Hello and welcome to this Tenancy Information webinar for Park Managers. This webinar is a collaboration between Residential Tenancy Authority and Caravan in Queensland. I'm Valentina Dimosca and I'm a Senior Community Education Officer with the Residential Tenancy Authority and I'm joined by Ellen Mung from Caravan in Queensland. Hi, Ellen. Hi, Valentina. Hello, everyone. Today, Ellen and I will be looking at a number of topics in this session and we'll be looking at things to consider before the tenancy commences, the starting of a tenancy, during and ending a tenancy, some specific topics that have been raised with either Ellen or myself over the years from Park Managers. We'll talk a little bit about RTA Dispute Resolution Service, the Queensland Civil and Administrative Tribunal, and give you a bit of information about RTA's investigations and compliance process. Today, our discussion will be around your obligations and what you need to know in terms of the Residential Tenancies and Rooming Accommodation Act, or the Act, or RTA Act as we call it. One of the first things to keep in mind is that both holiday-letting and manufactured homes are not covered by the Act. But once you've established that and you are accepting a tenancy that's either short term or longer term, there are a couple of things you need to keep in mind even before the tenancy starts. And one of them is to make sure that the caravan or site that you're renting out is clean and in good repair. The locks and security devices are in good working order. There's a full set of keys for one tenant and an entry key for the other tenants, and that there are contact details for the tenant if there's an emergency. Remember, you also have an obligation to not be in breach of any health or safety laws. For example, there's a section in the Electrical Safety and Regulation Act that stipulates that all residential caravans in Queensland must be fitted with a working safety switch. So it's very important to ensure that you're complying with all the relevant legislation. Once you are starting a tenancy, there's two options. There's the short term tenants or a long term tenancy and the tenant decide which one they're entering into. Now, a short term agreement or short term tenancy, a written agreement isn't required but it is recommended. There's no formal one through the RTI but it is recommended that you do one. But you must also give the tenant a copy of the park rules and a copy of the pocket guide for tenants in caravan parks. With long term agreements, you do need to give a written agreement to the tenant and it's called the Form 18B and that will include by standard terms and special terms. And you must also give the tenant a pocket guide for tenants in caravan parks and an entry condition report. You may give them an entry condition report for moveable dwellings and you may also, if a bond is taken, you'll have to go through the bond lodgment process with them and you may fill out a hard copy for more. Look at one online in the RTI and lodge it that way. Alan, with the paperwork that I've mentioned so far, would you consider that that is quite critical? Yes, Valentina. Look, having no paperwork causes problems. You need to be able to identify three types of people will be coming into a caravan park generally will be a tourist, someone looking for some short term accommodation and someone looking to stay more permanently with long term accommodation. Some parks are still only issuing just a site receipt and that's not enough to show which of those three things a person is when they're coming into a park. So you've got to have paperwork that will show the grounds that the person is allowed to enter the park. If there's a problem down the track, you need to be able to show a third party such as the police or QCAT what the intent of the arrangement was. Okay, so keep that in mind. As frustrating as paperwork can be sometimes, it is very important. Absolutely, 100%. With starting the tenancy and the tenancy agreement in particular, it's important to keep in mind that you need to fill that out with all the relevant information so that both you and the tenant are clear about what you're agreeing to for the rest of the tenancy. The agreement needs to include the name and address of the tenant and yourself, the starting and end dates and whether the agreement is a periodic or a fixed term agreement. Oh, and also in terms of the rent, how much is it? How should it be paid? And also the services that must be paid for gas, electricity, sewerage, water, and having all that upfront actually reduces disputes in the end, doesn't it? Absolutely, yeah. As long as everybody can see what they're entering into and everybody agrees to what's on that document so it's very clear who's required to pay for what. These are all the standard terms in the agreement and it is important to have all those details there. Equally and even more important is to be very clear about the special terms. Special terms may include details about pets, rent increases, charging for utilities, and pest control. Be clear about the special terms you are putting in and check with either the RTA or CPAQ that your special terms are compliant. The other important part of the tenancy agreement is in fact the park rules. They form part of the agreement and you need to give a copy of those to the tenant before taking any money from them or signing anything that commits them to the agreement. Alan, do you find that there's a bit of confusion around amongst caravan parks around park rules? Yeah, I do, Valentina. Sometimes people think that there is an endless list of park rules but anything that they want as a park rule within their environment, they can include that on a document. Unfortunately the legislation is very clear about what can and what can't be a park rule. It's things like how the parks, common areas, play areas, swimming pools and toilet blocks can be used, how much noise people can make and at what times, where and when any sporting or recreational activities can occur. Speed limits for cars and other vehicles and where cars and other vehicles can be parked. The disposal of rubbish and where the pets can be kept. So there's a very defined set of rules as stated in the legislation and you can't just go making a park rule about anything that you would like because that wouldn't comply with the law. Now, some of you may decide that you do wish to take a bond. There's no requirement to take a bond. However, if you do take a bond, the maximum that you can take is two weeks or if you're charging electricity, the maximum you can take is three weeks. You must give the tenant a receipt straight away after you've taken their bond money and also lodged the bond with the RTA within 10 days. You have two options for lodging that bond. You can fill in a bond lodgment form, a form tooth that you and the tenant sign and then lodge with the RTA within 10 days or either you or the tenant can lodge the bond with the RTA online. There's four easy steps to lodging a bond online with the RTA. You go to the RTA website, follow the link to QGov registration. Once you register, you'll be asked to accept the terms and conditions and complete the lodgment details and pay by credit card, debit card or BPAY. There are many information resources on the RTA website to assist you in this process and you can also call the RTA contact centre where support officers can walk you through the process. Now that we've covered some key aspects of starting a tenancy, we're going to go into during a tenancy. Now one of the things during a tenancy is that you may need to do is to enter a premises. It's very important that you're aware that there's rules of entry that are outlined in the legislation as to when you can enter, why you can enter and how much notice you have to give before you enter. You have the right to enter a rent of caravan to inspect it or to carry out maintenance, routine inspections or to show a prospective tenant the caravan or site. However, you also have an obligation to not interfere with the tenant's reasonable peace, comfort and privacy. In most cases, you must give the tenant appropriate notice with an entry notice of 4.9. However, no notice is required in the case of an emergency or if the tenant agrees. Something else that often comes up during a tenancy may be breaches. Breaches are in fact breaks of the agreement and they can be done by either the tenant or the park manager. So breaches may include rent arrears, noise complaints, damage, unapproved pets or unapproved occupants. When you have found the tenant has breached the agreement, you have a number of options. You can communicate with them and reach an agreement with them about how that breach can be remedied, how they can fix the problem. In the example of rent arrears, you may be able to reach an agreement with them that they may not be able to fix it straight away, but they may be paying you back over time. But you need to put that in writing. If you feel that the tenant may benefit from support from other organisations, whether it's a neighbourhood centre or a rent connect program, you may decide to refer them to somewhere so they can have some assistance to be able to remedy that breach. Or you may decide that the best way to do that if neither of these have worked is to give them a notice to remedy breach and that will notify them that they have made a breach of the tenancy agreement or the park rules and that they need to fix that by a certain time. Again, a reminder that a notice to remedy breach can be issued by either the park manager or by the tenant. So what happens if you have given a tenant a notice to remedy breach and you've given them a timeframe and they haven't rectified the breach? They haven't remedied the breach. You have the option of giving them a notice to leave and in the case of where the tenant has given you a breach notice and you haven't remedied the breach, they can give you a notice of intention to leave. The other option is that either of you, the tenant or the park manager, can apply to the RTA for its free, dis-brief resolution service and they will be able to assist you to try and resolve the matter. In some cases the breach may be rectified but then a little bit later on the same breach happens again. What are some of these situations? Well, it's not unusual in a caravan park, Valentina, for people to keep doing the same thing over and over. A good example would be excessive noise. It could be rent arrears or they might be driving too quickly on numerous occasions in the park. So with a breach notice, you can issue it initially. If they fix the problem up within the allowed timeframe then that one goes away. Two months later they do the same thing again, issue a breach notice and again they stop doing that thing within the allowed timeframe so that one goes away. If on a third occasion within the 12 month period you have to issue a breach notice for the same thing, immediately after you have issued that third breach notice, you do not issue a Form 12 notice to leave. You make an application to QCAT for an urgent application for a termination of that person's tenancy under the grounds of repeated breaches. Ending a tenancy. So a tenancy can end in a number of different ways and there's a particular section in the Act that outlines the number of different ways by which a tenancy can end. Some of those are that you give the tenant notice to leave, that the tenant gives you a notice of intention to leave or that the tenant abandons the caravan or site. Another one is that both may mutually agree in writing to end the tenancy or you or the tenant can apply to QCAT for an order to end the tenancy and the final one is that the tenant may die. For all of these types of endings to tenant, timeframes do apply so it's important to look into the legislation to speak to the RTA to go on our website or to talk with CPAQ to be clear about the timeframes for notices for each of these and what to do around each situation. So when a tenancy does end the tenant has to return the premises in the same condition was at the start of the tenancy, less fair wear and tear of course and both you and the tenant also need to complete an excellent condition report and in your case and the tenant's case take some photos of evidence particularly if you feel you will need some evidence with regard to damage and so forth if there will be a dispute about a bond for example. The quickest way for bond refund is an agreed refund so that's where both you and the tenant agree that they may get the whole bond back or that you may keep some of that bond because of it could be for whatever reason could be some damage that was done and if both of you agree you can both sign a hard copy and send that in or you can go to our website and apply for a bond refund through the fast track process through our new web services at the RTA. So again staying with the ending of a tenancy we mentioned earlier in the presentation that one of the ways a tenancy can end is through abandonment so if a park manager believes on reasonable grounds that the premises is abandoned they may enter the premises by giving an entry notice and allowing 24 hours notice before going in to inspect the premises. Ellen, what would some of the reasonable grounds be? People will quite often, Valentina, look at whether the person has been at the site whether they've stopped paying their rent whether there's been any activity at the caravan and its caravan parks are fairly small environments so it will be generally quite obvious to a caravan park manager if a vehicle has been abandoned. It happens fairly regularly but if you do believe and what the law says is on reasonable grounds so for any of those things you suspect are happening then you can reasonably assume that the person has taken off and that the property has been abandoned. So you have two options you can issue an abandonment termination notice or you can apply to QCAT for an order to end the tenancy on the grounds of abandonment. So applying to QCAT for an order it really is very important that when you are inspecting the property or deciding that it's abandoned that you take photos, keep some evidence write everything down because they will ask for evidence as to why you think that the property has been abandoned and the tenancy needs to end. Another issue that comes up at the end of a tenancy in some cases is what happens with goods and documents that may have been left behind particularly if a caravan has been abandoned. So there's a number of rules around disposing of goods. Goods and documents left behind after a tenant has moved out must be returned or disposed of according to a specific set of rules goods may only be dealt with once the tenancy agreement has ended so you have to establish that it has ended and that the goods have been abandoned. And personal documents in particular such as cash, passports, birth certificates, photographs must be given to the tenant or if you can't contact them to the public trustee within seven days of ending the tenancy you must make an effort to contact the tenant about these items. There's also detailed information on our RTA website as to how to dispose of goods valued at less than $1,500 and those valued at more than $1,500 because there's quite specific rules about that in the act and you can also find out what to do for caravan and its contents have been left behind. Another issue that is related to the ending of a tenancy is the deaths of a soul tenant. Ellen, have you found this to be an issue on caravan parks in caravan parks? It does happen, Valentina. It's not super common. Several times a year we'll get a call from a park saying that a resident has deceased in the park and check with us what the process is and what they should do. So obviously the first thing that people would do would notify the police and let them do their job. When it comes to the caravan and the belongings of the person, really you should only be dealing with the executor of the estate or a lawful representative of the deceased. It has been known to happen that people will turn up and state that they are the son or the daughter or the brother or the cousin of the deceased and that they gave them a TV or a fridge or a mattress or something else as a gift recently and they just want to get that out of the caravan and ask for permission to enter the caravan. We would suggest that park managers should not let those people enter the caravan. If you do and they take those belongings and they aren't an authorised person, it has been the case where a park manager has been held liable for the cost of those items. So just ensure you're dealing with the right people and that's the executor or the lawful representative of the deceased. And similarly with RTA's bond claims, RTA does require notification from an executor of a tenant in the estate or an authorised person in order to deal with bond briefings. So we come to some specific topics, Alan, that you've come across in your work with caravan parks. Would you like to discuss some of these in a bit more detail? Yeah, sure, Valentina. Some of the things that do come up in caravan parks, they are close living environments and you've generally got a lot of people contained in a small space. So things like neighbour versus neighbour disputes can come up and that generally comes down to a personality clash between people and they got in each other's nerves a little bit and it can escalate somewhat. And quite often one or both of those parties will expect that the caravan park manager will do something about it. The situation is the same as if you were living in a house side by side. The caravan park manager doesn't need to become involved, that two parties need to sort it out themselves. However, if their behaviour between the two of them becomes such that it interferes with the peace, comfort and privacy of the other residents in the park, then either of those parties can be issued with a notice to remedy breach. Other things happen like you might get drug activity or some other form of unlawful activity in a park. There can be matters of serious nuisance where someone is displaying behaviour that is unreasonable or threatening or... Objectionable. Objectionable. You can contact the police. They do have the powers to remove somebody from a park for up to 24 hours if they think that's the appropriate action to take. Yeah, that's right, Ellen. And as well as calling the police, you can make an urgent application to QCAT for an order to end a tenancy on the grounds of a tenant's objectionable behaviour. You can also apply to QCAT for an order to exclude a person, even if they're not a tenant of the park for up to a year because of their behaviour. One of the things we did bring up early in the webinar was what happens when there's a breach where either party has broken their agreement and sometimes when a breach has happened, there's a bit of a disagreement about whether a breach, even if it has happened, and the disagreement between both the tenant and the park manager. So in those sort of situations, the RTA looks at resolving disputes as a three-step process. We recommend, as a first, that you try to resolve the matter between each other as the second step. If you can't resolve it that way, that either you or the tenant apply to the RTA for a free dispute resolution service. And if that still doesn't resolve it, we would give you a notice of unresolved dispute and you would go to the Queensland Civil and Administrative Tribunal, which is QCAT. So when trying to resolve a disagreement between yourself and the tenant, it's important to have some good, clear communication to state what you think the problem is, how it can be fixed, what you would like to happen, what's the outcome you want. And to also be very clear about what your rights and obligations are under the Act so that then you can focus on the fact those steps are very important and it's also important to look at what are the options available to you and to the tenant. If that doesn't work, you can apply to the RTA for dispute resolution. You can do that through filling out a form 16 or if it's about a bond dispute, if you can't agree as to how much of the bond you are keeping due to damage, et cetera, you can apply for a dispute within the bond refund process online. So when you contact the RTA, it's important to remember that the conciliator is impartial and the whole thing is a confidential process. Most disputes are resolved or dealt with through the phone so the conciliation process happens through phone conversations and the conciliator is looking to get you and the tenant to come to an agreement that you will both own. They're not looking to say who's right or who's wrong. The RTA does not have the power to make such decisions. We are there to help you to resolve the issue to come to an agreement and then we get you to put that into writing. If, however, you don't come to an agreement and the issue isn't resolved, we would give you a notice of unresolved dispute and you would have the option to take that to Queensland civil administrative tribunal where they have the power to make a decision. For more information on QCAT and how to apply, go to their website qcat.qld.gov.au up on their screen. We can't emphasise enough how important it is to actually make sure you have all your evidence with you. Elle, would you agree there that it's vital that people bring everything with them? Absolutely, Valentina. The referee or the adjudicator, they're hearing many, many cases in one day. They don't like to muck around. They like to get a very, very clear picture of why people are there. They like to get a very clear picture of each person's point of view. They like to have very clear and concise bullet-pointed documents and information, photographs, any records that you can provide and support your argument and your point of view is what they're looking for. You need to be clear, you need to be concise and you need to be able to speak to the referee in a way that they can very, very easily understand what's going on. The RTI has done a webinar in the past with QCAT adjudicators and if you need more information, please watch the video and also go to the QCAT website. In addition to our dispute resolution service, the RTI also investigates offences against the act. These offences are sections of the act which have penalty points next to them. An example is not lodging a bond. Has penalty points attached to it? Unlawful entry has penalty points attached to it. When such offences become known to the RTI an investigation is conducted and this investigation is an impartial fact-gathering process. There is sometimes confusion about the difference between disputes and investigations or breaches and offences. Disputes are about breaches of the tenancy agreement and therefore they're civil matters and they are heard in QCAT whereas offences are criminal matters and they are heard in the magistrate court. When a complaint about an offence against the act comes to the RTI the investigations unit look at a number of different options for dealing with that complaint once it's substantiated and they are firstly to provide education to issue a warning letter, to issue a PIN which is a fine or to commence a prosecution. So it's important to understand your obligations and particularly to be aware of the parts of the act that do have penalty points attached to them and if you do find yourself in a situation where there has been a complaint about your particular park or yourself to be aware of this process and that matters don't necessarily go into prosecution but they can. That reminder to be aware of your obligations under the act leads us very nicely to the end of this webinar. Certainly if you have any questions or doubts or uncertainness to what your rights obligations are for a particular situation please don't hesitate to contact the RTI at the number on your screen or to go to our website and look at the resources there or to contact Caravanning Queensland. Absolutely Valentina we'd love to hear from people just give us a call in the office and it doesn't matter what your question is check in with us and we'll help you out. Thank you very much for your time.


What's good YouTube? This is your boy Chiwara back at y'all again with another art tutorial If you're new to the channel go ahead and hit that like button, comment, subscribe Make sure you hit post notifications so you will be notified every time your boy drops some heat Let's jump right into this video First time we're gonna do is drop the opacity down on the picture Lock that layer and create a new layer right above it.   You see my how my lines we looking first thing we're gonna do We're gonna go ahead and outline everything on the picture before we start And now that we finished with the line work. We're gonna go ahead and Select everything We're gonna go to object expand the pins Then you're gonna go to your pathfinder and click merge So we can make all our lines one and then we're gonna Duplicate the layer by dragging it to this blank sheet of paper lock the top layer Make sure you got your bottom layer selected And we're gonna click a skin tone That's pretty good skin tone start with you want to go to your red tangle tool. You want to drag the color Over your line work Then you want to right-click the color go to arrange and send to back so we can send the color behind the line work Now we're gonna select everything together And then we're gonna click merge so we can make our color one with the line work Do you want to right-click it go to isolate select group and now we can click these colors individually And to get the color out the hair if you want to get the color out the hair What you want to do is You want to click the drop-down menu right here. You want to click it again? When you inside of it you want to stroll to the last black layer you want to Lock them all just by strolling up while holding The left on your on your mouse and then you want to unlock the top to Lock all the black line work, but keep the top to unlock and then you want to close it Now what you can do you can come over here and click this The selection tool and we can we can delete the pieces of hairs And what we just did we locked the black line work And we kept the colors unlocked so when we make a selection we will not click our line work We'll only click the colors and now that we got a good Base color what I like to do when I'm shading I like to go ahead and start with my darkest colors And then I want to I want to go up from there. So what we're gonna do is We're gonna lock that layer and we're gonna add a new layer in between The color layer and the line work I'm gonna get our dropper tool and click this skin tone Then we finna come Find a good nice shadow to put on the skin And as you can look at the original picture we see he got a lot of dark shadows Under the eyes and above the eyes So that's what we're gonna go for first and I noticed he got that same dark shadow inside of the ear Like whatever is closer to these dark shadows That's what we just gonna go ahead and make this one dark shadow layer Before we go to the the brighter layers above that. So we're gonna I see around his eyes he have a dark shadow under his lips It has a dark shadow. So we're gonna put one there and inside the ears. So that's what we're gonna go with first Go ahead and start with that you want to try to Make it make sense. So We're gonna try to make it make sense with all the creases You can look at a lot of different pictures like if you're doing you trying to do cartoons or get better at your cartoon Here's just go through a lot of pictures. They got that got different light sources hitting from different directions. Just pay attention to a lot of pictures you look at like Pictures that you got in your phone or take a couple pictures of yourself and different scenarios and try to See where the shadows is coming more and where the lights hitting more you just practice on it Because to get better at shading you got a kind of in a sense understand it, you know saying like you don't have to understand like the proper way of How to explain it or talk about it, but as far as just understand it as far as know what you're doing like know Why shadow is coming in this way or know why the light is coming from this way So when you're drawing a picture from stretch and you just want to figure out how you should add your shades You can just already Have in your mind like okay, which way I want the light to come from and which way do I want these shadows come from? Because once you figure it out and learn it and learn your own methods of doing shading It will make your artwork stand out so much and it'll make it so much better to give it It'll give it more of a feel So if you're gonna add another layer Underneath our dark shadow, so we're gonna try that layer Then we're gonna click it skin tone and we're gonna pick a layer. That's That's kind of in the middle Dark and light that's a good So now what we're gonna do We're gonna look at how it's shadows is shaped on his face and we're gonna use this shadow to Make the shape that we see I Notice His cheekbones are very like extinguished so Just like you drawing the line where that's the same way you got to kind of draw out the shadows Because if you really look at this picture, you'll kind of see it. It's kind of like this I'm just following how it is on the original picture Then we got the light shadow the sign to do the highlight. So what we're gonna do We're gonna create one more layer And then we're gonna click a we're gonna find a brighter skin tone So we can do all the little the little shines on the face So once you go right there Make my brush a little bigger too And what shading do it helps better shape out the face You know I'm saying because without all these Shadows and shades we put on the face here to just be so flat But you as you can see once we added the shading it gave It gave the face that we just drew more dimension and it gave it more It gave it a different look like without it It was just flat but when we start adding the shades it start looking more and more like the person so Always remember when you're shading it's a it's a part of the face Detail too as well because you as you can see soon as we take it off It don't look like it's the same person But soon as we add it on it We you can tell we use these shades to go ahead and shape out the rest of the face So what you want to do what you want to remember is when you shading look at Look at your picture and you want to try to copy it as much as you can you want to try to copy every shadow Just like it's it's line work. Just like you trace the line work You want to try to do the same thing when you're looking at the The shadows you want to try to go through it and you want to try to See if I was tracing the shadows what I would have did was I would have got my darkest color and Everywhere I see this little dark Complexion I would have just went and traced that like above the eyes under here Same thing on the other side. It's a dark shadow right here Dark shadow under the nose under the lips and that's all it is you just want to You just want to copy exactly what you see on the picture And the closer you get like the better your picture be like it just take practice the more you do it the better you You'll be at it and there you have it man How to shade in Adobe Illustrator if you're new to the channel go ahead and hit that like button Come in subscribe moheek coming soon, and I'm out this thing


Okay, good afternoon. And today she will present inflammatory bowel disease treatment updates. Also today we have Dr. Lauren George, assistant professor of medicine at the University of Maryland School of Medicine. And she will be presenting Navigating Your Daily Life with IBD. Before we get started, we have a few housekeeping items. Please submit your questions as the presentation is going on and the physician will answer them at the end. This session will be recorded and an email will be sent out the week of October 19th. Thank you very much. And with no further ado, I will turn this over to Dr. Wong. Thank you, Erin. Hi, everyone. Thank you for joining us this afternoon. Erin has pointed out I'm Dr. Yuni Wong with the inflammatory bowel disease program at the University of Maryland. For the next 15 minutes, I would like to give an overview on some of the newer agents we have available to our patients with inflammatory bowel disease. For the sake of time, the older drugs including mesalamine and diopurines are not covered in this talk. Here's a quick outline of the groups of medications that we have on the market, including anti-tumor necrosis factor anti-TNF, anti-integrin, anti-IL1223, and the Jack inhibitors. But first, let's talk about what are biologics because this term gets used a lot to encompass a lot of the newer agents that are on the markets. Biologics are antibodies that stop certain proteins in the body from causing inflammation. Unlike steroids, which is a non-selective agent with major side effects, biologics act more selectively targeting all the factors that we know are responsible for inflammatory bowel disease. Which biologic is right for which patient really depends on multiple factors and your provider will discuss further on the risk and benefit of each one. Let's first talk about anti-tumor necrosis factor, anti-TNF agent. This is a very busy slide, but I'm gonna walk you through it. Here at the top of the diagram is the lumen of the intestine where bacteria tends to hang out. And in normal situation, when a bacteria invades through the wall of the intestine, we have a response mechanism that will detect these as invaders. And a cascade of chemical reactions will occur releasing chemicals that leads to inflammation that ultimately targets the killing of these bacteria to destroy them from invading your intestinal wall. However, we know that in inflammatory bowel disease, there is a hyperactive immune system causing this cascade to never turn off, causing damage on the intestinal wall. And what the anti-tumor necrosis factor do is it blocks this cascade right here where the TNF alpha is preventing this inflammatory process from going on and on and on, allowing your body to repair the damage that it has seen in the intestinal wall. So this is to highlight where the anti-TNF molecule acts. So what are anti-TNF agents that are available on the market today? The oldest one in Fleximab, very well known as Remicade, has been on the market for the longest time. You may also hear about some biosimilar agent by the names of whenflexis or inflectra that are now on the market as well. This agent has been approved for moderate and severe ulcerative colitis and Crohn's disease. It's usually given through an IV infusion that takes about two hours. The first three doses are closer together at week zero, two, six, and then every eight weeks in general. The second anti-TNF agent that came out on the market is Adolimimab, also known as Humira. This is a subcutaneous injection that patients will do on their own. It's also approved for moderate and severe UC and Crohn's disease. Just like with Remicade, there's an induction dose that requires four pens at the first dose followed by two pens two weeks later. And then in general, most patients stay on one pen every two weeks. Circulizumab simzia is approved for moderate and severe Crohn's disease. This is an injection that goes under the skin administered by the patient or by a nurse sent out by the company. It's given every two weeks for the first three doses and then is every four weeks for most patients. Symphony, also known as Golimumab, is approved for moderate and severe UC. This is an injection that is given after two-siding doses in general every four weeks. So we have covered the anti-TNF class of medications that are available. Now we talk about the safety profile and some special considerations that patients and providers should be aware of. Certainly with any medication, there's always a potential allergic reaction, which may include redness, hives, headache, fatigue, but severe, severe allergic reaction is extremely rare. Infection is of a concern because like we said, when you dampen the immune system, you run the risk of an infection. Majority of patients where majority of patients tolerate this medication very well, infection is rarely seen, but some patients may describe having cold-like symptoms that linger longer than average person, but very serious infection is rare. However, we oftentimes recommend checking tuberculosis and hepatitis B status before starting this medication to avoid reactivation of these asymptomatic infections. And along the line of infection, we need to talk about the importance of appropriate vaccinations, which I will discuss later on at this talk. Cancer risk. In general, the average American's risk of cancer depends on the race. We know that melanoma risk is about 2% in Caucasians and less than 0.1% in those with color skin. When we talk about anti-TNF safety profile, the melanoma cancer risk does go up to 4%, especially in our patients who are fair skin. Lymphoma has been reported, but it's extremely rare. Skin reactions, including psoriasis and eczema, have also been reported. We generally combat these with topical treatment. Rarely have to stop the medication unless if the psoriasis is extensive involving the scalp or an extensive area of their body. Lupus-like reaction that is characterized by rash, joint pain, muscle ache, and fever has also been reported, but rare. Some special consideration, patients who have heart failure that is advanced heart failure, multiple sclerosis, and those with certain type of hepatitis may need to be considered for other mechanism of action instead of using anti-TNF agent. But it is safe to say that we have ample amount of data now to reassure us that this class of medication is very safe to use through pregnancy and through breastfeeding. The next class of biologic that I wanna talk about is the anti-integrin. This is also a very busy slide, but if I can draw your attention and to the bottom of the slide, this is where the bloodstream is and this is where your intestinal wall is. When we see inflammation in inflammatory bowel disease, it occurs because of these white blood cells that invade into the wall causing damage and intestinal inflammation. The way antivial or vitilismab works is by blocking these white blood cells from invading the wall of the intestine, thereby eliminating the cascade of intestinal inflammation down the line. So before antivial came out on the market, there was a medication called Tessabri that we rarely use these days. It was first approved for moderate and severe Crohn's disease. It was an IV medication that's given by infusion. It works throughout the entire body. Therefore, there's infection risk, but more importantly, there was an increased risk of a severe brain condition called progressive mochiococcal, leukoencephalopathy, PML, that results from an infection from JC virus. As you can see, therefore we stopped using this medication and now we have antivial, which is a gut specific biologic approved for moderate and severe UC and Crohn's disease. It's an infusion medication. There has not been any reports of PML in large clinical trials and it's very safe to use through pregnancy and through breastfeeding. Next class of agent, anti-interleukin-1223. Again, a very busy slide, but in general, envision this as being the cell that leads to cascade of inflammation and the way Stalara works is by blocking this molecule that is on these cells that are responsible for inflammation in your gut. So Stalara has been approved for moderate to severe UC and Crohn's. It starts out with an IV induction followed by subcutaneous injections. In general, it's given every eight weeks. Common minor side effects include headaches, fatigue, nasal congestion, sinusitis, UTI has been reported. But in general, it's very well tolerated. There has been an estimate of about 1% chance of non-melanoma skin cancer with use of Stalara. And just like the other biologics we have pointed out, this is also safe to use through pregnancy and during breastfeeding. So the latest addition to the armitarium of drugs we have for our Crohn's and Colitis patient, this is the Jack inhibitor mechanism. And you may know the drug as Zelljans, which is approved for all sort of Colitis. So Zelljans approved for moderate to severe all sort of Colitis. It's an oral medication that's taken twice a day. Considerations for Zelljans include minor side effects, including headache, fatigue, nasal congestion, similar to the other drugs you've heard about, sinusitis and UTI have been reported. However, one important notes to be aware of is the high dose medication, the higher dose at 10 milligram twice a day, which is what we use for induction of remission when someone is having a lot of symptoms during a flare. Long-term use of that dose has been associated with chickenpox, wee activation or shingles. And so we generally recommend patient to start taking the chingrex vaccine if they are thinking about starting this medication. The other thing to note is in the rheumatology population, there's been increased risk of clotting, like clotting in the legs, clotting in the lungs when using the high dose of Zelljans. We certainly monitor patient's cholesterol level. We've seen that go up after using Zelljans. It's unclear of the safety profile during pregnancy and breastfeeding. So in general, in our women of childbearing age, we recommend that they come off this medication if they are considering getting pregnant. So just a quick slide on some vaccine recommendations that we should think about if we're thinking about using biologic therapy or Zelljans. Annual flu vaccine is definitely recommended. Pneumococcal vaccination, including Prevnar and Pneumovax, should be used. Chingles vaccine. Now we have shingrex, which is not live. So it's an attenuated vaccine that is safe to use and very effective, much more effective than Zostervax that we had before. However, there may be out-of-pocket costs for those that are not yet 50 years of age. Human papillomavirus vaccine should be considered in our patients age 11 to 26 and in some high-risk group up to 45 years of age. So the take home point is we have a variety of mechanisms to target Crohn's and all sort of colitis. They're generally safe and well-tolerated. A good vaccination plan can help prevent the infectious complications that we have talked about. Thank you for listening and I'd be happy to take questions during the discussion panel. Thank you, Dr. Wong. And if you have any questions, please submit them in the question bar and we will ask them right now. Our first question is, Dr. Wong, does NVIDIA affect your immune system? And I'm probably mispronouncing that, but does NVIDIA affect your immune system? So NTIVIO is gut specific and so theoretically it should not affect the immune system outside the GI tract. However, we still recommend the same vaccination as other biologics. One person writes, I have tried all these medications without success and had many severe side effects. Are there any other drug options? Yeah, so that's a great question. We do encounter several cases of this every year as a referral center. When we see patients who have suffered from side effects through all the FDA approved medications, there are medications coming down the pipeline that is even more gut specific. Some even working on just the lining of the gut without deep invasion into the colon wall or small intestinal wall, but definitely more drugs coming down the pipeline to help gear toward patients like the questioner about how to minimize the side effects of these medications we have to use. Next question is, how long has NTIVIO and Zelljans been on the market for safety concerns? So NTIVIO was first approved in 2016. Therefore, you can say that we've had about six, sorry, four years of real world data. And certainly before that, there's been clinical trials as well looking at the safety. Zelljans been around for a couple of years. And before that, of course, the clinical trial demonstrated the data. But it's important to note that Zelljans was actually used for rheumatoid arthritis patients and other ailments in rheumatology world before it even started being used in the GI world. So the safety data expands beyond the time when it was first approved for GI patients. What is the standard dose for Zelljans for an ultra UC patient? So the standard dose starts out with an induction dose, which is 10 milligram twice a day. And typically after the induction phase that extends up to eight weeks, patients, some patients may need it up to 12 weeks if they're really not doing grades by eight weeks. But in general, we try to get the patient down to five milligram twice a day after that. If you're currently on remicade and Crohn's disease is in remission, does it make sense to change medications? If your Crohn's disease is in remission on remicade, I would not advise changing medication unless if you're experiencing a side effect or if you have a diagnosis such as melanoma skin cancer or if you develop advanced heart failure. Next question is, how do you determine which medications to prescribe? That's an excellent question. That's really the million dollar question that we're trying to perform all these research to answer. How do we individualize therapy? At this point, we rely on data. What data do we have for the quickest way to get a very sick patient into remission? We look at which disease phenotype they have, meaning where the Crohn's disease had effect, where in the bowel the Crohn's disease has affected. How likely are they gonna respond to this medicine over that medicine? And that really does take a lot of tailoring as much as we can. And that's where we are really good at at University of Maryland, tailoring the therapy with the data we have. Can you explain a little bit more about the Schengel's vaccine for people over 50? Yeah, so currently any average adult is eligible to get the Schengrex. So it should be covered by payers. And that's two series, they'll get the first shot and then two months later, they can get the second one to complete the series. In general, we recommend it for all of our patients that are on immunosuppressive therapy, like if they're on a biologic medication, if they're going on Zellgen's, or if they are on ASA diet print, or a six more cap toe purine. But the payers are not paying for those that are under 50, so some patients will elect to get this out, pay out of pocket. Would all classes of biologics put one at equal risk for other everyday infections? This is being asked by a teacher returning to the classroom. So from the data we have, Intivio and Stellara seems to be relatively speaking safer than the anti-TNF agent when it comes to infection risk. You think about Intivio only working on the GI tract, so should be safest of all those three classes of medicine. But in general, if we have an older patient or someone who were very concerned about catching pneumonia and whatnot, we would favor using Intivio or Stellara if the situation is correctly matched up to that. I should also add, however, in times of COVID, it's hard not to talk about COVID, but in times of COVID, we have an international registry now called Secure IBD where all the doctors from around the world have been tracking IBD patients who have contracted COVID. What we're learning from that registry is that patients who are on biologics, including Remicade, Humira, Simsia, Symphony, Stellara, Intivio, we're seeing that all those patients are not at increased risk of complications when they get COVID. They're not seeing increased risk of hospitalization, they're not seeing increased risk of ventilator need, and more importantly, not seeing increased risk of death by being on these biologic medicine. So what I tell my patients is that even in times of COVID, these medicine are very safe to continue. Can you explain what happens in your body when a medication that was once effective loses its efficacy? Yeah, this is a very hot topic actually because it's very discouraging for patients who have been very compliant with their medication to suddenly lose response to it. The most common reason is when your body develops antibody, like it's rejecting the medication. And it's unclear why certain patients do that and others do not, but what we see is that when the dosing is not adequate, the risk of antibody development is higher. The other scenario is we commonly see young people develop antibody more commonly than older folks. Maybe their robust immune system is responsible for that. For a patient with renal disease and currently on dialysis treatment, is there any interference with a biologic? No interference in terms of renal disease or those that are on dialysis safe to continue these biologic medicine. Is it possible that Zell-Jans causes cholesterol issues because it's a systematic version as opposed to the colon specific version in trials? So no one knows exactly why Zell-Jans causes cholesterol to go up, but one theory that we have at our group is when patients get better quickly, they absorb a lot better. And so their cholesterol level naturally goes up. It's unclear to do head-to-head comparison because cholesterol level was not examined in the other biologics trial. So it may be that with all the biologics, the cholesterol goes up too as the patient gets healthier when their disease is under control. Once on a biologic must one stay on it forever as long as it's working or is the goal to ultimately get the patient off the medication? So we get this question a lot in our practice. Unfortunately, we don't have a cure, especially for Crohn's disease, we do not have a cure. The cure for ulcerative colitis is ultimately surgery, but with Crohn's and ulcerative colitis both are chronic condition, just like diabetes and high blood pressure. If we find the right drug that gets the patient well in order to stay well, then the medicine must stay on. Now, we never say forever because as we age, the immune system will change as well. So we have to go on a case-by-case basis on when we have a chance to pull off the medicine, but it takes very vigilant monitoring because the moment the disease starts creeping back, we got to act on it. Great, we have time for one last question. I am currently on steroids, is Shingricks recommended while you are on them? Shingricks is actually highly recommended when you are on steroids. Again, this is not a live vaccine, so very safe to take. Patients that are on steroids, believe it or not, they're at even higher risk of infection than any of these biologics that I had discussed today, which is why one of my opening slides point out that steroid is a systemic immune suppression with much more side effects that we want to avoid at all costs. Thank you very much, Dr. Wong. And we appreciate your time today. And now I would like to introduce Dr. George. We'll talk about navigating daily life. Sorry, bear with me one second. Well, my computer pulls this up. All right, well, thank you everyone for tuning in today. I'm Lauren George, I'm also an assistant professor of medicine at the University of Maryland in the inflammatory bowel disease program. And Dr. Wong just gave an excellent presentation on how to get your disease into remission with our most current medical therapies. And now I'm gonna switch gears a little bit and talk about how to navigate the rest of your life while you have IBD and maintain your overall wellness. So some topics that we'll talk about, we'll talk about stress, as well as diet and exercise and sleep. I'll briefly touch about IBD health, but I think Dr. Wong covered many topics.  So what is stress? We all know we have stress, as certainly 2020 has been a stressful year, but stress is a natural process in the body. It's our body's response to outside factors. And when our body senses an outside factor that it doesn't like or it is fearful of, we know that we have some physical side effects. Our heart rate goes up, our blood pressure increases. We have an increase in hormones, it's called adrenaline and cortisol that are our stress hormones and form our fight or flight response. And so stress is very normal and our body has very normal mechanisms of us to deal with outside factors and treat stress. However, being under chronic stress is not normal. Patients who are, and people who are under chronic stress, it takes a toll on your body, both mentally and physically. And physically it decreases your immune system. There are certainly people who this is a larger concern in, patients who have pre-existing psychiatric diagnoses or anxiety or depression, patients who have chronic medical conditions like Crohn's disease or ulcerative colitis, patients who have physical limitations, all of these can be impacted even more by the stress of the outside world. So talking about stress management, we certainly all need a little stress management, but there are certain things we can do. Maintaining a routine is really important, especially with all the changes in 2020 and working from home and our kids are at home, getting yourself into a good routine will allow your body to get used to the new daily activities, maintaining your physical health. And we'll talk a little bit more about that. Sleep hygiene, making sure we're getting good quality sleep.  We wanna make sure we stay connected to our relatives, our loved ones, our friends and doing things for enjoyment, still keeping up with our hobbies, finding something outside of work or our physical illness to take care of. Also wanna pay close attention to screen time. That's a whole hot topic, but certainly it's easy to get stuck on the computer or in front of the TV all day these days. Financial wellbeing is always important. I won't really touch on that. And then I'll give some information about support and resources, but in the end, if stress management, if what we're doing at home isn't working, sometimes we need to reach out for help. So maintaining a routine, it's really important again to maintain that sense of continuity and normalcy. So create a schedule.  Every day you wanna have some goals and intentions and things that are achievable in the short term and prioritize what needs to happen today and what might need to happen tomorrow. Our physical health is very important right now and physical health overall plays a large role in how your IBD symptoms are gonna be managed. So you wanna make sure you're eating healthy, diets with good, healthy proteins, like lean meats, chicken, fish, whole grains, fruits and vegetables, things you really wanna limit, sugary beverages, you wanna limit your processed food and your alcohol and this is a great time right now to start a food journal or work on meal prep. You know, work on cooking with your family or with your kids and have something to do. You wanna make sure you're staying hydrated and this is mainly with water. Unfortunately, coffee is not a great hydrating material but water is safe and then you wanna exercise and stay active. So exercise actually does reduce those stress hormones we talked about, adrenaline and cortisol and it stimulates a positive hormone or endorphin which improves your mood and improves your overall physical functioning. You know, there's many ways to exercise. I just put some examples here but there are things you can do even if you don't wanna go to the gym or don't wanna go to a public class. There are activities both indoors and outdoors. Sleep hygiene, so sleep is very important. Sleep hygiene is essentially a term for adopting a set of practices or habits that allow you to fall asleep and stay asleep throughout the night and get quality sleep. And sleep is important for physical and mental health. It's gonna improve your productivity and your focus and concentration the next day. It's also gonna improve your overall quality of life.  And while we can work on medications and therapies to put you into remission, if you're not sleeping well or taking the time to get high quality sleep, we may not be able to get rid of the fatigue.  How can we work on our sleep hygiene? Daytime napping should be limited. If you are gonna nap, it should be under 30 minutes. And that allows you to not get into that deep levels of sleep, the REM sleep. You wanna avoid larger meals throughout the day, avoid alcohol. These things are going to give you that, you know, post-lunch sleepiness that we all experience sometimes exercising during the day. If you exercise too late at night, it may keep you awake. You definitely wanna make sure you're being exposed to natural light throughout the day. And as we enter the colder winter months, that's important that you make sure, you know, if you're in a place near a window, you wanna establish a bedtime routine. Everyone should aim for at least seven hours of uninterrupted sleep if possible and create a pleasant sleep environment. Don't have the TV on, put away your cell phone, you know, have a nice relaxing, comfortable temperature environment that enhances your chance for sleep success. You know, briefly touch upon IBD health. Again, Dr. Wang gave a great presentation about the medications we have, but it's just really important right now that you keep a close eye on your body. And you stick with the plan that's been decided between yourself and your doctor. So pay attention to your body, especially GI symptoms. If you are experiencing GI symptoms, you certainly wanna call your doctor and let them know. Sometimes they're due to active inflammation and IBD and sometimes there are other factors at play and we can help sort that out so you get the appropriate treatment. You also wanna continue your medications and less told otherwise. Again, Dr. Wang so nicely mentioned that we have a database now, the secure IBD database that informs us that our biologic medications are very safe as far as complications of COVID. And therefore, we and our GI societies are recommending you maintain your medications unless there is a specific reason not to. And you should always discuss that with your doctor prior to stopping your medications.  Most providers are still doing telehealth. We are mainly telehealth other than new patient appointments here at the University of Maryland. And that allows you a little more flexibility and freedom in keeping your appointments. And it's not as inconvenient. And certainly if you have had a procedure or something that's been rescheduled during the pandemic, keep a list of that so that as things reopen and you're getting your schedule back on track, you know what needs to be done and things don't fall through the cracks. And again, if there's any questions, you need to call your IBD doctor. We're here for you to answer any questions or concerns and help to a shared decision-making process. So mental health, this is what I wanna talk about the most. Depression and anxiety are very common in the general population. And they're even more common in our patients with Crohn's disease and Ulcerative Colitis. There are numerous studies showing that there's increased rates of anxiety and depression in IBD patients, in patients who have active inflammation and symptoms and in patients specifically with Crohn's disease. And therefore this is a really important topic because we've learned that, you know, treating your IBD is not just about putting you into remission, it's about maintaining your overall health and wellbeing. So who's at more risk for anxiety and depression? Cause certainly anyone can develop these conditions and symptoms, again, patients with Crohn's disease, patients whose IBD is involved in places outside of the intestine, patients with joint pains or eye manifestations or perianal symptoms. If you've had a history of surgery, you're more likely to have feelings of anxiety and depression.  And it's very normal to have feelings of anxiety and depression when diagnosed and certainly when hospitalized and when ill. Otherwise we know that females are more likely to have anxiety and depression. Patients with lower socioeconomic status who have a lot of psychosocial factors and pressures are more likely to have anxiety and depression. Younger patients and active smoking. So some of these we can fix and some of them we need to work on the symptoms themselves. Mindfulness is a great technique and has been shown in a few studies to improve quality of life and improve symptoms and inflammatory bowel disease. And you'll all get a copy or a video of this presentation down the road. And these are some links for some activities you can do at home. Meditation, yoga, structured breathing has also been studied and demonstrated to show improvement in quality of life and symptoms. And really it's all about learning to relax to the best we can in our modern society. And whatever you need to do to help you relax is the best way to do that. There are also apps. We live in a technologically advanced world. There's multiple apps here. Again, you'll get this presentation but for both mental health, calm and headspace have a lot of meditation exercises and breathing exercises. You can keep track of your diet and exercise and physical health with my fitness pal. There's GI specific apps, which are great that give you symptom trackers and help you find bathrooms nearby and overall allow you to keep track of your disease. And then habit trackers, just ways to kind of keep yourself productive and forming good habits. And of course, again, I talked about there's never not a reason to reach out and ask for help. And we have a lot of great resources for people who need a little bit of extra attention or help. And I will say that there's a support group. There's support groups run through the Crohn's and Colitis Foundation. The Baltimore support group is virtual and is actually run by our behavioral health specialist, Lauren Seibel. And certainly you can contact myself or anyone in our department or Lauren herself to find out more information, but that's a great way to connect to other patients who are going through what you're going through to ask questions and to get resources. There's also a help center through the Crohn's and Colitis Foundation that you can call to ask questions or get more information. They have the ability to set you up with peer-to-peer support and connect you directly with someone else going through what you're going through. And there's multiple Facebook groups all through the Crohn's and Colitis Foundation. There's also a large online community of patients with Crohn's and Colitis. Lots of support groups and forums and the ability to ask the expert questions on the Crohn's and Colitis website. And these are all great ways to reach out and make a connection or ask a question or just get a little extra help during these hard times we've been going through. And then obviously, most importantly, if you feel like you need extra support beyond a support group, always reach out and ask on how to get in touch with a mental health professional. Your doctor can place a referral. You can go to your insurance company website and search providers that are in network for you who are accepting patients. Psychology Today is a great resource to go online and look up providers in your area who are under your insurance plan. And then again, in the days of virtual Zoom conferences, there's a lot of online therapy options. And these are again, a few websites and apps that allow you to do virtual therapy. And obviously, if there's ever any more concerning feelings or dangerous feelings, there's a lot of hotlines to call. And I want everyone to have this information, the suicide prevention hotline, the Maryland helpline, there's also the National Alliance on Mental Illness and the crisis text line, if there's ever any concerns with home situations or a safety concern. And so I just wanna wrap up my talk by saying, there's multiple aspects to living with IBD. And you're gonna hear about a lot of them during this webinar. Dr. Wong talked about the medical side and that's what we need to, us doctors, need to help you with and take care of. But there's a lot of things you can do for yourself to improve your quality of life. And I hope this was helpful. I'm here to answer any questions. Great, thank you so much, Dr. George. And if you have any questions, please submit them now and we will answer them momentarily. First question is, does eating meals at a variety of times a day, not the same time of each day, have a negative impact on IBD? That's a great question. So the timing of your meals shouldn't negatively impact your IBD. Really, what you just wanna do is get in a good structured habit. Eating meals somewhat around our traditional meal times will allow you to make sure you're getting the appropriate amount of nutrition. And we'll also, if you are having active inflammation, potentially help you maintain a routine around bathroom habits as well. Great, thank you. If you have any other questions, please submit them at this time. What do you suggest for those of us who are going up to the bathroom throughout the night, what should we do about our disrupted sleep? That's a great question. Sleep is really important as I talked about and certainly waking up at night to go to the bathroom is not gonna help good sleep hygiene. I would first make sure you talk to your doctor that you aren't having active symptoms of inflammatory bowel disease because you may need some new medical therapy or a different treatment plan. Cause the goal in remission is that you are sleeping through the night and certainly at most only waking up once. If you do continue to have nighttime awakenings, manage them the best you can. I would say that once you go to the bathroom, go right back into bed, don't look at your cell phone, don't turn on the TV, try and make the bathroom trip as quick as possible so that your routine is disrupted as little as possible. One listener would like to know the name of the bathroom app again. Sure, I think it is, boy, sit. Erin, do you mind going back to, it's one of my last slides. But I believe it's called sit and squat, but I don't wanna give you the wrong information. Oh, go back, yeah. One or two more, yep, there we go. Sit or squat and bathroom scout. All right, thank you. All right, well, if there's any last questions, please submit them now. All right, well, those are all the questions we have today. And we will be sending an email with this recording, probably around the week of the 19th after the whole series is finished. And again, I wanna thank you for your time today in joining us for Living Well with IBD. We've been here today with Dr. Yuni Wong and with Dr. Lauren George, both with the University of Maryland IBD program at the University of Maryland Medical Center. Thank you again for your time today. Goodbye.


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The least regretted college majors. That's what we're going to be talking about today, but before we get into that, make sure if you haven't done it already to gently tap the like button in order to defeat the evil YouTube algorithm. On this channel, we talk about personal finance, careers, college degrees, and opportunities that will lead you to success. And we also go over how you can avoid some of the common financial traps that so many people fall for. If that sounds like something that interests you, make sure if you haven't done it already to hit the subscribe button and ring the notification bell so you never miss an upload. That's right, my price went up. You got to hit the subscribe button and the notification bell as well. But with that out of the way, let's go ahead and jump right in. Right now, today, we're going to be talking about the least regretted college majors or college degrees. Now, this is data that was released by Zippercruiter, which is one of the major websites that people go on to in order to find a job.  How much do you regret it? Do you regret it just a little bit or a lot? Now, people responded to the survey and there was a huge variation in the number of people who regretted their degrees in certain types of majors and other majors, which are the ones I'm going to be talking about today. Now, I'm going to talk about the list. I'm going to list them out, but I'm also going to go over exactly why, in my opinion, I think these degrees are ones that people don't regret. So first on the list, they kind of grouped together a bunch of different related degrees, and they called it health sciences and technology. Now, the regret for this one was around 18.9%. And the main reason that people regretted this one was because of low job satisfaction. Now, let's go ahead and compare that to the most regretted degree on the list, which was English and foreign languages at 42% regrets. And the main reasons were that it's impractical and there's limited job opportunities. Now, again, there's a ton of different degrees that would fall under this category. Examples of these professions that you might get degrees for would be becoming a radiation therapist or a dental hygienist. Another one might be physical therapy or occupational therapy. These are all examples of degrees that would fall under this category. So one that takes around two years or so and it would be considered an associate level degree would be radiation therapy. You could become a radiation therapist or a radiologic technician with this degree and you'd make around $62,000 a year. There's 250,000 jobs available and it's growing at 7%, which is faster than average. Those are incredible stats, especially considering you only have to go to school for about two years. Now, you always have to be careful with these types of degrees because whenever there's a very low barrier to entry, something that you can get into very quickly, you know, a year or two years, a lot of the time they'll end up becoming saturated. And it makes sense. I mean, if anybody can do it in a short period of time and make a really good salary, it's probably going to end up getting saturated. Now, another example of degrees like this that don't have a low barrier to entry would be a degree like physical therapist. Now, physical therapists generally are going to help ill or injured people improve their movement or pain. This is one where when I was doing my research, it consistently shows up as one that has some of the highest job satisfaction as well as meaning. This is because not only are you helping people, but you're also getting to work with them over a period of time and seeing them progress. So you get to see them when they're injured and when they, you know, maybe they can't move very well and then all the way to the point, maybe work with them for like six months to a year to the point where they can live a relatively normal life. So not surprised at all to see healthcare related degrees on here. I talk about this a lot on my channel, but healthcare is a really good direction to go for a lot of people. And what do you know? Number four on the list is also healthcare related. It's going to be health administration and assisting. This one comes in at only 17.9% regretting the degree. And the reason for that was again, low job satisfaction.  Now out of all the different types of occupations that you can go into when you're talking about broad categories, you know, you could go into business, you could go into technology, you could go into healthcare, for instance, out of all those different types of occupations, healthcare is growing the fastest by far. Employment and healthcare according to BLS in the United States is projected to grow in the next 10 years, 15%. Now the median annual wage for all healthcare occupations in the United States as of 2019 was about $68,000 a year. This is much higher than the median annual wage for all occupations, which is about 39,000. Now one thing that I always like to mention is that demand trumps pretty much everything else when it comes to looking at a career, looking at a degree. So if something has no demand, meaning businesses are not looking to hire people for that career, that is a really, really bad sign. When something has really high demand, like a ton of people are looking for people who have that skill set, that is a good sign because of the fact that chances are they're going to treat you better because a lot of other people want to hire people with that skill set as well and so they don't want to lose you and on top of that they'll probably end up paying you better as well. You'll also have more options. So if you end up in a job or a career that for some reason you just don't like or maybe you get tired of it, you can very easily find another career usually if there's a lot of demand. So like I always say, don't sleep on different healthcare related careers and degrees, they're pretty good. Number three on the list is going to be a classic, it's going to be engineering. Only about 15.9% of people who graduate with an engineering degree regret their choice and the reason for that is because the best jobs require advanced degrees. So everyone knows that engineering related degrees are pretty good. This is pretty much something that's known universally. Not only do engineering related degrees pay well with just a bachelor's degree, but this is one of the few degrees out there where getting a master's or a doctoral level degree can actually be worth it. A lot of the time, and I've made videos about this before, getting a master's or a doctorate is usually not going to be worth it just because of the fact that you have to take on a lot of debt and it takes quite a bit of time. However, some of the math related degrees as well as technology and engineering related degrees, you can find some exceptions there where getting a master's or a doctorate can actually be worth it and it can get you better career opportunities, better jobs, make more money, etc. Now, of course, not only can you get a job as an engineer after you graduate, but universally engineers are respected in just about any career out there. So engineers are commonly hired for completely unrelated jobs just because of the fact that companies know what they're getting when they hire an engineer. They're getting somebody who's very smart, very hardworking and self-directed. Now, I've said this before in some of my other videos and I was challenged down in the comments. People were saying that, you know, oh, they don't think that engineers get hired for other jobs. Well, okay, I did the research. Here it is on the screen right now. This is the most recent US census survey where they took a bunch of different degrees and they showed what types of careers they went into and their average lifetime earnings. So the 3.4 there is $3.4 million in average lifetime earning. So the average for all occupations in all majors is about $2.4 million in a lifetime. For engineers that go into engineering, they make around $3.5, $3.6 million in a lifetime. For engineers that go into a computer or a math-based job, they make around $3.7 million in a lifetime. Engineers that go into management make around $4.1 million. Even engineers that go into arts and media make around $3 million in a lifetime, which is $700,000 more than all degrees in all careers. You see right next to it, arts and media for all different types of majors only makes around $2.3 million. So this illustrates the point that I was trying to make, which is engineering related degrees are universally respected and they're going to be able to get you a job in all kinds of different industries, even if you decide that you don't want to go into engineering. Now on top of that, I did a video a while back where I talked about the degrees that create the most millionaires and engineering came up as number one. Now most of the other degrees on this list were business related degrees, but engineer did come out on top. They were number one. And honestly, I'm not surprised by that. The reason I'm not surprised by that is engineering is basically just practical problem solving. Sometimes math related degrees are very heavy in problem solving, but it's not practical. Engineering on the other hand, they're kind of just like the fountain heads that create an idea in their mind and then they figure out how to have that idea exist in reality. This can be extremely useful when it comes to becoming an entrepreneur later on, starting your own business, which is one of the best ways to become a millionaire. Now there's a lot of great things about engineers. I could probably go on and on with a bunch of other things, but let's talk about one of the downsides, which is the fact that the attrition rate for engineering majors is incredibly high. I looked at a bunch of different data and a lot of them suggest that about half of the people who start an engineering actually end up dropping out. They do not make it through the program. That is much higher than the average degree. And so you have to realize that there is a good chance that if you start an engineering, you won't make it through until the end. Engineering is one of the toughest degrees out there. It's very demanding. And a lot of people who are 18, 19, 20 years old just simply do not have the discipline to complete the coursework and to pass those tests. I remember I lived in a scholarship hall for about a year where there was like 50 different dudes, and maybe 10 of them or so were engineering majors. And I'm telling you, those guys, you pretty much never saw them. They would just be studying all the time, whereas the business majors were just like partying all the time. And then I was kind of somewhere in between. Everybody else studied hard. Don't get me wrong. I'm not trying to minimize other people's degrees, but it seemed to me like the engineers had the hardest time. Whereas people in the next degree that I'm going to mention definitely had more of a life. I just said it. Number two on the list is going to be business degrees. Yes, business degrees are the second least regretted degree. I've gotten a lot of flack on this channel in the comments, people making fun of business related degrees, but all the data suggests that business degrees are actually pretty good, even though they might not be one of the more difficult degrees, or they might not be a STEM degree. All the data that I've seen suggests that they are really solid. So for instance, right here, only about 15.5% of people regret getting their business degree. And the reason for that is because it's too general. Now I've talked about this a lot before. That is kind of the big problem with business degrees is the fact that they're really general, but the flip side to that is the fact that they're also extremely flexible. Business degrees get hired in every single industry out there, every single company hires business majors. So you have basically like an entire world to choose from if you get a business degree. The downside to that is if you're not specialized in something, companies are going to have a little bit of trouble seeing how you can contribute. Now there are other benefits to business degrees as well. For one, you can combine them with other degrees and they make a great combination. You can double major in business and math, business and technology, business and computer science, even business and like something random like healthcare makes a decent combination. Now in that video I talked about earlier, the degrees that create the most millionaires, business degrees were basically littering the list. I think six or seven out of the 10 degrees on the list were business related. This is for several reasons. For one, you can get pretty good jobs with just a business degree alone. I'm not arguing that, but I think the two main reasons that business degrees were ranked so high are for one, the fact that they teach you really solid personal finance skills like saving, investing, keeping a budget, etc. You just naturally are going to learn those skills if you learn how to operate a business. And you're going to learn those skills at a much younger age than most people. A lot of people don't start budgeting, saving, investing until they're in their 30s, sometimes even their 40s. If you start doing that in your 20s, let's say you graduate at 22 and you start doing it right away, you are way ahead of the curve. And I've made videos about this before. It's very easy to become a millionaire just by investing in a 401k and a Roth IRA. You don't even have to do anything else outside of that. Now that's the first reason, but the second reason I think they're so successful and they make so many millionaires is the fact that business degree will set you up in the business world where you're much more likely to become an entrepreneur. So let's say you work for a company for a few years, you work your way up the chain, you know, you get to a high level where you have a lot of responsibilities. It's almost like having training wheels for becoming an entrepreneur.  So there are a ton of benefits to becoming a business major. I think this is one that a lot of people sleep on for some reason. I see a lot of comments of people like making fun of business majors and hey, business is pretty good. It's solid. Now I'm going to get memed super hard for this next one. You probably know what it is already. Number one on the list is going to be computer science and mathematics related degrees. I know it. These are the least regretted degrees. It comes in at only 12.7% for regret. And the reason was because it's too stressful. So computer science, math skills in general, extremely hot right now, especially in the technology industry, the skills of a software developer or a software engineer or a data scientist are extremely hot right now. You can make hundreds of thousands of dollars a year if you're really good. Zippercruiter came out with a skills index rating where they basically just ranked different skills and how much money you can make from them, basically how valuable those skills were. And they ranked these by job prevalence, annual job growth, geographic location, as well as the salary. Now as you can probably guess, all things related, this list was full of computer science and technology related skills. You can see that like 15 out of the top 20 on the list relate back to computer science or software development. Without a doubt, coding, software engineering, software development, these types of skills are incredibly high in demand right now.  However, if you're a normal person where you don't have much experience when it comes to coding, it wouldn't be a bad idea to get a degree.  You don't have to go and get a CS degree, but it's not a bad idea because not that many people are graduating with a degree. And it really does set you apart because there are tons and tons of jobs out there. And there's not that many people graduating with this degree. I think getting a degree like this is a great choice. And I made an entire video about it. If you want to check that out, if you haven't done it already, go ahead, smash the like button, hit the subscribe button, ring the little notification bell, comment down below any thoughts, comments, criticisms, et cetera that you have on the video. And before you leave, make sure to check out my other videos right here. I made them just for you.


What we're going to see is him talking about facts and we see facts, he opens up, he starts to illustrate, his body language is open, he's more alive, everything comes to life. Do you remember what we'll call the house was at least? Age maybe. Okay. And whose house was that originally? My grandmother's, all right. Well, why is he locking down and not doing that when he's talking about his daughter? I'm saying she had a mark on her face. I mean, I don't even know what you're referring to. You don't recall your daughter ever having a mark on her face. And the reason that he's having this deviation and he's starting to lock up when he starts talking about little girl and getting down to timeline is because these guys are building now a timeline they can track when the last time this little girl was seen. They're not casually asking any of these questions. The house has nothing to do with the house. The house has to do with the last time this little girl was seen.  It's a big deal.