When you journey past level 1000 of the back rooms, stuff starts to get pretty weird. I'm not going live. And the level in today's video is absolutely no different than that. I've not gone over many levels past level 1000 since none of them are actually confirmed to be past level 1000. These are just new ones that people have explored. But since it's Brugtober, I want to kick off this week of scary disturbing levels with today's level. So if you like tiled, looping hallways with mannequins that follow you around when you're not looking and giant floating eyeballs, then welcome to Backroom's level 1411. Let's go ahead and get into it, shall we? So Backroom's level 1411 doesn't actually have a classification graphic. So I'm going to make one for it. So what I do, I'm going to give it a classification of a class three difficulty due to its environments and its entities within. And it's just overall strange effect that it gives you. The level is actually created by another YouTuber named Nostalgia. And the description of the level is as follows. Level 1411 is a series of interconnected and interlooped hallways that are constructed out of a small tile. Think of like the ballroom styles, but even smaller. The level's layout is kind of similar to level zeros and many others because it seems to have non Euclidean geometry, which if you're not sure what that means, pretty much it means you could just be walking in a straight line, but actually end up behind where you started. Pretty much reality doesn't make sense. The level's roof above you is made out of tile as well, but it's black and not white or gray. And it actually absorbs light and sound, which, of course, means there's going to be no echoing and means that any light that's shining will get sucked up into the roof and it'll be dark in some areas. The level seemingly has these mannequins placed in very random spots in the hallways. The mannequins themselves are around six feet tall and they're made out of what we think is wood. They kind of look like those little stick figures from art class. You know, the ones I'm talking about, but these are human sized. These mannequins give off extremely unnerving energies and vibrations. And even though they don't have any eyes, you can feel them staring at you. And even if they don't seem alive, either they seem fake or whatever, they're alive. Trust me, they are. Each time you see a mannequin, you need to keep your eyes on that mannequin until you're out of its direct eye shot or until you can't see it anymore. Because if you turn your head or if you look a different way, they will silently move closer to you until they're in range of attacking you. Kind of like that a pyrophobia level, but in real life.  All they have to do is to touch you, just a basic tap or poke on the shoulder and you'll be gone.   Like you still know what's going on, but you won't be able to move or talk or do anything because you're just a flat piece of meat laying there. That's got to be one of the actual worst things to happen in the back room. I mean, that's horrible. Wow. But if you somehow make it past these mannequins and don't get turned into a lump of flesh and you wander deep into the halls, you're still not out of the woods, because like I said earlier, this level is full of these dark areas and these dark zones where there's no lights because the ceiling and the walls absorb it. These areas are extremely enigmatic and they almost act as a sort of pocket dimension within themselves. So if you're walking for one second in the light, you see this dark area and then you walk into it, you'll be enveloped inside of this dark dimension. The entire light that was behind you will be gone and you'll be in complete darkness until you continue to walk the other way out of it. These dark areas, of course, attract smileers and other weird entities that live in the back rooms. You might even run across a phobic centipede or a skin stealer inside of these dark zones. We don't really know what all lives there, but you can take a guess. These types of entities like this type of level, because it brings a lot of opportunity for easy prey. You know, the mannequins will just take your bones away for some reason and you'll end up as lumpy flesh. And of course, that is easy prey for some kind of creature. It really is unknown why the mannequins do this, but we have some theories and I'll go over the theories later on in the video. But for right now, you just need to know that it does play a role in the level. Even deeper into these strange halls, there lies more weird stuff. The first is that there's rumored to be a strange enigmatic floating eyeball type creature that, according to legend, is from the very first victim that was turned into a lumpy flesh pile by a mannequin. And over the years, this eyeball that was small grew into its own sentient being and now it terrorizes the deep halls of this level. Anyways, the eyeball floats around in an unknown way and it's against sentient in an unknown way. But if it sees you, it'll chase after you. Its ultimate goal, of course, is to absorb you into itself. Now, the good news is this eye can only see in one direction at a time. Obviously, the way it's looking and since there's plenty of dark areas and corners you can hide in, I'm sure that you could probably evade it pretty easily and unless you can't then you're screwed. If you do encounter and evade the eye, then the exit of the level will make itself appear. And if you escape that eye, no matter where you're at in the level, you can look up to the ceiling and you'll be able to see a green glowing exit sign. All you have to do is follow that sign and you find the way out. But again, it's not that easy because there is another strange creature that lurks even deeper into the halls. It takes the similar appearance as the eyeball, except this is one giant yellow smiley face sphere thing. So it's just like a sphere with a smiley face. The face tends to lurk near wherever the exit is and it picks off unsuspecting wanderers that think they're about to make it out, which is kind of sad. Imagine like beating the entire level or running to the exit and then getting eaten by a smile. Most normal bathroom stuff, guys. Cool. And even deeper theory is that this smile face is the head of that first victim from the mannequin like the eye was, which leads us to the strange effects that this level might have and the theories we have on it. So the eye and the smile face are these large, weird body parts that have morphed into their own entity. They've developed a consciousness.  This leads us to believe that the level has the ability to take these body parts of wanderers who got deboned by mannequin and evolve them into entities of their own with their own thoughts and minds. Now, it's unknown if the wanderer has any power inside of these creatures or if nothing of them exists anymore, just their physical self blown up to be bigger, but it's definitely weird that the level can take these body parts and turn them into stuff like this, you know, giant eye, giant face, what other giant things are walking around deeper?  We don't know. We just can't tell yet. To enter the level, you have to be in a mall somewhere or on level zero and then find a mannequin on display. You touch it either on purpose or accidentally and you'll get sent here and you'll wake up at the start of the level. And if you want to exit, you have to encounter that eye creature. And of course, evade it until the exit sign appears and then go through the door and that's only if you can make it to the door before getting eaten by a smile. It's simple as that.  Sounds pretty easy to me. Yeah, let me know what your thoughts on this level are in the comments below. I really like the idea that it can take body parts and turn them into their own sentient beings like that's pretty cool. Anyways, yeah, that was level one for one one and the start of Brood to Over. All right, that was it for the video. I hope you enjoyed this explanation. This level was created by the YouTuber named Nostalgia. Go check him out in the description below if you want more. Their channel is really cool. Got some nice stuff on there. Y'all know what time of year it is. It's getting to be that Halloween time, which of course is my favorite holiday. And I love making videos on this time of year because the backroom just fits Halloween so well. Hope y'all are hyped for it. This week I have so many bangers coming out, so many terrifying things. I have more creepy stuff. All the things are coming soon. Make sure you get ready. Turn post-notes on and leave a like. Thank you for all you do. And I will see you all in the next video. Peace.


Hey everybody what's going on, I am Greg Sussman joined today by our own Frank Stamphill who's here to help us break down the waiver wire as we head into week number ten. What's happening Frank? Not much Greg. Doing about as well as a Jets fan can do right now. This is the lowest of the low, but it's a very important waiver wire week. We have six teams on a buy. Some people are calling this bymageddon, Greg. Let's get to it. Who are some people, Frank? I heard it through the grapevine. Nope. That's not a thing. Let's begin at the quarterback spot and this week, well, it's a lot of against your New York Jets and this week they have the battle of the swamp, the Snoopy Bowl between the Jets and the Giants.  All over Danny Dimes in this matchup against the New York Jets. This is purely a matchup play here as you look at the Jets secondary and what they've allowed over the past two weeks. Gardner mints you a couple of weeks ago, throws for three touchdowns. Ryan Fitz magic throws for three touchdowns as well. This Jets secondary just got torched by the likes of Devontae Parker and Preston Williams. Fine players, but again, you can have success against this secondary. Daniel Jones has struggled with turnover so far this season. Some interceptions holding onto the football when he gets sacked. He fumbles the ball a lot as well. Well, the Jets are 29th in sacks this year in the NFL. So I think Daniel Jones is going to have some time to throw. He could sit in the pocket. He can also get outside the pocket and make plays with his legs. We've seen him do that so far this season as well. And back in week eight, Daniel Jones reminded us of his upside. He threw for four touchdowns. He finished as the QB one overall against the Detroit Lions. I think the floor is pretty safe for Daniel Jones. He has at least 31 passing attempts in every game this season. The Giants defense is not very good as well. So if we do get some back and forth then that might lead to even more passing for Daniel Jones. I think there's a safe floor and I think the upside is there based on this Jets secondary. The upside certainly there for Daniel Jones who showed a lot of progress here in his rookie season. The best part for fantasy owners turns the ball over a lot and that causes well more points on the other side, which means he has to score more points. Danny Dimes against the Jets seems like a solid matchup on a big waiver wire week. They don't want to go with Danny Dimes. You're looking for another quarterback option. Look at Ryan Tannehill. He's facing off against the Kansas City Chiefs.  Ryan Tannehill could be the main beneficiary. Ryan Tannehill has been solid here, Greg, completing nearly 72% of his passes since taking over as the starter for the Tennessee Titans. He has over 300 yards passing in two of the three games that he has started. Reminded us of some of the rushing production that he can provide as well. In week 90 at 38 rushing yards and a rushing touchdown. He's had at least 19 fantasy points in each of the three games that he has started as well. Going up against the Kansas City Chiefs in week 10. This defense specifically their secondary in their past defense has played well so far this season. Overall, over the past two weeks, however, they have allowed three passing touchdowns in each of those games. So I'm looking at a Titans team that is likely playing from behind. It looks like Patrick Mahomes might be ready to play in this game. And if that's the case, then again, the Titans are likely playing from behind. Tannehill has had some success. Can make some plays with his legs. He's throwing for more yards. And I think that with six teams on a by obviously here, you know, we like Daniel Jones is the top ad. But if he is gone, then Ryan Tannehill is the next man up going up against his Chiefs defense. Tannehill has been fine. If you don't have any other choices at the quarterback spot, then it's OK. You can do worse than Tannehill going over against Kansas City team that he's going to need to throw a lot against. The Titans are going to have any chance to defeat. Let's move on to the running back position, Frank, where we've waited a long time to see that Ronald Jones has been freed, but it certainly looks like we've finally have a stylish rojo as a number one option in Tampa Bay. Once again, Ronald Jones has been freed here, Greg. And hopefully this is the last time that we're talking about this because Ronald Jones proved once again, why he's better than Peyton Barber and really the best running back in this backfield for Tampa Bay played a career high 53% of the snaps in week 10 for the Tampa Bay Bucks. He handled 18 carries for 67 yards and a touchdown that represented 78% of the Bucks running back carries in this game. He also saw two targets, which was more than Dario Gumbawali, who is the past cashing back on the team and Peyton Barber combined. The Bucks have the Bucks face the Cardinals heading into week 10 and the Cardinals, you know, are allowing 4.4 yards per carry to opposing running backs. They are 26th in the NFL in run defense DV away. The Bucks have been playing with some negative game scripts. They've been playing from behind. That's why we didn't see as much from Ronald Jones, but they are four and a half point favorites. The early line for this game against the Arizona Cardinals. So Vegas expects them to be playing with a lead. I expect that as well, which means that we should once again see 15 plus carries for Ronald Jones. Let's hope that this is the last time we're talking about this. Some people dropped Ronald Jones because of that lull that he went through. But again, a good matchup and he's taking over in this backfield. I have a lot of faith in Ronald Jones as one of the better waiver wire pickups this week. Ronald Jones is one of those guys that if he just gets going, he could potentially be a league winner. At least we thought when we drafted them each of the last two seasons. Hopefully this time it's real Frank and hopefully this time Rojo is here to stay. Up next is running back. You've been talking to me about for like a month now. It's Darius Geis of the Washington football team. I do have to throw it out there to you though. Are you nervous that how effective Adrian Peterson has been that they won't just throw him into the bench? Or does it make you make you cautiously optimistic about how good Darius Geis will be seeing all the success that a much older AP is having? I think that's actually a really good question. I'm going to go with the latter because this team is one in eight and I think that the Washington Redskins have to see what they have in Darius Geis. He is 22 years old. They use a second round pick on him. And Adrian Peterson is 34. He has played extremely well as you mentioned Greg. Since Bill Callahan, the interim head coach of Washington has taken over. AP is averaging 18.8 carries per game and 95.8 rushing yards per game. If you saw any of the highlights from AP this past week against the Buffalo Bills, he still has something left in the tank. I think that that's very obvious. But again, he is 34 years old. Darius Geis much much younger. I think that they have to see what they have in him. They already went to Dwayne Haskins. We'll see what they do coming out of the buy. But Darius Geis is eligible to return off the IR after week 11. Washington will be on a buy in week 10. Normally we don't really like to pick up players that are on a buy but I think that this is a good stash we saw in week 1 earlier this year albeit it was under Jay Gruden at the time. Darius Geis was the starter in that game and Adrian Peterson was a healthy scratch. So I am cautiously optimistic that this offensive line has played a little bit better that Adrian Peterson has been able to run well and that Bill Callahan wants to run the football. I think that they get Darius Geis involved. We already know as you said that Bill Callahan wants to run the football. He's also trying to make a claim at this job next year. Yeah, Adrian Peterson is the veteran. He's got the support of the locker room. But Darius Geis is the future. They've already turned the keys over to Dwayne Haskins and now it's time to see what they have in Darius Geis. Let's move on to the wide receiver position and that brings us to Indianapolis where Zach Pascal stepped up without Ty Hilton in the lineup. We thought Pascal probably was going to be the guy and yesterday he was. Only problem, Frank, is Jacobi Percet has a sprained MCL, at least, we think. Hasn't been ruled out for Sunday, but it does look like, at least we assume, that Brian Hoyer will be the quarterback. Does that make you a bit concerned for Zach Pascal? No, it doesn't concern me with Zach Pascal because he still led the team with targets with six, led the team with 19% of the target share, 44% of their air yards this past week, also had 76 yards and a touchdown on five catches. So I'm not really all that worried. They're going to have to throw the ball to somebody and it seemed like he was the go-to guy, even for Brian Hoyer. We saw late last week that Ty Hilton was ruled out with that calf injury. He's going to miss the next three to four weeks, but Zach Pascal is still out there in a large majority of leagues, which means that you need to grab him. I actually think that he is the top waiver wire add this week. Overall, he played 94% of the snaps this past week. In week nine ran 40 routes, which was most on the team as well. Up next for the Colster, going up against the Miami Dolphins. We know Xavier and Howard has been placed on IR. They have allowed 14 touchdowns to opposing wide receivers this season. That is the most in the NFL. They've allowed the seventh most fantasy points to opposing wide receivers as well. We saw Jameson Crowder have a big game in week nine against this dolphin secondary. So they need somebody to throw the ball to with Ty Hilton banged up. And I think based on Zach Pascal's snaps that he played, how many routes he ran, his target share, his usage and all that, I'm very excited about him for these next couple of weeks. Specifically in week 10 against the Miami Dolphins. I'm really excited about Zach Pascal stepping up because last time Ty Hilton was out, we didn't know what to think, Frank. I remember we recommended Dianne Kane. Devon Fungus was the thing. He's on his way back too. But it was Zach Pascal that really stepped up, perhaps the name that we weren't expecting all those weeks ago. Now, this time with Ty Hilton out, we ran up and picked up Pascal and it worked out yesterday. Against Miami, it should work out again. Zach Pascal clearly won the top waiver wire pickups this week. Another wide receiver worth picking up is Hunter Renfro as back-to-back games with the Oakland Raiders scoring a touchdown versus two of his NFL careers. It was a scramble yesterday for Derek Carr getting the ball out of Renfro, but it worked out. He made it three in a row, Frank, against the Chargers. Yeah, I think so. I like the usage that I've seen from Hunter Renfro over the past couple of weeks and this guy was in college for about eight years. I guess it's not surprising that he's finally making an impact at the NFL level. I think that he fits into this Oakland Raiders offense, an offense that is playing very well. I think he fits in perfectly because they have that deep threat. They have that Red Zone guy in Tyrell Williams. They have a do-it-all tie-it-end in Darren Waller. And I think that Hunter Renfro is very clearly their slot receiver, possession guy. He's got good hands. And right now, Derek Carr is relying on Hunter Renfro over the past two weeks, Greg. As you mentioned, in week eight, four receptions for 88 yards and a touchdown for Renfro. In week nine, six receptions for 54 yards and a touchdown. During that span, 11 targets, Leeds Oakland, 18% of the target share, Leeds Oakland as well. And we have a game on Thursday Night Football between the Raiders and the Chargers with a 47.5 total. We expect some points in this one. The Chargers secondary, 24th in past defense DVOA as well. There's six teams on a buy again. That's going to be a theme heading into week 10. So we're going to be desperate for some wide receivers based on the way that Hunter Renfro has played and has been used the past couple of weeks. I think that he is a viable replacement this week, Greg. As you said, so many teams on buy this week. It's tough to find a wider receiver to fill these holes. Hunter Renfro, maybe that guy here against the Chargers on Thursday Night Football. Moving on to the tight end position, which has been so, so tough. A couple of weeks back, I picked up Mike Koseki because why not? It didn't work out. I wish I stuck with that idea because yesterday against the Jets, Koseki was awesome. And he's really talented out of Penn State. We've just wanting him to flourish. Well, maybe that flourishing is finally upon us. You think he could continue to do what he did yesterday, Frankie? Yeah, I really do. And I'm happy that the Dolphins are finally getting Mike Koseki involved. He caught all six of his targets in week nine against the New York Jets for 95 receiving yards. Has played over 60% of the snaps in back-to-back weeks. He also ran 33 routes on 46 Ryan Fitzpatrick drop-backs against the New York Jets. And Preston Williams had a big game yesterday, but he's now dealing with a knee injury. He's going for an MRI, so we'll see what happens with that. That could open up even more opportunity for Mike Koseki. And it's a plus matchup. Going up against the Indianapolis Colts, they just allowed a touchdown to Vance McDonald. And they're allowing the seventh-most fantasy points to tight ends so far this season. I'm really excited about Koseki getting involved. Look, they use a second-round pick on this kid, and his workout metrics are insane. He is 96%ile or better in the 40-yard dash coming out of college. Speed score, burst score, agility score, and cash radius. That all comes according to playerprofiler.com. So the talent is there. The opportunity is starting to come. It's a really good matchup. I think now is the time to grab Mike Koseki. Mike Koseki is so, so talented. Those raw skills, as you said, Frank, they're off of the charts. Those metrics are crazy. The problem is, the dominance of the Jets every week. So I don't know how effective Koseki will be, but in this tight end landscape, we're basically streaming guys each and every week, and this week, why not Mike? Last week, one of the tight ends that you recommended, at least off the air to me, was Jack Doyle, because the amount of snaps he was playing, well, it said that, hey, he could be effective if he finds the end zone. He did find that end zone early on in the Colts loss in Pittsburgh, and he had a couple of other opportunities later on in the game. Well, once again, he out-snaps Eric Ebron by a massive amount, and he faces the Dolphins, where Ryan Griffin, the Jets tight end, had a touchdown called back. Are you going to continue to ride Jack Doyle into Miami? Absolutely, Greg, and you're right. We liked Jack Doyle as a stream last week, going up against the Pittsburgh Steelers, came through with some modest production, but he scored a touchdown, three receptions for 22 yards, and that touchdown on four targets in week nine for Jack Doyle, going up against the Steelers, and you mentioned how many more snaps he played than Eric Ebron. He played 54 snaps. Eric Ebron only played 24 snaps. Jack Doyle also ran 32 routes compared to just 24 Eric Ebron. I liked the matchup going up against the Miami Dolphins. Ryan Griffin yesterday had six catches for 50 yards, should have had a touchdown as well, didn't control the ball going down to the ground, blah, blah, blah, whatever it is. It's a good matchup for Jack Doyle. They need pass catchers outside of Zach Pascal, and I think that he can actually provide that for whoever the quarterback is. Jacobi Bresset or Brian Hoyer. So I like the matchup. I like the usage. Playing more than Eric Ebron. Give me Doyle going up against the Dolphins. Love the amount of snaps he's playing, and we saw Brian Hoyer coming into this game and rely on his tight end. Great news for us who are desperate for tight ends. He's running Jack Doyle against Miami this week. Finally, we get to the defense, and that brings us right back where we started.  Giants and Jets, last week we recommended the Jets against the Dolphins. I should have went the other way. So this week, Frank sticking against the Jets, going with the New York Giants defense. Yeah, normally, Greg, we're streaming defenses against the Miami Dolphins, and as crazy as this sounds, I think that the Jets might have replaced the Dolphins as the worst team in the NFL. The offensive line cannot block anybody, and teams are just getting after Sam Donald. He's making bad decisions. He's throwing off his back foot. He's fumbling. He's throwing interceptions. I understand the Giants don't get a lot of pressure, Greg, but the Jets allow a lot of pressure, even yesterday against a Miami Dolphins team who does not sack a lot of people. They sack Donald three times.  Since he has returned, the team is averaging right around 14 offensive points scored per game as well. So I think the Giants get after it. We get a revenge game from Leonard Williams, of course. I think we get some sacks against the New York Jets, some more bad decision-making from Sam Donald. You get some turnovers. The Jets have officially replaced the Dolphins as the team you want to stream your defense against. New York Jets and Sam Donald have struggled this year, early and often. Hopefully, this week, it's more of the same. That's it for us here on The Fan. We'll hurry up Frank Best of Luck in this battle of New York. I know we both want our teams to lose to get better draft picks, so good luck. Good luck to you as well, Greg. I think that the Jets are in a pretty, pretty good spot here to lose against your boy Danny Dimes and the New York Giants. Good luck to everybody else out there. You need some help on the waiver wire. Six teams on a bye. Tomorrow, JJ Zacharyson will join me as we tell you who to buy and sell as we head into week 10. I'm Frank Stanfield. I'm Greg Sussman. Thanks so much for watching. Enjoy the game tonight. We'll see you back here tomorrow.


The next item of business is a member's business debate on motion 3336, in the name of Stuart Macbeth 33, in the name of Stuart MacMillan on Barnardo's Scotland Nurture week. This debate will be concluded without any questions being put. I would ask those members who wish to speak in the debate to press the request-to-speak buttons now. I call on Stuart MacMillan to open the debate. Mr MacMillan, seven minutes are thereabouts, please. Thank you very much, Presiding Officer. At the outset, I would like to thank all the members who have signed the motion to have this debate. I would also like to thank the members who have stood back to either take part in the debate or listen to what is going to be said. Obviously, next week is the Barnardo's Scotland Nurture week, with the Parliament being in recess. I am glad that we are actually getting the chance to debate it today. I would like to thank the whips for allowing that to happen. For any parent, a child is a responsibility and a challenge, and it is very easy to feel swamped by both. For those parents whose children require extra attention or who may have their own difficult personal issues to deal with, those day-to-day challenges can certainly multiply hugely. In my Greenock and Inverclyde constituency, Barnardo is a part of the Nurture group network, which is vital to child development and wellbeing. In December of last year, I put forward a motion that was signed by quite a number of members. That was indicating or highlighting the additional funding that Barnardo had managed to receive to help with Inverclyde pupils. This network recognises the importance of Nurture in schools, so school settings and also the training practitioners across Scotland in running Nurture groups. Reaching out to parents and children is Barnardo's Greenock-based Nurture service, which offers advice, information, expertise and, crucially, the support that can ensure the young people who come through the stores and get the best possible start in life and enjoy the best possible future as a result. Nurture groups are a psychologist that designed teacher-led intervention for disengaged and troubled children, which removes behavioural barriers to engagement and attainment in schools through recreating, missing or distorted early attachments. Nurturing approaches are based on the recognition that the factors that lead to many young children failing to reach developmental milestones can be addressed by helping parents and those who are working with children to take relatively simple measures to improve attachment and thus the child's development. It is also a powerhouse of work to improve families' futures, offering a range of group and one-to-one services that are focused on building attachment relationships in the critical early years. Babies are born with 25 per cent of their brains developed, but by the age of three that figure has lept up to 80 per cent. The principles of early support are well established, children need warm, attentive and stimulating parenting at this age to support their social, emotional and physical growth. Its benefits to society, breaking intergenerational cycles of potentially crime, alcohol and drug abuse, and teenage pregnancy are widely recognised. Barnardo provides services that take an attachment-based approach to working with the most vulnerable and disadvantaged children and families across the country. Those include working in nurseries, primary schools and the early stages of secondary schools. Crucially, that also includes working with families before the school gates to ensure that children arrive at the school gates ready to learn. In Inverclyde, where levels of poverty, unemployment and drug and alcohol issues are sadly above the national average, Barnardo works with mothers-to-be as well as parents of newborns, toddlers and children aged 5 to 12, often using respected programmes. There are also services targeted at young parents aged between 14 and 25 who may feel removed from accessing mainstream services. That approach helps parents to build strong and healthy relationships with their children and improves educational attainment and life chances for whole families. As well as offering one-to-one support, Barnardo's Nurture service offers participants the chance to increase their social networks by meeting other parents. For many young parents facing the problems of isolation, that can be vital. There are now more than 300 nurture groups in schools across Scotland. That is a ratio of around one-to-every-eight schools—the Barnardo's work in Inverclyde and across other local authority areas—to help to build the capacity of the early years in teaching the workforce to take a nurturing, attachment-based approach to the work with children and parents. Nurture children are carefully selected at using the boxel profile, an online resource that allows teachers to develop an accurate understanding of children's emotional and behavioural difficulties and to plan effective interventions and support activities. Once in the group, a nurturing philosophy, rooted in attachment theory, is used to ensure that children with social, emotional or behavioural difficulties are provided with the early nurturing experiences that are vital to learning. Make no mistake, Presiding Officer. Nurture groups can turn children's lives around. In the autumn of last year, Queen's University of Belfast published an independent evaluation of the Nurture Signature Schools programme in Northern Ireland. That is a Government-funded pilot where nurture groups were set up in 20 schools and continued in a further 10 and thoroughly evaluated for outcomes and cost effectiveness. The two-year evaluation found that, across the 30 nurture groups, children made consistently large improvements in social, emotional and behavioural development. We also found that there was evidence that greater progress was made by those attending on full-time basis, looked after children and those not eligible for free school meals. Inverclyde, Barnardo's have adapted the original wellbeing outcomes used in getting a right for every child approach to suit their aims. We have sought to ensure that every child, citizen and community, will be safe, healthy, achieving, nurtured, active, respected and responsible. A central part of the Barnardo service is to stress the importance of attentive and stimulating parenting. It does this through initiatives such as the TPP, which is a positive parenting programme. The 5D Thrive, which encourages bonding and offers five cues to help with the emotional development of babies and also mellow parenting, is a programme aimed at vulnerable and hard-to-reach parents. That is an empowering experience for both parents and children. Barnardo's has helped children and their families for over 150 years. It is central to their aims as a belief that every child deserves the best start in life, regardless of their gender, race, disability or behaviour. They understand that being a parent or a carer can be hard work. Barnardo's children's centres provide a fun, safe haven for mum, dads, parents to be carers and children can learn, develop and spend quality time in a welcoming and supportive environment. I have been to see the facility that they have in Greenock and I cannot praise it enough. It is an outstanding facility. I am sure that I speak for everyone in the chamber when I say that we all value the work undertaken by Barnardo's in supporting children and families. Certainly, in my constitution, I am going to remember Clyde as well as across the country. However, I have got two points for the minister. First, can the Scottish Government look favourably at investing in nurture groups across Scotland? Secondly, there is a belief that all schools should use the boxhole profile to better understand and support the social, behavioural and emotional needs of their children. Can the minister be grateful if the minister could give the minister some consideration to be utilised in all of our schools in Scotland? I now call Ruth Maguire to be followed by Alexander Stewart. I thank my colleague Stuart McMillan for bringing the important topic of nurture to the chamber today. I am particularly pleased to have the opportunity to speak today having recently visited Blacklands primary and Co-winning academy in my constituency and having seen for myself the positive and tangible effects of nurture groups on attainment and inclusion. In Blacklands, there was a particularly touching moment when one wee boy alerted a teacher to the fact that one of his friends had done something well, and they had quite a cute well done song. It is a simple thing, but that in a nutshell is what nurture is about. It is about having a space where we can support children to develop healthy and supportive relationships and attachments, making them feel valued by others and confident in themselves, and teaching them how to communicate constructively and positively. In all of this, it is about equipping them with the emotional and mental resilience to deal with the challenges of life, whether the little everyday ones or the much bigger and traumatic ones. Nurturing emotionally healthy and resilient children paves the way for future generations of healthy and resilient adults. Those are really our skills for life. Not only is this of immeasurable benefit to the individual leading to a healthier and happier life, but it is of benefit to all of us, with evidence suggesting that nurture groups can work to reduce crime and health problems in wider society. At the immediate school level, the positive impact that nurture groups have on attainment and thus closing the attainment gap should not be overstated, I should say. With vulnerable or disadvantaged children, the first challenge, as Stuart McMillan said, is often ensuring that children get to school in the first place and are ready and willing to learn when they do. Nurture groups make a huge difference to all those points, resulting in improved attendance and reduced exclusions, improved behaviour and positive attachments to teachers and to the schools. When it comes to attainment itself, the results are no less impressive, with trials showing that children attending nurture groups demonstrate significant gains in academic achievement, including in medicognition skills, language and literacy. There is no doubt that poverty and income inequality play serious roles in educational inequality, but income is not the only factor. More important in a child's life than how much money their family has is stability, love, security and support. Nurture groups are founded on that recognition to ensuring that children get the right support at the right time from the right people and have equal opportunity to engage with learning whatever is going on in their life that is out with their control. In this, the nurture group approach dovetails with the GERFEC approach of the Scottish Government. I am very pleased that Scotland has the best ratio of nurture groups to schools in the UK at 8 to 3, and that the majority of local authority-funded nurture groups in the UK are in Scotland. Importantly, nurture groups allow children to remain part of their mainstream class and work in both primary and secondary school settings. They are eminently sensible and feasible and a good way of tackling some of the most complex issues that are faced by children at a very early stage in a meaningful and sustainable manner. I see a run out of time, so I will finish on that note. Thank you, Deputy Presiding Officer. Can I remind the chamber that I am a Serving Council on Perth and Canals Council and refer members to my register of interests? May I begin, Deputy Presiding Officer, by congratulating Stuart McMillan on securing this debate welcoming Barnardo Scotland's Nurture Week, which will take place next week? The importance of nurture in the development of children is one of the rare things that I think all of us in this chamber can broadly agree with, and that transcends the political divide. It is absolutely essential that children in Scotland grow up in an environment in which they are cared for, supported and crucially feel safe. Those are instances in which we should all manage to support. Many of us here look at the opportunity of going forward and it is vital to the children's development that they have ability to learn. We regularly debate the differences and ways in which we can close the attainment gap and the Scottish education system is moving in one way or the other, but we primarily focus on the curriculum and standard of teaching. Although those are, of course, extremely important, many children are at a significant disadvantage relative to their peers before they even reach the school gate. Many of those children who have come from a disadvantageous background and who have educational attainment is an area that they struggle at. Many of them have to manage outside the school on a day-to-day basis. The difference between living in an environment with drug, alcohol or domestic abuse and stressful situations at home can severely disrupt a child's education. I have seen first-hand as a councillor on Perth and Canos Council the impact that Barnardo Scotland has had on the lives of those youngsters. I congratulate and pay tribute to them for the work that they do. Their efforts are to be rewarded and congratulated. The work that Barnardo Scotland has done to tackle those issues by providing services at work and to the principle of positive attachment within the most vulnerable families helps to ensure that, when the children arrive at school, they feel safe and not just, importantly, they are ready to learn, because that is the problem situation that we are facing in this situation. That the individuals should get to school because of the situation that they find themselves in, because of the background that they are coming from, that they have difficulty in engaging at that level. We have to make sure that that is the case. Barnardo Scotland is picking up that, and, as I said, I very much support the work that it is doing. It is also clear that the poor attachment in early years of a life is not always what manages a child and the results that it can get and the risks that it has of potential mental health problems as they go forward. We are seeing more and more of that. We must look to tackle the root causes of the problem, as well as the methods of treating those youngsters who have complex issues and, as they experience more situations in their life, they become even more complex as they move forward. The nurturing approach that Barnardo Scotland has promoted is the best way for trying to manage that situation, in making them feel secure, in making them feel safe, in giving them the opportunity and working with their families and working with their school to ensure that that happens. The growing number of children who are affected by mental health issues is, of course, very concerning and makes it all the more important to foster stable and nurturing environments at an early age. Strengthening the emotional resilience of children to face anxiety, stress and mental health issues is essentially important as we move forward. In concluding, I am very happy to support the efforts of Barnardo Scotland ahead of the weeks series of events and activities in supporting both the emotional wellbeing and the mental health of those children as they go forward. I would like to begin by thanking Stuart McMillan for bringing this motion to Parliament today and for highlighting the very important work that Barnardo's do in improving childhood development in and reclyde and in other areas across the country. I would also like to thank Barnardo Scotland for their insightful briefing ahead of today's debate, which highlights many of the important issues. They are a great support to all the MSPs in the chamber. We can all agree that the importance of nurture in early childhood development is vital, and nurture week is a great way to showcase the best practice currently being exercised by Barnardo's in some parts of the country. It is also a good time to reflect on how we can use the knowledge of best practice and nurture principles, which all the research tells us absolutely works in terms of achieving positive outcomes for children and consider how we can embed this approach throughout our early years provision and education systems across the country. In terms of closing the attainment gap, we know that early intervention is absolutely crucial. Those children who face the most difficult beginnings in life, navigating family, situations marked by poverty, alcohol and drug abuse, violence in the home and those who may find themselves in care as a result of those issues, are most likely to exhibit signs of challenging behaviour and suffer from inequity and attainment at school. The damaging effects of early unmet attachment needs can therefore have a lifelong impact on a child's prospects. Given the Scottish Government's commitment to closing the attainment gap in education as its top priority in this Parliament, more focus and attention needs to be given to adopting attachment and nurtured-based approaches in early years. I hope therefore to see an acknowledgement of that in the forthcoming mental health strategy, which I hope will reflect the importance of embedding nurture and attachment in the early years of a child's life in order to prevent problems in mental health later down the line, some of which we heard about in the earlier First Minister's question session. Perhaps that is something that the minister could elaborate on in closing. I also hope that the forthcoming mental health strategy will reflect that commitment to working across portfolio areas. It is vital that those in health, education and the third sector are working closely together to tackle the complex issues of wellbeing and mental health and the undeniable impact that that has on other areas of life. With that in mind, I think that it is also worth drawing attention to the recent publication of a report by the Royal College of Pediatrics and Child Health into the state of child health in 2017, which includes several recommendations for action in Scotland. In particular, the report highlights that one in 10 children starting school experience social, emotional or behavioural difficulties. As many as five children in every class have some form of additional support needs, all of which puts pressure on other services. That shows just how important it is that we start to embed the practice of nurture throughout our education system from the very earliest stages. Not only will that ensure that professionals are equipped to support children who need extra support, but that early investment and prevention will have a long-term positive impact on the need for using services in later life. The report highlights that half of mental health problems start before the age of 14 and three quarters before the age of 24 underline the importance of early intervention. I hope that the Government will give consideration to the recommendations in that report in due consideration. In closing, because I realise that time is short in those debates, I think that the key theme of today's debate is about the deserved recognition of the great work in developing attachment and nurture in some parts of the country. There is also the wider issue of how we can further develop that practice in mainstreaming throughout our education system. As Stuart McMillan's motion states, that is the principle that all parties can get behind. I liked the mention in Ruth Maguire's speech about the well-done song. Perhaps we can all come up with some way to celebrate each other when we do, so I will work together in a positive way. By working across the chamber and with third sector groups such as Barnardo's and the Nurture Group Network, we can hopefully see an expansion of that approach. I hope that we are able to see real progress in this area during the lifetime of this Parliament. Thank you very much. Can I just clarify the well-done song? No, we didn't sing it just as well, but there we are, because it really gets parliamentary, but there we are. Can I now call Jeremy Balfour to be followed by—now, if I got this right, I've gone and drifted. No, it's David Torrance. Sorry, I drifted thinking about the song. David Torrance to be followed by Jeremy Balfour. Mr Torrance. Thank you, Presiding Officer. I would like to thank Stuart McMillan for bringing this motion to a chamber this afternoon to welcome Barnardo Scotland's Nurture Week. I'd also like to make a special thank you to Gordon MacDonald for the loan of his glasses, so he can actually see my speech just now. As a father of two, I would like to stress the importance of building a supportive and long lasting relationship with my children. A relationship that has lasted throughout childhood is just beginning to touch our young adult lives. However, as any parent will know, the first few years of a child's life are crucial for our emotional, social, psychological, neurological and physical development. To support children with insecure attachments, all members of the Scottish Parliament should encourage leaders and players in education to promote an urgent approach to help to create strong attachments to the foundations of children's positive emotional development. Ketus Mantra is Barnardo Scotland. Scotland's largest children's charity, we provide more than 130 local services throughout Scotland and work with over 26,500 vulnerable children and young people and their families. They provide help with issues such as attachment and early development, supporting parents in the community and providing guidance and advice on a case-by-case basis. This individualised service is a distinguished feature of Barnardo Scotland. The charity has successfully developed a structure in which staff can acknowledge and respond to children's, young people and families based on their individual circumstances, needs and background, rather than on their age, gender, class or status. I am sure that my fellow MSPs will agree with me that closing the poverty-related attainment gap, especially when working with young and vulnerable children, is certainly a priority. Barnardo Scotland has taken a unique approach to health and wellbeing in order to ensure that children living in the most disadvantaged areas are receiving as much attention to literacy, numeracy and health and wellbeing. Support services in Fife are an excellent example of how Barnardo Scotland individualises their support on a case-by-case basis, especially working with our support groups such as the Fife Advocacy Forum, Fife Council, NHS Fife and Barnardo's Child and Family Support Service, which has been providing services to children and families in need for over a decade. The Fife-based service currently has eight strands of service, including children's rights, intensive family support, assessment of parent capacity, family careers, family health, a nurture hub and substance abuse services. I stress that these services are often not a one-off appointment and families are encouraged to follow up with staff for up to a year after their initial meeting. This ensures that services that Barnardo Scotland can offer make a long-lasting impact on communities. I have the confidence that Barnardo Scotland's nurture week will bring awareness not only to the children and young people that are suffering but critically to parents who often take an extremely emotional and physical role in dealing with the day-to-day struggles of their children in need. Barnardo's nurture service not only offers a space for children to express themselves but also a space for parents of vulnerable children to meet and socialise, essentially creating ad-hoc support networks. This double effect is what Barnardo Scotland is essentially aiming for, creating and fostering support and extending that support in everyday life, not just under the care of compassionate staff and volunteers. Crucially, getting it right for every child brings all these initiatives together. Nurture in England Clyde has set a great example for the rest of the country by putting children at the centre of a local community. Nurture in England Clyde has adapted getting it right for every child to suit their needs. I call on every constituency to do the same by working and consulting with her council services and leaders of community development planning, as well as a range of stakeholders who can contribute to well-being outcomes. In conclusion, I once again like to thank Stuart McMillan for securing this important debate and commend Barnardo Scotland's young people and families. I call Jeremy Balford to be followed by Fulton MacGregor, the last speaker in the open debate. I thank Stuart McMillan for bringing the debate and the opportunity to talk about the important subject. I am sure that, as has already been said, we all agree that nurturing children within our society and our country is so important. It can create positive attachments, help the child mature, learn and thrive. For parents, it is often hard to nurture children, particularly those who are younger. I speak from experience as a father of twins who has just got to nearly six years old. Parents, wherever they come from, often need help. It is too easy for society and for even sometimes us as politicians to blame parents rather than support parents. I think that Barnardo's and others can bring such valuable experience to help. As someone who is still very new to this Parliament and still learning lots, what has surprised me perhaps the most since coming to this place is the importance that a child learns from zero to three, even before they start nursery or school. Often, as we have heard from other speakers, a child will nurture, will grow in those formative years, and what happens between zero and three has a knock-on effect into not only primary school but secondary and later into society. We need to support vulnerable families, we need to support children who have extra needs in regard to being able to nurture and to grow so that they will then grow not only in the younger years but in years to come. I welcome the work of Barnardo's and other organisations in the help that they can give many families within our community. Because if we get this right and we get this right for every child, we will see less children coming forward with mental health issues. We will see the attainment gap lesson. We will see families stronger within our society and whichever political party we are, that is what we all want to see in Scotland. I welcome this debate and I wish Barnardo's well next week. I hope that his campaign goes beyond the four wars and goes into the whole of our society and local authorities and families appreciate and realise a bit more what they can offer as we think to nurture our children. Fulton MacGregor I am sorry to disappoint everybody, I have still got one more to go. I thank the Stuart McMillan for bringing this debate to the chamber. Just like other speakers, I am delighted to be able to participate in this member's debate regarding Barnardo's Scotland Nurture campaign and, as Jeremy Balfour said before me there, I think that Barnardo's is a fantastic organisation and I wish them well with the upcoming campaign. Also, as others have said, most points have been covered in a very consensual debate and I stress that I recognise the importance of nurturing interventions for children and young people. It is particularly relevant as we have heard two children who may be facing inequity in terms of attainment and those who are at the greatest face the greatest challenges. The constituency that I represent poverty is fairly prevalent and this can understandably have an impact on childhood experiences and the direction that they may be taking. I am thinking, even specifically to the review of the looked after and accommodated young people that the Scottish Government has announced and I think that this all ties in together quite nicely. Within my own area, I mentioned my constituency there, and within my own area there is Nurture groups at St Monica's and inclusion support across the constituency and also great work done by North Lancer Council in terms of community learning and development. I know that a lot of parents in school speak highly of the support that they receive through those links. Last night, I hosted an event by Sam H in the Garden Lobby. I felt that it went really well and it was in relation to mental health and working opportunities, but it links. I feel quite nicely into today's debate because when I was speaking to some of the people there at the event last night, there was a lot of talk about the mental health issues faced by young people at the present time and the poor attachments and the difficulties that can have for young people starting school if they have not developed the proper attachments and had the proper nurturing. I was really pleased to hear Monica Lennon's question earlier to the First Minister. I actually had a supplementary there, but Monica covered the points that I wanted to come in on and allowed the First Minister to answer and give the direction that she and the Government are going and the ambitions that they have for young people with mental health. The Nurture group network annual Scottish conference is actually I'm pleased to announce being held in my constituency at the Cotebridge campus of New College Lancer. It's happened at the end of the month and the theme is teaching and learning for children with social, emotional and mental health issues. It's fair to say that this is a great opportunity for promoting the work of Nurture groups and demonstrates why such groups have had such a claim from teachers, parents, pupils, education professionals and others. I'll just take the opportunity again. As I said, a lot of the points have been covered. It's an area where everybody in the Parliament can put support behind. I thank Stuart McMillan again for bringing it to the chamber. Thank you very much, Mr Gaggin.  Seven minutes are there about. Thank you, Presiding Officer. Please forgive me at the premature nature of me rising to speak, but I think that you had to put your teacher voice back on there to tell me to sit down there. I'd also like to thank Stuart McMillan for raising this motion and for highlighting the fantastic work of Barnardo Scotland, which is being celebrated through their nature week. I've appreciated all contributions, highlighting all the local work that's happening right across everybody's constituencies or indeed council areas. Good attachment, positive relationships, Nurture support, stability, love are all essential ingredients for a good and happy childhood that sets the strong foundations for later life. Ruth Maguire articulated the wider societal benefits that we all feel, whether that's injustice, the economy or the health service, when we do have that focus on the early years, showing why it is everyone's business to get this right. That's why today I want to touch upon activities that this Government is doing in those important early years and throughout the child's life journey with a focus on Nurture. I do want to maybe distress that as well because while we do have that focus on early years, we should never misunderstand the fact that early intervention and early years are different, that once a child is beyond those early years, we shouldn't think that we should never give up on that child and make sure that we can act early when we can and provide support to a child and young person whenever they need that help. In terms of the early years, that starts in maternity services.  That is a point that is recognised and articulated very strongly by Suzanne Zidike and what she describes as the connected baby. I would certainly recommend to any member who is new to this Parliament to certainly look at the work of Suzanne Zidike and how she articulates the importance of attachment for all of our children. In January, we published the best start, our five-year forward plan for maternity and new care in Scotland. That includes a number of recommendations that are focused on providing family-centred, safe and compassionate care that recognises the importance of attachment and bonding. Post-birth skin-to-skin care is already very well established throughout Scotland and should continue to be promoted. Plus, women and babies should be kept together whenever possible to assist with bonding and attachment and to help to support breastfeeding, which is recognised as a positive proactive mechanism for supporting that important attachment. We are also, as a Government, committed to supporting parents, giving a fair and equal start for every child. It was good to hear some of our MSPs talking about the challenges that they have as a parent as well. We will continue to roll out the roll-out of the family nurse partnership programme to reach all eligible teenage mothers by the end of 2018. We will also ensure that every newborn in Scotland receives a baby box, which includes essential items for a child's first weeks. That will include materials that promote attachment to help parents to prepare for the arrival of their wee one. Our national parenting strategy also highlights how we will help parents to lay strong foundations for the living, nurturing relationships that we all know are integral to children's wellbeing. Our well-established play talk read campaign encourages parents and carers to incorporate playing, talking and reading into their daily routines. It helps to drive home the importance of positive interactions with children from day one. However, that does not just stop with parents. All staff working with children and young people play a crucial role in helping them to develop skills, positive mental health and to foster resilience. Our national practice guidance for an ambitious expansion of early learning and child care, building the ambition, describes good work practice in creating caring and nurturing settings that allow wellbeing to flourish. The guidance also sets out the importance of attachment, where the parent-child relationship is viewed as one of the most important factors in a child's development. Those nurturing approaches are especially vital for our looked-after children. That has been a point that was raised by Fulton MacGregor, Monica Lennon and others throughout their contributions. Our looked-after children currently demonstrate the poorest outcomes by comparison with their peers. Any of us in the chamber who are parents would never accept poor outcomes for our own children, nor should we for those who have a collective corporate parenting responsibility. The Government expects all corporate parents to work with young people and to consider fully how they can fulfil their statutory obligations differently and more effectively. Our commitment to getting it right for every child is at the very heart of that and all that we do for our children. It is also at the very heart of our curriculum. To support the development and practice of nurturing approaches in our schools, Education Scotland has also developed two national professional learning resources. The first is nurturing approaches in the primary school, which explores attachment and nurture in the early years. The second is a whole-school nurturing approach that promotes school connectedness, resilience and the development of social and emotional competencies, all of which are key aspects of promoting mental wellbeing. Further discussions are also taking place to adapt that for use in early-year settings. I also understand for Stuart McMillan that Education Scotland promotes the boxel profile as a useful tool to be used as part of a child's plan. The Scottish attainment challenge has also prioritised improvements in health and wellbeing. We will allocate £750 million during the course of this parliamentary session through the attainment Scotland fund to tackle the poverty-related attainment gap, targeting resources at the children, schools and communities that are most in need. A significant proportion of the Scottish attainment challenge funding has focused on taking forward nurturing approaches and nurture groups. Again, I hope that that provides some reassurance to Stuart McMillan on the two points that he raised. We recognise the importance of nurturing approaches and addressing and overcoming the barriers that some children experience in school. Barnardoes, though, are at the very forefront of this work. They are involved with more families through the attainment challenge than through any other services in Inverclyde. That close partnership working has been effective in attracting and engaging more families who need support in comparison to other services within the wider nurture service provision. In Inverclyde, 60 families are working with family support workers provided by Barnardoes and funded through the Scottish attainment challenge. Since March of last year, 90 staff have been trained in five to thrive by Barnardoes. The programme in partnership with Inverclyde Council is an example that we want to encourage other schools and local authorities to follow. We greatly value Barnardoes' contribution, and that is why we support them with core funding as part of the children, young people and families early intervention fund. I thank Stuart McMillan MSP for raising the motion and highlighting the important work of Barnardoes in embedding nurture approaches to services. Children only get one shot at childhood, and it is incumbent on us all to work together across professions, disciplines, portfolios and parties to strive to do our very best to help them get it right.


Hey today, we're going to talk about squat grip So there's a lot of confusion about how to grip the bar on a basic barbell squat We want to talk about that today So here's the key in all of the other lifts that aren't the squat the deadlift the bench press the press The hands are holding on to the bar like they're the prime thing that connects us to the bar but on a squat that's not the case in a squat the bars really sitting on our back and The hands are just there to keep the bar from rolling down the back So we have to figure out how to put our hands in the right position For a right relationship with the barbell and the body So the back bears the load of the barbell and the weight and not the hands wrists and elbows Because when we do this wrong we end up squats often will cause Tendonitis around the elbow and specifically the medial epicondyle and we want to try to protect this as much as we can when this Becomes a problem. It's hard to get rid of and a correct squat grip most of the time will allow us to avoid that issue So one of the things that I want to do on a squat grip is I'm going to try to get my grip as close as I can Because I want relatively Vertical forearms now the bigger you are if you're like me my grip is still pretty wide Skinnier people narrow people might have their I mean really will be able to put their hands right on top their shoulders But for everybody it should be a very very tight It's gonna be very tight at the peck-delt tie-in and in order to do that We have a good friend starting strength coach Paul Horn is invented what we call the Paul Horn stretch You can check out that video, but I'm gonna give you a quick taste of it right now So as you're trying to open up your shoulders to prepare for the squat You can do a stretch that looks like this Patrick You're gonna take a grip with thumbs on top the bar and we'll get there here in a second And he's got to try to drive himself underneath and just stretch and then come back out and take a deep breath come in a little bit and Breathe out and come back out again and narrow your grip a little more and Same thing and you could just kind of rock back and forth and the stretch is going to be here on the front of the dealt Because our hands aren't holding the bar on the squat I actually don't need to wrap my thumb around the bar on a squat like I would on all the other lifts Instead, I want to use compression Between the the bones the wrist and the bones of the forearm into the elbow to hold the bar in place Which means the bar needs to push on the bottom Pad of my of my hand to create the compression necessary to hold the bar in place on my back But the weight of the bar primarily is going to sit on your back not in your hands Conversely if we wrap our thumbs around the bar and we get over extension of the wrist We get it can lead to wrist problems It can lead to tendonitis in the forearm or of the elbow or if our grip is too wide and I have a big angle here I end up with too much moment on the forearm and not enough compression Therefore, it's not the compression that's holding the bar in place I have to end up taking this wide grip and I'm gonna have to hold the bar in place with shoulder extension Which can also cause problems and in the end on a squad if I'm gonna shoulder extend Eventually, I'm gonna round my thoracic. I'm gonna dump that bar forward. It's gonna roll up my back I want the bar to stay in place just below the spine of the scapula. So that's what we're gonna do So I want you to take a grip that's as close as you can comfortably take the wider It is there's too much moment the more narrow we get the more compression we get the more vertical forearms We have so take a grip as close as you can stretch into a little bit We're gonna put the bar just below the spine of the scapula here So that's nice as below the top of the traps notice that he really can you lift your elbows up at all a little bit? So leave your hands right where they are come back out Narrow your grip one inch and let's do it again If he can give me some extra Shoulder extension then that grip probably isn't close enough now This is a lot tighter. You can see the nice big shelf of muscle on his back Just below the spine of the scapula when you're ready stand up with the bar Walk back deep breath And give me a couple reps Good keep that chin down One more nice and slow and up fast good walking in touch the uprights and Good so a common error that we'll see with lifters is will actually swing the pendulum too far the other way So most know that over extension is bad But now we're starting to see people Overflex their wrists and that would look like this That's gonna go underneath No, so now he's his hand is on top of the bar Which means that there can't be any compression of the forearm Therefore, I'm not doing what I'm supposed to do here instead. He's gonna get down here bar in hand Neutral wrists and now the bar is against the pad of the lower hand and he can actually have some compression here across the forearm So just as much as extension is bad that flexion is bad as well Now, what's the problem with overextension? Well over extension creates a problem because it causes torsion or twisting here in the forearm The hand is loaded strange The forearm twist and we end up with problems often in the elbow and usually in that medial epicondyle When we grip the bar this way This is a very common grip for for power lifters or they'll often wrap their thumbs around the bar here So same position just like this and now I don't have a lot of compression here Rather, it's the moment force of the over extension in the wrist That's holding the bar in place and of course that can cause problems in the wrist just as much as it can cause problems in the elbow If all else fails and you've got pain in your elbow from your squat grip The primary thing we want to focus on is to make sure that the weight Lies across the back and not in the hands. We want to feel the weight of the bar On our back and not in our hands not on the not at the base of the palm Not back in the fingers as the more weight the hand bears The better chance we have of having some sort of problems in the wrist form or elbow So the key occasionally my way that I just taught you will also cause some elbow problems It's rare and that's why some people will wrap their thumbs or take a different grip in order to get all that weight on their back If the back bears the load of the weight And the hands don't it's going to protect the hands wrist forms and elbows from future potential injury Which is often like a just a tenonitis, right? So that's what we're trying to avoid in the squat When you get that tenonitis, it's hard to get rid of so as soon as you start to feel that coming on You've got to make sure you feel the load of the bar across your back and not in your hands For more how-to tips on this squat click the playlist right up there


Thanks. Well, it's a pleasure to be here. And that by Mark was just actually a bit of an inside joke. The mark also needs no introduction. The So Dan showed this slide earlier about our pathway and a slide that he has shown and I have shown a lot. And you know, one of our perspectives on this and how we make this a reality is of course the foundations of biomedical research and commitments to information technology and this iterative process of using the healthcare system, electronic health record, all the data we passively collect as a tool to engineer and adapt the system over time. And so because of this, and many of you I know are familiar with a lot of the work Vanderbilt has done, I just want to set up as a foundation that, you know, we use electronic health record to both feed research and implementation and a lot of the work that we've done to implement actually involved, you know, using our data to show that, you know, these experiences actually matter for our patients and it's led some of the iterations. So on the discovery side we have BioView which is de-identified that's not used for clinical care. I just want to set that up. And implementation side where I'm going to spend most of this time talking about is predict program which led to our ignite project. We did not imbibe as much alcohol before as Indiana and did not come up with this, you know, as creative a name as ingenious. And that's also led to some implementation activities around eMERGE as well. And that's all in the CLIA environment data in the electronic medical record. And as others have done it's been part of it primarily as a quality improvement initiative as opposed to research initiative. And then we look at what happens. And the discovery side BioView is formed from a de-identified resource of all the electronic health record data and other tools we bring in there. And that's about 235,000 individuals that we do research on. And, you know, a lot of that has been on disease associations but it's been a good tool for research into pharmacogenetic effects. One of the first we did as we were designing and launching predict was replicating this well-known association with Clopidogrel.  And honestly that was really important for our physicians because they were saying at the time I didn't necessarily, you know, I don't necessarily believe the research data. I want to see it in, you know, kind of real world data when they take 15 other medicines whether it matters.  Now that was maybe a different era. That was 2010. But, you know, it was an important aspect of it. And so we've done a lot of other discovery efforts here. It has not yet led to, interestingly, a new discovery of a new pharmacogenetic effect that we have turned around and implemented. But it has led to, for instance, a few revisions of some things we did. For instance, we first moved from alerting providers for both poor metabolizers and intermediate metabolizers, really based largely on the results that we had for Clopidogrel. So talking about predict and our implementation program, that's from our first flyer that we handed to patients. One of the things we decided to do first was define, you know, kind of who is at high risk if we were to implement a preemptive program, which was our desire. So we looked at 53,000 patients who have routine care at Vanderbilt. And we asked how many received one of, at the time, 57 medications with an FDA story for a pharmacogenetic-based prescribing. And we found that over 65% of those patients would have received at least one of those medications. You can see some of those individuals received quite a few, you know, with a significant number of people receiving 10 or more medications that had potential pharmacogenetic indications. And if you look at just six drug adverse events that have high morbidity or mortality, that equates to about 383 events over five years for those 53,000 people, or about 12 to 18 events for an average PCP. So this was one of those things we said, okay, this gives us some evidence to suggest that these events will be relatively common. Interestingly, it's skewed towards some of the more frequent medicines ended up being skewed to some of the more frequent medications with more serious adverse events like Clopidobrill. We did some surveys of providers. This was early on into the implementation of our program, but it was actually after it had been implemented. These are 121 people who had seen a patient with pharmacogenetic test results in their chart at some point, not with any direct education efforts or anything outreach from the program. And you can see by the top bar there that, you know, the vast majority of the physicians interestingly believed that genetic profiles would influence a person's response to drug therapy, that most of them believed specifically for Clopidobrill and also Warfarin that these would make a difference. And the factors influencing whether or not they would consider ordering a pharmacogenetic test was driven most strongly by their belief in the evidence of efficacy, which we found very reassuring. The fact that it was an institutional priority, for instance, is ranked towards the bottom of this list. Being prompted by an alert in the EHR itself was actually at the bottom of the list, but the interesting thing is people don't remember to order it without having prompted by an alert. So they won't order it because of it, but they will not order it without it. So when we set up Predict, one of the other things we did is we set up a review process. It starts with evidence-based review and guidance for professional society. CPIC was not really in existence when we started this. And so now a lot of that has been supplanted by CPIC guidelines and we are able to follow those and we do follow those and are involved in some of those now. And then the replication component that I mentioned before. Some of the replication was actually needed to give real-world models to what we were going to provide suggestions for, for instance, with Warfarin. And then we have a special division of our Pharmacy and Therapeutics Committee that would review these and then present these to the rest of the P&T committee before being implemented. This is what our intervention looks like when you open up a patient's chart. We have a homegrown EHR currently for another six months and then we'll be moving to EPIC. In this face page of our patient summary, we put the drug gene interactions between the allergies and adverse drug reactions and medication section. We don't necessarily expect people to look at these and act on and remember to look at these drug genome interactions when they prescribe, but it gets people used to seeing these kinds of results. And that's one of the reasons we put it up here. It also shows you what we had implemented, or do you have implemented? Clopidogrel, Simba Statenbier, Purine's, Tachrylemus on there, and I feel like we're missing, did I say Warfarin? Warfarin, it's five of those. In addition to that, we, of course, have clinical decision support on both our inpatient and outpatient environments for all of these. And that was really something we considered a requirement before we released them into the patient's chart. Those five interventions were released over the period of a couple different years as the evidence was developed and the decision support was developed. In certain cases, we had to enhance the underlying EHR to support, for instance, the calculations needed to calculate Warfarin dose. And so it took a couple of years to actually get that into the system. This is what it looks like for Clopidogrel. You're able to change your prescription with a single click. Dan showed this result before. This looks at the first about 10,000 patients that we had tested and how many had actionable results. So Todd talked about about 25% of their patients would have an actionable result for a given DGI. And Chris, I think you echoed similar numbers from the 1200 patients project. This cumulative result of 91% would be if you encountered that drug, essentially if you encountered all five of those drug genome interactions or sort of drugs in a patient who was genotyped, you would do something different than normal for 91% of them. And if you look at each individual drug, with the exception of the thyropurin example, each drug does have about a quarter of the patients who have an actionable variant on either an intermediate or a poor metabolizer status or it could be ultra rapid depending on your drug. Since we multiplexed this testing, it gave us, and a lot of these tested individuals were tested preemptively, it gave us the ability to look at our ability to reuse the data over time. And as I said, you know, we rolled out these five interventions over the period of a couple different years. And so the original people were just tested for Clopidogrel, and that was the only live test for probably the first year or so. And so the first 4,700 people that were tested were tested and had an immediate indication for one drug. And about 53% of those individuals at that point were essentially tested preemptively. And then as we unveiled more drug genome interactions in patients accrued more drug exposures over time, 4 years into the project we had used the data over 14,000 times on the 9,600 people we had tested, although about 6,000 of those people that were tested initially had no indication for being tested. And so not everyone who was tested did we use their data, but certainly some individuals we used the data multiple times. And so there's a cost savings here, even in a small number of drugs, to test multiple potential indications upfront in this analogy. When you look at what providers do, this looks at whether our providers followed a recommendation for Clopidogrel. And again, all these individuals will see decision support. A number of these individuals are tested prospectively. Some are tested as they walked into the cath lab, so the test results would come back after they potentially received their stent and had already been prescribed Clopidogrel. But you can see that providers responded in really a dose-dependent fashion based on the severity of the variants. So those that were poor metabolizers for CYP2C19, about 58% of them eventually got switched to alternative therapy. If you remove the contraindications for Prasagrel, which was the primary drug during most of this time, about 70% of the people were switched that were poor metabolizers. And then about half that number that were intermediate metabolizers, 33% were switched to alternative therapies. And of course, the alternative therapies also cost more. You have to recontact individuals in some cases to switch as well. But you can see providers are sort of making a real calculation on whether or not they want to switch individuals based on a number of factors, some of which is, of course, I think, perceived risk of the adverse event. As newer drugs have come out, you know, certainly there's a prevalent argument that the newer drugs are better. We should just switch to using those.  So we are, as Ignite, looking at a network, whether or not we're seeing this kind of effect, and what are the opportunities to tailor therapy based on genetics are. And so these are some initial results, looking at, in this case, anti-platelets. So you can see Clopidogrel is still a predominant medication used at three of our Ignite sites, Vanderbilt, the VA, and Aurora still continue to use Clopidogrel predominantly over Prasagrel and Ticagrel or the same thing is seen for warfarin. You can see a more dramatic, there is an increased prescription of the alternative agents in the case of warfarin, especially at the VA. And the VA, as many of you know, has a strongly driven formulary, and their formulary decision was new starts could use alternative agents off the bat. And they feel like that's ultimately more effective and is cost efficient for them. So, but outside of that Aurora and Vanderbilt, we still see a lot of use for warfarin. And I want to give another example of one of our adopter sites and their adoption and some of the influences of this. So Sanford is in the Dakotas and they have adopted a lot of the CPIC prescribing recommendations and had been going on for a couple of years. And this is actually showing the number of genotype for Clopidogrel coming through the cath lab. But one of the things that's really interesting is you see this inflection point here and this really results, this inflection point occurred essentially after Lori presented our data from Ignite on the outcomes from, with major adverse cardiovascular events following those who are switched to all genotype driven therapies versus not and showing that those events essentially decreased alternative agents in a significant way. And so this individual director of the cath lab became a supporter and their adoption has increased. We're also looking at cost effectiveness and this is work by Josh Peterson. He has a website that they've put up there on the bottom there. It's in beta and have done some initial simulations looking at the incremental cost effectiveness ratio per quality here. And you can see that the cost is pretty low with some given assumptions for minor little frequencies, event rates, the changes in odd ratio of events based on, for instance, Clopidogrel versus Prasigrel or Ticagrel or, but you know, it's probably not necessarily cost efficient to genotype just for Simvastatin in this example. Now these are, you know, this is early work, this is given a lot of assumptions. You can go online and actually simulate your own scenarios if you want. But, you know, you can see some cases that might be a clear win. Other cases it may not be, you know, this I think points to other experiments which Josh and his team are doing, looking at multiplex testing and that may be where some of the true wins are in terms of cost effectiveness. A few of our lessons learned, you know, implementation is about many things and you've heard about a lot of them and I just kind of pulled it down to a few but, you know, our laboratory test, even something simple like that we haven't talked a lot about is still a bit of a bleeding edge and we dealt with issues there and have dealt with issues transitioning that in a clear environment. You know, we've all dealt with a lot, recently a lot of EHR upheaval and changes and we're going through that ourselves now. That will probably we think settle down as many places have now adopted initial EHR systems but it is still a transition point and every implementation has been different and that's both environment and EHR specific and so we need to think about ways I think of going past that as Sandy and others have pointed out. We need to think about local provider buy-in in many ways and that's belief in clinical efficacy is very important. Ease of use and familiarity with the system are all very important factors there. We found that advice changes frequently and opportunities to reuse the data over time is frequent and that drives a need for surveillance and getting back to patients and those are points that Heidi and others brought up earlier as well. I want to give you one real world example from our samples and then I'll stop. So this is a 57-year-old that early on in the program who came in, who had diabetes, first incidence of angina and any no-none heart disease and she was cathed, received a stent, copitagal started, that stent closed off and closed off again and she was restented again and received more stents and by 11 months later by December she had been admitted nine times, had five interventions with nine stents placed and of course was at this time noted to be a poor metabolizer and was switched to Prasigryl. This highlights the need for these sorts of examples and potential power for some of the extreme cases. This is clearly an outlier but these cases do exist and is I think a powerful story of where there could be some cost benefit as well. So with that I'll end and there are many, many people who are part of this as well as with everyone else who has talked. So thank you for your time. Thanks for your unstenting efforts in this regard, Josh. Why don't you go ahead and sit down and we'll open up our discussion period.


Welcome back to Afternoon Express. Now, it's that time of the show. It's time for Winner Home on Afternoon Express, where we follow our three talented young design contestants as they turn three empty apartments into dream homes at the Polo Village at Valdivia State in the Cape Winelands. Now, the best part is that you, the viewer, stand a chance of winning one of the completed apartments valued at over three million rand. Now, week two has come to an end. This week, we learned about the benefits of a state living and we were creatively inspired by architect Shark Van Emden and interior designer Tom Dixon. Our design contestants got their first glimpse of their empty white apartments, but what colors will they choose to brighten them up? Our guest for today has some ideas. Excitement is running high for Winner Home on Afternoon Express and our minds are thinking in bright colors about all the ideas and possibilities of decorating those incredible apartments. Today, we have the color expert in the loft and result global color manager at Plaskon is here to give us a color forecast workshop on how to go about deciding on the perfect colors for small spaces. Good to see you again, Anne. Good to see you too. I'm really excited to think about the color schemes of what these apartments are going to look like and I'm sure they're going to be so diverse in so many different ways and paint makes a big difference to any space that you walk into. What are you hoping to see happen with these apartments on Winner Home? Well, I'm really excited because as you say, paint and color really makes a huge impression on the look and feel of a space. So I'm really excited to see the designers really push the boundaries and show us what is possible when you brave with paint and color. Everyone talks about these sort of forecasts for the seasons and it's always changing and I really find it overwhelming sometimes. What are some of the color forecasts that we can expect in 2016? Well, that's why we actually do the forecast. We do the research for you to show you what sort of stories are coming through, what colors are coming through to try and make the paint, choosing paint and color a little bit easier for you. And in our 2016 forecast, we've actually selected four trend stories that we've seen coming through quite strongly. The first one is called Element and it's inspired by natural landscapes and earthy colors. You know, that never goes out of fashion. But what we've seen is we've also seen pinks sort of from rose quartz and ice blues coming through included in this earthy palette. And I think that's just showcasing the fragility of earth. So our natural colors have changed a little bit to pinkies and blues coming through in that natural palette. Our second theme is called Discovery and it's inspired by all the space travel. You know, we're all fascinated with what's happening in space. What is out there? And then what happens is designers get inspired by that. You've seen Valentino come out of this galaxy inspired fashion range. So that also, it goes through all fields of design. So we've got those sort of colors coming through in our Discovery theme. Then our third theme is called Air Loom. And it's sort of a luxurious and indulgent colors from our past. Colors you know already like red wine and moody dark navy blues that are coming through. Any paint that's got red wine in a time hat. Those are colors that people are familiar with and feel comfortable with and nostalgic about and like to surround themselves with especially in times like this when the future seems a little bit uncertain. And then our fourth theme is called Connect and it's really a palette of bright colors and it's just optimistic and we can't all be sad and we want some fun and we want some optimism and that's a trend that we've seen coming through a lot in arts and crafts. I think I like that one of Connect. I think Connect is such a nice one especially in the world that we're living in where everyone's like dark and there's so much stuff going on around the world and families. It's nice to brighten up a space to at least give you a different perspective on the world. But that's the one that people are most scared of. Yeah, it is daring, it is daring in so many ways. But you've mentioned sort of themes and the way that you can tell stories of different rooms but what about specific colors? I mean if I'm going into a sort of Plascon store and I want to go and buy myself colors where do I find these specific colors? Which one should I try and choose? What are the trending colors for this year? Well you're not the first person to ask that. Lots of people want to know what are the colors happening now? So that's why we actually bought our Plascon Spaces magazine to show people what are the latest colors and how to use them. So in there in the latest issue we actually highlight four colors. One of them is called Ravine and I spoke about neutrals but there is also a contemporary neutral. So we know beige and we don't want boring beige and gray is also giving a bit too much now. What Ravine is, is it's a mixture of gray and beige so we call it grayish. Oh grayish. So that's a very trendy neutral palette which is beautiful. Then our second one that we highlight there is this grown-up pink I like to call it. Pink was always seen as a baby color. And so this is a grown-up pink. Pantone named Rose Quartz is the color of the year. So this is just a grown-up one and we show you how you can use it in interiors. Our third one that we feature in there is one that really surprised me. A military green, which you wouldn't expect. Which I've seen happening in fashion at the moment. Well you know what happens? It happens across all the design disciplines. And this one color I didn't expect would look so fabulous on a wall and it really does. So we show you all those trendy colors coming through in the mag. I'm telling you what, I find this all overwhelming and there's so much to think about and so many different colors and stories that you can't tell but it's also exciting because there's a lot that you can do. Exactly. But I've seen homes where people have tried to do it all and I've seen people go from room to room with a different color, especially people who have got newborn babies that want to paint the little girl's room blue and then the lounge is a nice warm beige. Are you allowed to do that? Or how do you go about planning the colors of different rooms in a house? You know, it's so important to actually do that. You must consider everybody in the family. If you've got a teenage daughter and she wants magenta pink in her room, paint that because obviously color also is like a therapy. It has an energy to it. So kids especially often ask for colors that they feel comfortable with and want to surround themselves with and need that energy. So it's very important that your kids have colors in their room that they feel comfortable with. In your family room, of course, go for something that all the family will feel comfortable with and that can be sort of reflect the family's personality. The home needs to reflect the family's personality. But you can still have connection and flow. So either with your flooring and your skirtings and your doors could all be painted the same color. So you still want flow going through your home but definitely let everybody's have a room that they love and feel comfortable. They're safe haven. Yeah. One thing that I've also realized about decorating homes, I mean, whenever you try to do it, your budgets have to get increased and increased and increased and stretched and stretched. So when you're painting different colors in your house and maybe your walls are going to be different colors, you're going to have to re-buy furniture. You have to re-buy some other things, potentially, or if you're starting fresh, you have to buy furniture to match that and that is incredibly difficult. Well, one of the things is, think about paint. A five liter of paint costs around 500 rand and you can totally change the look of a room. Sure. 500 rand. I mean, a cushion can cost five rand. So it is the cheapest way. I know. It really is the cheapest way to re-paint your home but do use a good quality paint because you don't want your paint to look dirty and tidy. So a cashmere or double velvet will look nice and new and fresh for long. You don't want people touching and all of a sudden there's dirty marks on the wall. Going crazy with colors, you also want to make sure that it matches everything else. Exactly. You want to paint at the moment to make sort of new and old. So if you are choosing a weathered look paint effect on your wall, you might want to add to that a nice contemporary piece of furniture. And vice versa, if you've already got furniture and it's got the ball and claw and it's really old, your granny passed it on to you, you know, jazz it up with some color. Paint it in one of those bright colors. You won't believe how fabulous painted furniture looks and it's so contemporary at the moment. So, you know, you can make your furniture look contemporary again. You can make your walls look old if you want to. So basically do what makes you feel good, but at the same time just play. Try something new.  Go and take some reading material. Be inspired and just change up your spaces at home. Absolutely. And thank you so much for doing this. It's such a pleasure. Well, on that note, we have some exciting news. Standard chance to win a golden ticket into the winner home final draw when you buy any Plaskon product, an SMS, the word Plaskon, the last six digits of your barcode and full name to 32979. You can visit Plaskon.co.z for more details on how it all works, as well as much more inspiration on color forecasts and how to go about choosing the perfect colors. Lovely. Every weekday we follow our talented design contestants as they turn empty properties at Valdivia State in the Cape Wildlands into dream homes using finishes provided by Caesar Stone and Plaskon. And the best part is that you can enter the grand prize competition on privateproperty.co.za for a chance to win a finished apartment valued at over 3 million rand. Now, Winner Home is proudly brought to you by Private Property in association with Ned Bank.