Hey everyone, I'm Raif Darasi, and in this video I'm excited to sit down with our very special guest Tom Villa to discuss his work in HIV clinical trials. But first, I'll start by introducing our esteemed guest, Thomas J. Villa, otherwise known as Tom, works to help end the HIV epidemic by leveraging three decades of experience as a healthcare executive in biotechnology, graduate medical education, and community health. Tom serves as community advisor to various teams researching effective strategies to prevent, treat, and or cure HIV, including both the HOPE and RID HIV Martin Delaney collaboratories for HIV cure research. Those of you who have been following my content are very well aware of the Martin Delaney collaboratories, and I'm also in the HOPECAB. He has special interest in use of behavioral and social sciences research to enhance the impact of biomedical interventions through use of a participant-centered, full-person approach. Tom is a serial research participant himself. He has been a volunteer participant in more than two dozen HIV clinical studies, including several ongoing observational studies, early phase and phase one interventional trials, and those involving analytic treatment interruption. A practicing writer, Tom sees the arts as an untapped means to engage and inform the wider community, not typically involved in clinical research. Tom, thank you so much for sitting down with me and having this conversation. Thank you so much for inviting me here today, Rife. All right, well, I will start by asking you a very broad general question I ask a lot of our guests, which is, what is your current assessment of the state of the global HIV AIDS epidemic? Wow, that's a big one. So I think that overall, looking at the HIV epidemic globally, that we are obviously in much better shape than we were in 40 years ago and even 30 years ago in the early days of the pandemic. You know, we have effective anti-retroviral medications for people who have access to the medications, which again, we're getting better at providing. We're not there yet. We don't have access for everybody, but we're doing better than we were. For people who have access to medications, living with HIV is manageable. It's not a walk in the park, but it's manageable. But I think that that has added or brought new challenges for us. So people with HIV who are on medication live longer, healthier lives, but we also deal with complications or comorbidities, other health conditions that typically come with aging. We tend to suffer or experience more of them and at earlier ages than people without HIV. So while the HIV is manageable, other health conditions add other challenges. And I don't think that the health system here in the US has managed to grapple with that yet. We don't really have effective programs to help people manage that. We have a few pilot programs. It's an academic medical centers, but we don't have widespread access to effective programs. And from what I understand, similar is true in other parts of the world. So we still have a work cut out for us. Yeah, certainly. And I'm glad you've mentioned comorbidities. That's something that I'm talking about more and more on this channel because for a long time, for me, my messaging was very black and white. It was once you're on HIV medication and you're undetectable, you live a long and healthy life. There's nothing else really to worry about. And the more I learned, the more I realized that it's way more nuanced than that. Way more nuanced. It's important that we're having that discussion.  I mean, your perspective that you just mentioned is not a surprise. I think one of the challenges is that our approach to HIV here in this country has been a public health approach. So a public health is focused on providing population level intervention strategies to try to reduce or eliminate a public health risk from a disease that can be an infection or disease like COVID or HIV that can be passed within the community. And that's all fine from a public health perspective. That's important and necessary. But then there's the whole other perspective for people living with HIV, the response really needs to be a healthcare services response. And our healthcare system hasn't really caught up to everything yet. So it's two separate responses. And all of our federal response has been on the public health side. There has not been a coordinated response on the healthcare side. So again, some academic medical centers have done a good job of piloting programs to help people aging with HIV. So it's not that there hasn't been any attention. There has been. But at the systems level, there hasn't been enough. So for instance, Medicare is not doing anything in terms of managing aging with HIV. And we don't see programs at the federal level necessarily focusing on that either we have funding for some pilot projects, but we're 40 years into the pandemic. So that's such a great distinction that you're making the two approaches to addressing the HIV epidemic here in the US. I've never heard it put like that, but it makes it very a lot clearer for me kind of in my head what direction we've been focusing on and what direction we need to also tackle. Right. We need we need both. It's two separate systems. The public health system is not the healthcare system. So some of the physicians, some doctors, particularly those who work at academic medical centers, may be involved with both. But your typical physician that you see in the community is not doesn't work with public health. They're not involved with public health. So it's it's really it's two separate systems and they work differently. Their funding is very different. There are approaches are very different public health focuses on groups of people, the population and healthcare focuses on you or me as an individual patient. So it's too separate with your understanding of the two systems. Do you think that they would benefit working together? Well, it's not that they don't work together, but as with any large system, you know, they're each system has its own rules. They have their own funding streams or payment mechanisms. So it's just it's complicated to get them to really mesh, if you will, they're focused on different different aspects. They're focused on the pandemic from different perspectives. And again, a lot of the federal response has been on the public health approach. I think there's opportunity for more federal response on the healthcare approach. We need the centers for Medicare and Medicaid services to step up and to become more active and to take a larger role in helping to address this within the Medicare system. And but with that said, the Medicare, Medicare, which covers health insurance provides health insurance to older Americans age 65 and older. There are lots of things that people 65 and lots of other conditions that affect more people than HIV. So it's a challenge. Okay, well, before we jump into the topic of clinical trials and all all of your experience there, I want to ask you a little bit about your about you personally. When were you initially diagnosed with HIV? So I've been living with HIV for 25 years. And as you can imagine during that time, have seen, you know, significant changes in how HIV is managed, what we understand about it, how it's managed, the treatment for it, etc. And as I mentioned, things have come a long way. So they're much better today. We still have work to do, but much better today than they were 25 years ago and certainly better than they were back at the beginning of the pandemic in the 1980s, which I also remember. So in what are some of the ways that things have changed for you since then, since you were initially diagnosed? Well, the treatments are much better. So, you know, now treatment comes down to taking typically for many people, one pill once a day. That was not the case initially. So initially, you had to take combinations of medications that often multiple times a day and different medications had different requirements. Some could be taken with food, some had to be taken with food, others could not. And they had all kinds of challenging side effects. They were much more toxic than today. So the medications have improved greatly. They're more effective and they're easier to take. And then there are longer lasting options, long acting options today too, where you don't have to take a pill a day, but you can perhaps have an injection that lasts for a month or two. And at some point in the future, probably much longer. So that's all gotten better. And I think that from the standpoint of the public understanding of HIV, there's much more in depth information about what it is and how to prevent it and how to manage it and live with it. And how to avoid passing it to other people. So all of that is much better than before. We need to continue to make sure that that information is getting to all the people who would benefit from hearing it. And that's a challenge because there's lots happening in the world and lots of information to share. So that's always a challenge. Well, you're doing a lot of work to help contribute to dissemination of all that information, including sitting with me today. So I appreciate it. Well, thank you. How did you initially get involved with clinical trials? I worked back starting back in the late 80s. I worked for a biotechnology startup company that developed and introduced into clinical practice new technologies to diagnose and monitor cancer. So I was pretty familiar with clinical trials, sort of what they are and how they work and all those kinds and understanding the results because that was part of my work in the field of cancer. But going back to the 80s and 90s all the way up through the early 2000s. But I had never participated in a clinical trial myself. So my initial involvement really came from reading about one of the outbreaks because there have been more than one. There have been a number. Outbreaks of the Ebola virus in West Africa. And in reading about the sort of the desperate attempts to sort of control this contain this really dangerous virus that was killing so many people and work that was initial work that was being done by scientists to try to develop a vaccine. I realized that because HIV is very prevalent in West Africa where these Ebola outbreaks were that any vaccine would have to be tested and shown to be safe and effective in people living with HIV before it could be offered to people in West Africa. And so I said to myself, hmm, there's a chance to put my virus to work. I can volunteer for one of those. And at least that way I would be doing something useful with my virus and make making my virus work, basically. And so I found the name of the investigator in the in the newspaper article is reading and I wrote to her and said, hey, when you get to the point where you have clinical trials, keep me in mind how do I join. I didn't hear back from her, but I sort of kept that in mind and found another opportunity to participate. So I did participate in one of those and since then I've participated in a bunch other HIV related clinical trials and is an investigator. Is that just the person that's actually doing the studying and the research because I know in being in hope in the hope cab. We have our principal investigators and no one actually sat me down and said, this is what a principal investigator is. And I have no idea PI. So there's a lot of terms like that that I think community can benefit from understanding. That's a great point. So yeah, so investigator and researcher really mean the same thing. Very but but the principal investigator, the PI or PI is because sometimes the study has more than one. Those are the ones who are the like the lead researchers for that particular study or that particular research team. And then there will be other researchers who are part of the team like staff members on part of the team. And they may just be called investigators or researchers or research staff, but they mean essentially the same thing. Did you have any concerns for your safety or your health when you did the initial clinical trial or was your past experience with cancer treatment enough to kind of alleviate that? No, well, I think anytime you participate in a clinical trial, you need to sort of understand what it is that you may be getting into and talk about that with the study team, the research study team. And hopefully with your own physician, your own health care team and your family or friends or other people that you trust and see whether the trial might be a good fit for you and whether you feel comfortable. And for me, not only whether I feel comfortable, but do I think that I have something special or unique or meaningful to contribute to the trial. So in the case of the Ebola study, as I said, the Ebola vaccine study, I knew that because the vaccine was needed in West Africa and HIV was prevalent there, it would have to be shown safe and effective and people with HIV. So for me, that was enough to say, look, I can do something unique. I can, you know, because I'm living with HIV, I can add something unique to this study. That was my motivation to volunteer. But yes, you need to make sure you understand what you're getting into and that you think it's safe for you based on your health and everything else at that time. And were you in that trial getting exposed to the Ebola virus? No, no, no. This was a vaccine. So it was a vaccination to prevent Ebola. I participated in the trial where a portion of the volunteers like myself received the vaccine to see if it was safe, if they had any side effects from it. Did it generate an immune response that looked likely to protect them in the future from exposure to Ebola? And then other people got a placebo, which was typically saline water or something like that, which has no effect. But that's how they run a trial. They give some of the participants the actual vaccine and some a placebo and then compare the two groups to see if there was a difference. So no, I was not exposed to the virus. This was just a phase one trial. So it was just seeing whether this vaccine was safe and effective. I mean, that and that touches on something my ignorance in that knowing that you can look for certain markers without having to expose someone to whatever they're hopefully being vaccinated against. You can look for certain markers to see that they would have an immune response without having to expose the person to that thing because obviously there's moral concerns there. Yes, good point that you bring that up. So during the recent COVID-19 pandemic, vaccines were tested and the way that they were assessed to see whether they would be likely to be effective was that they did exactly what you just said. So volunteers who are in these clinical trials got the vaccine and then they had blood drawn later and scientists looked at immune markers in their blood to see whether their body had generated the immune response that would protect them likely to protect them against a future exposure to COVID-19. There are some trials for things that are less dangerous. There are some trials that do require or do involve exposure to the actual virus or pathogen, whatever it happens to be. But those are sort of unique and they would not use that kind of a trial for something as dangerous as let's say Ebola. Okay, good clarification. So many people are interested in clinical trials, ask questions about it, how can they get involved as it relates to HIV cure and HIV medications. But there is a bit of a veil of secrecy or at least a lack of information when it comes to clinical trials and what that entails, what's it about, how does it work. Can you walk us through what a typical clinical trial might look like from the vetting process to the clinical trial itself to afterwards follow-up, anything like that? Wow, okay. I know I asked you a lot. No, no, no, that's okay. Let me mention first of all for people who are interested to learn more about this, the National Institutes of Health, the NIH Clinical Center has on its website like a tutorial or an introduction for people who are interested to learn about clinical trials and the steps that are involved. So that's something that we can provide, a link to that if that's helpful. I think they do a pretty good job of stepping people through what the various steps are. In terms of what would this look like for a potential participant, I guess the first step would be how did you find out about the clinical trial. So many people find out about the clinical trial because their healthcare provider, their physician, talks to them about it and says, hey, there's a clinical trial about XYZ. I think you might be a good candidate for this trial because you're living with HIV or you have XYZ situation, condition, and would you be interested in learning more? So a lot of people would find out about it through their individual physician. Of course, you can look for clinical trials on your own. So you could go to the website clinicaltrial.gov and that's like a government supported website that lists all of the different clinical trials. And you can look them up based on health condition and location and everything else and learn about what's happening in your area, but that's a little daunting. I mean, there's a lot of information and some of it's pretty technical there. So you can do it, but that's probably not how most people find out about them. And then of course, you know, there are posters or flyers in health clinics or you may see them in the newspaper or online announcing a particular clinical trial in your area that's looking for volunteers. So typically, the first part would be that you decide you're interested for however you learn about it and you contact the study team. And they would typically have some sort of a screening process where they would ask you either over the phone or online or in person. They would ask you a series of typically a few questions based on your age and whether or not you have the health condition they're studying and some other sometimes some health related questions to see if you might be a good fit for the trial.  And then you would have a more in-depth discussion about what the trial involves and what qualifications, if you will, would qualify you for the trial or which ones might exclude you from participating, etc. Just before you continue on, do you typically do you have to reside in the geographic location where the clinical trial is being held or are there instances where people are flown to a location and congregated together? That's a great question. It really depends on the individual trial. So many trials are looking for people who live within, let's say, commuting distance, if you will, of the particular site, the health clinic or the research site where the trial is taking place. Because they many might involve frequent visits over a period of time, you might have to come in once a week for a couple of months or somewhere longer. You might come in once every month or once every two months for a year or two years. So that would be a lot of back and forth if you didn't live in the area. But there are some trials that would provide transportation, whether it's local or long distance, it really just depends on the trial. And then the other thing is there are some not really clinical trials per se, but what they call clinical studies. So these would be observational studies where they're just trying to understand more about a better particular condition or individuals who are living with it. So they're not testing a vaccine or a treatment. They're just studying people, the condition and what it's like, the experience of living with it. There are some that you can participate in virtually. So that's an option for people as well. Great. And then so say you do the questionnaire, you meet with them in person possibly. Everything looks good. You're approved for the clinical trial. What happens next? The team would have somebody review what they call in the informed consent form. So that's where you would sit down and go through in great detail, talk through what the trial involves, the potential risks and benefits of the trial to you as a participant. Whether there's any support provided like transportation assistance, whether there's any compensation with the trial, some do some don't and sort of what you can expect in terms of your schedule and the timeline for completing your participation, etc. And then if you feel comfortable and you agree to participate, you would sign the informed consent form. And then you would be in the trial and you would follow the schedule that they've discussed with you for however many clinic visits might be involved. And typically involve a physical exam of some kind, depending on the trial, probably some laboratory work, some blood testing. It may involve surveys or questionnaires that you would fill out either in writing or they would ask you sort of in conversation during your visit. But all of that would be spelled out and explained as you discuss the informed consent and sort of what the whole trial participation would look like. Okay, and then once that the clinical trial is done, do they send you on your merry way? Do they go over their findings with you? Is there like a dialogue that happens at the end? Yes, they would send you on your way. So when you're finished, you would know as you're going through the trial, you know, you'll be able to watch your progress based on the schedule that they've mapped out for you as an individual participant. You'll know where you are on your map in terms of completing your participation in the trial. When you have finished, there would typically be some, there may be some sort of follow up. So it really depends on the kind of the trial. Maybe your trial was relatively simple and you finished and that may be it. There may be others where there's follow up schedule that certain times in the future, check back in with you. Again, it really depends on the trial itself. The same is true when it comes to sharing the results, the findings from the trial with participants. So that's something that researchers generally try to do, but results typically, they don't know the results of the trial when your participation is finished. So, you know, the trial may have, if it's an early phase trial like some of the ones that I was in, there may only be a dozen participants, but others may involve hundreds or even thousands of people. So it may take months or years even for them to finish recruiting and doing everything that needs to be done with the trial with all the other participants. So they wouldn't have results for some trials for many years after your participation is finished. And then it may take another months or years for them to analyze the findings and to write and publish their findings of the research and then to begin sharing that with the public. So it's really a lengthy process. And that's something that you can bring up with the research team when you're talking about participation. When will you have any results? How are you going to share those with me? I'm interested or I don't really care, whatever the case may be, in hearing the results, let them know. And have you noticed a difference in the way that clinical trials are executed or how they've evolved over time since when you first started to present day? I mean, each of them is really different and they're designed and conducted by individual teams of researchers. So it's a little bit difficult to compare one to the next because they're each kind of different. I mentioned earlier one that I participated in that was a vaccine trial. So that was sort of set up and run in a particular way as a vaccine trial. I've participated in others like the one looking at HIV cure. So whether a combination of monocle antibodies might help to help my immune system control HIV without the need to take medication every day. So that was very different from the vaccine trial. And then there are others that I'm in, like I'm in one that's a 10 year study for HIV neurocognitive disorder. So this is really just, they're not testing anything, all they're doing is studying me and the other participants. So we come in once a year for a three day visit once a year and go through a whole bunch of tests through an MRI neuro psychology testing where you do memory exercises and word games and numbers to see how your brain is and your memory are working. And they basically just compare that year after year after year after year to see if there are any differences over time from aging with HIV. So they're not testing a treatment of any kind. They're really just seeing does HIV living with HIV for long periods of time. How does that does it affect the brain and if it does have so they're very different. That's fascinating to hear too. Yeah, and I find the trials interesting. So you asked before how to get involved. I mean, for me, if I'm going to volunteer my time to go participate in the trial, I want it to be something, as I mentioned, that I feel that I have something special to contribute to the trial. And something where I think the trial is interesting to me personally, I pick every brain every time I go to the for my visits. So I ask lots of questions. I try to learn as much as I can while I'm there. It is it's interesting in in talking about these clinical trials. One thing that I've heard about recently and learned more about is something called an ATI or an analytic treatment interruption. Can you explain what an ATI is and why it's sometimes necessary. Sure. So let's maybe before we talk about a treatment interruption, we can just talk about treatment for HIV. So I'm sure most of your listeners are familiar with the fact that the recommendation for anybody living with HIV is that we start on treatment immediately after diagnosis and that we stay adherent to treatment. So we take it as directed typically once a day and we do that consistently in order to achieve an undetectable viral load and that having an undetectable viral load is what enables us to live a long and healthy life. And it also means that we can't transmit HIV or pass it to other people through sex as long as we're on treatment and viral load is undetectable. So that's sort of the guideline, if you will, and people understand that as undetectable equals untransmittable u equals u with clinical trials that are working towards research being done to develop ways to potentially cure HIV in the future. Sometimes the only way that the researchers can tell whether the treatment or whatever it is that they're testing in the trial. Sometimes the only way we can tell whether that made a difference or not is to ask the participants to voluntarily stop their HIV treatment for a period of time and then to see whether their HIV will rebound to become deductible again and how long does that take. And is that longer or shorter than what we would normally expect. Sometimes, and that's called an analytic treatment interruption where you stop your HIV treatment in a clinical trial, not not at home on your own, but in a clinical trial we are closely monitored. You typically come in every two weeks, sometimes perhaps once a week. You have clinic visits, physical exams, laboratory tests done to make sure that everything is still safe. And that you're not having any harmful side effects, and they would monitor to see what effect, if any, the treatment they're testing had on your ability to manage or to control the HIV without your regular HIV medications. It seems like there would be a number of implications there. The possibility of developing a drug resistance while the viral load is rebounding. Maybe there are long term effects of viral load rebound on the body that we don't really know enough about is how do we tackle considerations like that. Yeah, that's really important questions. So yes, that's why I mentioned, you know, treatment interruptions are not something that we should do at home. Don't try this at home. They've been shown treatment interruptions were tested years ago, just in general, back in the early days of HIV treatments when the treatments were more toxic. One of the challenges was that when you were taking HIV medications every day for a long period of time, the side effects could get really challenging, really difficult, really hard for your body to deal with. So one of the approaches that was tested in clinical trials like we're discussing was what was called intermittent treatment or treatment interruptions where you would cycle on and off your ART. So you might take your medication for a certain period of time, and then you would take a break, and then you would go back on treatment. And so those that those approaches were actually tested in clinical trials to see did they work to help people control the HIV. Did they did it help reduce the side effects that people were dealing with from the medications? Did it lead to problems like drug resistance that you talked about, etc. And in general, it was found was that that approach is harmful that it did not control HIV effectively. It might have reduced side effects from the medication, but it didn't control HIV effectively and it did lead to problems like drug resistance, etc. So those approaches were sort of put aside as not good. So you're right. In general, we do not want to interrupt treatment as a general rule. However, as we mentioned a minute ago, in some cases, in a clinical study, we might need to in order to find out whether this new experimental treatment makes any difference or not. So in these limited cases, we might have to take that risk. And it is a risk. You do if you're a participant, you're taking some risk that there might be side effects or other unwanted things that come come from this. You mentioned drug resistance. There's a possibility that that because of the treatment interruption that when you restart your medication after the treatment interruption, that you that the old medication that you were taking may no longer work because your body developed resistance or your body developed resistance to it. That problem has been dealt with pretty well, because researchers have figured out at a structure of the treatment interruption so you taper off certain medications and so that's been that problem is really not a major issue any longer. It's still there, but but it's not nearly as common as it used to be. There might be some short term risks from a treatment interruption and analytic treatment interruption during a clinical trial. You might have your HIV viral load becomes detectable again. So it's possible you could pass HIV to your sex partners. So that's a potential risk and you have to take steps to prevent that there's a possibility that if you're living with other viruses. Let's say many of us are living with, let's say if you had chickenpox when you were a child, you have still have that virus in your body, it could theoretically become reactivated because of the stress from having the HIV come back without medication could reactivate other viruses like that and you may have some side effects from that. And there are other, you know, many of the human papillomavirus, cytomegalovirus, herpes, simplex virus, these are all viruses that are very common among many people. And they could become reactivated during your treatment interruption, because your body is stressed out trying to manage the HIV in addition to everything else. Again, I think that researchers have learned a whole lot over the past two decades, and that's why these treatment interruptions are set up in a way where you're very carefully monitored. You're coming in every week or every two weeks for clinic visits, you're having safety lab tests done. So I think the short term risks are pretty well understood and very well managed the longer term risks are not as well understood. So as I'm sure you can understand, in order to sort of assess the long term risks, you have to take a long time, you have to do studies that are 10 or 20 years long in order to see, well, what's the effect of these treatment interruptions in 10 or 20 years. So there's one study that was published two or three years ago from Barcelona, Spain, that showed there are long term risks from treatment interruption increases in things like heart conditions and stroke and cancer. So we certainly need to pay attention to those. That was one study in one place, and the people who participated in it had gone through, they had been on all different kinds of medications, and they had gone through different kinds of treatment interruptions. So we just, we need to do more studies to understand this better. And I think that that's something that would be really important for for us as a research community and HIV community to push for. Yeah, so thank you for highlighting all the considerations. I think that it's, it can be very exciting, the opportunity to be part of a clinical trial that maybe is testing a vaccine or a potential cure, or a new medication. But, especially if you're living with HIV, something like an ATI is not something to be taken lightly. It's something that you should really be informed about, know your risks, and be able to make an informed decision. Yes. Yeah, no, that's a really good point. I think I've heard some people say that they would be interested to participate in a clinical trial focused on HIV cure, because they want to take a treatment holiday, they want to be able to have the treatment interruptions so they can take a break from taking their normal HIV medications every day. I think that is not a good way to think about this. Treatment holidays have been shown by research not to be good for us. So they can produce harm. So we don't want to take treatment holidays. I think that the reason to participate in an ATI, an analytic treatment interruption, is only in the context of a clinical trial where you have your research team, you have your regular HIV doctor, all of you on the same page.  And considering the potential long term effects of an ATI or just whatever treatment you're getting as part of the clinical trial might have on your body, is there any responsibility on the investigators part over the long term once the clinical trial ends? Certainly if the investigators find through their analysis of the research of the data they collect during the trial, if they find that there are risks, then they would reach back out to participants. So they would in fact reach back out to participants and say, hey, we just want to let you know we found XYZ risk. We're letting you know that this is what we found. We'd be happy to share this information with your healthcare provider so that you can look out for it. So they will do that. I think that there's an opportunity for the research community to set up a some maybe let's say as some sort of a registry where people who have participated in an analytical treatment interruption like myself could volunteer to participate in this sign up or register in this registry. So that would help the research community to monitor how we do over time. I think that would be a really important sort of like next step or study to look at the long term effects of treatment interruption, if any. It may turn out that there are no major effects and that would be wonderful. But I think we won't know until we look so we need to figure that out. And if we're going to be asking more people as so we're making steady progress in this research towards a cure. As we do that, if we're going to be asking more people to participate in these kinds of trials, then I think we we do owe it to them as you mentioned to have something in place so that we're looking at what the long term effects might be. Yeah, it's to me it's almost intuitive. I maybe say obvious that there should be some kind of registry to be able to have a log of people everyone that's involved for long term possible effects but I can I can understand and see that from the investigators point of view that might not be their primary concern or their focus and so that might be like a blind spot for them. They're worried about this clinical trial and then move on to next research. Right. And the thing is that that kind of a registry would have to be set up as a trial, like a whole separate trial. So it wouldn't, it wouldn't necessarily involve only the people in that one trial. I think the registry would ideally would invite people who have participated in any and all trials with an analytic treatment interruption to participate in the registry. So that would really have to be set up as its own study and have its own research team and its own funding and. And then you have to figure out how do we find and keep in touch with all of these people who, you know, over the course of five or 10 or 20 years, you know, have may move they they have all kinds of changes in their lives and we have to figure out ways to keep in touch with all of them so it's a you know it's a relatively heavy lift if you will, but I think that it makes sense to think that way. And I think another potential benefit of that would be just having a larger pool of data and having that kind of cross communication and connection with various studies. Yes. So I think if we want to sort of think big picture now or talk big picture. I think one of the shortcomings if you will, or one of the challenges for clinical research hiv cure related clinical research at this point is that a lot as we mentioned earlier that clinical trials are sort of designed by an individual team of researchers. And then they're conducted at specific sites, you know, locations or clinics. And unless you happen to have some way some contact with the team or the researcher at one of those clinics, you may not even learn about the particular trial so you have no chance to even participate. And your clinic may participate in some trials, but not in others. You know, there are a whole lots of trials for all kinds of things taking place all over the world all the time. Your particular healthcare clinic or doctor or hospital obviously doesn't participate in everyone. So what I think would be interesting or helpful would be to have a central service if you will, like clinical trials. But which included not only clinical trials of interventions like new treatments, but other kinds of clinical research that may just involve surveys or other things that you could take virtually that where you would be those might also be listed in that same directory, where we could offer people other ways to participate in between these interventional trials these treatment trials or other things that take place. Well, I've taken note of these suggestions for the possibility that I have an interview with investigators or any other potential decision makers funders who can kind of get us closer to that goal because it sounds like it would have a huge impact. Well, you've also mentioned partner protections. Yes, when it comes to clinical trials and ati specifically. Why should we be concerned about the participants partner or well if any. Yeah, thank you. What if any current safety mechanisms are in place. So I think traditionally the trials that involve an analytical treatment interruption where you go off your medication for some period of time. And therefore, if you have some, you're no longer undetectable during that time, you might have a chance of passing HIV to sex partners trials would require that participants use condoms. In order to prevent transmitting HIV unintentionally to their sex partners. So that's been the traditional approach over the past decade, as we mentioned earlier that, you know, the whole concept of you equals you has become really I think the what most people count on for prevention of transmission to sex partners. So if I'm living with HIV, if I'm taking my medication, and I have an undetectable HIV viral load. I know that I can't pass HIV to my partners. And my partner also knows that if I'm taking my medication that I can't. And I'm undetectable that I can't pass HIV to them. I think the norm in many places in many communities has become that people are counting on you equals you, and they're counting on the fact that prep is available to people who are interested in taking it to prevent themselves from contracting HIV through sex. So, I think that there's much less. It's less common perhaps that it used to be back in the early days of the HIV pandemic, for people to disclose their HIV status. So I think we need we need to help people who are participating in these trials, who were asking to stop their treatment temporarily, we have to help make sure that they're not passing HIV unintentionally to other people. And you say we have to do you find that there is mechanisms in place to kind of educate and support participants in that way or is that something that needs to be addressed. Again, I think the traditional approach has been for clinical trials to include as part of the informed consent process that the participant agrees that they will use condoms. We also know from lots of other research that condom use is very low. Many people don't like to use condoms. So I think that we need to do more than simply making condoms available. We also know that these days that prep helps prevent HIV transmission. So we're acquisition. So one of the additional ways is to make prep available to the partners of participants if they're interested in using prep while the while the participant is volunteering in the trial. So that's something that the research study site could locate in their community, other physicians or clinics that provide prep services and then help the participant and their partner linking them to those services so that they can get prep. So that's another step. There's safer sex education that that could be part of the solution, making sure that the participant in the trial and their partners understand ways that that we can have sex more safely with lower risk of transmission while the person while the participant is off their HIV medications during the trial. I think that there there's been research a group of us have published some recommendations in terms of making a formal partner protections package where all of these different techniques would be available or that research teams would learn about these techniques and they would have all of these different opportunities and support systems in place while they're conducting the trial so that participants have different options. Fantastic. So you you're developing or have developed this partner protection package. How are you getting this out to researchers? Is there a site or a place that they can go? This is work in progress. So the and there are a bunch of different groups who are working on this. So Dr. Michael Paluso at the University of California, San Francisco and Korean Dube at the University of California, San Diego have been promoting these approaches both in their clinical sites where they're conducting research, but also on a larger level through publishing their recommendations in professional journals and also to the age clinical trials group, which is the network that runs many of these clinical trials. Fascinating. Wow, we are already like approaching the hour here. I feel like we are just getting into this thing. It's there's so much to talk about. But before I wrap, I do want to talk about your interest in using art as a means to engage and inform the wider community. So as I'm sure all of your listeners can tell from listening to the conversation here, clinical research is pretty complicated, pretty complex. As you mentioned at the beginning of the discussion, you know, there are a lot of like acronyms and technical terms and other things that are difficult to understand if this is not your work and you're not doing this every day. And there are a lot of people who just may not know about or even be interested in all the hard science, technical aspects of clinical research. But I think that the arts can really help us reach more people. So for instance, if I mentioned or you mentioned in the introduction that I'm a writer. So for me, by writing about my experience living with HIV or participating in some of these clinical trials. I hope that I can help sort of humanize and make more real some of these experiences in ways that other people can read and say, Oh, I get that I understand or hey, I've been through that too. There are other people who may use different art forms. So they might paint or they might create podcasts or or music or or some other approach that helps get people's attention and then gives an opportunity to talk about some of the things that we've talked about today. Where maybe it's not hard science and less maybe a little less technical but but where we can share information. So I think there's lots of opportunity to do that. I agree 100% and that's in part why I'm also doing what I do on social media as my own light kind of art in a way. Fantastic. How can folks follow your writing and or anything else that is going on with your life or that you're sharing. Well, I've published some things in positively aware. I have some that I will be submitting to other magazines like the body calm and a new magazine. I do not at this point have my own website or YouTube channel. It's something I'll consider in the future but I'm I just have to see where that goes. Is there anything before we wrap up that you would like to share talk about cover before we end this. I think just about in clinical trials and clinical research in general that my experience has been very good participation does take dedication and because it takes time and effort to participate. You've got clinic visits and lab work and typically various kinds of medical procedures that are involved. So it's, you know, it involves commitment of work, but I feel that that it has been a way for me to contribute. I'm grateful for people who contributed in the past who participated and through that helped scientists to develop the medications that keep us healthy today. So my participation is a way to sort of pay that forward to future generations and I would encourage people who might be interested to learn more and to really give it a serious thought as I said has been a really good experience for me overall. I've met lots of wonderful people. I have found many opportunities to make my virus work as hard as I do so. Well, thank you so much for taking the time and energy to give us a really good clinical trials one on one. I have a feeling that there's going to be a lot of follow up questions and comments to this interview so I would love to bring you on at some point to kind of dive into this a little deeper possibly answer some questions that that viewers might have if you're open to it. Absolutely. And I will definitely be posting the the two resources you mentioned one the NIH clinical sector and then also the clinical trial.gov link I'll have those both below. People can check that out and I'll include the ACTG as well. Why not. All right, everyone at home, please comment below your thoughts, comments and questions. I'm happy to follow up after the fact. Tom is ready and willing as well. And Tom, a huge thank you to you again for being so gracious everyone at home. Thank you so much for watching. Be sure to like this video. Subscribe if you haven't already hit that bell so you get a notification every time a new video comes out and please share this with anyone who might find value in this content. That is the best way you can help support me and my channel. All right, until next time. Cheers.


How's everybody doing welcome back to my channel this week is gonna be insane Me and the whole me and the are gonna be collaborating on a full back piece and we're gonna complete it in the next two days So with that being said, let's get this day started. Let's go all right, so I'm just gonna explain that this is Something that we seen and we instantly knew it was it so maybe start on the top obviously Do you want like want this arm to be darker than the background still? Yeah, yes I think that would be a good idea. It's like breathe. Just glow. Just bring a shadow Just let it start to glow. Exactly because I was also thinking like putting just Solid black against this and you can do with your style This is gonna stand out apart from my black I would want to do solid black behind that spine and then fade it out to gray right here because this right here It's gonna look like light black light You know and rather than being like super dark too light and make it look like it's glowing From outside in if I did with my style on this light drapery What is that? Oh, I see it. Is it a fly? Hold on. Don't move. Don't move.  My can it wait did it fly? Oh, bro. Don't not move Do not move, bro. I got it. I Got it. Don't don't you worry? Hold on did I catch it? That's the question.  I think we could I think if you cut here It'd be easy to put this spine back in mm-hmm. So if you do this shape mm-hmm cool Breaking point right here. And then if you have to you can go this way. Yeah I was even thinking leaving the whole stencil on or if we get yeah, if we can I feel like if we have I just can't get ready to re-stem so if we have to okay Yeah, if we have to if we have to cut this bright one off all the way up like this. Oh, that's good Oh One more. Oh, okay check it out Oh Perfect, okay Okay, check it out. Oh Yeah, that's perfect. Yes, sir. Go ahead and have a seat right here.  Oh, yeah, this is not gonna be a bad setup. Thank God. Yeah, that looks bro Dude, it's not sometimes like tattoo itself It's not bad. It's sitting. Yeah, especially when he stretches out. It gets super wise. Damn, bro You got like wings on your back. I Feel like I'm in the movie Oh, yeah, that's perfect I would just probably maybe tape like right on the side, huh? Yeah Let me see. All right. Cool. That looks pretty saucy right there.  It looks insane. So I'll say let's not worry about the tab will like Sten so all of this and then talk about it at the top. Yeah Sir, I'm a third kid in the center Everything good so far Mostly you're in Wow Just a line work is already crazy.    I want to break so we just finished putting on the stencil and We do have a game plan on how to approach this huge project The first thing I'm gonna be doing is attacking the skull with all the contrast behind it and a little bit of the background on this area Yeah, and I'll be hitting the right shoulder. We're gonna be coming across the top transitioning until I run into Kevin and then Probably do a switcheroo. Yeah, once we switch I'm gonna be attacking the background on this area and start shading in Wherever I need to because it's gonna be doing the architecture the details on in the architecture And I'm gonna be doing the background of that Building most of my details and like all the structure using a three super tight And I'm probably gonna be using an 11 curve mag with a 14 round liner running at a 5.0 What about your voltage?  All right. Oh, I just completed what I was supposed to do on my side And he's done doing what he had to do on his side So now we're gonna switch and he's gonna start doing the cloak It's just not doing the the frame here of the architecture And I'm gonna start doing the background here shoulder area. How you feeling, bro?   Yeah, yeah Yeah What about you? How you feeling Andy? I'm feeling good. Yeah, it's gonna be insane. Yeah, you guys are working pretty good together communication there.  Yeah, you know Good teamwork over there. Good teamwork. Good canvas Most importantly, all right, so we're gonna go eat we're gonna come back. We need that energy. We need that protein would be for precision and Just something I've been comfortable with actually took a lot of time to To get good with it and I came from primarily using mags but I Don't know. I just got something different out of it and the look that it gave me was just was just different So using the three-round liner definitely Patience was just slowing everything down So that you could inevitably inevitably Become faster with it, you know pacing myself to take a step back do things more precise and slowing the voltage down Slowing the voltage down definitely give me more control over where the needle goes and You know, that's the irritation to the skin using higher voltage Probably be more for line work Getting smoother tones or blends, but it is gonna really irritate the skin Because a lot of redness And it kind of tends to skate like the needle will kind of glide versus Be more grippy when you're running at a lower voltage it tends to Stick and give you a lot of control and where you're hitting That's it. I'm gonna call it. Oh, yeah. Yep Oh, yeah We went at it for probably 10 hours today Yeah, I'm about 10 hours I'm going to get this done. Okay. The veil or the cloak the dark part of the veil And then get that light one pop out wrap around this way And then I think the rest of this is mostly you. Yeah, that's yeah. Yep. Yep. Yeah How you feeling bro? You ready? Day two I guess one tip that I have from for everybody that's looking to collaborate with someone else is Personally me what I look for is How different is their style? Because you want a piece to look unique And if you're collaborating and this is my personal opinion If you're collaborating with someone that does exactly what you do The whole piece is going to look like you did it, you know, and it's not going to have any specific Feature points of the piece, you know in this case With his style is completely the opposite of what I do You know, so that opens up a whole different possibility of things that we can do with projects like this How different can can we make a piece look like and make it look unique? You know spot on two different superpowers We still stay true to our styles. Exactly. Yes. We don't have to compromise to satisfy No, and it still works any works. We just it just almost works too well on this I don't know much about uh dragon ball z but Oh Super saying is that what it is right? That's what they write.  I thought it was a light day. Yeah, it sounds about right for rough a day Yeah, about 20 hours. Sorry my guy real quick How does that feel am I good to go for me? Okay after tattooing today's back to back on the same client and you know having to move around throughout both days I feel like The most important thing I I learned was that communication is key Because sometimes, you know, we didn't want to get in each other's way But also we had to get things done, you know at a certain rhythm. So I think the way we were Moving around was really smooth It was it was tight.   We looked at it and it was like damn these guys are moving Then you guys got to do a couple push-ups We had to stretch They found out Kerry can walk on his feet and his hands To everyone that's thinking about getting a full back tattoo, uh, what would you tell them?  It takes a warrior for sure for for this kind of piece because There's going to be breaking points when you want to quit, you know, yeah, especially if you're going back to back sessions If you know, you're like your pain tolerance is very little From getting a tattoo in your forearm or your bicep If you know like you needed multiple breaks You definitely have to I would say they need to Split their sessions for for a back piece You sat great though to be honest. It wasn't even you didn't seem Hurt enough where I would have made you go home. Yeah Just sometimes where I think it's a better to reset and live to five another day Exactly for both of us and I didn't see you even get to that point yet Not even close getting to that point. No one likes to see anybody uncomfortable Yeah, so that's it for this crazy episode. Uh, we went at it for 20 hours full back piece two artists one client and Drop a comment Because this deserves a whole bunch of love because he made it through and you know now that people can say that


Here's a smart casual outfit for spring. So here I am in a very basic, but unfinished look. I've got a micro-stripe button-down shirt, stone-colored cotton trousers, brown belt, brown shoes. Now to finish it off, there are a couple different ways I could go with this. But the obvious choice being to throw in a navy sport coat. Looks good, it's classic. But what if I want this to be more casual? That is when we bring in the full zip cardigan. You still get that sport coat look, but a much more casual feel. Also, because you've got more coverage, it can pull double duty as a transitional outerwear piece. Two final details, first, the watch. On my wrist, I've got the Vacheron Constantin Traditionale and for fragrance, Au Sauvage by Christian Dior.


Good evening aspirants. Welcome to the Hindu news analysis by Shankar Aayez academy for the day 2nd May 2021. These are the list of news articles that will be discussed in today's news analysis. They are provided along with the page numbers of the different editions of the newspaper. Hope you people are aware that we have introduced a new segment in our news discussion from yesterday and in this segment we'll be discussing a few previous year's film's questions each day for the benefit of aspirants. So now let's move on to the session. Now let's take up this question which of the following protected areas are located in the Kaveri basin and the options given include Nagarhol National Park, Papikonda National Park, Satyamangalam Tiger Reserve and the Bayanad Wildlife Sanctuary and we need to find the correct answer. See Kaveri basin lies in the states of Tamil Nadu, Karnataka, Kerala and Pondicherry. When you take the Nagarhol National Park which is also called as the Rajiv Gandhi National Park it is located in Kodagu and Mysore district of Karnataka which lies in the Kaveri basin. Note that Nagarhol Park is declared as the 37th Tiger Reserve in India. Next comes the Papikonda National Park. It spreads over the east and west Godavari districts near Godavari basin of Andhra Pradesh. Now here you should remember it lies in Godavari basin and not in Kaveri basin. Coming to the Satyamangalam Tiger Reserve it is located in the Kaveri basin that is situated about 88 kilometer from Coimbatore, Tamil Nadu and it finds itself at the joining of the eastern and western guards and finally on coming to the Bayanad Wildlife Sanctuary. See the Bayanad Wildlife Sanctuary is located in the southern trenches of the famous western guards and it is ranked eighth in the list of the world's biodiversity hotspots. This Bayanad Wildlife Sanctuary lies in the Kaveri basin of Kerala and it is renowned for having a huge number of Asian elephants and tigers. And apart from this it also has leopards, jungle cats, leopard cats, spotted deer, sambar deer, goat, sloth bear, wild dog, wild boar, then Indian pangolin, striped necked mongoose and a plethora of other mammals as well. So based on this analysis all the options except the second one are a part of the Kaveri basin that is only Papikonda remains entirely inside the east and west Godavari districts near the Godavari basin and therefore the answer is option C that is 1, 3 and 4 only. Now look at this question the experiment will employ a trio of spacecraft flying in formation in the shape of an equilateral triangle that has sites 1 million kilometer long with lasers shining between the craft. The experiment in the question refers to option A Voyager 2, option B New Horizons, option C Lisa Pathfinder and option D Evolved Lisa and the right answer is option D that is Evolved Lisa. Now let's see in brief about the four options. When you take option one that is Voyager 2 it is related to space exploration. See Voyager 2 is a pair of robotic US interplanetary probes that was launched to observe and to transmit information to earth about the giant planets of the outer solar system and the farthest reaches of the sun's sphere of influence. Whereas New Horizons is a US space probe that flew by the dwarf planet Pluto and its largest moon Charon in July 2015. I know that it was the first space probe to visit Pluto. Also Lisa Pathfinder formerly the small missions for advanced research in technology 2 or smart 2 is an ESE spacecraft that was launched on December 3rd 2015 and it began orbiting a point called the Earth Sun L1 which is roughly 930,000 miles that is approximately 1.5 million kilometers from the earth in the sun's direction. See Lisa Pathfinder is a mission that was led by the European Space Agency which is also called his ESA with contributions from NASA and this Lisa Pathfinder has successfully tested a key technology that is needed to build a space-based observatory for detecting gravitational waves and coming to E-Lisa or the Evolved Laser Interferometer Space Antenna it is an experiment that will employ a trio of spacecraft flying in formation in the shape of an equilateral triangle that is sides 1 million kilometer long with lasers shining between the craft and therefore the right answer is option D that is Evolved Laser. Now let us take up this question with reference to the visible light communication technology which of the following statements are correct. Statement 1 VLC uses electromagnetic spectrum wavelengths 375 to 718 nanometer statement 2 VLC is known as long-range optical wireless communication statement 3 VLC can transmit large amounts of data faster than Bluetooth and statement 4 VLC has no electromagnetic interference and we need to find the correct answer using the code that is given below. See visible lights communication is a data communications variant which uses visible light between 400 and 800 THz that is a wavelength of 780 to 375 nanometer. So the first statement is correct. Coming to the second statement it is partially correct because VLC is a subset of optical wireless communication technologies but it is short-range communication and not long range as given in the question. So the second statement is wrong. See the VLC technology they use fluorescent lamps to transmit signals at 10 kilobit per second or LEDs for up to 500 megabit per second over short distances and there are also types of VLC such as Li-Fi which can transmit signals at several megabits per second and this is much faster than Bluetooth. Also aside from the size of the visible light spectrum light travels 186,000 miles per second which is way faster than the 344 meters per second that is traveled by radio waves in hair that is used by Bluetooth. So statement 3 is also correct. Also visible light communication is a preferred communication technique because of its high bandwidth and immunity to interference from electromagnetic sources. So based on this statement 4 is also correct and since the question wants us to find the correct answer the right option is option C that is 1, 3 and 4 only. Now let us take up this question what is the importance of using pneumococcal conjugate vaccines in India? Statement 1 these vaccines are effective against pneumonia as well as meningitis and sepsis. Statement 2 dependence on antibiotics that are not effective against drug resistant bacteria can be reduced and statement 3 these vaccines have no side effects and cause no allergic reactions. Select the correct answer using the given code below and the right answer is option B that is 1 and 2 only. Now let us see why this option is correct. See pneumococcal conjugate vaccines or PCV they prevent pneumococcal disease and this vaccine is a mix of several bacteria of the pneumococcal family which are known to cause pneumonia and therefore conjugate is included in the name of the vaccine. Usually these conjugate vaccines are made using a combination of two different components. Pneumococcal conjugate vaccine can prevent pneumococcal disease which refers to any illness that is caused by pneumococcal bacteria and this vaccine is highly effective against meningitis, sepsis and pneumonia. So therefore statement 1 is correct. Also pneumococcal B conjugate vaccines have reduced the burden of antibiotic resistant bacterial disease globally says the Lancent study report of 2017. So statement 2 is also correct. See vaccines as tools to reduce antimicrobial resistance have historically been under recognized yet the positive effect in reducing antimicrobial resistant has been well established. For example hemophilus influenzae type B as well as streptococcus pneumoniae or pneumococcal conjugate vaccines have impressive track records in not only preventing life threatening diseases caused by these bacteria but also in reducing antibiotic use and antimicrobial resistance. And when you take this pneumococcal conjugate vaccine has got mild side effects like mild soreness or hardness at the site of the injection lasting from 1 to 3 days a slightly raised temperature and more serious side effects of this pneumococcal conjugate vaccine such as allergic reactions are quite rare. So therefore statement 3 is wrong because it says that it has got no side effects and caused no allergic reactions. So therefore the right answer is option B that is 1 and 2 only. Now let us take up this FAQ article. This FAQ article is about the recent fires in Indian hospitals. See over the past year there have been deadly fires in hospital buildings including those treating COVID-19 patients. These infernos have caused huge loss of life and property. For example fires in hospitals at Baruch in Gujarat and Viral and Mumbra in Maharashtra have killed at least 37 people and this article is a discussion on that. Now let's see what this article has got to say. The syllabus covered by this article is highlighted below for your reference. See fires occur in many public buildings in India every year and these fires kill a large number of people and they also ensure many. According to the National Crime Records Bureau 330 people died in commercial building fires in 2019 while fatalities for residential or dwelling buildings were much higher at 6329. See the National Crime Records Bureau abbreviated to NCRB is an Indian government agency that is responsible for collecting and analyzing crime data as defined by the IPC and special and local laws. Now coming back to the article see in many of the fire accidents electrical falls were cited as the leading cause of fires but many experts do believe that it is the inadequacy of the state government which caused these fire accidents. See the state governments are being lax when it comes to the building safety laws and they also fail to equip the public buildings with modern technology. Now say for example it is take hospital ICUs or intensive care units. As you know the ICUs are a great fire risk because they are oxygen surfaced. So they need to meet high standards of safety in order to avoid fire accidents but most of these state governments do not take the necessary steps to provide such safety. Now before discussing the issues and compliances first let us learn about the National Building Code of India. See the National Building Code is a basic model code that is published by the Bureau of Indian Standards Part 4 of this code provides specifications and guidelines for design and materials that reduce the threat of destructive fires. Under this code all existing and new buildings are classified by nature of use such as residential, educational, institutional, assembly, business, mercantile, industry, storage and sardis. When you take hospitals they come under the institutional category. Note that the first edition of NBC was published in 1970 and the second edition in 2005 and the recent edition was published in 2016 which is the third one. Now let us see about its recommendations. Firstly the NBC recommends the location of buildings by type of use in specific zones. This will ensure that the industrial and sardis structures do not coexist with residential, institutional, office and business buildings. Secondly it specifies the technical requirements for special buildings, high rises, educational and institutional buildings that are higher than nine meters and those with an area of over 300 square meters. Such specific technical requirements will prevent accidents to a greater extent and thirdly when it comes to fire safety the code recommends the specifics of fire resistance based on the materials that are used in exterior walls, interior wall bearings, floor, roof, fire check-dose, fire enclosure exist and so on. Next the code also specifies the technologies to alert and fight the fire. For example the code talks about the automatic fire detection and alarm system, downcomer, pipelines connected to a roof tank, then dry riser pipelines that firefighters can use to douse upper floors, automatic sprinklers and water sprays, then fireman's lift, fire barriers, escape crews, markings and so on and so forth. See incorporating these technologies into a proper design and ensuring that certified fire resistant materials are used in the construction can reduce these fire accidents to a greater extent. Even after having such norms why is the fire accident still occurring and what is the problem behind? See national building code is a recommendationary document and the states have been asked to incorporate them into their local building by-laws. Also fire prevention and fire protection is a state subject so the rules for fire prevention and fire protection are laid in the form of state regulations or municipal by-laws and most of the states have incorporated NBC in their safety laws but they do not practice or enforce it. For example let us take Maharashtra. See Maharashtra has had the fire prevention and life safety measures act since 2008. Section three of this act make the provisions of the NBC mandatory and also schedule one of this act is borrowed from the code. So the state of Maharashtra has incorporated the NBC in their state laws but they have not been able to follow or enforce this act. For example inspection of public buildings is not carried out on a regular basis also many public buildings do not have proper functioning fire extinguisher. See the above lack of compliance was also stressed in a CAG report and according to this report only 11 out of 53 inspected public buildings in Maharashtra have proper firefighting installations like the fire extinguishers. Also states like Kerala and Tamil Nadu have not properly incorporated the NBC terms in their local firefighting laws which makes their enforcement even tougher. The discussed shortcomings have caused a lot of fire accidents recent times. Now let us discuss some of the steps that is taken by the government to overcome it. See recently the Supreme Court of India has directed all the states to carry out fire safety audits of dedicated COVID-19 hospitals in order to prevent further accidents. Also the central government's fire safety committee is planning to conduct periodic audits on fire installation, heating, ventilation or air conditioning, then on electrical substation and other electrical equipment in the union government's hospitals and in addition to that the health ministry also circulated strict guidelines stipulating third party accreditation for fire safety in hospitals and adding to that the national disaster management authority has stipulated requirements for fire safety in public buildings including hospitals which incorporate elements of the NBC decides design guidelines on maintaining minimum open safety space, protected exit mechanisms, dedicated staircases and crucial drills to carry. See with the recent fire accidents it has become evident that the state forces lack the manpower to inspect and ensure compliance with safety codes including the NBC. So the article suggests for making heavy fire liability insurance compulsory for all public buildings because such an insurance would offer protection to occupants and visitors and they will bring about external inspection of safety and it will also force the hospitals to follow safety guidelines and to adopt modern technologies in firefighting. So with this information let's move on to the next news discussion. Now look at this news article this article reports about the court refusing to stay the counting of votes for the local body elections in UP after the state and the election commission gave reassurance about covid safety protocol. So in this context let us see about panjayati raj system in India the syllabus covered by this news article is given below panjayat is the name of the local government system in India and it means a group of five persons. But in practice a panjayat is a council of elders representing a village and a panjayati raj is a form of government at the village level where each village is responsible for its own activities. Ancient India had some similar form of local governance but formal institutionalization came with the Magna Carta of local democracy in British India that is the repent resolution of 1882 providing for rural local votes. Next the Montego Glemsford reforms of 1919 made local self-government under the proposed scheme of dayaki a transferred subject and following independence the first draft of India's constitution did not include any provision for the panjayat and this is despite Gandhiji seeking to make village panjayats the very foundation of democracy independent India. Subsequently it was included only as a DPSP provision under Article 40 and in the course of time Balwin Tri Meta Committee, Ashok Meta Committee, Tungtan Committee, Gardil committee they gave recommendations in favor of panjayati raj being institutionalized. At last through the 73rd amendment to the constitution constitutional status was accorded to the panjayats and the act provided a complete framework and also it imparted certainty to it. So what are the constitutional changes it brought about? See the 73rd amendment act of 1992 has added a new part that is part 9 consisting of 16 articles and the 11th schedule to the constitution. The 11th schedule of the constitution created by the amendment contains 29 subjects on which the panjayat shall have administrative control and the 73rd amendment envisages the Gram Sabha as the foundation of the panjayat raj system to perform functions and powers entrusted to it by the state legislatures. See Gram Sabha consists of the adults of the electoral role in that village. The amendment act of 1992 contains provision for passing the powers and responsibilities to the panjayat for preparation of plans for economic development and social justice and by that the panjayat system covers the village level or the Gram Panjayat, the clusters of villages or the block panjayat and the district level that is the district panjayat. One notable aspect of panjayati raj institution is its socially inclusive character. See clause 3 of article 243 D ensures participation of women in panjayati raj institutions and the amendment provided that one third of the seats in all panjayat councils as well as one third of the pradhan positions must be reserved for women. Seats and pradhan positions were also reserved for the two disadvantaged minorities in India that is the scheduled caste and the scheduled tribes. This reservation was in the form of mandated representation proportional to each minority's population share in each district and in terms of clause 4 of article 243 D the officers of the chairpersons in the panjayats at the village or any other level shall be reserved for the scheduled caste, the scheduled tribes and women. While reservations for the scheduled caste and scheduled tribes are in place in other elected bodies like national and state legislative assemblies the 73rd amendment is the first one in India that mandated women's reservation and this made it a landmark piece of legislation. Further reservation for the OBC candidates can be provided by states by passing legislation to that effect and this has led to significant social upliftment but the panjayati raj institution has been consistently criticized at various fronts. One is that the state governments which has to devolve the powers is reluctant to do so thereby making the panjayati raj institutions powerless to carry out governance functions. Secondly the tax collection power of the panjayati raj institution is limited so its coffers are almost always dependent on the state government thereby compromising the political independence it was envisaged to experience. Thirdly various studies point to the distrust in the panjayati raj institutions and people seem to be looking at it as a political institutions and this is more evident in the PISA areas that is the tribal panjayat areas. So therefore addressing these issues is an urgent need to ensure smooth functioning of these grassroot level institutions and the grams varaj dream of Mahatma Gandhi and the power to the people dream of Rajiv Gandhi are the essence of true democracy and making it a reality lies in policy corrections. So with this let's move on to the next news article. Now let us take up this news article. This article is regarding the first blow away galaxy that was discovered by Germany Telescope. So in this context let us discuss about this discovery. The syllabus covered by this article is given below for your reference. See a new study led by the astrophysist from the University of Minnesota shows that high energy light from small galaxies may have played a key role in the early evolution of the universe. See after the big bang when the universe was formed billions of years ago it was in an ionized state this means that the electrons and protons they floated freely throughout space and as the universe expanded and started cooling down it changed to a neutral state when the protons and electrons they combined into atoms akin to water vapor condensing into a cloud. Now however scientists have observed that the universe is back in an ionized state and a major endeavor in astronomy is figuring out how this happened. Astronomers have theorized that the energy for reionization must have come from galaxies themselves but it's incredibly hard for enough high energy light to escape a galaxy due to the hydrogen clouds within it that absorbing the light and this is more like the clouds in earth's atmosphere that absorbs sunlight on an overcast day. So in this context the recent findings are very important. See using the data from the Gemini telescope the researchers have observed the first ever galaxy in a blow away state. See this means that the hydrogen clouds have been removed allowing the high energy light to escape and the scientists suspect that the blow away was caused by many supernovas or drawing stars exploding in a short period of time. Here the researchers compare the star formation with blowing up of the balloon. If the star formation was more intense then there would be a rupture or hole made in the surface of the balloon to let out some of that energy and in the case of this galaxy the star formation was so powerful that the balloon was thrown into pieces. Note that the galaxy studied by the researchers is named as POX 186. It is so small that it could fit inside the Milky Way. So what made the blow away possible in this galaxy? The reason for this could be its compact size coupled with its large population of stars which amount to a hundred thousand times the mass of the sun and the findings confirmed that a blow away was possible furthering the idea that small galaxies were primarily responsible for the re-ionization of the universe and this is giving more insight into how the universe became what it is today. If this one scenario is possible then that means that there are other galaxies that also existed in blow away states in the past and understanding the consequences of this blow away gives direct insight into the impacts of similar blowaways during the process of re-ionization. With this information finally let us discuss the Germany Observatory which was used for this discovery. See the Germany Observatory it consists of 28.1 meter diameter optical or infrared telescopes that is located on two of the best observing sites on the planet and the two are located in Hawaii known as Germany North and in Chile known as Germany South. The twin telescopes provide nearly complete coverage of the sky and are among the world's most advanced optical or infrared telescopes. This Germany Observatory is owned and it is operated by a consortium of partners from the US, Canada, Chile, Brazil and Argentina. See the Germany telescopes have been used to make invaluable observations of extra solar planets and the recently deployed Germany planet imager which is also called as GPI it allows direct imaging and analysis of exoplanets that are a millionth as bright as their host star and the telescopes are also used for a number of other studies that are relevant to astrobiology including observations of the solar system star formation and evolution the structure and dynamics of galaxies and also on distant quasars. With this we have come to the end of this news discussion. Let's now move on to the next news article. Now our next discussion is going to be based on this news article. See recently the geographical indication or GI tag was sought for matibananas and this article is related to that. So in this context it is learn about matibana and also about the GI tag. See matibana is a particular variety of banana that is cultivated in many parts of Nagarkoil and Bhatmanabha Buram in Tamil Nadu. Matibana is also used by the tribes of western guards for curing jaundice. Coming to GI tag, see GI is an indication that is used on products that have a specific geographical location and this GI tag will preserve the qualities and reputation of a product from that defined geographical locality. Know that the geographical indications of goods, registration and protection act of 1999 aims to provide for the registration and better protection of geographical indications and the tags are used by the office of the controller, general of patents, designs and trademarks and it comes under the department of promotion of industry and internal trade under the ministry of commerce and industry. Know that the registration of a GI is valid for a period of 10 years and it can be renewed from time to time for a further period of 10 years age. When talking about its significance, see this GI tag conveys an assurance of quality and distinctiveness which is essentially attributable to the place of its origin and also once the GI protection is granted no other producer can misuse the name to market similar products and it also provides comfort to customers about the authenticity of that particular product. At the international level geographical indications are covered as a component of intellectual property rights under the Paris Convention for the Protection of Industrial Property and GI is also governed by the World Trade Organization's agreement on trade related aspects of intellectual property rights. And on coming to India, geographical indications registration is administered by the Geographical Indications of Goods Registration and Protection Act of 1999 which came into force with effect from September 2003 and know that the first product in India to be accorded with GI tag was Darjeeling tea in the year 2004 to 2005. So with this we have come to the end of this particular news article. Let's move on to the next news discussion. Now look at this article. This article says that the gross revenue from goods and services tax hit a record eye of 1.41 lakh crore in April. See the tax collection has been above 1 lakh crore for the last seven months continuously and this suggests that the economic activity is not yet badly affected due to the second wave of COVID-19 pandemic. And in this analysis we will discuss about GST its features and the information related to GST Council. This element for the analysis is highlighted here for your reference. First, let us see the trend in monthly gross GST revenues during the period October 2020 to April 2021. So you can see that in the last seven months the GST collections have been above 1 lakh crore and the article highlighted the factors that might have been the reasons behind all high GST collections in April and these are factors like economic recovery and evasion measures and year end financial closures of the companies. Now let us see about the GST and its relevant features. The goods and services tax act was passed in the parliament in 2017 and it came into effect on 1st July 2017. In relation to this the 101st Constitutional Amendment Act of 2016 was enacted. This act added clause 12A to article 366 and this clause under the article 366 defines GST as a tax on supply of goods or services or both except taxes on the supply of the alcoholic liquor for human consumption. Apart from alcohol, electricity, petroleum products are also kept outside GST temporarily. To make it simple know that GST is a destination based tax on consumption of goods and services. It is levied at all stages right from production to final consumption along with the provision of input tax credits wherever applicable. When we say input tax credit we refer to the reduction in the tax already paid on inputs. As a result the person will actually in the end would have paid only the actual tax on the value added. Know that GST is a single domestic indirect tax for the entire country and GST has multiple tax rate slabs for different categories of products like 5%, 12%, 18% and 28%. The list of items that would fall under these multiple slabs are worked out by the GST council. See it is a dual GST with a center and the states simultaneously levying tax on a common base. GST to be levied by the center is called the central GST or the CGST and that to be levied by the state is called the state GST or the SGST. Import of goods or services would be treated as interstate supplies and it would be subject to integrated goods and services tax which is also called as IGST in addition to the applicable customs duties. In case of IGST the tax is levied and collected by the government of India that is the central government. Know that the collected amount under IGST is shared between the union and the states as per law. Legally the constitution under article 246a clause 1 empowers the states to make laws with respect to GST imposed by the union or by such state but under clause 2 of article 246a only parliament has exclusive power to make laws with respect to IGST. Now let us focus on the GST council. As per article 279a of the constitution the GST council is a joint forum of the center and the states. It is a constitutional body under article 279a and under this article GST council is constituted by the president to administer and govern GST. The finance minister of India is the chairman of the council and the council also includes the union minister of state in charge of revenue of finance as its member then it also includes ministers dominated by the state government's as its members. See the GST council is devised in such a way that the center will have one third voting power and the states will have two third voting power and the decisions are taken by three fourth majority. One half of the total number of members of the GST council shall constitute the quorum at its meeting and the council is empowered to make recommendations to the union and also to the states. Because of the composition voting power etc the mechanism of GST council ensures harmonization on different aspects of GST between the center and the states as well as among the states. Now if you take the news article it also lists the breakup of tax collected under GST where it mentions about the GST SES collections of above 9000 crores. See generally a SES is a form of tax that is charged over and above the base tax liability of a taxpayer and it is usually imposed when the state or the central government looks to raise funds for specific purposes. Here GST says is levied and collected for a specific purpose and the purpose is for providing compensation to the states for the laws of revenue arising on account of implementation of the goods and services tax. So with this we have come to the end of this news discussion. Let's move on to the next news article. Now look at this news article. This article is about a form of string puppetry in Assam called Putola Nash. It says that a trust in Assam in association with UNICEF Assam has produced videos using this string puppetry for creating mass awareness of COVID-appropriate behavior. Know that Putola or Putola Nash is a traditional string puppet theater from Assam. Here Putola means doll and Nash means dance and this remains popular in Assam whereas other forms of puppetry and shadow theater have disappeared. This puppetry mainly performs Ramayana either entirely or by episodes as well as scenes from the Mahabharata. According to some sources Shankara Devi the Vaishnavite saint of Assam had employed it to propagate the new Vaishnavism in the 15th century and in his time the puppeteer was called Tatakya Bachikar. Have a look at the image for better understanding. Know that puppetry has played an important role in disseminating knowledge in most parts of the world and it imbibes elements of all art forms such as literature, painting, sculpture, music, dance, drama etc. And puppetry has been used traditionally in India as a popular and an inexpensive medium to transmit knowledge about Indian myths and legends. The most important types of puppets in India are string puppets, shadow puppets, rod puppets and glow puppets. Now let's see in brief about each of them. See India has a rich and ancient tradition of string puppets or marionettes. Marionettes having jointed limbs controlled by strings allow far greater flexibility and are therefore the most articulate of the puppets. Examples of these are the Kath Putli in Rajasthan, Kundai in Orissa, Gombi Atta in Karnataka and the Bommalata in Tamil Nadu. Next comes the shadow puppets. See they are flat figures and they are cut out of leather which has been treated to make it translucent. Shadow puppets are pressed against the screen with a strong source of light behind it and examples of these are Togalu, Gombi Atta in Karnataka, Tholu Bommalata in Andhra Pradesh and the Ravana Chaya in Orissa. Coming to rod puppets, they are an extension of glow puppets but often much larger and supported and manipulated by rods from below. This form of puppetry now is found mostly in West Bengal and Orissa. Examples are Uttilnouch in West Bengal and Yampuri in Bihar. Finally on coming to the glow puppets which is also called as sleeve ant or palm puppets. For these puppets the head is made of either papia marsh, cloth or wood with two hands emerging from just below the neck. And the rest of the figure consists of a long flowing skirt. The manipulation technique in these glow puppets are simple with movements being controlled by human hands. Note that in Kerala the traditional glove puppet play is called Pawakuta. So with this let us now move on to the prelims practice question discussion. Now let us take up this prelims practice question regarding Germany Observatory. Statement 1 says that it consists of twin optical infrared telescopes more than 8 meter diameter located completely in North America. Statement 2 says it helps in studying astrobiology including observations of the solar system, star formation and evolution. And statement 3 says that recently it has helped to observe the first ever galaxy in a blown away state. When you look at statement 1 it is incorrect because the Germany Observatory consists of twin 8.1 meter diameter optical infrared telescopes is located in two places. One is Hawaii known as Germany North and the next one is Chile known as Germany South. And when you look at the other two options based on a discussion we can conclude that they both are correct. And therefore the right option is option B that is 2 and 3 only. Now let us discuss this question about the GST Council. Statement 1 says it is a statutory body established under Goods and Services Tax Act 2017 and statement 2 says the council is devised in such a way that the states will have one-third oting power and the centre will have two-third oting power. See when you take statement 1 as per article 279a of the constitution the GST council is a joint forum of the centre and the states and it is a constitutional body under article 279a. And under this article GST council is constituted by the president to administer and govern GST and therefore statement 1 is wrong. On coming to the second statement the council is devised in such a way that the centre will have one-third oting power and the states will have two-third oting power and the decisions are taken by three-fourth of the majority and the council is empowered to make recommendations to the union and also to the states and hence second statement is also wrong. And since the question wants us to identify the correct statements the right option is option D that is neither 1 nor 2. Now look at this question about the geographical indication tag. Statement 1 says the geographical indication tag helps consumers to get quality products of desired trades. As statement 2 says the GI tag is valid for a period of 20 years. So when you look at the first statement it is correct because the GI tag conveys an assurance of quality and distinctiveness which is essentially attributable to the place of its origin and it provides comfort to customers about the authenticity of the product and it also helps customers to get quality products of desired trades. And when you take the second statement which says that the tag is valid for a period of 20 years this statement is wrong because the GI tag is valid for a period of 10 years and not 20 years. And since the question wants us to find the correct statement the right answer is option A that is 1 only. Now let us take up this question with reference to India's puppetry and their native we need to find the correctly matched pair. So when you take the first pair it is incorrect because the traditional marinades of Rajasthan are known as Kathputli. See in Kathputli the puppets are carved from a single piece of wood and these puppets are like large dolls that are colourfully dressed. I know that their costumes and ad gears are designed in the medieval Rajasthani style of dress which is prevalent even today and when you look at the other three options they all are correct that is they all are correctly matched. So the right option is option C that is 2, 3 and 4 only. The list of main's questions is provided here. You can write your answer and post them in the comment section below. With this we have come to the end of today's interview analysis. If you like the video don't forget to like, comment and share and do subscribe to Shankara's Academy YouTube channel for more updates regarding UPSC civil services preparation.