As-salatu wa s-salamu ala Sayyidina Muhammad wa ala aliyah wa sahbihi wa sallim Yaqulullah Ta'ala, in Kitab-i Hilkareem, Allah SWT says, Inna qur'ana al-Fajri kana mashhooda This is in Surat al-Isra verse 78 Verily indeed the recitation of qur'an at dawn is ever witnessed So this is an urge for us to start our connection with qur'an Sayyidina Muhammad SAW says, It will be an arbitrator on the day of judgment. It will be a negotiator for you. It will be a mediator One day A boy came to his father and he asked him Why do you read the qur'an day after day after day and you do not You do not memorize anything. You haven't memorized it. What's the use of reciting the qur'an? So the father said to him, I will answer you later but now I want you to go to the river and to fill up this basket which is made of straw and I want you to bring the water in this basket here The basket was used to put some coal to As to be used for the fire for fire So it was black dirt dirty The son said, oh Baba, how can I do that? It's impossible The water won't hold in this basket So what happened the father the father looked at him and he said Go ahead. Just try it The son went to the river and he filled up the basket but When he tried to come back He found out that the water is leaking And when he got to his father there was no water And he taught him Baba, how can I do that? It's not holding he said the father said be patient. Just go ahead and do it again Okay, the boy went back to the river filled the basket and then get back Same thing no water The father urged him to do it a third time fourth time and then he said Baba It's impossible to do it so The father looked at him and and said Look at the basket Do you notice anything different? The boy looked at the basket and he said oh Baba The basket is clean. It's not dirty anymore So the father said Now I can answer your question This is what the Quran does in the heart It cleans it. It cleanses it The Quran The Quran would get your heart to be clean So even if you don't memorize the Quran keep reading it Even if you don't understand it keep reading it Even if there is no way that you can Memorize it keep reading it Looking at the Quran itself is a better so Allah subhanahu wa ta'ala gave us this book his holy book as a way of As a means to connect to him And normally when you love something when you love someone you like to get connected to him with the best thing that he loves So this is I'm answering one of the questions. This is just an introduction and inshallah just Will will go on so our Topic today is to talk about the fseer of juz amma the 30th chapter of the Quran And the reason I chose this chapter in particular Because it has the short surahs that we keep repeating repeating repeating in our Prayers Now imagine our prayer how how connected it will be if How if we are having Khushua in our prayer So what will happen? There will be presence now with the With the prayer it's not just going up and down and ruku on sujood when we Imagine the the actions of the prayers who are standing before Allah subhanahu wa ta'ala Then we are bowing to Allah subhanahu wa ta'ala. We are doing sujood to Allah subhanahu wa ta'ala Imagine that there is a king who wants everybody to bow to him Even if they if they don't like it that they feel that there is there is some kind of humiliation in in bowing and in prostrating to anybody but The more the more you The more you do now the more The closer you you are to Allah subhanahu wa ta'ala Then you will understand the power of Making sujood to Allah subhanahu wa ta'ala So We chose as I told you I chose this chapter in particular to get connected to Allah subhanahu wa ta'ala And to have more presence in our prayer when we read the ayahs We remember the meaning instead of getting involved with this and that and this and that in the prayer So before we start then I also wanted to stop by surah al-Fatiha To give some explanation of surah al-Fatiha since we all start with since we all repeat surah al-Fatiha in our prayers So Bismillah ar-Rahman ar-Raheem When we when we start reciting the Quran we start with Audhu billahi minash shaitan rajeem I seek refuge with Allah subhanahu wa ta'ala from the cursed devil Why do we say this istiada? Why do we say this form? It takes away the whisper of shaitan to keep A person away from receiving the light of the Quran Or to keep a person away from reciting the Quran The devil prevent is The when we say Audhu billahi minash shaitan rajeem the devil is prevented from hindering us from adhering to what we were commanded Or from luring us into what we were prohibited from Audhu billahi minash shaitan rajeem It's a command from Allah subhanahu wa ta'ala to start our reciting of the Quran with this tawwud with this form And it's mentioned in the holy Quran in surah al-Nahid when Allah subhanahu wa ta'ala says If you want to start reciting the Quran then start with Audhu billahi minash shaitan rajeem Then go on to Bismillah ar-Rahman ar-Raheem in the name of Allah most gracious most merciful Why do we say Bismillah ar-Rahman ar-Raheem? Each and every action that does not start with Bismillah ar-Rahman ar-Raheem With this form with this with these blessed words then It's missing some of its reward So say Bismillah ar-Rahman ar-Raheem so that your actions will be facilitated Because nothing whatever you are doing Is done by your power or by you because you know how to do it or by you because you learn about it Or by you because and so and so and so and so nothing is done except With the power of Allah subhanahu wa ta'ala So Start your actions with what pleases Allah subhanahu wa ta'ala by saying by the name of Allah subhanahu wa ta'ala Sometimes a person would say okay, but I I sinned how can I say Bismillah ar-Rahman ar-Raheem and start any action And the answer is in the form itself. We say Bismillah ar-Rahman Bismillah because he is ar-Rahman ar-Raheem Because he is the one who who has mercy For us. He is the one who is going to take care of us. He is the one who will accept our tawba if we make the tawba sincerely So what does ar-Rahman mean? Sayyidina Muhammad sallallahu alayhi wa sallam says So be merciful to those to Allah's creatures so that Allah subhanahu wa ta'ala will have will be merciful to you Now you might ask, okay, what is the difference between the two words ar-Rahman and ar-Raheem ar-Rahman Is A name of Allah that shows mercy to all to everything that he has created To Muslims to believers and non-believers to animals to to everything Whereas ar-Raheem Allah shows Extra mercy to those who believe And this is what explains wa ka'ana bil-mu'minina ar-Raheemah He didn't say wa ka'ana bil-mu'minina ar-Rahmanan He says wa ka'ana bil-mu'minina ar-Raheemah. It was merciful with the believers Allah subhanahu wa ta'ala has created mercy and divided it into 100 portions He descended down one And he kept 99 portions up in the in the sky for him to Have mercy on the Ummah of Sayyidina Muhammad sallallahu alayhi wa sallam on the nation of Sayyidina Muhammad sallallahu alayhi wa sallam on the day of judgments But what about the one portion that was descended on earth? This is The mercy of the mom to her to her child the mercy of the animal mom to her child The mercy of the animal to another animal the mercy of a human being to another human being This is the mercy that we are practicing in this dunya This is the mercy that Sayyidina Muhammad sallallahu alayhi wa sallam has ordered us to do And to practice so We started with awd billahi min shaytan regime bismillahi ar-Rahman ar-Raheem and now We will be reciting al-Fatiha Allah subhanahu wa ta'ala says in the hadith al-Qudusi In the divine hadith I divided And i will explain what does this word mean now between myself and my servant To two halves Means here al-Fatiha When we recite the Fatiha Allah subhanahu wa ta'ala has divided the Fatiha In two portions And we know that it's al-Fatiha because what is going to be mentioned after this So misfun li one is fun la one portion for me one portion for my servant as far for as for the The portion that's for Allah subhanahu wa ta'ala So it has three So this is the portion that is for Allah subhanahu wa ta'ala So we started with bismillahi ar-Rahman ar-Raheem at the beginning of the action to be done Then we followed it by We are thanking Allah subhanahu wa ta'ala for the results of the actions We are thanking Allah subhanahu wa ta'ala for all the bounties. If we are thanking Allah subhanahu wa ta'ala for everything Now We move to the next ayah, which is In this ayah, we have someone who is worshiping and someone who is worshiped Someone who is asking for help and someone who is helping And this is this ayah is between Allah subhanahu wa ta'ala and his servant So this is the second part of the surah The third part of the surah Is So when a person says When when Allah subhanahu wa ta'ala says Allah says three parts is this surah three eyes are for me three eyes are for my servant and one eye is Shared between me and him So Allah subhanahu wa ta'ala says So when the servant says All praise and thanks to be to Allah Allah subhanahu wa ta'ala will say My servant has praised me What if the call And when the servant says Allah subhanahu wa ta'ala will say So when we say My servant has glorified me When we say most gracious most merciful What if the call and when the servant says The owner of the day of judgment or the king of the day of judgment depends on the reading Then Allah subhanahu wa ta'ala will say My servant has exalted my status So this is the first part Allah goes on and says You alone we worship And you alone we seek help Then Allah subhanahu wa ta'ala says This is between me and my servant So my servant will worship me and I will give him Help My servant will ask me and I will give him So this is the relation between the servant and Allah subhanahu wa ta'ala When is the Closest point between the servant and Allah subhanahu wa ta'ala It's when he is when he is doing sujud because Sayyidina Muhammad sallallahu alayhi wa sallam says This is the closest way that the A servant can be close to Allah subhanahu wa ta'ala is when he is making sujud So when you are doing nafila when you are praying extra extra Other than the fard just make dua when you are doing the sujud And imagine yourself that you are Doing sujud to the lord of all creatures So when he says Call My servant asked me and he will be given what he asked for So what is it that we are going to ask Allah subhanahu wa ta'ala? Now look at the pronoun We were talking about Maliki and we are talking about him now the The pronoun shifts What's the reason When you talk to someone Then we are you are telling him that we are doing this especially for you Now we are telling Allah subhanahu wa ta'ala that we are worshiping you only And we are asking help from you only We guide us to the straight path In one of the explanations The uh one of the people of Allah one of the friends of Allah al awrya He said Is The correct path, but what is the correct path for us? Is So we ask you Allah to guide us to connect us with Sayyidina Muhammad sallallahu alaihi wa sallam who is going to lead us to on the sirat That will Lead us To go to you too So you will Keep us with him So you will keep us connected to him in the day after and we will be resurrected with him. We will be Uh, we will be with him in the day after in al firdous al a'la So Guide us to the right path Which sirat Which path Sirat al lazeena an'amta aleyhim the sirat of the path of those whom you have bestowed Your grace upon The sirat of those whom you have guided Kairil Magdoubi aleyhim not that the sirat of those who who uh earned your anger Not those walla balleen. Not those who went astray No Those two types knew the reality knew the truth, but they didn't follow it. We don't want them We want the sirat al mustaqeem That would lead us That will grant us that will Guarantee for us that you will be pleased for us We want to do our best in this dunya so that we will be from those whom Allah subhanahu wa ta'ala has said Allah subhanahu wa ta'ala is pleased with them And they are pleased with him. How can how can someone be pleased with Allah subhanahu wa ta'ala? They will be pleased with the bounties that Allah subhanahu wa ta'ala has Provided for them Has prepared for them With the grace that they are going to enjoy in there In the day after So in summary We started the surah with alhamdulillah So Allah subhanahu wa ta'ala has created everything to serve us We thank Allah subhanahu wa ta'ala for all his bounties But The more we thank Allah subhanahu wa ta'ala the more we find that we are unable to do it properly And that's why in one of the du'a said the Muhammad says We cannot praise you The way that you deserve to be praised And if we want to Learn one form of the best forms of thanking Allah subhanahu wa ta'ala We will say Alhamdulillah Ya Allah We thank you In a way that is suitable to the grace of your face face and The The greatness of your supreme authority And why do we say that this is one of the highest forms of thanking Allah subhanahu wa ta'ala So It's narrated that One someone was praising Allah subhanahu wa ta'ala And he said this form So the angels did not know how much of Good deeds to write for him So they checked with Allah subhanahu wa ta'ala. They said ya Allah if someone You told us you told us that if someone does this we were right So and so has not if someone does this we were right so and so good deeds So this this slave of yours said this form and we don't know how what it's not in the catalogue What what's right for him? So Allah subhanahu wa ta'ala says Write it as is and I will reward him for that So this is This is the mother This is the the surah that we start the quran with It is the seven repeated ayas And this is the seven repeated aides that we repeat In all our prayers in each and every raka'a we pray to Allah subhanahu wa ta'ala And one of the things that is Mentioned by Sayyidina Muhammad ﷺ is that it has been given only to his umma It's exclusive for the people of Sayyidina Muhammad ﷺ for the nation of Sayyidina Muhammad ﷺ There is nothing like it in the Torah in the Zabur This sounds or in the bible We have always to remember That Allah subhanahu wa ta'ala is This is the one who we always thank The one who is in charge the lord of humans Jin Angels animals everything Everything that has a soul and some some intellect even animals know when they are in danger they will turn away so We have to Remember Allah the lord of everything he has created And we have to know that he is the one who takes care of everything that he has created In surat hood is six. Allah subhanahu wa ta'ala says And there is no creature on earth, but that upon Allah is its provision We are Allah knows everything Kullum fi kitabi nubin And everything all is In a clear register So always remember That we have to depend on Allah subhanahu wa ta'ala on all our affairs Subhanallah So everything happens We have to know that We have to depend on Allah subhanahu wa ta'ala So now whenever we read surat al-fatiha we have in mind these these reflections Think of what you are reading now. So think of what you are reciting in your prayer Now we move to Surat al-nabab Does anyone have any question? The dua okay, I have Please repeat the dua So Moving now to surat al-nabab Surat al-nabab is the first surah of the juzat 30 And if we if we want to connect it to the surah before the surah before is surat al-mursalat Surat al-mursalat Talks about Inna matua aduna lawaqia. It talks about the day of judgment What Allah subhanahu wa ta'ala has Promised is going to happen. So Surat al-nabab Is the surah that comes after surat al surat al-mursalat So what is that that thing that Allah subhanahu wa ta'ala has promised? It's the thing the day of judgment that that the non-believers Deny Those who don't want to believe in Sayyidina Muhammad sallallahu alayhi wa sallam deny those who don't want to believe in a resurrection after death They deny So this surah talks about the the Explanation of what's the day of judgment the day of judgment which is super Important and that's why Allah subhanahu wa ta'ala is talking about We that's why we all have to Get prepared For it. We have to get prepared to meet Allah subhanahu wa ta'ala. We have to get prepared to To bring our deeds in front of Allah subhanahu wa ta'ala We want to be happy on that day. We want to be of the of those who of the winners on that day So in rejection Of the non-believers questioning the reality of the day of judgment And due to the to their denial of its occurrence Allah subhanahu wa ta'ala revealed this surah to Sayyidina Muhammad sallallahu alayhi wa sallam So the first ayah says What are they asking about This is an indication that the question is about something very important So they are asking about the day of judgment They're not asking to learn about the day of judgment They are asking because they deny the day of judgment because they they mark the day of judgment They are asking about the great news What's that great news? It is the harvest that Each and every person will bring with him to meet Allah subhanahu wa ta'ala It's the fruits of the actions in their dunya So If they did good, they will be afforded if they did bad they will be punished This is something very important This is what each and every person is Getting in this dunya is working on in this dunya just to to do What Allah subhanahu wa ta'ala want us to do or some people would deny that So what is this that they are asking about some people So some people This is what they are in this agreement. The first group Is the the first group believe in Allah subhanahu wa ta'ala The first group believe in the day of judgment. The first group are preparing themselves for that day But second group are not They don't believe in the day of judgment. They don't believe in resurrection after death. They don't want to believe in that So Allah subhanahu wa ta'ala says Allah severely threatens and warns those who deny the day of judgment The word kalla in itself in the arabic word is Rada wa zezir wa nahi Is a word of command is a word of ordering To be away from Ordering to not to do this thing So it means they should stop What they are doing denying they should stop what they are asking about in a mocking way No They will come to know kalla say alamun Thumma kalla say alamun Me again they will come to know In the Quran in the holy Quran if an ayah is repeated it be it it's Done This repetition is for affirmation It's for assurance So what's Allah subhanahu wa ta'ala is affirming Is affirming that there will be a day of judgment. It will be Now if we want to to learn about knowledge About what we Learn about So it will be three levels So the first one is And the second is The third level is If someone for example comes and tells you that he went to so and so city and He found the most beautiful spot on earth So he gave you He gave you the information You know that this person does not lie. So you take it Now you have the information you have Now you asked the next level you asked about it About this spot and you knew that he was correct So you traveled to it Now you have This is the truth But When you go there And when you wonder and when you visit this place and you really find it that When you see what he saw when you find that this is really the best the most beautiful The most beautiful Place on earth Then you you will have Then you are Your status now is Allah. So there is nothing that will Make me uncertain of this. This is certainty And this is what will happen in The day after but it will happen even before someone dies When someone dies This uh, Allah subhanahu wa ta'ala it's talking about those who don't believe So During death while he is dying Then we He called Allah subhanahu wa ta'ala at that state You were hideous That this will happen So we unveiled your Uh, the veil that was on on your eyes and now you are seeing what where your Destination will be Fadah sarukah liyum hadi now you can't see what you you couldn't see before And this is why when people are on their deathbed sometimes you feel that they are talking to things that we don't understand It's not that they are hallucinating. It's They are seeing some some things that we don't see They started to shift to move to that space to that place So now know everyone knows that at this point everything is true So They will know they will realize what is their position? Where are they where what will happen? And Where they will be When there is a comparison between what's good the winners and the the losers The losers will feel so bad. They will feel so the punishment when they See themselves in hellfire, but when they know that the The winners are Enjoying the bounties that of itself is another level of punishment We will stop here inshallah And inshallah next week same time where we'll go on Uh, I would like to see do you have any questions? Is there anything that was not clear? So please Mention it Thank you You can unmute yourself and uh, ask your question if you have any I All right, so at this time now inshallah You're with us. You have Oh Oh May Allah show our his Love and mercy upon you and your families new loved ones Whether they are living with with you whether they are still alive or whether they passed and uh proceeded us may Allah The most affectionate and loving Cleanse our soul cleanse our hearts in this in this blessed month and fill it with The divine light was all Allah And inshallah We will be meeting next week inshallah


An in-entertainment Ghanian singer Kevin Boyd has been remanded in police custody after being arraigned before the Addeton Secute Court for alleged beating his baby mama, kicked her on the ribs and used iron rod to hit her head right hand several times. Kevin Boyd's bail application will be head by the hour court today after he pleaded not guilty to the crimes leveled against him. The chief superintendent, Mario Sethard, the compliant Deborah Boyd, a trader, had accused who has been in relationship for more than 10 years and have two daughters.


Hi guys and welcome back to my video. I haven't been on here in forever and I wanted to do a little update video on how things have been going here in Arizona, how work's been going, working in a COVID ICU and I'm also it's hard to tell but I am like 30 weeks pregnant right now while recording this video so I kind of have a lot to like update you guys on and talk about so I wanted to just do a brief update video for anyone who's interested or cares. If you follow me on my Instagram I've kind of updated a little bit about this already so you may have already seen that but okay where do we begin? A couple of weeks ago I actually went on light duty for work for my pregnancy and for a complication that I was having. If you want all the details I'll link like a full update video down below that's on my other channel but essentially what it came down to was I was like really overdoing it at work and I was starting to have like some changes in my body and cervix that were like kind of preterm labor so to speak and this was at 23 weeks pregnant which if you know that's like not where that's not the time you want to give birth and so after like finding this out my OB and I decided that light duty would be a good option and fortunately my workplace offers this. I know that so many of your guys' work like don't offer this so I'm very thankful that I can be doing this right now essentially I'm being a unit secretary on one of our ICU units and it actually worked out great because with COVID being so crazy in Arizona we had to make like several new ICUs and so we didn't have like unit secretaries for these new ICUs that we had made so I've been doing that for the last couple of weeks and it's really helped me just like take it easy I still am able to work and like get my hours and I'll have to burn through like PTO or take time off I'm not on bed rest any of that but I have been able to take it easy because prior to going on light duty I was getting my butt kicked at work and I know so many of you can relate with working in COVID units you know across the United States across the world even and we were getting annihilated here in Arizona as far as just a ton a ton of sick patients running out of resources and I was getting you know three very heavy patients in the ICU that were all like manually prone and invented and I just had I was overdoing it I wasn't able to eat enough or drink enough and as much as like I tried to like do those things it just wasn't like possible for me during those shifts and so I would go home and be like wow I'm like super crampy and I thought well I've just been on my feet all day it's probably that and then it turns out that I actually was like having some cervical shortening and funneling like internally if you're an OB person then maybe you know like what that is but luckily I've been on light duty and it's been nice and COVID is actually starting to like go down here in the state of Arizona which it's been so nice over the last couple weeks to see it we've closed two of our COVID ICUs and we're like having more normal nurse patient ratios not pairing like our one-to-one therapies like CRT and what not with other patients and so it's just been like kind of relieving to see that it is getting better and like we've been in the thick of it for so long and it just kept getting worse worse worse just so to see it getting better it's like awesome it's also kind of like eerie because we've been through this before where we had a surge we were really overwhelmed and then the surge like ended and we actually like had like no patients we were calling off nurses it was very weird and that's sort of kind of what's starting to happen now is that the other day we actually had to like say hey does anyone want to go home early so a nurse like got to go home early and um we have like empty rooms and it's just kind of like this eerie feeling of like okay this is nice and it's a nice break but is this like sustainable like are we going to continue to just like have reduced COVID patients or is this like another calm before the storm so i'm really hoping with the vaccine with you know just COVID literally infecting so many people here that we start to develop some sort of like herd immunity and that we don't see another one of these huge like surges i'm sure maybe we might have another little one i don't know but it's been crazy i want to make a video just sharing like COVID stories that things that i've experienced personally or other nurses have experienced in like my ICU unit because i have seen so much good and bad through the last couple of months like an overwhelming amount that i think it'd be nice to kind of document it and just be like i don't know these are some stories from working as a COVID ICU nurse obviously i want to like be HIPAA compliant and all that but i've just seen like some crazy things that in the moment i'm like this is this is crazy but then i go home and i'm like what what happened at work today um and it because we've just had such high acuity and so many of these patients it's like just astronomically astronomically just a ton of stories both positive and negative sad happy a mixture of all the emotions so if you're interested in that i think i want to do kind of like a COVID i don't know like a COVID wrap-up video because i know COVID's still going on but kind of like a COVID stories from an ICU nurse i don't know let me know if you're interested in that but that's um where i'm at i'm still on like duty i will probably be on my duty for another i don't know week or two i have another appointment with my OB coming up and i'm gonna see if i can get cleared to maybe go back um if it's gonna be safe also i'm hoping that with the numbers of COVID just being a little less and us having a little better staffing that i can at least like have a normal assignment and i don't like want to ask for favors just because i'm pregnant and whatnot but i do have to like look out for myself and this baby before everything else and i would tell anyone else that it's just hard to like live that for myself sometimes and i felt really guilty initially going on like duty because i saw all of my other nurses like still struggling and i was like sitting there on the computer not really i was being helpful in a different way just um it felt weird for me so okay that's my update i hope you guys uh enjoyed that and i'll see you in my next video bye


My name is Swasti Amato and today I want to talk to you about the new journal, the new open access journal that the European Society for Cognitive Psychology wants to launch. I'll start with a little bit of background in case you're not familiar with the situation. So the European Society for Cognitive Psychology, SCOP, currently has an academic journal which is called the Journal of Cognitive Psychology. The Journal of Cognitive Psychology requires a subscription to read it. So basically the only people who have a subscription are researchers who work at the university because the university has a subscription or students who study at the university. But normal people who are not academics cannot read the Journal of Cognitive Psychology. Now, SCOP is not happy about that situation because they feel, as many researchers feel, that the research which is publicly funded by taxpayers should be freely available for everyone to read. So if the taxpayer pays for research, then the taxpayer should be able to read the results of that research. That makes a lot of sense. So what SCOP wants to do is create a new journal in which all articles are free to read for everyone. So it's just going to be a website and you can read all the academic papers on the website for free. Now, it still costs a little bit of money, of course, to maintain this website, to maintain this journal. And therefore the people who pay are the authors. So if you're a researcher and you publish a paper in this journal, you pay a small fee to the journal and the journal uses this money to maintain the website and to maintain the journal. And that's the basic idea behind open access, open access publishing. It's a publication system that's a little bit weird, maybe if you're not an academic, but it's quite widely accepted, I would say, within academia. So it's an author's pay kind of system. Now, all of this is very new. SCOP announced only two days ago that they want to create this new journal and that they want to basically break with their current journal of cognitive psychology. That is a very bold move. It is very rare that an academic society like SCOP takes such a radical decision. So I think, first of all, congratulations to them, that they have been so brave and so progressive to take this step, which I really think is a step in the right direction. And right now, what they want is input from the community, from us, essentially, about what this new journal should look like. Because they're going to create a new open access journal, but what exactly this journal is going to look like is still up in the air. And they, we need your opinion to kind of decide these things. So what I want to do here is just go through a few of the ideas that have surfaced on the Internet. Candice Mori, who's going to be the editor-in-chief of this new open access journal, which, by the way, has no name yet. So I just called it the new journal because we haven't decided the name yet or SCOP hasn't decided the name yet. And she put out a call in which she said on Twitter and also on a blog post, as editor of SCOP's new open access journal, I want to know what cognitive psychologists want from us. So tell me. So let's just take a look at all the ideas that she received and I'll try to explain a little bit what these ideas are, what they mean, and bias it a little bit with my own opinion. So the first reply that Candice got was from Frauke Hermens, who says that she wants low or no publication fees. So the publication fee is the fee that the author pays for publishing in the journal, as I explained just a minute ago. And she wants to have those fees either non-existent, which is probably not possible because then there will be no money to run the journal. But if there is a fee, at least it should be as low as possible. And I fully agree with that. I mean, it shouldn't be very expensive to maintain a website with a few PDFs on it, especially because all the work is essentially done by volunteers, academics who do that for free, right? Who edit the papers and write the papers, etc., for free. So it shouldn't be too expensive. And she says, okay, I want low or no publication fees. And I think plus one for Frauke Hermens. And that is going to be really one of the key points, I think, for the new journal to keep those publication fees as low as possible. But I don't think there will be non-existent. There will be some publication fee, probably. Then Jim Grange says, I would like to see open review. What is open review? Well, what is review anyway? If you're an academic and you submit a paper to a journal, then you generally receive feedback from two or three of your colleagues. And they tell you whether they like the paper, maybe they want you to change some things or run an additional experiment, etc. And then based on that comment, those reviews of your colleagues, the paper is published or not. Now, currently, those reviews are always hidden. So if you read a paper, then you know that it has been reviewed, but you don't know what those reviews were. And what Jim Grange means with open review is that the reviews are published alongside the paper. So you can read the paper and you can also read how your colleagues essentially felt about the paper. That is kind of a new idea that's gaining a little bit of traction in the scientific community. It's kind of perceived as a little bit radical, maybe. It is different from the question of whether reviews should be anonymous or not. So right now, if you receive feedback on your paper, it is generally anonymous. So you don't know who the reviewers are. Some people feel that reviews should not be anonymous, that reviewers should sign their name under their reviews. But that's slightly a separate question from open review. So what Jim Grange would like to see is open review and perhaps still anonymous. Now, let me read a little bit more. And then actually Jim Grange clarifies what he means. He says, I think open review doesn't have to mean named review. So as I said, you can have open reviews, but it can still be anonymous. And then James Bartlett again says, open review would be great, but perhaps it would be great to have the author details hidden. Seeing this increase female minority acceptance. So what he means is that right now, if a reviewer receives a paper to review, he or she can always see who the authors of the paper are. Now this can bias your opinion, of course. So if you get a paper to review and you know that the author is a very good famous scientist, you may be more inclined to have a positive opinion about the paper. And that can bias against young researchers. It can bias against minorities. It can bias against women. It can bias essentially against everyone except white males like me. So it might be good. It might be fair to remove the author details from a manuscript when it is reviewed.  The downside of this is mostly practical because it is not easy to make a manuscript anonymous. Because even if the author names are not above it, most scientific fields are very small. So you can kind of guess based on the content of the paper who wrote it. Most authors also tend to cite themselves quite often. So if you see that if you get an anonymous paper that cites Mato 12 times, then you know that probably it was me who wrote it. Because I'm my own biggest fan, so to say. So I think that anonymous author, anonymous reviewing is in principle, I think it's a good idea and I think that James Bartlett is right and that it would make it more fair for minorities and women. But it is practically very difficult to implement, I think. Now then we scroll down a little bit further and then Chris Hartgerink says, please opt for CC buy, this gets technical. I'll explain what he means. He says please opt for CC buy or CC zero licensing only CC buy and C or MD are horrible. Now what does he mean? He's talking about the license that is attached to the open access articles. So if you publish an article and it's free to read for everyone, there's always a license that tells you what you are and are not allowed to do with the article. The most common license is the CC buy license that allows you to basically do everything you want with the article as long as you provide credit to the original authors. That is why many people perceived as the most fair open access license. Then you have the CC zero license, that's a public domain license. That means that you are basically allowed to do everything with the paper and you don't even need to provide credit. I think most people will provide credit because it's kind of the nice thing to do, but you're not legally obliged to do so. So that is the most, I would say the most free license, but it's quite uncommon. So he is a favor of the CC buy, the open access license or the public domain license. According to Chris, those are the best ones and I kind of agree. And he says that CC buy and C or MD are horrible. Now those are licenses that put additional restrictions on what you can do with an open access paper. So NC stands for non-commercial and it means that you can do everything with a paper as long as you don't use it for commercial purposes. I think that's an unnecessary restriction because why wouldn't you be allowed to make money? If you have a clever way to make money out of someone else's research, why not? And MD means no derivatives, means that you can do everything with the paper that you want but you are not allowed to modify it. So for example, imagine that you're writing a review article and you want to extract a figure from a paper, but you're not entirely happy with the figure as it is and you want to change it a little bit, the colors or the title on the x-axis or anything. Hopefully not the actual data, but just some aesthetic things. You would not be allowed to do so with this MD, no derivatives clause. So it's also unnecessarily restrictive. So that's what Chris says. Then we scroll down and then we get another kind of technical point. I think a lot of the concerns, a lot of the questions that people have about the new journal are kind of practical. They want things to be easy and user-friendly. And this is also the core of Tom Falkenberry's point, who says, I would wish for allowing or encouraging non-Microsoft Word submission formats such as latex, markdown, etc. Now, plus one for Tom, because if you submit a lot of academic papers, then you know that the submission process can be quite annoying. So for example, I personally write most of my papers in markdown and then once I'm ready to submit a paper, I have a very nice paper, I think, with the nice PDF, nice figures, etc. And then I go to the submission website and I find that I have to submit it in .doc format, which means that I have to go back and convert everything and then I upload it and then they convert it again and I look at it and the result is not nice and I go back and I have to, you know, and it's very annoying and it can take quite a bit of time in order to get it right. So Tom Falkenberry says, OK, let's make things as easy as possible and just accept a wide range of submission formats. Plus one for that. Then we go down and then David Barner, who actually has done some good work in the open access movement himself, but that's a different story, makes a very important point. He says it's a mistake to always package open access with many other innovations such as open review. High quality open access is already a huge advance and I 100% agree with him. So I think the top priority for the new journal should be to create a high quality journal that is free to read for everyone. Once we've established or once Escob has established that, that's already a major advance. Now, we can think of all kinds of innovative publishing things like open review and a very cool manuscript submission system and what have you. And that can be nice, but the core should be the high quality open access. And we should be especially cautious of innovating too much and scaring off potential authors. There's a small group of people on Twitter and on blogs, et cetera, who have all kinds of radical ideas of what publishing should look like. I think often those ideas kind of make sense, but not everyone agrees with them or many people kind of feel uncomfortable with them. And if we with the new journal become too radical, the risk is that it scares off a lot of the potential authors and even maybe a lot of the potential readers. So again, plus one for David Barnard saying that let's focus on high quality open access for now. And then add those innovations perhaps if they are accepted and if they actually make sense. But it's not the main goal. Well, let's go. And Candice actually replies to him and she seems to kind of agree with that. She says the top priority is launching and accepting submissions and stuff incidental to journal policy such as having all kinds of innovations will require longer. So essentially I think the idea of Escob and Candice Moray is to just get this high quality open access journal out there and then maybe add innovations later along the way if they are sufficiently supported by the community. I hope that's what she needs. I think that's what she needs. And then we have another important point by Fernando Blanco. And he says that he would like decision to publish not to be based on subjective criteria such as the foreseen impact novelty ellipses. I guess you know what I mean. Now, I do know what he means because there are two, there are basically two streams of thought when it comes to peer review. You have people who feel that basically the only thing that you should review is the methodological quality of a paper. And if you've conducted an experiment that was done correctly and you've analyzed it correctly, etc. Then it should be published regardless of whether it's interesting or new or whatever. So the only thing that matters for publication is whether it is good solid science. And then you have another stream of thought of people who feel that things should be published only if they are important enough so that novelty or perceived impact etc. has also a criteria for publication. Now, personally I tend to agree with Fernando Blanco that it's best to review only the things about a paper that you can really objectively review, which is basically the methodological side of a paper. But I think my gut feeling at the moment is that the consensus is going in the other direction and that many people feel that also things such as novelty and perceived impact are an important publication criteria. And I suspect that the new Open Access Journal will actually use those kind of subjective criteria for acceptance as well. We'll see, but I think I'm afraid that Fernando Blanco will not get what he wants, but he nevertheless gets a plus one from me. Well, then we have some references to John Barron, an apparently mythical figure who has created an Open Access Judgment and Decision Making Journal that has been free for at least 10 years. I actually didn't know about this journal, but it seems pretty cool and it seems like something that could be a model for the new escort journal. So I think people are definitely going to take a look at that. Daniel Larkins agrees, he says, that this, meaning John Barron's journal, is by far the best example of the future of scientific publishing. Okay, and then we have someone, Michael Cain of the Cain WMC Lab, Working Memory Lab, I suppose, says something I also agree with. I actually find myself agreeing with a lot of the things that are said here, perhaps meaning that I'm very malleable, perhaps meaning that people who are engaged in this discussion are reasonable people. He says, regarding content, perhaps room for review articles and opinion pieces would be nice to have an open outlet for these, an open access outlet for these. And I agree because right now most open access journals are focused on empirical papers, meaning that papers that describe experiments. But every once in a while you also want to write a review article, right, to kind of summarize the state of the literature or sort of review your own research over a certain period. And it would be nice to have an open access, a high quality open access outlet for these review articles, and right now that doesn't really exist. There's the Frontiers, there are the Frontiers journals, it's never clear to me whether Frontiers is one journal or a whole bunch of journals, and they actually do publish review articles, but Frontiers is perceived by many people to be kind of dodgy and not really a very good outlet. I cautiously agree with that, I don't like Frontiers very much either, because it is commercial, it has a very strong commercial aspect to it. So yes, plus one for the idea of accepting article literature reviews and opinion pieces. Then we scroll down a little bit, what do we find? We have some very valuable input from Alex Holcombe who offers, he's a very famous, well he's a moderately well-known guy within the open access field, and he offers to help with the practical side of things, and I think he could be a very valuable person to have on board personally. Scroll down. Yeah, that's kind of it what people have been saying on Twitter. Now let's move to Candice Murray's blog post, because she also wrote a blog post in which she asked people for feedback. And I was reading the comments on her blog post and one kind of stood out, and I think it's an important comment by Catherine Tevinot from Lausanne in Switzerland, and she says she's critical, most people are not critical, and that's dangerous, right? If you don't get criticism, you're not going to make the optimal decision, but she is critical. And she says, I really do not think that paying to publish our own paper will allow us to gain in transparency and fairness during the review process. Now what she means, I think, is that she's afraid that because a journalist paid for every article that they publish, they have a very strong incentive to basically publish everything regardless of quality, so that they're also going to accept very poor manuscripts for publication. Well, she makes a good point, and this is actually a real problem with open access. And Frontiers, which I just mentioned, is an example of that. Frontiers is a commercial organization, it's owned by Springer, and they publish, at least that's perceived by many people to be the case, they publish everything regardless of quality because they just make a lot of money doing so. And that's of course not the way that sign should be done, right? Paper should be vetted on their quality, at least their methodological quality, before they are published. And she's afraid that they will not... Catherine Thévenot seems to think that that is a general property of open access. That's what I read in her comment. But it's not, right? Because Escob is a non-profit organization that wants to create this open access journal to publish the best signs for free, freely available for everyone. They have no financial incentive, they don't want to make money. If they don't like a paper, they will not publish it, regardless of whether that costs them a little bit of money, because they're not in it for the money. So I think that's why these academic societies such as Escob are so important, because they can kind of stand above these financial incentives, right? They can really maintain, guarantee a level of quality, I think. That's at least the hope, and I really know the people in Escob, and I really believe that they will do that. And I know that Candice More will be an excellent editor, who will be like a guard dog maintaining the quality of the journal. So I don't agree, actually, with Catherine Thévenot, but I do think there are important points that a lot of people will be asking. Then she continues, she says, Moreover, the suggestion to commit the reviewers to give their name is the best way to subvert the system even more. So she's talking about an anonymous review, right, where reviewers sign their name below their reviews. We are not living in Alice in Wonderland, and if one is strongly positive about one of our papers, it will be almost impossible to avoid a positive bias when it will be time to judge his or her paper. And she, again, she has a point, and actually I do agree with this. The problem is that what she means, I think, is that if reviewers sign their review, they know that their name is out there, and it will be very difficult to give a negative comment, right? A negative review. Especially if you know that the people you are giving the negative review to are going to review your paper later on. So you could create kind of a dynamic in which authors give, you know, I give you a good review, and you give me a good review, right, tit for tat kind of. And that is a real risk. And even without the tit for tat component, I know that if you sign your name under a review, I always sign my reviews, at least when I'm allowed to, but I have to admit that it makes me probably more positive. I try to be critical when I find that it is difficult to be very critical if your name is out there. It's a downside of non-anonymous reviews. So the question is, what is worse? Is it worse that if reviewers are anonymous, that they can be very negative and very nasty in the comments, which is a bad thing, or is it worse if reviewers are not anonymous, that they tend to be overly positive about indoor reviews and maybe even create kind of a tit for tat economy in, you know, I give you a good review. You give me a good review. You know, those are two real downsides, I think, and the debate, what the scientists are currently debating is what is worse or what is best, you could say, to frame it a little bit more positively. But I think it is by no means a fact that this new ESCOP journal will have named reviews, right? It might very well be that most people in a society and in a community prefer reviews to be anonymous. And if that's the case, then that's the way it will be probably. And as I mentioned at the beginning of this video, open review is not the same as a named review, right? You can have open reviews that are still anonymous. So one of the things that ESCOP and Kenneth Morrie and everyone in the community has to decide is what we feel is the best way to implement the review process for this new journal, right? Because this new journal is going to be us. We decide the rules. We decide how we want to interact with each other. But I think that Catherine Tevenot, her comment is important because if you look on Twitter and on blogs, et cetera, you see and you hear a very vocal subset of academics who are very progressive and who want all kinds of radical change in publishing, but they are not representative for the average scientist. And this new ESCOP journal should be acceptable for and accepted by everyone in our community, including people who may not be the most, you know, strongest proponents of reform of academic publishing, et cetera. It's really a community journal and its success will depend on how well it is accepted by the entire community. So I encourage everyone, also people who are critical about these kinds of initiatives to give their opinion and tell Candice and tell ESCOP what they are afraid of and their concerns with open access, their concerns with open review, et cetera, et cetera. Well, that's it. That's what I wanted to share with you. And finally, I want to again congratulate ESCOP for taking this courageous step in the right direction. And I want to call on everyone who's been with me, if you're still watching, to give your go to Candice Maury's website or Twitter, give your opinion, tell her and tell ESCOP, tell everyone what you would like to see in this new open access journal. And in this way, you can help to make the journal the way you want it to be, and you can also help to make it a success. Thank you.


So hello everybody. Good morning. Thank you for being here. My name is Lara Kürzer. I'm from the German Organization La Kimia Help I'm my alone my patient myself, and I'm lazy my alone my patient. So this is the perfect topic for me So I would like to introduce to you Very special guest from England and she's working in the Royal Surrey country hospital and and she's a senior physiotherapist and Her specialty is the rehabilitation of patients with complex and chronic diseases and she's also involved in teaching and supervision of students and other physiotherapists and assistants and She provides assessment to clinical diagnosis with inpatient rehabilitation and she assists with clinical specialists for the setting and monitoring of standards and policies of clinical practice and She participates and I think this is very important in the evaluation in evaluation projects To raise the awareness of current research Relent to this speciality. So she's up to date That's always important for us for us patients and Today she will share with us her expert opinion on the rehabilitation Self-care and quality of life and multiple myenoma. So thank you for being here. Join. Hi guys Hi, good morning. Mine. My name is Ja Hui Gan. You can call me Jia, which is short of Ja Hui and I'm a Chinese so it's quite hard to pronounce it anyway So just have a background introduction of myself. I Since I graduated with a background of physiotherapists, I used to work in Singapore in a public hospital where I went to on my rotation and I Oncology rehab is something quite niche to Physiotherapy field 10 years ago. I first Developed my interest in oncology rehab and also first as opposed to multiple myenoma occasion Was when I was rotated to John Hawking Hospital Which is an American hospital. This was based in Singapore Following that I went to also Brooks University to further my study in Muscular Scatter Rehabilitation I also did some specialized study in cancer care study to further develop my interest in oncology rehab Following that what brought me back to you okay, it was because I married to my husband who is an Italian Right today We let's have an overview on what we are going to discuss for the next one hour First of all, we're going to explore what the challenges faced by myeloma survivor in their daily life and what a barrier for them to participate in physical activity or exercise and Also, we're going to look at that. What are the facilitator to overcome this barrier to make them exercise and also to enhance their ability to participate in self-care and We also have a going to have a little bit of insight on what are the available evidence of exercise program at different phase of disease and also we need to know what are the safe Prescriptions to progress our exercise so with a remarkable advancement in disease-directed typing life expectancy in myeloma survivor Extending however with accumulative burden of the bone disease like lute bone disease Compromise immunity and treatment related toxicity could actually prevent the return of them to good quality of life and also the ability to self-care and self-manage It could be wise to focus on non-invasive Strategy to maximize their quality of life and well-being It's a plasma cell bone marrow cancer 80% are more of the myeloma survivor as we present that with bone morbidity This actually position them at high results pathological fracture also the musculoskeletal pain World War Collapse by long-born fracture This could lead to skeletal deformity muscle wasting, deconditioning, function and decline or even lead to disability But on the other hand this bone pathology and musculoskeletal Condition could mean that they could benefit from increase their activity level so the the main side of multiple myeloma including Crab, we call this a crab, which is short of hypercalcemia renal failure, anemia and also bone lesion could be the barrier to stop them to participate in exercise program and Secondly the side effect of myelobrathic therapy can be anything pain, neuropathic, fatigue, weakness and also their psychological effects such as fear of infection, lack of motivation, something that even got into depression and also a lot of them will tell us that I'm not sure how to exercise safely Lastly as a multiple myeloma is highly prevalent in elderly, so actually later Declined in physical ability, it could be an unavoidable issue, just like the issue in an aging population So who are the people actually affected by sight and symptoms of multiple myeloma? So as a accumulated burden disease of sight effect survivor With advancing age, high age, as well as multiple, less, multiple myeloma disease tends to be affected the most This sight effect might not just impact on the psychosocial well-being or myeloma survivor but might also, a lot of times I would say not might also, a lot of times they also impact on their closest environments such as their family member as well as their friends What are the physical activity guidelines for cancer survivors? According to American Colleges of Sport Medicine and World Health Organization they both suggest at least 150 minutes of moderate intensity aerobic and strengthening physical activity At least 75 minutes of vigorous intensity similar activity for cancer survivor and I mean physical activity This means that then you're not necessary to go and do a lot of sports More toners or we call it sparring exercise training You can do anything which is enjoyable and Functionate to yourself such as leisure time physical activity Transportation like walking to walk cycling to walk cycling to shopping Any occupational related activity such as your work household course, it can be very tiring as well. You need to do cleaning laundry gardening and So-tongue as well as you can plan for any physical activity in the context of your daily or personal family life such as Decay of your child children play with your grandchildren walk the dog or joining any community service activities so There are actually multiple way to accumulate these 150 minutes of moderate intensity exercise With a concept of short bout like five or ten minutes of moderate intensity and gradually build it up to hundred fifty minutes per week So as a definition, what is moderate intensity exercise? so if we perform an exercise test professionally On a treadmill or by a cycling test So we are actually targeting 50 to 70 percent of maximum heart rate According to a both rated percif-exception scale. It will be four to six out of ten that you should feel a Bit light to somewhat hard. So it's not too difficult. Oh In ten of vigorous intensity exercise So we are targeting 70 to 85 percent of the maximum heart rate. Oh according to the both rated percif-exception scale you should feel Seven to eight out of ten, which is somewhat hard to heart But not very hard. We will define it as a very hard intensity of exercise So how many of you make this exercise? Activity level per week. Can you raise your hand? briefly If you do an exercise log how how about your daily activity your physical activity Cleaning walking you might achieve this level a lot of people achieve it so How many myeloma survivor actually met that physical activity guideline So during active treatment period, they were approximately 7% of them met the physical activity guideline, which is quite boring. Oh During the off treatment period, there should be more active But there were about one-fifth of them met the physical activity guideline According to John's eto 2004 Despite of low number of myeloma survivor met the physical guideline They suggest that by just engaging in moderate intensity exercise They do presented with higher quality of life score In another study latest study by Craig Dandy Dutting There was slightly increased number basically few percent of increased number of myeloma survivor met the physical activity guideline When we compare with the other cancer survivor group, there were higher number of them Which is 30 to 45 percent of them met the physical activity guideline and So These findings suggest that myeloma case Can be more deliberately Lividating with other type of cancer and this could represent an additional Challenge for them to call dissipate in regular physical activity or Simply just self care and self-efficant self-efficacy in their activity daily living so now we're going to look at this Literature review down your systematic way with the title of the effectiveness of exercise program in Patient with multiple myeloma, which was my study in 2016 So just a brief information about metatology So manual search in addition to 10 electronic data base search will was contacted With the aim to prevent omission. So we We also perform manual search at local library such as the library at University of Oxford and University of Oxford-Berthie University and also we went to the reference release Try to identify any exercise program, which is specifically in multiple myeloma case On the other hand, we also perform some website search Google scholar search and consultation We team the available clinical framework. Hopefully we can identify any article Which hasn't been published. Oh, it's going to be published To following the results itself. We only managed to identify seven study We was not too bad, I will say From the study from these seven study select tab, we analyze the effectiveness of exercise program to Teammatic analysis and we looking through the specific elements of the exercise program and it's related outcome measure internal physical outcome measure physiological outcome measure or any clinical outcome measure used by the medical oncologist Exercise performance the quality of life psychological well-being in order to answer this research question so from the eventually the data We obtain from the data analysis We also went to some appraisal for the quality of the study selector, but we're not going to talk in detail today From the for the from this literature review, we divided the outcome into Three phases of exercise intervention. First of all, we're going to talk about The exercise intervention during a active multiple myeloma treatment phase so during Active myelobrative treatment phase. We managed to identify for home-based exercise program There were individualized assess home-based exercise program, which is a one-off session and while the power discipline were undergoing high-dose chemotherapy or autologous stem cell transplant so There went to stretching exercise Basically, you need to warm up a little bit to get your engine warm out and get yourself ready to prevent any musculoskeletal injury and Also aerobic exercises. They're suggesting to do any aerobic exercises. Usually they like to do walking and they the recommended Intensity here it seems a bit Contracted because here saying there is about 65 to 80 percent of the maximum heart rate But seems like between moderate to maximum intensity, but actually The author gave them the board rate that perceived essential scale to go home and suggest them to just work at the light They got to feel between light to somewhat heart, which is moderate intensity exercise So I will say that went to moderate intensity exercise Then they also have to go into strengthening exercise. Basically, they use tera-band to progress their strengthening and You may observe that these four home-based exercise basically have a common order, which is Column Dr. Column who has a nursing background and they were done this study in United States in quite a prominent cancer research centre and But the different of these hope for home-based study is the duration of the program with apparently have reduced from six months To 15 which which is less than four months and they also use the profit let a appointing alpha to Targeting the anemia effect. Hopefully by working on this the anemia effect could suppress the confounding factor to cover masking the effectiveness of home exercise program and all these for all these study are actually randomized control trial with a treatment group and control group accept the second study by Kuhn and Colloman 2004 which is a qualitative in nature basically they run to focus group focus group and team at the analysis to identify the outcome in the earlier study 2003 with 40% of the dropout rate Basically, they will know much different between treatment and control group apart from the The treatment group has in shown improving their lean body weight But when I look into detail they say that they're not actually increase in their lean body mass weight basically your your muscle mass versus your fat T-Shield level But is they maintain it by the control group, which is the the group that didn't do any home-based exercise They drop significantly versus the home-based exercise group And in the second study the quality study All the power disciplines in the treatment group they believe that exercise is positive and They're benefited from exercise in terms of improve their mood that is some of the in very reported that they have reduced the use of their anti-depressant and They're also improving their fatigue level keeping their body in shape Some of them tell us that that if they know That can attend some benefit from exercise they should start the exercise earlier and still when they're invited to join this Cancer study This research study In this in 2008 for four fifteen weeks of Home-based exercise program for power discipline underwent chemotherapy only or 30 weeks for people underwent stem cell transplant It didn't show any different of six minute walk test, which is the aerobic capacity assessment But they had shown improving numbers of red blood cells and platelet transfusion Attempts and days of stem cell collection However, there's Outcomes became statistically Significant versus the control group was only after the eliminated the power discipline who didn't respond to appointing L4 Supplement This clearly suggests of the selection bias in data analysis. So I'm not too convinced by the outcome Lastly we say about the primary treatment in Myeloma patient usually is high dose chemotherapy, which can cause unresolved factor This is shown by the latest study by Coleman 2012 that There is no any Improvement in any of the outcome measure for a study in less than four months But both control and treatment showed that they became more and more factor Slipless net at night and they also getting more decondition and some of them became function and decline so from these four home-based study without regular Face-to-face contact but one of assessment and then go home do your home exercise program Doesn't seems really work. So what we suggest in our literature is The S home-based exercise program during my love brother if Face should provide with some some level of face-to-face supervision and to be regularly contact it can be an Individual one-to-one session to assess their needs or can be a group session if their needs is not to Specific or have to be treated one-to-one We should progress the exercise component or sometimes we have to step back a little bit when their condition is not It's not that idea. Oh, sometimes they get further functional decline during the treatment phase So one of the latest home exercise program Gen D 17 last year in prostate cancer such as their cell efficacy In power dissipant who only participated in home-based exercise program actually became negative at three at third month because of lack of face-to-face contact and Lastly we suggest that the exercise training should be ongoing right after you complete the treatment Milo operative treatment and this home-based exercise program Show that that might not be sufficient in their duration and intensity Oh, they might have premature complete of their exercise program while the participants do have their needs to be met second phase we're going to discuss will be exercise intervention during my love multiple my my remission phase mix exercise training program Apply both qualitative and quantitative data analysis selector 37 patient out from safety in stable maintenance maintenance phase Where the power dissipant will either off treatment or they were undergoing maintenance treatment to undergo this mixed exercise program during the first treatment They have to go to weekly one group section Leaked by a physiotherapist or choice of a home-based exercise and The exercise content is quite similar to your home-based exercise program which including aerobic stretching aerobic exercises and moderate intensity and resistant exercise including weight lifting Teraband exercises as well and in the second phase of the exercise program between 36 months that how to go into home-based exercise three times a week and They also come in to attend a group session once a week. This study actually run by University College of London and Eventually There were 28 out of 37 which was about 75 percent of the power Discipline complete this six months study mainly due to logistic issue, which is the most common problem family or work commitment as well as Miloma disease progression that cannot tolerate this program animal and just for your information This majority of these participants had significant lytic bone disease at their long bone spinal bone collapse Underwent orthopedic surgery recently and they also require regular energy share Tidation, which is pancular so in this study They analyzed both participants who Completed and didn't completed the exercise program. It showed that participation in this mix exercise program had significant improve in their patient reported quality of life measure by functional assessment cancer type general version as well as the fatigue score and you can see that from This one would call my day, which means minimally important difference Score also improve Not all the majority of them also improve more than three The other outcome measure including up a link and low link strength had shown Significant improvement over time point they run the test to one way repeated ANOVA test However, there were no significant changes in ten of the or two max, which is the Arabic capacity as well as the factory link body mass Which is quite similar to the home exercise program Because they only compare among themselves not compared to the control group and this suggests that The even the maintenance treatment during the off-treatment phase multiple myeloma itself can be quite debilitating These mix exercise program might not be sufficient in their intensity Lastly, we're going to talk about the quantitative analysis From this mix exercise program So the first thing they identified was fear associated with risk of born Fracture and the power discipline Described that the multiple myeloma itself is very frightening and That will warn of the risk of born fracture So they will not share how should they do their exercise and they become over protective and over defensive to to do their activity daily living or Any sports exercise, which is not out of expectation and secondly the power discipline report that by the major That they feel that the increase in their confidence mainly improve to chew the group to group contact with the health care professional as well as Contact with the other myeloma survivor and patient advocate That actually improve their confidence in other area of their life and that that to explore other activities outside of home and most importantly they feel that This exercise program gives them hope and they have changed their perception of the future So it's quite good Quite a positive outcome Right now let's set Research study aside. Let's see in real life. How much does a multivator myeloma survivor that do exercise? I break down life into into smaller segments and right now I'm in a really good segment and so during this segment. I have to really take advantage of this I've got to do what I can do and so that's what I'm doing right now focused on the climb and I'm going with 15 other individuals and we're going to climb Mount Kilimanjara My name is Bob Dickey and I was diagnosed with multiple myeloma in 2010 I Actually had no idea what multiple myeloma was except I knew it was it was really serious The initial chemo really didn't do anything my numbers. I was pretty advanced I was able to get into the city of hope and that's really where things started to turn in the right direction And they saw where I was at and they knew it was a time was of the essence and On July 4th of 2011. I had a stem cell transplant and it went really well It was very difficult Something I hope not to ever do again, but realize it could it could happen that the treatment and the difficulty of the treatment has Set me up and and given me an advantage on the training side of it because The the treatment really made me focus on these small segments just getting through just getting through getting to the next treatment Getting to the next day and during the stem stem cell transplant. It was really getting to the next 15 minutes I did Mount Whitney a year after my stem cell transplant. That was a great thing to do. It was very difficult This is the next big climb and on my training hikes. It's one more lap around the top Let's go to the bottom and go back up again one more time. I've done it twice today I think I can make it a third time is pushing yourself just a little bit harder each time I think that's what's going to allow me to make it to the top of Kilimanjara is because I Know I train harder than I would have if I hadn't had the experience and I enjoy the process of Pushing myself really hard. I think that the process is Probably more important than probably even that summit day the summit day Will be the validation of everything that that I've done But it's the process of getting there that I think is the most important Honestly, don't you think this man is much more active than anyone of us here whether they're healthy or not healthy So the last phase of exercise program we're going to talk about will be Pre-hap pre-hap validation, which is a trend nowadays in preventive Preventive rehabilitation so There were two study recruited Recruit a 2k study were recruited to look at the influence of a six month multi model High intensity training program almost same 41 years old female subject with a former sports background As a nature of niche field in pre-hap there is actually a lack of evidence to support on this topic Which is not out of expectation The value of these two case study was it applied Sensitive and uncommon clinical outcome measure in a longitudinal setting which I would say is is rather Relative in common in a physiotherapy field In this six month high intensity multi-moder training program was aimed to double up the power Strength endurance big flexibility actually do anything you can name about so it's more a Funds than the exercise program. We have seen just now and To develop these various physical Capacity one of the distinctive feature of this exercise program. It was frequent chance of the exercise To in order to develop seven capacity for example in order to develop power The these subjects have to underwent different jump weight lifting Resistant exercise or as well as their combination in a functional movement setting Following these six month exercise program these subjects had further trend without direct supervision But and monitoring of her outcome measure So you can see from these graph from Year 2000 to 2011 the IGG level has improved from 2.5 3 to 1 point at full and This one is bone marrow plasma cells lever has in had improved from 20 percent to 10 percent and Also the exercise performance including how scored hundred meter core Bench bench press they all has improved Another thing I will talk about here, which is not in this graph will be the cardiac Autonomic control which will measure to the heart rate variability. It has showed significant increase Compared to their baseline and this study also compare the outcome from the cardiac autonomic control By compare with six healthy H make subject. It also showed significant improvement So this study suggests that this case study after rain first Suggest that fitness training could be beneficial to survival sheet outcome in smothering multiple myeloma case However, further randomized control trial study is really required So let's go back to This literature review to see how is the effectiveness of exercise program We will say that majority of the study selected presented with some positive correlation between participate in exercise program it shows some improvement in various aspects including physiological psychological quality of life However, it is very hard to suggest a single type of exercise or exercise program for all Different stage of myeloma patient because there's quite lack of study Recruiter and the study recruiter will quite variety in their design the stage of multiple myeloma as well They are treatment selected and last thing will be Their methodology quality was quite variety as well But however, we will say that it is safe to exercise even in a vulnerable multiple multi common BDD case Finally will suggest an individualized assessment to establish a personalized exercise program Or just simply some advice tell you to each patient condition and their concurrent treatment need Because we sometimes not necessary about exercise that might have other needs for example to treat their neck pain back pain and extra in a high common BDD Cancer like multiple myeloma we have to consider some of the safety factor when designing a exercise program of providing Physical activity advice so in an acute enemy case We should avoid high intensity high speed exercises in a severe immunocompromised case We will suggest to avoid activity that might increase the risk of infection for Significant or sudden draw of the platelet cow to avoid high impact or contact spots or activity to prevent uncontrolled breathing For severe deconditioning and fatty case to try to plan something which is meaningful to them I'll just advise them to policy back in a light to moderate intensity exercise finally if If a person report to you that they present that with some of the side effect from The treatment do you allow them to take Brandy of rest in between of the day in between of the exercises Encourage them to maintain their hydration level encourage them to drink Do not policy back in vigorous exercise in enhancing physical activity level Behavioral chance intervention to promote positive effect of exercise shall be provided Firstly we talk about environment queue environment queue can be anything From regular syndrome monitoring cell management coaching decision support in their daily life and This is not necessary to be provided by health care professional But it can be anyone like friend family fellow male Loma patient support patient advocate, especially Support from the community service Go setting go setting in term of a long-term goal as simply as Walking your dog for half an hour going out for hiking going out for shopping do your grocery Going out for a family trip or even going back return to work To gradually build on the short-term goal in terms of physical activity level or True personal review of exercise performance. It can be facilitated to using various goals setting to Such as a smart goal to our goal attainment Attainment scale So in 21st century, how can we miss out the technology? So what we are talking here is we may use mobile technology such as just use your smartphone or gamification Including virtual reality game and this lady who is very active day is actually playing a key neck to Xbox Use we in a clinical setting actually all this is applying in the NHS health care system and it's very common in Singapore and Hong Kong and these Technology support could be a promising too for scalable support of therapeutic activities and Continuity of patient care outside of health care setting in the community or at home So lastly we're talking about cell monitoring or physical activity We can use petrometer or acetylometer by mobile technology. I'll just simply use the exercise lookbook like Christina use in her study So this cell monitoring strategy allow the Myeloma survivors select their daily training volume based on their physical Readiness as well as the affected labor to enhance the effectiveness to provide regular monitoring By family friend health care professional and patient advocate Following multi aspect of support myeloma survivors should be motivated with the drive of For from the drive of positive benefit of physical activity True happy formation in order to be self-efficacy and to be able to self-care future direction I would suggest a multi-disciplinary pre-hap service should be established by Physio Doctor patient advocate Anyone even psychology in addressing both physical activity and psychosocial component To prevent development of multiple myeloma. Oh just simply Prepared them to go into chemotherapy or stem cell transplant Which is actually this program is available in my current hospital Rosary County Hospital and some of the hospital in London We will really require more evidence from a methodology vigorous study a different phase of multiple myeloma in got to guide cost effective exercise program and Lastly we suggest try to maximize the use of technology to support long-term treatment My tech home message would be an explicit recommendation was Try to await in activity and be physically active as active as possible I mean that try to do something which is enjoyable and meaningful to yourself And also it can be meaningful to your family member or at your word and Try to get support from anyone Including and pay a to maintain yourself advocacy and we are very helpful anyway So and thank you So thank you very much very nice Session very much information. I think it's very important Yes, we are a little bit late, but I think we should take the chance and ask some questions because I think This is a really good chance to To ask her. She's a very professional Physiotherapist, so who has some questions? So you want to ask for the power point. Yeah, sure no problem So maybe I will does somebody have a question or I shall ask one So ma'am, I would like to ask if there are any specific Exercises that are not good for myeloma patients that they should like not do So We went to some part of it like the precaution of exercise So we will talk about we talk about like when their blood level is Altered when their side and symptom are acutely not well So we will suggest not to do bouticular exercise have to be Specific to their personality because we know that from this study to the focus group a lot They're quite frightened to move so Try not to give too much information to them But specifically asked about ask them some question. What is their current condition? What is their medical condition? What's your blood test? They're astray their CT scan in order to give them advice, but what I can say to you is What exercise to instill tell them what not to do, but suggest them what to do So we want the bottom-up strategy encourage them to move so At this point I would say some of the exercise which is very good for the stretching You know, a lot of them have a bone lytic lesion Problem so they tend to present up with some outer puncture like quite kind for today quite slouch and quite tight At particular part of their body such as their chest their low back So, you know, they are biomechanic are not very good. So we encourage them do a corrective stretching So the corrective stretching because they get tired quite quickly with such as you to be seen by Physiotherapies even osteopath kinesiologist To get some idea about what kind of a corrective exercise to do because I will say their Battery level their energy level is quite limited So maximize to use what they have to do the important targeted individualized exercise Some questions So I would ask one question So I think one main problem is the lack of motivation because it's actually a physiotherapy So would you share some experience from your daily life in the clinic? What do you do when you have a patient with Who was maybe has some fatigue who was depressed who doesn't want to move at all? who I see Depressed and people who do not want to do any exercise every day I would say a half of them do not want to get up from bar to do anything In an acute setting because they do not understand what are the benefit of the exercise So we work as a multidisciplinary team by a Files from a physiotherapy Excel is not sufficient. We need the doctor. We need the nurse We need anyone even the catering staff to tell our patient. It's important. You need to get up to move and We tends to make something more functional people do not like to Deprive from their ability to use toilet So we tend to set some simple goal like get out to the bed Try to sit on the chair and slowly We need to set the goal for how many meter is your toilet away from your chair So we give them like short-term goal and your long-term goal short-term goal We aim that you can go to use toilet long-term goal is you able to go home Let's say what to your kitchen make yourself a cup of tea and you manage to use a stair Do the stairs softly go up and down Gain back your independence in your daily life But for this is quite a deconditioning deconditioning case for Younger adult who need to go back to work. So we will do something slightly more advanced like said like test there. What are their muscular skeleton Impairments sometimes some of them do have some neurological impairment caused by the cold compression Valdipra compression Neurobiotic so we need to give them something more Tailor advice, but this is quite expensive and our waiting list in the National Healthcare System to see a visual edge is quite high quite long if you're out of Acute setting so that's why we want them to come back to the group exercise So we are Designing some of the group exercise But unfortunately because of the funding issue we have to take all sort of patient But we try to get everyone in hematology or people similar to Multiple sclerosis we categorize them together and do their group exercise together Thank you Any more questions if not Thank you very much for this really nice session I think now we have lunch break