when you're on video. So the camera is looking right at you, not up your nose, but also standing. And I do want to say a word or two about sit stand. The goal is not to stand for long periods of time. Standing is actually more harmful over long durations than sitting. And so the ideal is that you're taking breaks throughout the day to adjust that up. Stand for maybe 15 minutes, sit back down, we want movement. Our ergonomists often say your next posture is the best posture. And if you don't have that height adjustable surface, you can still get that movement, right? Like I said, go to the kitchen and maybe put your laptop there on the counter and work for 10 minutes, come back to your desk. We want that kind of movement. The last thing I'll say here is just like we talked about primary and secondary workspaces, surfaces also kind of have like this primary secondary thing. Our desks are our primary surfaces. Ideally, we don't want them cluttered up with tons of stuff that we're not using. So keep that primary surface for the tools and the content and the things that you're primarily working with. Think about having another surface, it could be the top of a storage cabinet where your other anticipated things might be found. Maybe it's where work that you might not reference every day, but you might reference once a week or once a month sits so that we don't find that your primary surface is all cluttered up. Now let's turn our attention to tools and then after that I'll begin to wrap up. There's tons of different tools that we use to do our work, including all of the digital things. But like those surfaces, they also kind of come in primary and secondary forms. Meaning your laptop, webcam, mouse, keyboard, maybe microphone are things you're probably using a lot. So they belong on that primary surface. But there's other things, could be notebooks, could be pens, papers, could be a printer that maybe you want to think about as having in a secondary location once again so that it doesn't clutter up your primary work surface. External monitors or a laptop stand like what's shown in this image can be very helpful in terms of maintaining that great posture like we talked about before. Because why? The eyes always win. When we get that surface up we're less inclined to hunch over looking at a small screen. Wi-Fi extenders and mesh networks also relate a lot to the design of home office space because sometimes we'll find that there's an area of our home that's a little bit removed from the cast that we want to use as our primary workspace, but because it is removed it doesn't get good connectivity. Invest in the tools necessary to get the Wi-Fi to the place that's best rather than sacrifice that and find yourself working in the middle of a busy living room. A good Wi-Fi extender or mesh network can do really good things as can noise cancelling headsets. Oh my goodness they can really deal with some of these spatial things that we can't control otherwise. They can help isolate acoustical distractions for you. They can also help reduce the distractions for the person you're interacting with through these microphones that are able to cancel out anything other than voice level frequency. So those are just a handful of the considerations around tools and then we just need to think about how all of this comes together. I'm going to break another PowerPoint rule by transitioning from these beautiful Hermmiller images to a picture I took an hour ago of my own home workspace. You know I've worked primarily from home for years. This is what works for me, but you know what? I've done lots of little tweaking and experimentations. I have another bookcase off to the side that you can't see here that holds my printer and some other tools but I've got a primary work surface that works really well for me. I like to keep it clear. I adjust it a lot. The area behind me, yeah I can set a few things there but it's primarily there for plants and other things that make my surroundings into something that I like and yes there's a boombox there because I love to crank the tunes when I do email. Loud music and email go really well for me. You also can see I've got an external mic because I do a lot on video. A great ergonomic mouse from Logitech. So think about what's right for you and make it work as a system and if you still need more information there's an excellent tool for you which I've already mentioned many times our work from home tool wfh.hermanmiller.com. It is not a sales tool. It doesn't recommend any products to you. It is solely there to help make recommendations. It also gives you a score. Don't worry so much about the score. Look at the recommendations and how it's seeking to help you not only in terms of physical ergonomics but also some other dimensions that we didn't really unpack yet today. Cognitive ergonomics related to how we think and feel as well as social. You know we might think of social ergonomics as how the space impacts our relationships and yes that's really important in corporate offices where there's lots of people together. It's still really important working from home. You are social people. I'm a social person. We need to think about all facets of our work from home experience and this tool is designed to help you do that. So I hope that that has given you some new ideas, some new tips, more importantly a more holistic view of what you can do to take control over the environment around you or to empower your employees to do so to create productive, healthier and ultimately just better work from home experiences. Thanks.


You're listening to This Week in Chiropractic. Here are the headlines for the week of May 7th, 2021. In news, a new Kickstarter campaign has raised over $1.6 million for the first Bionic knee. The E-Knee claims to be an intelligent knee support solution and features compression a 28-hour battery and a control box. The device will retail for $469 per pair. A new chiropractic school is coming to Kentucky according to Dynamic Chiropractic. A private Christian University, Campbell's Bill University in Kentucky, plans to accept students during the 2021-22 academic year as reported by Dennis Short, Dean of Chiropractic Operations. In events, the World Federation of Chiropractic has announced their biannual congress to be held September 23-25, 2021. The event with a tagline Chiropractic for a new normal will be 100% virtual this year due to the uncertainty around the COVID pandemic. In research, rubber pillows and spring pillows may have better performance than feather pillows for neck pain according to a systematic review and meta-analysis from clinical biomechanics. Authors identified clinical trials assessing the effects of different types of pillows on neck pain, waking symptoms, neck disability, sleep quality and spinal alignment. The meta-analysis revealed significant differences favoring the use of rubber pillows to reduce neck pain, reduce waking pain and neck disability, and enhance the satisfaction rate. Pillow designs did not appear to influence sleep quality in patients with chronic neck pain. A meta-analysis failed to identify any moderators that would enable clinicians to identify which patients are likely to benefit more from spinal manipulative therapy. The study looked at individual participant data from 21 randomized control trials to analyze 23 potential patient moderators, things like duration of back pain, smoking, previous exposure to spinal manipulative therapy. The results showed small effects that did not represent minimally relevant differences. A new systematic review reports an association between back pain and mortality in women and adults with more severe back pain. Eric Rosine et al. looked at 11 studies with over 80,000 participants. The presence of back pain in itself was not associated with an increase in mortality. However, back pain was associated with a modest increase in all-cause mortality in studies of women and among adults with more severe back pain. Two conflicting papers have been published regarding the Global Summit on Manipulation for Non-Musculoskeletal Disorders. A large majority of participants in the Global Summit, which took place in September of 2019, published their findings in an open-access systematic review in chiropractic and manual therapies. The authors concluded that they found no evidence of an effect for SMT for the management of non-musculoskeletal disorders and recommended that governments, payers, regulators, educators, and clinicians should consider this evidence when developing policies and considering reimbursement for treatment. Following that publication, four participants in the Global Summit, who declined authorship, published another paper in the Journal of Manipulative and Physiological Therapeutics. The article in press shares concerns that the authors of the systematic review were extrapolating beyond the data and making sweeping policy implications based on weak scientific evidence. Those are the headlines for this week in chiropractic, May 7th, 2021. For links to these stories and more, go to thisweekinchiropractic.com. Well, let us take a look at some of these papers and some of these stories. There's a lot of research recently with many of the publications coming out around this time of the quarter. Before we get to the research, let's talk about this Kickstarter campaign for the E-NE, your Customized Intelligent Knee Support Solution. Now, I think we probably most of us agree that external supports aren't ideal. I mean, there's cases when you want to use them, but we have seen these exoskeletons in the news at least. They're doing a research and testing in the military for full-body exoskeletons. And of course, what was the Matt Damon movie? Elysium came out that featured not just exoskeletons, but jetpacks and things. There's another one with Tom Cruise like that. But this is kind of the first consumer targeted at least and probably consumer available exoskeleton-like device. And it's a knee brace. It's got, I'm not sure exactly how it works. It's not very clear. There's these red coils, which apparently provide some added support. It is a compression sleeve, much like what you would just find at your drugstore. But it does have a battery and a control box. And so it's got to be adding some type of mechanical support. In Hong Kong dollars, they've raised over 1.6 million. That is equivalent to roughly $200,000 US. The thing with these Kickstarter campaigns is that a good percentage of them never actually make it to production. And so if you put your money in and the product doesn't ever come out, you're kind of at a loss. I mean, the creators of it could opt for a fund you, but usually what these funds are used for are pre-production, machining, finding a factory. And so that money is used. It's just that there's always, almost always barriers to actually getting them out into the market. So it'll be cool to see if these come out. I would play with one, but I probably will not buy one. If you got an early enough, they weren't too expensive, but they are going for MSRP of $480 for a pair, I believe. Maybe it's just a little bit less than that. What are your thoughts on new chiropractic schools being created? This is a story and dynamic chiropractic from the beginning of April that some chiropractors in Kentucky are planning on accepting students for a new program at Private Christian University in Campbell'sville, Kentucky. Now, there's other programs that have come up recently, one in Florida, part of a medical school. There are talks about University of Pittsburgh fundraising to create one. And they, of course, are hosting the primary spine practitioner seminars once or twice a year, which is a certification you can get. And that's Michael Schneider. That's the PSP program is Michael Schneider, Don Murphy, John Blinking on his name, but a number of people who are doing the PSP program, which probably has shown, you know, viability for chiropractic program at Pittsburgh. Now, Kentucky is a much smaller state, much less populated. I just, I worry based on the data on market demand, more for PTs, and the data there is more clear. There's over 200 physical therapy programs, most of them at public universities, and over 40 in development right now. But a letter from the College of Academic Physical Therapies came out recently saying that in 2030, by 2030, there will be an oversupply of 25,000 PTs. And I can't imagine it would be very much different for chiropractic. Now, our utilization rate is only what average 10% across the nation, low back pain, neck pain, musculoskeletal disorders, and other things that we can potentially help with are prevalent. And so there's certainly a need if we can penetrate the market. The question is, can we do that by opening new schools? Or do we need to make some reform to the ones that are already out there? Interesting to see. Certainly will be fun to follow this and see how it goes if they actually do make it to launch and make it to accreditation and then make it to graduating the first class. Well, the World Federation Biennial Congress is coming up in September. It'll be 100 percent virtual, which is going to be great, because I've not been able to go. I was really hoping to go in Berlin a couple years ago. So virtual would be great. Now, I'm going to be curious to see how they do it. I participated in the Carloquium a couple months ago, which used a platform called Verbello, which is this second life fortnightish virtual world that you actually walked around through. They the WFC says they are partnering with the best in the business, as well as Parker seminars to develop a worldwide reputation for delivering outstanding online events. I did not participate in Parker seminars, unfortunately, but it looked like a much better implementation than Carloquium. Carloquium wasn't bad. They're really great pros to it. But on the whole, I personally don't think that's the way to do virtual conferences. Something more like what I think Parker seminars did, I can get behind that. We'll see what they're they're going to do. Production values got to be high, right? They got to invest in more than a webcam and air pods, right? You've got to have good quality audio number one, good camera and lighting number two, and then, you know, some good production. So, hey, WFC, if you want some help, I sort of am figuring this stuff out. I don't really know what I'm doing yet, but I'd love to make sure that this conference, at least the production side of it, is a hit. Alright, lots of research over the past few weeks. It's kind of that time of the quarter when multiple journals pre publish their papers online, at least. And so I've only included a few, but there's quite a bit to go through. So we'll be quick on the first few. I really want to spend time on the global summit.  So this, this paper caught my eye, the effects of pillow designs on neck pain, waking symptoms, neck disability, sleep quality and spinal alignment in adults, systematic review and meta analysis. I've yet to read through it all, but the conclusions are that rubber pillows and spring pillows may have better performance than feather pillows. This kind of makes sense to me. I mean, at least for those of us who've grown up using pillows and having slight flexion at night or at least laying on the side, you've got to have some support to that. Now you can make the argument that it's better to just lie flat. You know, Katie Bowman, if any of you have read her stuff, nutritiousmovement.com, makes the argument for just laying on the ground. They've gotten rid of all furniture in their house. And that's, that's something to aspire to. But, you know, pillows like memory foams or the purple pillow, I've got a purple mattress have not tried their rubber pillow seem to be better, according to this study. So I thought that was pretty interesting to look at. I need to get a new pillow. So if you have a recommendation dropping in the comments, if you have a pillow you love other than sorry to get political the my pillow one, I don't think I'm going to support that. Moving on though, moderators of the effect of spinal manipulative therapy on pain relief and function in patients with chronic low back pain. So the authors took individual participant data from what was it I said about 11 studies. So they were actually able to get the individual data to do this meta analysis. And what they're trying to find is, are there any moderators that can tell us who's going to respond to spinal manipulative therapy? This currently is somewhat of a holy grail right now in research with Greg Kochak doing the the biomechanical, you know, this engineered device that looks at stiffness. And then another study they did that looked at just who responds and it's the people who respond like that's they don't know how to tell who will respond until you actually try the adjustment and measure their response. And if they respond well, then continue if they don't respond, try something else. And then they looked at the stiffness of the spine to see if that would change anything. These authors are looking for a number of other things, whether they're smokers, whether it's chronic, how long have they had it less than a year, longer than a year, have they had spinal manipulation in the past 23 different moderators, I think are what they evaluated. And for the most part, nothing, nothing really worked. There were some small, small effects with smoking and previous exposure and duration of low back pain, but not enough to make to be clinically significant. So the hunt continues for moderators that will allow you to tell who will respond or not. I really liked this paper by Eric Racine and others. We know that back pain is the most common cause of disability in the world. 80% of people experience it throughout their life. And the economic burden, the burden of disability from low back pain and neck pain is higher than really just about any other condition, even the big bad ugliest, the cancers, the HIV malaria in the economic burden, right, loss of work, loss of pay, inability to just get up and move around during the day, right. These are measures of disability. There's all these metrics like years lived with disability, a disability adjusted life years, quality adjusted life years, all these ways to try to quantify the impact. But what we know, we know that back pain doesn't really cause death, like a lot of these big bad ugliest do, right.   But it turns out there might be an association. And so if you look at people with low back pain, and it turns out particularly women who are disproportionately affected by back pain, at least when considering disability, when you look at women, and when you look at those with a more severe back pain, there is an association again, no causation can be inferred, but there is an association with all cause mortality, meaning that well, it could mean a lot of things, right. People who are more likely to have severe back pain, including women, oftentimes are also the people who are more likely to be in poverty, more likely to just be unhealthy in other ways. And this comes back to probably, I'm making some assumptions here. This is not necessarily what the paper said, but it comes back to the social determinants of health, right, these things that we can't affect as healthcare practitioners directly, the environment, the education, the demographics, the region that you grow up, are social determinants of health, and will determine how healthy you are, access to healthcare as well. So it's not too surprising that there's an association. But to my knowledge, this study has never been done before. And I think it's important now, when you're talking about disability to keep in mind, yeah, actually, it also is associated with mortality. Well, the global summit on, oh, I've got the wrong paper here, by the way. No wonder I made a mistake here. So let's see if I can pull it up while I'm talking about this, but the global summit happened in September of 2019. And 50, count them 50, researchers with experience, you know, well known researchers like Jan Hardfix and Pierre Cote, so many that you would know went to Toronto, following a multiple months long research, and pulling up lots of different papers and randomized control trials that look at non musculoskeletal conditions, right? This is a claim that's existed ever since chiropractic started that we can cure diabetes and cancer and bedwetting and infantile colic, all of these things that just up till now don't have great support. They looked at these did a systematic review. And the conclusion was, yeah, there's really no evidence of an effect of SMT for the management of non musculoskeletal disorders. And these authors kind of voted on, yeah, do we do we agree with a statement for each of these conditions? And as a whole, and it was over 80%. For some, it was 190, 94% agreed. But, but there were four authors, again, respected researchers who you would know. Christine Gertz, Eric Hurwitz, Bernadette Murphy, and Ian Coulter, names that anybody who follows chiropractic research would recognize at least, who said, well, no, wait a minute, wait a minute, they declined to author this systematic review that was the result of the global summit and said, none of you guys are taking this too far. They didn't necessarily disagree with many of the statements, but some of the kind of implications, the conclusions, they say they were extrapolating beyond the data and making sweeping policy implications based on weak scientific evidence. So again, that original systematic review from the global summit of 38 plus authors, in their conclusion, recommended that governments, payers, regulators, educators, and clinicians should consider this evidence when developing policies or in other words, the lack of evidence when developing policies and considering reimbursement for chiropractic, for infantile colic, for asthma, for, you know, all of these non-musculoskeletal conditions. When I read that, I was, I also was a bit concerned. You're saying that there's a lack of evidence to support or refute, the original paper says support or refute any benefit, any efficacy, effectiveness of chiropractic adjustments for these non-musculoskeletal disorders. But then you're saying that governments and payers should consider this when making decisions. I mean, I don't know for sure, but my impression is that medicare and the government, they want to pay as little as they possibly can. They want to limit the amount of money they spend on treatments, even if there is pretty good evidence, unless it shows them that they will save more money later on. And so to suggest that they take this paper to inform their policy decisions, to me, was a bit of a reach. And that's really what Christine Gertz and the other authors felt now. That said, this paper on extrapolating beyond the data from my reading had some misquotes and misstatements about the original systematic review. I read through it and they're trying to say that the authors were lumping these conditions all together and saying all of these conditions like asthma, like bedwetting, like infantile colic, all of these things are just one thing. But when you really look through their systematic review, they did break them out and they assess the quality and the quantity of evidence for each. The second paper also states that, let's see if I can find it here, that they said that SMT was not effective and should not be studied further, but they didn't. They clearly said that, albeit in just one sentence, but they said that further research needs to be done. And so it's just interesting to me from an outsider, someone who isn't really involved in publishing research, but to see this type of discussion and debate back and forth. I think it's healthy. I think it's good, but I think it's important for us to take the time to evaluate on both sides each of these claims that they're making about the others. And I'm very curious if there's any hard feelings here. I'd love to get the corresponding authors on a podcast to discuss these. I think it'd be very valuable to get more details on this. So I think, as many others have said, that we should keep abreast of this literature. So the links to all of these are in the show notes. Just head into this week in chiropractic.com and look for May 7th and the links to these papers will be right there in the show notes. You can get them hopefully the full paper, although it is interesting to note that this reply from Gertz et al. was published behind a paywall in JNPT. But I encourage you to go take a look at these articles as well as others that I will tweet out and share. And hopefully next week and the next two weeks do another show with many of the other research papers that have come out. In the meantime, please let me know if there's any stories I missed. Tell me what your thoughts are on new chiropractic programs coming and being developed. And also send me a message to let me know if there's something that you'd like to hear or someone you'd like to hear on the show. I'd love to bring in co-hosts to have more of a discussion rather than just my opinion, get some more informed people into this show. So thank you very much for watching. This has been This Week in Chiropractic for May 7th, 2021. I'm Dr. Nathan Cashin, and I'll see you in the next one.